MSPT - EXAM 3 ANKLE Flashcards
(217 cards)
1
Q
Function of the foot and ankle
A
Stability and Mobility
- Base of support
- Allow tibia/fibula to advance forward
- Adapt to uneven terrain
- Absorb shock
- Act as rigid lever for push off
- Tool, weapon, object manipulation
- Proprioception, balance
2
Q
Joint type of distal tibiofibular joint
A
Fibrous/syndesmosis
3
Q
Motion of the tibiofibular joint
A
Mortise widens to allow full DF (dome of talus rolls posteriorly into mortise)
4
Q
Ligamentous support of tibiofibular joint?
A
Anterior tibiofibular
Posterior tibiofibular
Intertransverse membrane
5
Q
If the tibiofibular joint can’t widen to allow the talus to roll posteriorly…
A
patient will have limited DF
6
Q
Articulation of talocrural joint
A
Mortise/malleoli articulating with talus bone
7
Q
Normal ROM of talocrural joint
A
DF: 15-20 deg
PF: 45-50 deg
8
Q
Closed pack position of talocrural joint
A
Max dorsiflexion
9
Q
Open packed position of talocrural joint
Clinical significance?
A
10 deg PF, neutral IV/EV
Position to cast or perform joint mobilizations
10
Q
Capsular pattern of talocrural joint
A
Loss of PF > loss of DF
11
Q
Ligamentous support of talocrural joint
A
Medially: deltoid ligament
Laterally: ATFL, CFL, PTFL
12
Q
What ligament is most commonly injured? Why?
A
ATFL
- Inversion/PF injury
- More motion in this direction
- Weakest ligament
13
Q
Articulation of subtalar joint
A
Talus and calcaneus
14
Q
Normal ROM of subtalar joint
A
Inversion: 20 deg
Eversion: 10 deg
15
Q
Closed pack position of subtalar joint
A
Supination
16
Q
Open packed position of subtalar joint
A
Midway between max of ranges
17
Q
Capsular pattern of subtalar joint
A
Loss of inversion > eversion
18
Q
What is subtalar neutral
A
Subtalar joint midway between inversion and eversion
19
Q
What happens to the calcaneus during open chain and closed chain supination/pronation?
A
Always everts during pronation and always inverts during supination. The rest of the foot accommodates to this motion.
20
Q
Joints of the hindfoot
A
Distal tibiofibular
Talocrural
Subtalar
[determine motion of foot]
21
Q
Joints of the midfoot (Chopart’s)
A
Talocalcaneonavicular Cuneonavicular Cuboideonavicular Intercuneiform Cuneocuboid Calcaneocuboid
[slide/adapt to rear foot]
22
Q
Joints of the forefoot
A
Tarsometatarsal (Lisfranc’s)
Intermetatarsal
Metatarsalphalangeal (MTP)
Interphalangeal (IP)
23
Q
articulation of Chopart’s joint (midfoot)
A
Midtarsal joints between
- Talus + calcaneus
- Navicular + cuboid
24
Q
Motions of the midfoot
A
DF, PF, Abd, Add, Rotation
[Contribute to pronation/supination total motion. Allows foot to conform to uneven terrain]
25
Ligament support of Chopart's joint
```
Plantar calcaneonavicular (Spring) ligament
Plantar cuneonavicular ligaments
Short/long plantar ligaments
```
26
Articulation of Lisfranc's joint
Cuboid and 3 cuneiforms articulating with metatarsals
27
Motion of Lisfranc's joint
Capable of small glides in all directions.
[Contribute to overall foot supination and pronation]
28
Type of joint: MTP joints
Condyloid synovial with 2 degrees of freedom (PF, DF, Abd, Add)
29
Closed packed position of MTP joints
Full extension
30
Open packed position of MTP joints
10 deg extension
31
Capsular pattern of MTP joints
Loss of extension > loss of flexion
32
Self-report measure used for the ankle
Foot & Ankle Ability Measure (FAAM)
| Lower Extremity Functional Scale (LEFS)
33
3 causes of calluses
Excessive friction
Shear
Loading
34
Who has too much wear on the lateral edge of the shoe?
Typically a pea cavus, excess supination at the subtalar joint
35
In weight bearing, a "supinated" foot requires the forefoot to...
pronate in order to allow 1st MTP to contact the ground
36
Who has too much wear on the medial heel of the shoe?
Pes planus or excessive pronation
37
Why check AROM before PROM?
Patient shows you what their pain-free range is
38
What should you remember about checking ROM on a swollen foot?
Don't check PROM yet - "put the fire out before inspecting the damage"
39
Common gait deviations
```
Decreased toe off
Decreased step length with uninvolved LE
Decreased stance time with involved LE
Walking outside/inside borders of foot
Early heel off on involved side
Walking on toes (absent heel strike)
Decreased weight shift to involved side
```
40
3 rockers of gait
```
Heel rocker (rearfoot)
Ankle rocker (mid foot)
Forefoot rocker (forefoot)
```
41
MOI of lateral ankle sprain
Rolls into inversion/supination
42
Ligament damage: lateral ankle sprain
ATFL 1st, most commonly injured
Then CFL and then PCFL as severity increases
43
Differential diagnosis from lateral ankle sprain
Avulsion or fracture
44
What is a high ankle sprain
Sprain of distal tibiofibular joint, specifically the intertransverse membrane
45
MOI of high ankle sprain
Twisting on a planted foot
Mortise widens too much, talus becomes unstable within the mortise
46
S/s of high ankle sprain
Pain in lower leg above malleoli
Pain with squeezing lower leg
Pain/laxity with distal tibiofibular spreading
Pain with abduction of foot
47
Differential diagnosis from high ankle sprain
shin splints
compartment syndrome
stress fracture
DVT
48
What is important for long term results and reduce recurrence of sprain?
Exercise-based treatments, especially ones including wobble board
49
More effective treatment strategy to reduce recurrent ankle sprains in male soccer players
Proprioceptive training
50
What is a medial ankle sprain
Injury to deltoid ligament (pain during LR)
51
MOI of medial ankle sprain
Eversion/pronation
52
Causes/risk factors of achilles tendinitis
Rapidly increasing running mileage or speed
Adding hills or stair climbing to training routine
Pes cavus foot type
Overpronation of foot
Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort such as final sprint
Overuse from natural lack of flexibility in the calf muscles
Middle-aged recreational athlete most commonly affected
53
S/s of Achilles tendinitis
Pain over heel (insertion point)
Pain worse after resuming activity after period of rest and usually worse in morning
Pain with activation, palpation, or stretch of the gastric/soleus complex
Pain with push off, walking uphill, or toe walking
54
Quick test for achilles tendinitis
Walking on toes
55
What kind of forces are best for realigning collagen fibers?
Eccentric shearing exercises
56
What components of PT improved self-reported outcomes for achilles tendinitis?
Eccentric training, TFM, US
57
What was effective in reducing pain and improving PF strength in runners with achilles tendinitis?
PT: US, TFM, ice, wobble board
| Custom semi-rigid orthotic insole
58
S/S peroneal tendinitis
Pain behind lateral malleolus
Pain at PL/PB path or insertion
Positive resisted iso testing of eversion
Pain with end range/passive stretch into inversion or supination
Pain with figure 8 walk or walking on sides of feet
59
Possible contributing factors to peroneal tendinitis
Pes cavus, varus rearfoot, excessive supination
Increased training or activity involving repetitive and/or high power toe off with lateral motion
60
Risk factors for tibialis posterior tendinitis
Pronated foot (pes planus)
Pes cavus
Excessive walking, running, standing, stairs
61
Tibialis posterior tendinopathy can lead to
PTSS (posterior tibialis stress syndrome) and adult-onset flat foot
62
S/S of tibialis posterior tendinitis
Pain behind malleolus and in arch of foot (often burning)
Walking on sides of foot to avoid pain
Unable or weak in standing on tip toes
Pain with resisted isometric testing of inversion and/or PF
Pain with stretch of posterior tibialis
63
How to differentiate between tibialis posterior tendinopathy and FHL tendinopathy
Extend the big toe or resisted toe flexion
64
What are shin splints
General term to describe pain in the lower leg region related to running activities in athletes. Also called ERLP (exercise related leg pain)
65
Shin splints can be used to describe:
Muscle soreness of the tibialis anterior, tibialis posterior, or peroneus
Anterior or posterior tibialis or peroneus tendinitis
Anterior/deep posterior compartment syndromes
Tibial stress syndrome or fractures at the origins of either TA or TP
66
What muscles are affected in anterior, posterior, or medial tibial stress syndromes
Anterior: TA
Posterior: gastroc/soleus
Medial: TP
67
Etiology/risk factors for tibial stress syndromes
Training errors
Biomechanical abnormality
Coaches often blame lack of stretching
68
Clinical presentation of tibial stress syndrome
Pain in lower leg compartment, swelling, weakness, tightness, limited functional mobility, running ability
69
What is compartment syndrome
Result of swelling or inflammation that causes increased interstitial pressure in closed fascial compartments containing muscles, nerves, and vascular supply.
As pressure increases, muscle and nerve function is impaired and necrosis of soft tissues eventually develop
70
Signs of emergency (CS)
Extreme pain, tightness, firm to touch
Absent pedal pulses
Numbness
71
Etiology of osteochrondral lesion of talus
History of ankle sprain
Chronic ankle instability (CAI)
Trauma
72
Pathology: osteochondral lesion of talus
```
Pain, welling
Catching, grinding
Stiffness
Point tenderness
Average age: 20-30 yo
Sometimes few clinical findings
```
73
Treatment for osteochondral lesion of talus
Cast, NWB 6-18 weeks
| Surgery
74
What has a similar etiology, pathology, and treatment as OCD of talus? When would you consider it?
Talar dome fracture
Consider with deep pain during WB activities
75
Indications for lateral ankle repair
Chronic ankle sprains or instability. Patients are usually under 40 and athletic
76
What should you avoid after a lateral ankle repair?
Inversion and PF
77
Population for achilles repair
Male athletic, 30-40 yo
Often degenerative changes (tendinosis) in tendon are present from hypovascularity and microtrauma (repeated tendinitis)
78
What are the 2 most commonly ruptured tendons?
1. Biceps
| 2. Achilles
79
MOI achilles tear
Push off in knee extension (sprint/jump)
Sudden DF in full WB (fall, trip)
Land on PF foot from a height
80
Difference in WB status between traditional rehab and early motion rehab for achilles tear
Traditional: 8 weeks to WBAT
| Early motion: 2 weeks to WBAT
81
What fracture is common in professional dancers?
Lisfranc fracture
82
What is club foot?
Talipes equinovarus - congenital deformity
Foot is twisted in (inverted)
Without treatment, patients walk on their ankles or sides of their feet
Common (1/1000 births)
Often coexist with other congenital abnormalities
83
How is club foot treated?
Manipulation and surgery
| Orthoses hold feet in correct position
84
Etiology of plantar fasciitis
Inflammation of dense band of tissue that extends from bottom of calcaneus to base of MTPs
85
Chief complaint of plantar fasciitis
Pain in heel and difficulty walking first thing in the morning (post-static dyskinesia)
Pain due to inflammation and scar tissue
86
Risk factors for plantar fasciitis
```
Job requiring prolonged time on feet
Recent weight gain
Recent increase in running
Tight gastroc/achilles
Flat feet or high arch feet
```
87
Typical exam findings of plantar fasciitis
Tender to hell/PF insertion
Pain with FWB, especially on flat foot and DF
Walking on sides of feet to avoid the stretching of the PF that occurs during pronation
Contractile testing (RROM) strong and pain free
Pain with passive DF and/or great toe extension (1st MTPJ)
X-ray may or may not show a heel spur on medial tuberosity of calcaneus
88
Pes cavus and pes planus is often present in plantar fasciitis. Why?
Planus: excess pronation; PF always getting overstretched
Cavus: PF i short/tight and doesn't lengthen adequately during WB
89
Why does a patient with plantar fasciitis have more pain in the morning?
Sheets PF foot and shorten the fascia; causes overstretching in the morning
90
Symptoms of tarsal tunnel syndrome
Sensory disturbances in tibial nerve distribution of foot (pain, numbness, paresthesia)
Intrinsic weakness (clawing of toes)
Pain behind medial malleolus
91
Contributing factors to tarsal tunnel syndrome
Fallen arches, obesity, diabetes, trauma, or inflammation to area
Prolonged standing, walking, new exercise
92
What is a Mortons Neuroma
A neuroma is a benign tumor of a nerve.
Morton's neuroma is not actually a tumor, it is a thickening of the tissue that surrounds the digital nerve leading to the toes
Occurs as nerve passes under IMT ligament connecting the MTPs - often between 3rd/4th digits
93
Symptoms of Mortons neuroma
burning pain or feeling of a rock in your shoe at the balls of your feet
94
Most effective treatment for Mortons neuroma
Shoe modification (no high heels or narrow toes), orthotic that spread MTs apart ("cookies"), Cortisone injections
Surgical resection usually last resort
95
What is hallux rigidus/limitus
Progressive restriction of motion in 1st MTPJ (especially extension)
Decreased toe off, trouble going to tip toes, trouble squatting
96
What is the difference between hallux rigidus and limitus?
Called limitus in early stages
Called rigidus when motion is maximally restricted or absent
97
What kind of condition is hallux rigidus?
Progressive DJD-type condition
- Trauma can occur
- Can be due to RA or gout or cumulative micro trauma
- High heels
98
Function of the 1st ray
Support medial border of foot
Propulsion point (TSt/PSw)
99
What is hallux valgus/bunion?
Valgus - refers to angle on 1st MTP; 20-30 deg angle
Bunion - resultant callus formation, thickened bursa, bony exostosis on medial side of 1st MTP
100
Causes of hallux valgus
Hereditary
Abnormal foot mechanics
High heels/narrow toed shoes
Gout/RA
101
How do you figure out how to treat bunionectomies?
Over 100 surgical procedures. Read post-op report to guide treatment. Pay attention to if and what joints were fused (don't mobilize fused joint).
Early exercise programs are effective
102
In relaxed standing, most patients are in what position?
Pronated
103
What is an abnormal navicular drop test?
> 10 mm
104
What is a normal rearfoot varus?
2-8"
105
If a patient has leg-heel (rearfoot) varus when in STJ neutral, the patient will most likely...
compensate in weight bearing by excessively pronating to get the plantar surface of the medial side of their calcaneus in contact with the ground
106
If a patient has rearfoot varus and does not compensate...
he/she will be walking on the outside edge of the foot
107
If a patient has leg-heel (rearfoot) valgus (rare) when in STJ neutral, the patient will most likely...
supinate when in weight bearing in order to get the lateral/plantar surface of their calcaneus in contact with the ground
108
If a patient has rearfoot valgus and does not compensate...
he/she will be walking on the inside border of the foot.
109
What rearfoot/forefoot alignment is most commonly seen?
Rearfoot varus
| Forefoot varus
110
If a patient has forefoot varus when in STJ neutral, the patient will most likely...
pronate and/or plantar flex the 1st ray (1st MT and medial cuneiform) in order to get their medial metatarsal heads in contact with the ground (when weight bearing)
111
If a patient has forefoot varus and does not compensate...
he/she will be bearing more weight than normal on the lateral side of the foot
112
If a patient has forefoot valgus when in STJ neutral, the patient will most likely...
supinate and/or plantar flex the 5th ray (5th MT) in order to get the lateral side of the foot in contact with the ground (when weight bearing)
113
If a patient has forefoot valgus and does not compensate...
he/she will be bearing more weight than normal on the medial side of the foot
114
Most pronation occurs at the subtalar joint. Compensations require...
midfoot and forefoot mobility
115
What is the difference between rearfoot valgus and calcaneal valgus?
Rearfoot - measured in NWB
| Calcaneal - measured in relaxed standing (measures the compensation)
116
Calcaneal valgus occurs in what kind of foot?
Pronated/pes planus
117
Abnormality of structure and alignment of the foot can lead to...
abnormal strain, injury, and abnormal structural development throughout the kinematic chain
118
Effect of excessive subtalar pronation throughout the kinetic chain
Tibial IR --> femoral IR -->
- Patellofemoral pain syndrome
- Increased lumbar lordosis/LBP
119
Toes: compensated hip retroversion
Toe out
120
Toes: compensated hip anteversion
Toe in
121
Toes: compensated tibial ER
Toe in
122
Toes: compensated tibial IR
Toe out
123
Normal tibial torsion?
13-18 deg ER
124
Toes are normally straight ahead due to...
compensated slight hip anteversion and slight tibial torsion
125
What do you use to assess loss of protective sensation of the foot/ankle
Sims-Weinstein monofilaments
126
What does the Star Excursion Test indicate
Functional deficits related to chronic ankle instability. Determines reach deficits both between and within subjects with unilateral chronic ankle instability.
127
Theory behind fibular taping for lateral ankle sprains
ATFL shortening due to trauma results in anterior, inferior position of distal fibula in relation to tibia
128
Ottawa Knee Rules for Radiographs of Acute Knee Injuries in Adults
55 years or older
If > 18 or < 55 and:
- Fibular head tenderness
- Patellar tenderness
- Inability to flex knee to 90 deg
- Inability to bear weight and walk 4 steps
129
Indications for navicular taping
(+) navicular drop test
Overpronation
130
Indications for low-dye taping
Overpronation
Plantar fasciitis
131
Indications for fibular taping
Pain relief
Ankle sprain, lack of DF ROM (phase II or III rehab)
Reinforce manual therapy glide technique
132
Toes are normally straight ahead due to...
compensated slight hip anteversion and slight tibial torsion
133
What do you use to assess loss of protective sensation of the foot/ankle
Sims-Weinstein monofilaments
134
What does the Star Excursion Test indicate
Functional deficits related to chronic ankle instability. Determines reach deficits both between and within subjects with unilateral chronic ankle instability.
135
Theory behind fibular taping for lateral ankle sprains
ATFL shortening due to trauma results in anterior, inferior position of distal fibula in relation to tibia
136
Ottawa Knee Rules for Radiographs of Acute Knee Injuries in Adults
55 years or older
If > 18 or < 55 and:
- Fibular head tenderness
- Patellar tenderness
- Inability to flex knee to 90 deg
- Inability to bear weight and walk 4 steps
137
Indications for navicular taping
(+) navicular drop test
Overpronation
138
Indications for low-dye taping
Overpronation
Plantar fasciitis
139
Indications for fibular taping
Pain relief
Ankle sprain, lack of DF ROM (phase II or III rehab)
Reinforce manual therapy glide technique
140
What ligament provides the primary support to the medial longitudinal arch of the foot?
Plantar calcaneonavicular (Spring) ligament
141
What three motions occur with open chain supination of the foot?
Calcaneus inverts
Foot adducts
Foot plantar flexes
142
What three motions occur with closed chain supination of the foot?
Calcaneus inverts
Foot abducts
Foot dorsiflexes
143
What effect does pronation of the foot have on the tibia?
IR
144
At what point in the gait cycle is the foot the most pronated?
Midstance
145
Where is tarsal tunnel? What is in it?
Behind medial malleolus
- Tibialis posterior muscle
- Flexor digitorum muscle
- Posterior tibial artery
- Posterior tibial vein
- Tibial nerve
- Flexor hallucis longus muscle
146
What does the tibial nerve innervate?
```
Abductor hallucis
Flexor digitorum brevis
Flexor hallucis brevis
Lumbricals
Quadratus plantae
Flexor digiti minimi
Adductor hallucis
Interossei
Abductor digiti minimi
```
147
What are the 2 branches of the tibial nerve?
Medial and lateral plantar nerves
148
Cutaneous distribution of the tibial nerve?
Heel and sole of foot
149
Foot drop can be caused by (3):
L5 radiculopathy
Common fibular nerve injury
Tibialis anterior rupture
150
Medial malleolus is more... than the lateral
Anterior/Inferior
151
Function of the talus
No muscular attachment - joins the foot to the leg; shock absorption; reduces friction/shear for movement (a lot of articular cartilage
152
Cuneiforms form the...
transverse arch
153
What is the function of the 2 sesamoid bones under the 1st MT head (FHB tendon)?
Help with gait and push-off (pivot on these bones). Increase mechanical advantage.
154
What would result if individual had decreased mobility of transverse tarsal joints
Lack of mobility
Inability to balance or adapt to varied surfaces
Gait disturbance during mid stance
Compensation: excessive ankle, forefoot motion
155
Mobility and rigidity of the Lisfranc joints
1st and 2nd joints are limited in mobility to allow for rigid propulsion
Mobility increases from 3rd to 5th joints
156
Pronation/supination and mobility
Pronation of whole foot increases mobility
Supination of whole foot decreases mobility
157
Importance of plantar fascia
Provides important dynamic support to arches of foot
158
Function of the arches
Protect neurovascular structures on plantar surface
Absorb shock
Store energy
159
In active individuals, which arch abnormality leads to soft tissue injuries due to overstretching of tendons?
Pes planus - everything is on stretch and muscles have to work harder
More mobility, less stability
160
In active individuals, which arch abnormally leads to bony injuries?
Pes cavus - not enough shock absorption
More stability, less mobility
161
Lateral tibial torsion associated with
increased Q angles and recurrent patellar dislocations
162
Pott's fractures
Fractures of the distal tibia and fibula - result from sprained ankle causing avulsion fracture (stretched ligament or tendon applies tensile force on bone)
163
What is inside the sinus tarsi?
Neck of talus and ATFL (tenderness indicates injury to those structures)
Venous plexus often torn in sprained ankle --> golf ball-sized swelling
164
Most commonly fractured tarsal bone
Calcaneus (usually high-impact loading)
165
What kind of avulsion can occur during lateral ankle sprain?
Avulsion of 5th MT at tuberosity if fibularis brevis is pulled from distal attachment
166
How does dancing en pointe occur since you can't plantar flex 90 deg
Mobility through intertarsal and metatarsal joints
167
Why should the ankle be relaxed when you perform hamstring strength MMT?
Gastroc is capable of knee flexion
168
Foot loading during gait: walking
1.2 x BW
169
Foot loading during gait: running
2 x BW
170
Foot loading during gait: jumping
5 x BW
171
The foot normally assumes a slight toe out position. What is this called? What is normal?
Called: Fick Angle
Normal: 12-18 deg
172
Claw toe
MTPJ subluxated into extension; proximal and distal interphalangeal joints are hyperflexed
173
Hammer toe
MTPJ hyperextended; Proximal interphalangeal joint is hyperflexed; Distal interphalangeal joint is neutral
174
Mallet toe
Flexion contracture of the distal interphalangeal joint
175
Dorsiflexors
Tibialis Anterior
Extensor Hallucis Longus
Extensor Digitorum Longus
Peroneus Tertius
176
Plantar flexors
```
Tibialis Posterior
Flexor Digitorum Longus
Flexor Hallucis Longus
Gastroc and soleus
Peroneus longus
Peroneus brevis
```
177
Inverters
```
Tibialis Anterior
Extensor Hallucis Longus
Tibialis Posterior
Flexor Digitorum Longus
Flexor Hallucis Longus
```
178
Everters
Extensor digitorum longus
Peroneus tertius
Peroneus longus
Peroneus brevis
179
Innervation of anterior compartment
Deep fibular nerve
180
Blood supply of anterior compartment
Anterior tibial a.
181
Innervation of lateral compartment
Superficial fibular n.
182
Blood supply of lateral compartment
Fibular a.
183
Innervation of posterior compartments
Tibial n.
184
Blood supply of posterior compartments
Posterior tibial a.
185
Test the L2 myotome
Hip flexion
186
Test the L3 myotome
Knee extension
187
Test the L4 myotome
Ankle dorsiflexion
188
Test the L5 myotome
Great toe extension
189
Test the S1 myotome
Ankle plantar flexion
190
L2 dermatome
Mid-anterior thigh
191
L3 dermatome
Medial femoral condyle
192
L4 dermatome
Medial malleolus
193
L5 dermatome
Dorsal 2nd/3rd toe web space
194
S1 dermatome
lateral heel
195
Muscle weakness: deep peroneal nerve injury (L4-S2)
```
TA
EDL
EDB
EHL
FT
```
196
Sensory alteration: deep peroneal nerve injury (L4-S2)
Triangular area between 1st and 2nd toes
197
Muscle weakness: superficial peroneal nerve (L4-S2)
FL
| FB
198
Sensory alteration: superficial peroneal nerve injury (L4-S2)
Lateral aspect of leg and dorsum of foot
199
Muscle weakness: tibial nerve (L4-S3)
```
Gastroc
Soleus
Plantaris
TP
FDL
FHL
Quad Plantae
ADM
FDM
Lumbrical
Interossei
Add Hall
Abd Hall
FDB
FHB
```
200
Sensory alteration: tibial nerve (L4-S3)
Sole of foot except medial border, plantar surface of toes
201
When is a traditional exam "enough" as opposed to full LQ exam?
Problems that "make sense" and/or relatively uncomplicated
Injuries consistent with MOI or pattern of activity
1st time injuries, new onset
Post-surgical rehab
202
When should you take it from a traditional exam to a full LQ biomechanical exam?
Runners
Chronic and/or recurring problem
Symptoms associated with repetitive use or overuse
LQ multi-joint problems brought on with activity
Concurrent symptoms on the other side
Problems that still don't "add up"
Pt appears to have asymmetry
Pt appears to have structural alignment issues
Prescription of orthotics
203
At PSw and IC you observe inadequate knee extension ROM. This indicates
knee flexion contracture
204
At MSt you observe excessive knee extension. This indicates
Decreased quad strength
| PF contracture
205
Correction with heel lift or orthotics if anatomical LLD is
> 1.5 cm
206
Potential causes of anatomical LLD?
Genu valgus/varus
Problem with growth plate
Coxa vara/valga
207
Potential causes of functional LLD
Scoliosis
Short QL
Pelvic rotation
208
Antalgic gait
Serves to protect from further injury or pain
Reduced stance phase time on involved LE
"Quick step" with or decreased swing phase with uninvolved LE
If hip pain, pt will tend to lean toward involved hip
209
Arthrogenic gait
Stiffness (limited ROM) of hip or knee results in difficult clearance during swing phase. To avoid swing foot from dragging on ground, patient must:
- PF opposite leg
- Circumduct swing leg
210
Ataxic gait
Usually associated with neurologic impairment
Wide BOS, poor balance, staggering, irregular, jerky, weaving
211
Gluteus maximus gait
If hip extensors are weak, patient will lurch trunk backwards at heel strike, in order to keep the hip joint in stable extended position
212
Quadriceps weakness gait
Hyperextension or "snapping back" of knee from IC to MSt. Strong contraction of plantar flexors moves tibia posteriorly during stance, compensating for weakness in quads
213
Steppage gait
Due to weak or absent dorsiflexion strength, the patient has problems with foot clearance in swing. One way to get the foot to clear is to excessively flex hip and knee during swing. Will likely see "foot slap" immediately after heel strike.
214
Apropulsive gait
Weak plantar flexors or severe flat foot (decreased or absent "push off")
215
Rigid orthoses
Maximal correction and control of deformity
High durability
Lightweight
Poor shock absorption
Least space taken up in shoe
216
Semi-rigid orthoses
Less control and correction than rigid
More motion control that soft
May be more comfortable for wearer
217
Soft orthoses
Least control of motion
More accommodation of deformity and shock absorption
Decreased durability
Lightweight
Different densities
