Foot Mechanics Chart Flashcards

Question

Tests with "All" as the indication (21)

Answer 1

1. LE Posture Exam 2. Fick Angle 3. Miserable malalignment syndrome 4. Hypertrophy-ABH 5. Too many toes sign 6. Keen's Sign 7. Accessory Bones 8. Knee alignment 9. Tibia Varum 10. Single leg stance position 11. Tibial torsion 12. WB-LLD 13. Helbing's Sign 14. Haglund's Deformities 15. WB-Neutral foot 16. WB-Pronated position 17. WB-supinated position 18. Morton's foot 19. NWB-Plantar surface for calluses 20. Bergman's position 21. Circulatory tests-pulses

Answer 2

Uncompensated or compensated (does the problem exist but the patient can compensate) * Uncompensated- patient cannot adjust for the deformity for some reason (classic ex= forefoot varus 80% of people do.) * Compensated- another joint compensates for the deficiency * Plantegrade position- when you stand your feet always try to go to the floor. we don't stand around with med side of foot sticking up in the air. * Classic Ex: Forefoot varus position (3 ways it gets foot to the ground) * 1. Drop the first metatarsal down * 2. Internally rotate the whole leg * 3. Pronate through the STJ (most common, when in doubt always blame STJ) * Treatment- forefoot post in an orthotic (bring ground up to foot ) * Can't measure forefoot position in weight bearing has to be non weight bearing, can measure rearfoot.

Answer 3

* Only be around last 20 years * Patient is standing neutral position first * better not to mark it skin moves to much Palapate the navicular and measure from the floor * Patient relaxes- palpate the navicular and measure to the floor * Measure with the patient’s foot in neutral and when the patient is relaxed (compensating) * Difference \> than 10 mm= compensated pronated foot * Difference\< 10mm= normal

Answer 4

Keen’s sign- are the ankles the same size yes? no?(sprains, distastasis, achilles, etc) * Asymmetry= Keen’s sign * Can document using the figure 8 measurement * could be non-traumatic or truamatic

Answer 5

* 1st ray should be parallel to other rays * Plantar flexing the first ray could be a compensatory action so we have to assess it * take outside hand with 4 metatarsals inside hand over first metatarsal. Hold the foot like you’re eating a sandwich (a toe sandwich) * Outside hand is stationary inside hand is moving * Move up into dorsi flexion back to neutral and then down into plantar flexion (1st metatarsal) * the pasive mobility should be a 1:1 ratio ( some people say a finger's width in each direction don't worry about that) * 3 passive dorsiflexions, 3 passive plantarflexions * If the dorsiflexion is limited and the plantarflexion is increased, then it is indicative of a hypermobile plantar flexed 1st ray (compensation for a forefoot varus) * Pt could be normal hyper or hypo but hyper is most common

Answer 6

* - 5-18\* angle that is formed at the feet * Feet should be angled out, not straight forward * Have patient march and then stop to get true standing posture

Answer 7

* check for rear foot first * (Not the same as goniometry for inversion and eversion. With gonio you would find 0 then have them invert measure then evert and measure and take the difference. This is not what we are doing in this test it is gonio.) * Static resting rear foot position- where the foot lays measured with a goniometer. this is pts starting 0 position * Usually in a few degrees of varus * Calcaneus, talus, and distal 1/3 of tibia(lower leg) need to be in a straight line * Patient is prone in a figure 4 position because usually a pts leg will ER this stops that from hapening. Don't let them cross their leg over have them put the plantar surface of their foot on their knee stabilizing the leg * The patient's foot is off the edge of the table, and the therapist is at the end of the table. Make sure their foot is in line with the table if it is not move the leg around to get it into position. * your inside hand under anterior aspect of their leg thumb Palpate the head of the talus and index finger over the dome of the talus. * With your outside hand grab the metatarsals 4 and 5 * Move the foot back and forth (inversion and eversion) really far and then move smaller to the point where you no longer feel the dome or head of the talus on either side or you feel them equally (this is subtalor neutral resting position. * Give slight dorsiflexion pressure with your outside hand(as much as you can without changing the position of the foot also stop when you feel resistance) * Trying to replicate the midstance phase of the gait cycle where everything is in line * the ankle should be at a 90 deg angle. * (Alternative way to figure out Neutral (measure STJ all the way through inversion and eversion and remember that inversion is 2/3 of the motion passively all the way to eversion and back off 1/3 or inversion and back of 2/3 of the motion) * First way is the better way to do it through your palpation * remember everything starts with the foot whether it is low back or hip.) * now look at forefoot it should be parallel the 5 metatarsals should be parallel to the table= neutral position * if big toe side is closer to the table that is a forefoot varus position * if lateral is toward the table that is forefoot valgus position

Answer 8

* Hip IR * Patella in the femoral trochlea so it’s internally rotated * External tibial torsion proximally * Distal tibia varum * STJ pronation * Think of it as in out in out

Answer 9

1. Initial contact (may be the forefoot in a CP child) 2. Loading response (analogous to foot flat) 3. Mid-stance (body directly over the foot and everything is lined up) 4. Terminal stance (moving forward)(called heel off toe off in classic terms) 5. Preswing- right before toe off 6. Initial swing 7. Mid-swing 8. Terminal swing The initial swing mid swing and terminal swing are analogous to acceleration phase and deceleration phase in classic terms

Answer 10

Equinus Foot- when a patient lacks more than 10\* in dorsflexion * pt. in long sitting measure dorsiflexion make sure pt is in neutral position * palpate in sinus tarsi and dome of the talus to make sure they do not pronate, sometimes pt. will try to pronate so they can go further * problomateic because you need 10 deg minimum for normal dorsiflexion in gate, you need 20 deg for running. * STJ compensates for ankle and therefore person will be pronating * Measure dorsiflexion

Answer 11

pt standing * forcebly dorsiflex first phalange and the Medial longitudinal arch should raise up * When you dorsiflex the toe, the arch should elevate * Tightens the medial longitudinal arch and the plantar fascia * Someone that is a pronator loses the elevation of the arch/windlass affect * You can see the lack of windlass affect in people as they walk. When they toe off arch should raise up, and it won't if they pronate. All due to plantar fascia

Answer 12

Do not have to know these just know that it is out there and we can go find it if we need it.

Answer 13

* Usually happened from forcible push off pt will report they feel that someone shot them there usually very painful in the beginning * Check the achilles by using the gap test (run finger from attachment to the calcaneus and look for drop) * Achilles tendon rupture test * Squeeze the gastroc (pretty hard so you can see it), mechanically tightening and the foot will plantar flex (if the achilles is ruptured the foot will not move at all) * Qualifier- If the ankle deviates, it could be a partial tear of the achilles. When the ankle deviates it deviates away from the side that was ruptured

Answer 14

* Patient is in a weight bearing position make sure pt is relaxed and not weight bearing on one foot more than the other. * Pt is NOT standing in neutral for this test this is resting position. their compensated foot position * Draw a line that bisects the 1st MTP joint and the medial malleolus * palpate and find the Navicular tuberosity theoretically should be on that line theoretically feiss' line and "ideal foot" (supinated foot in davie's personal experience) * Draw a line parallel to the floor and divide the area into 3’s * 1st third (upper)= normal (first degree static pronated foot) * 2nd third(middle)= pronated * 3rd third(lower)= very pronated

Answer 15

Beurgers- don't have to worry about it commonly done for pdd. elevate extremity and see how long it takes for blanching to return if pts have vascular response problems then this gets to be one of the better tests

Answer 16

2/3 of gait cycle is the stance phase (60-66%) depending on where you read Where action occurs Classic terms for stance phase 1. Heel strike 2. Foot flat 3. Mid-stance (body is directly over the foot) * Neutral position of the foot- critical factor * Where prolonged pronation would occur if you deviate from neutral position and is why you use orthotics 4. Heel off 5. Toe off Swing phase approx 1/3 of gate cycle * Acceleration phase 1. Toe off 2. Mid swing * Deceleration phase 1. Mid swing 2. Heel strike

Answer 17

* Patient is prone * Flex the knee to 90 deg * Planterflex and evert the foot * Resist that motion watch and or palpate what happens to the peroneal or fibularis tendons (should be like a 3+ MMT) * If they subluxate over the fibula the extensor retinaculum is loose if they don't it is normal

Answer 18

Accessory bones- when looking at your partner look for any funny bumps. * Os trigonum(most important), os navicularis (over the navicular bone, second most important), os vesalianum (on the lateral side near the 5th styloid) there are about 20 of them.

Answer 19

Pronation is abnormal when: (\*\*\*Know This\*\*\*) * Its excessive * Maintained in a pronated position for a prolonged period of time * (Excessive compensatory prolonged pronation)-Longer than 25% of the gait cycle. will cause problems in all of the joints all the way up to the lumbar area.

Answer 20

* Patient is in prone figure 8 for position * Start with doing subtatalor/rear foot position in a neutral * Assess forefoot position relative to rearfoot- assess is it neutral varus or valgus? * grasp 4th and 5th met heads and dorsiflex * draw a straight line parallel to table using a small gonio * stationary arm is lined up with the table * moveable arm right under metatarsal heads. * Medial side closer to the table= forefoot varus (If the patient is standing the medial side elevated) * 80% of people have some forefoot varus * Lateral side closer to the table= forefoot valgus (if the patient is standing the lateral side elevated) * picture on power point has a tongue depressor showing this the forefoot position. * One of the most common compensations are pronation of subtalor joint or first ray compensations

Answer 21

1. Windlass effect 2. Feiss' Line 3. Navicular drop test 4. Longitudinal arch angle 5. 1st Ray mobility test 6. Equinus foot 7. NWB-STJ Neutral 8. Midtarsal joint mobility 9. NWB- forefoot position

Answer 22

* Morton’s foot occurs in about 22% of indivisuals * 2nd toe and metatarsal longer (must be both) has never found a number of how much bigger * Palpate patient's metatarsal and phalange to assess length * Foot mechanics change * Normal great tow twice as long as other toes so you toe off on the great toe * Weight bearing comes off of the 2nd metatarsal instead of the first since it is longer * Stress fractures, hypermobility syndromes sprains at MTP joint * Morton’s extension orthotic forces weight bearing to no longer come off of second toe in gate cycle

Answer 23

* almost did this when we palpated * Dorsflex all of the toes as far as you can so that the plantar fascia is tight * starting from the medial calcaneal tubercle (where fascia originates) run finger along all of the bands/respective metatarsals (345 are harder to feel because the lat side is flat med side should be easier to feel) * if this hurts it confirms plantar fasciatis it will hurt as soon as you palpate the medial calcaneal tubercle it will also hurt when they stand.

Answer 24

* Tap on the posterior tib nerve between Tom, Dick, and Harry * Can use a reflex hammer * Look for tinglies into the foot * Tarsal tunnel syndrome flexer retinaculum puts pressure on the nerve if person pronates or posterior tib dysfunction usually * Dr. Glenn asked Dr. Davies if you should dorsiflex the foot for tinels. If you want to stretch tarsal tunnel you can evert STJ or dorsiflex toes but subtalor movement will tighten it the most. was his answer

Foot Mechanics Chart Flashcards

(48 cards)