Midterm Notes Flashcards
(112 cards)
1
Q
Open kinetic chain
A
When one end of a chain is free to move
2
Q
In the lower extremity - when the foot is not in contact with the groung.
A
Open kinetic chain
3
Q
Allows shared movement for close packed position and non-weight bearing stresses on articular surfaces
A
Open kinetic chain
4
Q
Closed kinetic hain
A
Both ends of the chain are not free to move
5
Q
When contact with the ground surface anchors the lower extremity, putting into action the subtalar joint, locking and unlocking mechanisms of the mid-foot across the trans-tarsal joint, load bearing of the arches, internal rotation of the tibia and glide of the fibula
A
Closed kinetic chian
6
Q
Describe closed kinetic chain
A
Subtalar joint in action Locking and unlocking of mid-foot across trans-tarsal joint Load bearing of arches Internal rotation of tibia Glide of fibula
7
Q
General foot/ankle info
A
26 bones
2 sesamoids
8
Q
Work distal to proximal in ____ and proximal to distal in ____
A
Lower extremity
Upper extremity
9
Q
Three major sections of the foot
A
Forefoot
Midfoot
Rearfoot/hindfoot
10
Q
Forefoot
A
Metatarsals and phalanges - 5 rays
11
Q
Midfoot
A
Navicular
Cuboid
Cuneiforms 1,2,3
12
Q
Rearfoot/hindfoot
A
Calcaneus
Talus
13
Q
Three arches of the foot
A
Lateral
Medial
Transverse
14
Q
If keystone drops, so does
A
The arch
15
Q
Lateral arch keystone
A
Cuboid
16
Q
Medial arch keystone
A
Navicular
17
Q
Transverse arch keystone
A
Second metatarsal head
18
Q
Normal weight bearing and subsequent callus formation usually occurs at three sites
A
Calcaneus
1st and 5th metatarsal heads
Plantar surface of big toe
19
Q
Calluses appear where
A
Constant friction
20
Q
Abnormal weight bearing
A
Pes planus
21
Q
Abnormal weight bearing occurs at
A
Calcaneus
2,3,4 metatarsal heads
22
Q
Create forces which may lead to morton’s neuroma
A
Abnormal weight bearing
23
Q
Patient may have pinch calluses on the lateral and/or medial edges of foot from
A
Hypersupination
Hyperpronation
Abnormal weight bearing
24
Q
Pronation of the foot =
A
Abduction (external rotation) + eversion + dorsiflexion (anterior translation) - non weight bearing subtalar motion/calcaneal primary motion
25
Supination of the foot =
Adduction (internal rotation) + inversion + plantarflexion (posterior translation) - non weight bearing subtalar motion/calcaneal primary motion
26
There are no muscular attachments
Talus
27
If subluxated, the talus will block ___ due to altered weight distribution and the affect upon the locking and unlocking mechanisms of the foot and may lead to numerous foot complaints
Normal motion in the mortise (dorsiflexion)
28
Altered position of the talus that affects the ankle will cause
Whole body effects from tibia up
29
Altered position of talus may stress tibia/fibula interosseous ligament adding to or causing
Shin splint pain
30
Altered position of ____ may affect leg length
Talus
31
Altered motion of talus may affect ankle proprioception altering
Afferent signal
32
Components of a medial collapsing arch
Anterior talus
Inferior navicular and cuneiforms
Superior cuboid
Everted calcaneus
Possible spreading of metatarsal heads
Possible splay foot
33
Most common position of ankle injury
Plantarflexion/inversion
Open packed position/closed kinetic chain
34
Typically fracture or dislocation are caused by
Dorsiflexion/eversion
Closed packed position
35
May all relate back to the same underlying mechanical problem of a collapsing arch and hypo-tonicity in the muscularity of the lower leg
Interdigital neuritis (morton’s)
Plantar fascitis
Hallux valgus
Tarsal tunnel
36
An intact motor system can adapt via ____ and _____. The adaptations of the motor system are represented by ____
CNS control
Muscle system activity
Muscle imbalances
37
Primary shock absorbers for the spine
Foot and ankle
38
Foot and ankle conform to the ground surface for ___ and then become ___ for propulsion
Contact
| Rigid lever
39
The foot and ankle conforming to the ground surface for contact and then becoming rigid lever for propulsion occurs via
Locking and unlocking process, which occurs at the trans-tarsal joint aka midtarsal joint
40
Trans-tarsal joint
| Midtarsal joint
Talus/navicular and calcaneus/cuboid
41
Articulations between talus/navicular and calcaneus/cuboid are usually subluxated/misaligned in a
Mid-foot sprain or ankle injury
42
Classic area of investigation if the patient experiences pain in the mid foot upon weight bearing not associated with obvious edema or extreme point tenderness
Midtarsal joint
43
The function of the fibula during dorsiflexion above 90degrees will create
A palpable rising of the fibular head
44
The function of the fibula during dorsiflexion above 90degrees is essential for
Proper ankle function and stability
45
Fibular movement plantarflexion
Fibular head anterior, inferior, medial
46
Fibular head movement dorsiflexion
Posterior, superior, lateral
47
The best exercise for feet is
Walking in soft sand
| Towel gathering may be substituted
48
Pt for exercise of feet
3 sets of 20 repetitions, 3 times per day
49
What can be substitued exercise for feet for walking in soft sand
Towel gathering
50
Cryotherapy and motion is easy to accomplish with the use of
A plastic soda bottle - 12 oz size
51
Fill 12 oz water bottle with water and freeze
Use anytime exercises are being done or when the foot is painful
Roll foot over frozen bottle for 3-5 minutes then perform the exercises
If the foot is painful, ____
Cryotherapy and motion
Ice between each set if foot is painful
52
If all attempts for the body to correct the foot problem have failed or if time is critical
Orthotics may be used
53
Understand the differences between custom and generic
| Posting
Orthotics
54
A modified hinge joint at the connection of 2 long bones (levers)
Knee
55
Least stable joint in the lower extremity when the foot is in contact with the ground surface (closed kinetic chain)
Knee joint
56
Largest joint held together by soft tissue
Knee joint
57
Coupled motion of knee joint
Flexion with tibia on femur internal rotation
| Extension with tibia on femus external rotation (screw home)
58
Quadriceps angle
ASIS - center of patella/tibial tuberosity - center of patella
Men <10 degrees
Women >10 degrees
20 degrees is unstalbe for all
59
Shin splints
Symptoms
Differential
Preventative
Rehabilitation
60
Pain behind the knee cap medial side while walking or running up hill or up steps usually associated with a weak vastus lateralis
Medial patellar tracking syndrome
61
Pain behind knee cap lateral side while walking or running down hills or down steps. Usually associated witha weak vastus medialis (VMO)
Excessive lateral patellar syndrome
62
For medial weakness exercise the joint during the last 15-20 degrees of
Knee extension
63
For lateral weakness, exercise should exclude
The last 15-20 degrees of knee extension
64
Taping and straps across patella tendon
May be hlepful
65
Impact at the fibular head may affect directly or indirectly
The common peroneal nerve
66
The fibular head is an insertion site for the
Biceps femoris
67
A slip of the IT band and the lateral collateral ligament with biceps femoris
Fibular head
68
Fibular mus have normal motion to allow
Normal biomechanics at knee and/or ankle
69
Semi-weight bearing sub-talar neutral casting
| Orthotics
Fucntional orthotics
Accommodative orthotics
Generic
Normal foot
70
Functional orthotics requirements
Support the foot so that the subtalar joint will function around neutral position
Allow normal motions in the proper sequence and eliminate abnormal/compensatory motions
Conform to all contours of the foot that help function
Be comfortable within a 2 week period
Be capable of being adjusted
71
Accommodative orthotics
Any orthotic device that does not attempt to establish foot function around the neutral subtalar position (of restraicts motion from proper sequence)
72
Generic orthotics
The term used to indicate an off-the-shelf product
Aren’t specifically fitted to your feet and may or may not fit foot properly
Usually made at 4 degrees of varus correction
73
Normal foot
A foot that functions around neutral position and adapts well to terrain with normal shock absorption and goes through acceptable pronation and supination
74
Semi-weight bearing sub-talar neutral casting procedure
Adjust patient’s feet
Determine forefoot and rearfoot angles
For heel lifts use 1/2 of the measured difference but no more than 6mm inside the shoe
Place one foot on the unopened side of the foam
Place the other directly over the open foam impression box, making sure the knee is directly above the ankle
With your rearward hand, lift the foot into dorsiflexion at the 4-5 metatarsal heads to prepare for finding neutral position
Remove the rearward hand and grasp rear and side of the calcaneus to prevent any lateral movement.
75
Posting forefoot
Orthotic will generally have 4-6degrees of intrinsic forefoot varus angulation so you must subtract that anmount from your measurement. Do not post less than 3degrees. Max angle should not exceed 15-18degrees or it will not work in shoe
76
Rearfoot posting
Orthotic will have no rearfoot angulation. Therefore post one for one. Max positing is 5degrees
77
Determining sub-talar neutral
Adjust foot. 6-8 degree changes are not uncommon
Pt supine - place outside thumb on 4-5 metatarsal heads; place inside thumb and 1st finger into space on either side of talus; place foot into slight dorsiflexion and atttempt to place the foot in a position that is neither inverted nor everted, neither pronated or supinated. Attempt to equalize the holes where your fingers are located then measure angle off tibia
Pt prone - repeat process, measure forefoot angle. Normal is 0-6degree varus; check for functional hallus limitus (FHL)
78
Great toe dorsiflexion normal
70-90d
79
Great toe dorsiflexion under load normal is
35d
80
Family physicians are frequently called on to evalutae patients who have
Acute knee injuries
81
Each year, knee trauma is responsible for an estimated ____ visits to ER departments in the US
1.3 million
82
The anatomic characteristics of the knee, it’s exposure to external forces and the functional demands place on the joint may explain
The frequency of injury
83
Only ___ of patients with knee trauma have a fracture
6%
84
Standard texts imply that radiographs should be routinely obtained for every patient who
Presents with knee injury
85
Reasons for the unnecessary use of radiography include
Fear of lawsuits
Failure to obtain an adequate history
Expectations on the part of patients
86
Overuse of radiologic studies has become a significant ___ problem int he US
Economic
87
Fractures in the knee may occur in
The patella
Femoral condyles
Tibial plateua
88
Patellar fractures are divided into
```
Transverse
Vertical
Upper pole
Lower pole
Comminuted
Osteochondral
```
89
The 2 main MOI’s of patellar fracture are
Direct trauma to the anterior aspect of the knee
| A powerful contraction of the quadriceps muscle (transverse, upper pole and lower pole fractures)
90
____ are essential to assess traumatic patellar injury
Radiographs
91
In addition to AP, notch, andn lateral views, ___ and ___ views with the knee in 45d of flexion may be necessary to identify an osteochondral fragment
Merchant
| Infrapatellar
92
Fractures of the femoral condyles involve the
Distal 9-15cm of the femur
93
Both the diaphyseal and metaphyseal regions may be involved . Fractures may also show
Intra-articular extension
94
Most condylar fractures occur as a result of
MVA’s
95
other causes besides MVA of condylar fractures are
Falling on a flexed knee or
| Falling from a height
96
In young people, higher energy is necessary for a fracture to occur, therefore, more ____ is present
Soft tissue damage
97
In older patients with osteoporosis, less energy is needed to produce a fracture; therefore, less associated
Soft tissue damage is present
98
Fractures of the tibial plateau are important because of the
Weight-bearing areas
99
Fracturs of tibial plateaus may involve
Metaphysis
Epiphysis
Articular cartilage
100
MOI fracture of tibial plateau
Compression
Valgus force
Combination of both
101
The fractures involve the lateral plateau, medial plateau or both (bicondylar fractures)
Fractures of tibial plateau
102
The clinical decision rules created in ____ and ____ are the best known guidelines for appropriate use of radiographs in acute knee injuries
Ottawa
| Pittsburgh
103
Ottawa knee rules
```
Age 55 or older
Tenderness at head of fibula
Isolated tenderness of patella
Inability to flex knee to 90d
Inability to walk four weight-bearing steps immediately after the injury andin the ER
```
104
Pittsburgh decision rules
Blunt trauma or a fall as MOI plus either of the following:
Age younger than 12 years or older than 50 years
Inability to walk four weight-bearing steps in the ER
105
Knees of 74% patients evaluated radiographically. ___ were found to have fractures
5.2%
106
Logistic regression analysis found fall or blunt trauma MOI knee had sensitivity or __ and specificity of ___ for the presence of knee fraction.
92%
| 57%
107
The prospective part of study for knee found combo of all 3 criteria was ___ sensitive and ___ specific for knee fracture
100%
| 79%
108
Pittsburgh decision rules were ___ sensitive and ___ specific for diagnosis of knee fractures
99%
| 60%
109
Ottawa knee rules were __ sensitive and ___specific
97%
| 27%
110
Ottawa ankle x-ray
Only required if there is pain in malleolar zone AND
Bone tenderness at posterior edge or tip of lateral malleolus OR
Bone tenderness at posterior edge or tip of medial malleolus OR
Inability to bear weight both immediately and in the ER
111
Foot x-ray ottawa only required if there is pain in the midfoot zone AND
Bone tenderness at base of 5th metatarsal OR
Bone tenderness at navicular OR
Inability to bear weight both immediately and in the ER
112
Ottawa for people
19 years and older
