O - Biomechanical Exam (Lab) Flashcards by Jenn Cantilli

when pt walks into clinic:

what type of pt is a supine exam important and why

someone walking toe in or toe out
* good to look to see if there is a long bone abnormality (femur or lower leg)
* is it bony or soft tissue

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how can the knee influence the sagittal and frontal planes

sagittal: flexion contracture & recurvatum
frontal: varus & valgus

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when is a better time to measure Q angle and why

dynamically - SL squat or step down

people could have normal alignment in static but valgus collapse dynamically

norms:
* females: 15-18deg
* males: 8-10deg

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what is a malleolar position assessment? what are the norms? what would be abnormal?

tibial torsion/fibular migration
position of malleoli relative to table

norms: 15-25deg external malleolar torsion
abnormal: internal, <15, closer to 0 (likely toes in)

when born tib and fib straight across, as develop fib moves post which gives angle of TC joint

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if you see someone toeing in or out, what is the process to figure out if it a bony abnormality

start at greater troch
palpate med and lat fem condyle
* in line w the table? or retro/anteverted?
* if retroverted, put them in neutral & do quad set to hold
malleolar prominent tips, looking up from bottom
* use inclinometer on one (number doesn’t really matter bc won’t write a goal to change it)

malleolar position:
* >25deg - likely out toe
* <15deg - likely in toe

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what is the gold standard for measuring leg length

standing radiograph

unnecessary for most people

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what are 2 things to do before measuring leg length and why

bridge - eliminate rotation
gentle traction - eliminate elevation

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what are 2 ways to measure leg length and what are considerations of each

ASIS to medial malleolus
* problem is going over tissue bulk/swelling will make one seem longer than the other

hooklying w feet together, are knees level
* are femur or tibia longer
* this is subjective

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what makes it true FF equinus as opposed to fake

stuck in position
* fake equinus - people will collapse into position in supine but can be moved out of the position

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what is FF equinus

PF deformity of MTJ
lacking 10deg DF

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what are the 3 ways to assess midtarsal joint mobility

longitudinal axis
oblique axis
lock-up

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why is midtarsal joint mobility such a key piece to the assessment

if limitation in TC DF, pts collapse through midtarsal joint to compensate

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if lacking TC mobility/DF, how will the pt’s gait present if MTJ is mobile vs rigid

mobile - pronation in late stance
rigid - early heel rise

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how is MTJ mobility assessed in longitudinal vs oblique axis

longitudinal: FF inv and eve
oblique: FF DF-ABD, FF PF-ADD

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why do you measure DF in a lock-up position

gives supinatory bias, inv calcaneus
* takes away mobility thru midfoot to assess TC specifically

in gait TC should be in neutral or slightly supinated when DF - measurement mimics needed function

oblique and longitudinal axises cross/are perp in sup –> more rigid foot
axises are parallel in pron –> more mobility

internal joint mechanics help dictate amt of mobility

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what is the Feiss line

medial malleolus to where 1st MT hits ground
* assess position of navicular relative to line –> shows arch height

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why are 1st and 5th rays assessed separately

each have their own axises

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what is the significance of a PF 1st ray being mobile or rigid

PF 1st ray - hit ground early

mobile - ground will push ray up
* he doesn’t care bc the functional impact is basically 0

rigid - can’t move once hits ground
* problematic

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norm for hallux DF in walking and stair climbing

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walking - 65deg
stairs - 85deg

if sagittal plane restriction, difficult to smoothly transition over foot in gait

what is hallux abducto valgus (HAV)

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medial deviation 1st MT head
lateral devation of hallux
lateral shift in position of sesamoids

laxity of medial capsule and ligaments
d/t oblique forces

HAV

what are 3 possible etiologies

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family
footwear
faulty biomechanics

HAV

how can footwear be an etiology

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pointed toe box provides ABD force

HAV

how can faulty biomechanics be an etiology

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unlocked midtarsal joint
1st ray unable to PF against GRF
DF position of 1st ray tensioning plantar fascia creating functional hallux limitus

what are 8 components to a supine exam

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hip neutral (ante, retro, neutral)
malleolar position (internal, external, normal)
FF position
MTJ mobility (longitudinal & oblique axis)
arch height
1st & 5th ray positions / mobility
hallux DF
toe positions (HAV, Morton’s, claw, hammer)

when do the intermetatarsal and hallux ABD angles become important

if going to have surgery * bigger the angle, the more aggressive the osteotomy

# intermetatarsal angles normal, mild, mod, and severe

norm: 6-8 mild: 8-10 mod: 10-15 severe: >15

# halllux ABD angles normal, mild, mod, and severe

normal: 5-20 mild: 20-30 mod: 30-40 severe: >40

# morton's toe what is it how does this impact biomechanics what pathologies can result

1st MT shorter dec stability inc load on 2nd MT intractable plantar keratosis metatarsalgia

# morton's neuroma what is it what are sx

fibrotic tissue about plantar digital n. * primarily b/w 2nd & 3rd or 3rd & 4th sx: pain, burning, numbness

what is the likely cause of claw toes and hammer toes

abnormal shear happening thru rays of foot

what is talonavicular congruency

symmetrical feel of talar head in reference to navicular * STJ not pronated or supinated

why do you load the forefoot after finding talonavicular congruency to assess alignment

locks MTJ in position of maximal pronation

# ideal STJN what is the normal rearfoot relationship | calcaneal position

normal calcaneal position 3-4deg varus

what is considered an abnormal RF

subtalar varus * >3-4deg of calcaneal inv w STJ in neutral

# ideal STJN what is the normal RF to FF relationship

plane of MT heads is perpendicular to posterior calcaneal bisection

what is considered an abnormal FF

FF varus - MT head plane inverted relative to calcaneal bisection FF valgus - MT head plane everted relative to calcaneal bisection ## Footnote make sure you align calcaneal bisection before assessing this, significant STJ varus can trick you into thinking FF varus

what pt will you likely see lacking calcaneal eversion

hypopronatory foot

what is normal calcaneal mobility

20deg inversion/ADD 10deg eversion/ABD

what are 3 components to the prone exam and how are each assessed

**STJN** * calcaneal & distal 1/3 leg bisections * RF relationship * FF relationship **calcaneal mobility** * inversion - ADD * eversion - ABD **TC mobility** * knee ext & flex

if there is a leg length discrepancy, what happens up the chain on the long side

foot - pronation * functionally shorten longer leg knee: * flex / hyper ext * genu varum/valgum pelvis * inominate elevation spine * scoliosis ## Footnote takes less effort to pronate than supinate, otherwise would see supination on shorter leg

what does measuring neutral tibial stance assess

total RF varum * tibial varum w STJ varum would in camt of inversion when hitting the ground

how can calcaneal position be assessed in standing and what is the importance of this

in STJN (should be equal to prone) relaxed stance (norm: 4-6deg pronation) can measure amount of calcaneal excursion from STJN to relaxed stance (1:1 ratio) * can help determine if compensated or uncompensated

# hallux DF how is it measured what is normal vs abnormal

relaxed stance, passively ext hallux norm: 20deg functional hallux limitus <20deg w FWB

# hallux DF what is the windlass mechanism/test how is this mechanism changed by pts who toe out

with DF, arch lifts up * job of plantar fascia bc doesn't elongate/stretch * test: how much DF in relaxed stance people who toe out, harder for plantar fascia to do its job * get more tension * some irritation * more load on post tib, med gastroc, achilles tendon

what are 6 components to a standing exam

posture tibial varus calcaneal excursion (STJN -> relaxed) FF position navicular drop (STJN -> relaxed) WBing hallux DF (windlass test)

O - Biomechanical Exam (Lab) Flashcards

(45 cards)