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Orthodics > Foot, Shoes, and Orthotic Interventions > Flashcards

Foot, Shoes, and Orthotic Interventions Flashcards

(63 cards)

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1
Q

Initial Contact

A

Eccentric anterior tib/long toe extensors, concentric quad, eccentric hamstrings, glut maximus eccentric activity

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2
Q

What controls decent of the foot during loading response?

A

pretibial regulates ankle PF, Quads regulated knee flexion eccentrically

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3
Q

What prevents hip flexion?

A

Gluts, hamstring and adductor magnus prevent hip flexion via eccentric actions. Highest ground force reactions seen at this stage

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4
Q

What controls tibial advancement during mid stance?

A

Eccentric soleus and gastroc (lesser degree)

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5
Q

What decreases late midstance?

A

Glut max decreases in late mid stance due to vertical alignment of pelvis over the femur.

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6
Q

What is in highest demand during terminal stance?

A

body weight vector approaches MTP’s, Highest demands on the triceps surae (eccentrically) due to large dorsiflexion moment at ankle

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7
Q

Foot clearance during initial swing:

A

Concentric pretibial muscle activity for foot clearance. Short head of biceps femoris flexes knee concentrically

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8
Q

What assists with hip and knee flexion during initial swing?

A

iliacus advances hip to 20 d of flexio. Gacilis and Sartorius assist hip and knee flexion concentrically

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9
Q

Disorders of the Hindfoot

A 
Achillies Tendinosis
Sever’s Disease
Retrocalcaneal Bursitis
Peroneal Tendinosis
Ankle OA/Subtalar Joint arthritis
Ankle Impingement
Tarsal Tunnel Syndrome
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10
Q

Tendinosis

A

mucoid degeneration of Achilles Tendon
degenerationwithdepositofmyelinandlecithininthecells.
Active DF and PF is painful +/-­‐ painful arc

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11
Q

Paratendinopathy

A

inflammation of the paratendon (membrane that surrounds the tendon or fascial plate (insertional point

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12
Q

Achilles Tendinopathy

A

Graston Technique modified
Eccentrics
Stretch – multidirectional
ICE with Stretch

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13
Q

Exerises for mid portion achilles tendinopathy:

A

Responds to eccentrics with ankle in plantarflexion and dropping into extreme dorsiflexion – three sets of 15

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14
Q

What do insertional achilles tendinopathy need to avoid?

A

extreme DF

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15
Q

Severe’s Disease

A

a traction apophysitis to the insertion of the Achilles tendon
boys 7-15

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16
Q

Cause of severe’s disease”

A

shear stresses applied to the unossified apophysis.

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17
Q

Whee is pain with Severe’s Disease?

A

Pain in posterior heel that is worse With activity and weight bearing
Pain on squeezing posterior calcaneus near growth plate

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18
Q

Treatment and Orthotics for Sever’s Disease

A 
Heel Cups
Heel Lifts
Orthoses with Medial Longitudinal Arch (MLA) and medial Posting
Taping
Rest
Stretching Achilles
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19
Q

Retrocalcaneal Bursitis

A 
Describe by location of pain and swelling
May exist as a constellation of symptoms
May exist with Achilles tendinopathy
Often associated with Haglund’s
Radiographs help with location
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20
Q

Assessment of Retrocalcanel Bursitis

A

Passive dorsiflexion may be painful
Two finger pinch test anterior to achilles
MRI and Ultrasound form gold standard to determine soft tissue swelling.

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21
Q

Haglund’s Deformity

A

Presents as a constellation of symptoms
Painful soft tissue swelling at Achilles tendon
Describes as an enlarged area of Post lateral calcaneus
bony deformity

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22
Q

Haglund’s Syndrome

A

includes pathology of Achilles tendon and the Achilles bursa

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23
Q

Posterior Impingement of Ankle

A

Caused by overuse or trauma
Dancers have overuse
Trauma cause forced pf with running/soccer Plantar flexed and then impact. Os trigonum (accessory bone in the ankle) will cause pain.
Bony spurs
Slightly displaced os Trigonum (Accessory Talus), hypertrophy of post talus or loose body

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24
Q

Assessment of Posterior Impingement of Ankle

A

Complaints of pain in posterior lateral ankle
Pain increased with passive plantarflexion
Pain increased with repeat active plantarflexion
Posterior lateral pain on palpation
Morning stiffness
These people are on their toes a lot. Mobilizing the patient into plantar flexion is always painful

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25
Physical Therapy for Posterior Impingement
``` Treat hypomobility at Talocrural joint Talocrural mobilization-­ distraction Talocrural manipulation-­‐ distraction Talar glides posterior – for df Mulligans mobs with movement for df Maitland physiological mobs – subtalar,TC Active stretching of the ankle Active movements of the anterior compartment in conjunction with stretch of the posterior compartment: Shuffle Gait/moon walk gait exercise ```
26
When is preoneus longus active during gait?
Active through midstance to late stance Decelerates speed and amount of supination at STJ Helps the midfoot and forefoot relatively pronates
27
Disorders of the Midfoot
Arthritis of the Midfoot and Lisfranc Plantar Fasciitis Cuboid Syndrome PTTD
28
What is Lisfrance associate with?
rheumatology | Rheumatoid or Osteoarthritis
29
Lisfrance injury:
Associated with Sporting Injury or axial load May occur with foot structure and indirect injury Pronation and abduction or dorsiflexion with abduction elicits pain
30
Plantar fasciitis
Pain with first step in the am or after a period of inactivity Relieved by activity until stress increase Pain on palpation at medial calcaneal tubercle Pain usually unilateral No burning or numbness
31
Baxter’s Nerve Entrapment
Pain not as bad with first step but worsens as day progresses burning or numbness present Thought to be about 20% heel pain Present in athletes Pain may be present at rest Abductor digiti minimi muscle weakness can be present
32
Facial attachment of plantar fascia?
Abductor Hallucis and Abductor Minimi | Plantar Fascia communicates with paratendon of Achilles Tendon at periosteum
33
Tarsal Tunnel Syndrome
Related to foot type Tarsal tunnel: canal formed between medial malleolus and flexor retinaculum Shooting pain in the foot, with numbness, tingling or burning
34
Nerve affected with tarsal tunnel syndrome:
Medial Calcaneal Nerve (branch of tibial nerve) | Nerve to Abductor Digiti Minimus
35
What foot deformities is tarsal tunnel syndrome associated with?
Association with pronation, mechanical stretch with arthritis, Ligamentous injury, trauma and obesity
36
Tarsal Tunnel vs Plantar Fascitis
Tarsal Tunnel pain without weight bearing Pain at night-­‐ pain described as burning No pain on palpation of plantar fascia Pain on triple compression test with plantarflexion and eversion and compression of Tibial nerve. Toe abductors and intrinsic muscles of feet weak with advanced cases
37
Physical Therapy Treatment for TTS
Stretching of calf Tibial nerve mobilization Treatment of subtalar and midtarsal and hallux Strengthening post Tib and peroneus longus
38
Where is pain felt with fat pad syndrome?
Pain is felt in the center of heel or perimeter Pain is felt with deep palpation or squeezing Pain is worse with weight bearing
39
Tarsal Coalition
``` A union between two or more tarsal bones May be osseous or ligamentous Can exist with or without pes planovalgus Really flat feet Ridged foot ```
40
Causes of cuboid syndrome:
forceful eversion of the cuboid while the calcaneus is inverted, with resultant disruption of CC joint congruity Associated with Sprain commonly in sports
41
Pain with cuboid syndrome:
Antalgic Weakness with resistance of eversion Pain on palpation of cuboid Pain on movement into supination or adduction
42
Who often has cuboid syndrome?
Ballet due to repeative jumps with pronation
43
Cuboid Syndrome Assessment
History of pain and overuse into plantar flexion and inversion Pain with weight bearing, jumping and running Special tests-­‐ squeezing the midtarsal joint with superior to inferior pressure Forced abduction and pronation of the midfoot
44
Functional movements with cuboid syndrome:
Antalgic gait during push off Antalgic gait during side to side motion Hopping increases symptoms Rest decreases symptoms
45
Contraindications to Cuboid Whip
``` Bone Disease Gout Acute injury with bruising and swelling Neural injury Vascular injury And most importantly -­‐ Neoplastic Disease ```
46
Disorders of the Forefoot
``` Bunions (HAV) Hallux Limitus and Rigidus SesamoidiEs Metatarsalgia Turf Toe in sports ```
47
Bunions
Hallux Abducto Valgus is associated with change in the Abductor Hallucis thickness Significant differences in Dorsal Plantar (DP)
48
Exercise for Bunions
Muscle Activity for Abductor Hallucis with short foot and toe spread TSO (Toe Spread Out)has a greater activation Both exercises should be incorporated into program
49
MOI for turf toe:
Foot loaded axially with fixed equinus and toe extension | heel is always elevated
50
Turf Toe Evaluation
``` Pain distal to sesamoids Evaluate dorsoplantar drawer test Active flexion and extension Resisted flexion and extension for disruption of FHL or FHB Test migration of sesamoids ```
51
Morton’s extension
A rigid Morton's extension is essentially a continuation of the polypropylene or graphite shell of the orthosis beyond the first metatarsophalangeal joint (MPJ), extending to the tip of the toe.
52
Grade I turf toe:
attenuation of plantar structures localized swelling minimial ecchymosis
53
Treatment of Grade I turf toe
symptomatic | return to play as tolerated
54
Grade II turf toe
partial tear of plantar structures moderate swelling restricted motion due to pain
55
Treatment of Grade II turf toe
walking boot crutches prn return to play: up to 2 weeks may need taping upon return
56
Grade III turf toe
complete disruption of plantar structures significant swelling/ecchymosis hallux flexion weakness frank instability of hallux MTP
57
Treatment of Grade III turf toe
long term immobilization or surgery | 10-16 weeks return to play
58
Hallux limitus ROM:
< 45 in open chain
59
Hallux rigidus ROM:
<10 degrees
60
Normal ROM first MTP:
45-65
61
Orthosis for Hallux Rigidus
Unload the 1st ray with cut out Reverse Morton’s extension Kinetic Wedge
62
Placement of metatarsal bars?
start with them 1/16 of a inch proximally. The patient may not feel relief for a week so educate your patients about the need to continue to wear the pad or bar
63
Tailors Bunion or Bunionette
Exostosis or inflammation of the 5th metatarsal base

Orthodics (16 decks)

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