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Flashcards in exsc 460 exam 2 Deck (108):
1

anterior line of gravity passes through what?

anterior superior iliac spine
bisects the knee
bisects the ankle
foot at the second toe

2

bones in the hindfoot

talus and calcaneus

3

hindfoot joint

subtalar or talocalcaneal joint

4

function of hindfoot

conversion of rotatory forces of the lower extremity

5

movements of hindfoot

gliding and rotation
pronation and supination

6

bones in the midfoot

navicular, cuboid, and cuneiforms

7

midfoot joint

transtarsal joint

8

function of midfoot

transmits movement from rearfoot to forefoot and promotes stability

9

2 axis' of the midfoot

oblique and longitudinal

10

when subtalar joint pronates,

transtarsal planes become parallel and foot becomes flexible

11

as subtalar joint supinates,

transtarsal planes converge medially and foot becomes rigid and lever-like

12

bones in forefoot

metatarsals and phalanges

13

name the 2 functions of the feet

support: stability for upright posture with minimal muscle effort, flexibility to adapt to uneven terrain
locomotion: rotation of tibia and fibula during gait, flexibility for shock absorption during gait, rigid lever during push-off

14

function of the arches

absorb and distribute GRF produced by body during ambulation or static erect posture
assist ambulation by increasing speed and agility

15

longitudinal arch

may be divided into medial and lateral
Feiss' line used during assesment: line drawn from inferior tip of medial malleolus to plantar surface of first metatarsal phalangeal joint. navicular tuberosity

16

Hallux Valgus

big toe deviates away from midline of body and toward midline of foot
metatarsus primus varus

17

etiology of hallux valgus

mal foot posture, pronated or flat foot
forefoot varus
tight shoes
hereditary
abnormal mechanics during 1st phase of gait
arthritis

18

pathological changes of hallux valgus

abnormal excess stress on medial aspect of head of 1st metatarsal
callus formation
bursitis
exostosis
bunion formation
severe loss of plantar flexion

19

management of hallux valgus

prevention: proper fitting shoes, properly fitting orthotics, improve ankle dorsi flexion ROM
conservative: doughnut pad, toe crests, toe splint, ice massage for inflammation and pain, exercises to strengthen flexor and extensor muscles of great toe.

20

surgeries to fix hallux valgus

weight bearing xray required
structural: problem is osseous
positional: problem is soft tissue
combined: requires surgical correction of bone and soft tissue

21

Hallux Varus

big toe deviates towards midline of body and away from midline of the foot. uncommon in the west.

22

etiology of hallux varus

congenital: majority of cases
acquired: idiopathic, develops spontaneously in middle age, related to chronic arthritis

23

Management of Hallux Varus

mild cases respond to passive stretching exercises for adductor hallucis and proper footwear.
more severe cases require surgery.

24

mallet toe

flexion contracture of distal phalanx

25

diagnosis of mallet toe

can occur on any of 4 lateral toes

26

pathological changes of mallet toe

usually asymptomatic, possible formation of corn of callus over dorsum of affected joint

27

claw foot

condition characterized by extension of the metatarsophalangeal joints and flexion of interphalangeal joints.

28

etiology of claw foot

congenital or acquired
associated with forefoot adductus, arthritis, or neuromuscular pathology
result of defective lumbricals and interossei muscles
associated with pes cavus or equinus

29

pathological changes of claw foot

hard corns or calluses over dorsal surface of toes
may effect gait and functional ability

30

management of claw foot

if acquired, corrective footwear
if congenital, surgery

31

Hammer toe

condition characterized by extension of the metatarsophalangeal and distal interphalangeal joints and flexion in the proximal interphalangeal joint

32

etiology of hammer toe

seems to be congenital because bilateral.
caused by improperly fitting shoes
significant number are idiopathic

33

diagnosis of hammer toe

usually involves only one toe, primarily 2nd but sometimes 3rd

34

pathological changes of hammer toe

calluses or hard corns develop over proximal interphalangeal joint of affected toe.

35

management of hammer toe

proper fitting shoes: adequate toe box
taping of affected toe
severe: surgical fusion

36

Pes Planus

flat foot, depression or loss of longitudinal arch, decrease in angle of inclination of calcaneus

37

assessment of pes planus

anterior line of gravity
heel should be in neutral position
Feiss' line

38

types of pes planus

rigid, congenital: secondary to tarsal coalition
flexible, acquired: break down of support tissue over extended period of time.

39

diagnosis of rigid pes planus

rare, talus drops medially and inferiorly, navicular drops, produces medial bulge
accompanying soft tissue contractures

40

diagnosis of flexible pes planus

when non weight bearing arch appears normal

41

management of pes planus

no pain: no treatment
conservative: arch supports, proper fitting shoes, exercise to strengthen muscles responsible for maintenance of longitudinal arch.
surgery reserved for severe cases after conservative management failed.

42

assessment of pes planus

anterior line of gravity
heel should be in neutral position
Feiss' line

43

types of pes planus

rigid, congenital: secondary to tarsal coalition
flexible, acquired: break down of support tissue over extended period of time.

44

diagnosis of rigid pes planus

rare, talus drops medially and inferiorly, navicular drops, produces medial bulge
accompanying soft tissue contractures

45

diagnosis of flexible pes planus

when non weight bearing arch appears normal

46

treatment of pes cavus

if recognized early, stretching and orthotics
when late structural changes, surgery is required.
plantar fasciotomy
treatment for flexible pes cavus is orthotics.

47

Pes Cavus

high arch, excessively high longitudinal arch

48

Etiology of Pes Cavus

primary: develops after 3 years-idiopathic
dropping of forefoot, forefoot is pronated, contracture of plantar fascia, heel varus, clawing of toes.
secondary: number of causes, neurological disorders, myopathies, soft tissue overactivity or weakness, direct trauma to foot.
flexible or rigid

49

diagnosis of pes cavus

high arch
tight plantar fascia
claw foot
heel varus

50

pathological changes of pes cavus

painful calluses form on plantar surfaces of metatarsal heads and on dorsum of clawed toes.
forefoot is thickened and splayed.
toes don't touch the ground.
function diminished in activities involving prolonged ambulation.
shock absorption reduced leads to increased stress fractures and strains.

51

treatment of pes cavus

if recognized early, stretching and orthotics
when late structural changes, surgery is required.
plantar fasciotomy
treatment for flexible pes cavus is orthotics.

52

Equinus

condition where foot is plantar flexed on itself or on leg

53

metatarsal equinus

foot is plantar flexed on itself at level of tarsometatarsal joint

54

forefoot equinus

foot is plantar flexed on itself at level of midtarsal joint

55

osseous block

normal dorsi flexion at the ankle is limited due to an impingement of tibia on neck of talus

56

muscular

an acquired or congenital shortness of gastrocnemius and soleus prohibits dorsiflexion at ankle, most common cause

57

diagnosis of equinus

10 degrees of dorsiflexion needed for normal midstance phase of gait.
compensations:
apropulsive gait
early heel-off
flexion or recurvatum at the knee
abnormal pronation of midtarsal and subtalar joints

58

pathological changes of equinus

calluses
claw foot or hammer toe
hallux valgus
plantar fasciitis

59

treatment of calcaneal varus

orthotics with medial heel wedge to correct heel varus while allowing normal subtalar pronation.

60

Calcaneal (heel) varus

deformity exhibited when non weight bearing by an inverted calcaneus. calcaneus is closer to midline.

61

Etiology of calcaneal varus

failure of calcaneus to completely derotate from original infantile position. feet develop in supinated position.

62

diagnosis of calcaneal varus

subtalar joint pronates to bring calcaneus vertical to the ground and forefoot in contact with the ground.
component of supinated foot.

63

pathological changes of calcaneal varus

reduced shock absorbing ability.
lateral ankle sprains.

64

treatment of calcaneal varus

orthotics with medial heel wedge to correct heel varus while allowing normal subtalar pronation.

65

Calcaneal (heel) valgus

deformity exhibited while non weight bearing by an everted calcaneus. calcaneus is further from the midline.

66

etiology of calcaneal valgus

failure of toddlers arches to develop properly
secondary to femoral neck anteversion, genu valgum,
due to medial weight thrust

67

diagnosis of calcaneal valgus

Helbing's sign, medial bowing of achilles tendon
navicular tuberosity is lower (Feiss' line)
component of pronated foot

68

pathological changes of calcaneal valgus

associated with problems involving pronated feet

69

treatment of forefoot varus

orthotic devices

70

forefoot varus

deformity exhibited when forefoot is inverted to bisection of posterior calcaneus

71

etiology of forefoot varus

result of failure of head and neck of talus to completely derotate from original infantile position

72

diagnosis of forefoot varus

during weightbearing, compensation at triplanar subtalar joint usually allows medial forefoot to contact the ground.
produces heel valgus, seen as medial bowing of Achilles tendon.

73

pathological changes of forefoot varus

resembles pes planus or pronation
8 degrees of forefoot varus should result in 8 degrees of calcaneal eversion.
hallux valgus
callus formation under head of 5th metatarsal

74

treatment of forefoot varus

orthotic devices

75

Calcaneal (heel) valgus

deformity exhibited while non weight bearing by an everted calcaneus. calcaneus is further from the midline.

76

etiology of calcaneal valgus

failure of toddlers arches to develop properly
secondary to femoral neck anteversion, genu valgum,
due to medial weight thrust

77

diagnosis of calcaneal valgus

Helbing's sign, medial bowing of achilles tendon
navicular tuberosity is lower (Feiss' line)
component of pronated foot

78

pathological changes of calcaneal valgus

associated with problems involving pronated feet

79

treatment of supination

orthotics with lateral posting in forefoot and hindfoot.
strengthening weak muscles and stretching tight ones. surgery reserved for rigid cases.

80

forefoot varus

deformity exhibited when forefoot is inverted to bisection of posterior calcaneus

81

etiology of forefoot varus

result of failure of head and neck of talus to completely derotate from original infantile position

82

diagnosis of forefoot varus

during weightbearing, compensation at triplanar subtalar joint usually allows medial forefoot to contact the ground.
produces heel valgus, seen as medial bowing of Achilles tendon.

83

pathological changes of forefoot varus

resembles pes planus or pronation
8 degrees of forefoot varus should result in 8 degrees of calcaneal eversion.
hallux valgus
callus formation under head of 5th metatarsal

84

treatment of forefoot varus

orthotic devices

85

Pronation

deformity of foot consisting of combination of heel valgus and forefoot abduction

86

etiology of pronation *

compensatory due to problems such as:
forefoot varus
rearfoot varus
limited ankle dorsiflexion
tibia vara
genu varum

87

diagnosis of pronation

may be evident during static posture, excessive pronation or pronation for too long at wrong phase of gait cycle.
forefoot abduction
navicular tuberosity is lower
Helbing's sign

88

pathological changes of pronation

can lead to subsequent malalignments in the lower limb.
bilateral pronation causes accentuated lumbar lordosis

89

treatment of pronation

orthotics
medial posting needed in the hindfoot
exercise for muscle imbalance or tightness
surgery rare

90

Supination

deformity of foot consisting of a combination of heel varus and forefoot adduction

91

etiology of supination

failure of the foot to derotate from original infantile position.
muscle imbalance
compensatory due to:
forefoot valgus
rearfoot valgus
limb length discrepancy

92

diagnosis of supination

forefoot adduction: anterior line of gravity runs lateral to second toe.
navicular tuberosity is higher due to rotation of forefoot.
lateral bowing of achilles tendon.

93

pathological changes of supination

ankle sprains and overuse injuries, loss of force absorption, stress fractures

94

treatment of supination

orthotics with lateral posting in forefoot and hindfoot.
strengthening weak muscles and stretching tight ones. surgery reserved for rigid cases.

95

Pronation

deformity of foot consisting of combination of heel valgus and forefoot abduction

96

etiology of pronation *

compensatory due to problems such as:
forefoot varus
rearfoot varus
limited ankle dorsiflexion
tibia vara
genu varum

97

diagnosis of pronation

may be evident during static posture, excessive pronation or pronation for too long at wrong phase of gait cycle.
forefoot abduction
navicular tuberosity is lower
Helbing's sign

98

pathological changes of pronation

can lead to subsequent malalignments in the lower limb.
bilateral pronation causes accentuated lumbar lordosis

99

treatment of pronation

orthotics
medial posting needed in the hindfoot
exercise for muscle imbalance or tightness
surgery rare

100

Supination

deformity of foot consisting of a combination of heel varus and forefoot adduction

101

etiology of supination

failure of the foot to derotate from original infantile position.
muscle imbalance
compensatory due to:
forefoot valgus
rearfoot valgus
limb length discrepancy

102

diagnosis of supination

forefoot adduction: anterior line of gravity runs lateral to second toe.
navicular tuberosity is higher due to rotation of forefoot.
lateral bowing of achilles tendon.

103

pathological changes of supination

ankle sprains and overuse injuries, loss of force absorption, stress fractures

104

treatment of supination

orthotics with lateral posting in forefoot and hindfoot.
strengthening weak muscles and stretching tight ones. surgery reserved for rigid cases.

105

Club Feet-Talipes

congenital gross deformity of the foot.
direction may vary:
equinus
calcaneus
varus
valgus

106

etiology of talipes

cause is idiopathic, theories:
intra-uterine compression
arrest in fetal development
dysplasia of muscles
abnormal tendon insertion

107

club foot combinations

talipes varus
talipes valgus
talipes equinus
talipes calcaneus
talipes equino varus: most common

108

treatment of talipes

conservative: gradual manipulative reduction
stretching contracted tissue
corrective casting, changed every 1-2 weeks for 6-8 weeks.
correction is maintained by daily stretching by parents.
wearing of clubfoot or prewalker shoe.
operations confined to soft tissue prior to 8 or 9 yrs of age.