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Biomechanics exam 3 ( Armi) > Pes Cavus > Flashcards

Pes Cavus Flashcards

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1
Q

Pes cavus

A

high arched foot

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2
Q

Pes cavus is a ——–plane deformity

A

Sagittal

usually with other type of planal deformities

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3
Q

Pes cavus might be

A

congenital or structural abnormalities

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4
Q

deformities with an inverted calcaneus ( frontal plane deformity) may present with a

A

high arched foot

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5
Q

A rigid FF valgus is compensating by

A

STJ supination

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6
Q

A compensated FF valgus might appear as

A

a pes cavus foot type

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7
Q

Is pes cavus fixed or a functional deformity?

A

can be both

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8
Q

Is pes cavus foot pronated or supinated?

A

can be either supinated or pronated

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9
Q

A FF varus with a cavus foot deformity is likely to compensate with

A

pronation

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10
Q

What are some radiographic findings for supinated foot?

A 
-Increased calcaneal inclination angle
Decreased talar declination angle
-posteriorly displaces cyma line
-Plantar deviation of Meary's line
-Increased stair-step effect on metatarsals 
-Bullet hole sinus tarsi
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11
Q

Meary’s line

A

A line that is bisecting talus

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12
Q

What is stair-step effect?

A

when you look at met you can see them individually when the foot is supinated

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13
Q

what do you see on DP radiograph for supinated foot

A
  • decreased talocalcaneal angle
  • FF adducted on RF
  • Increasead FF /metatarsal overlap
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14
Q

What do you see on high arched foot w/o supination radiograph

A
  • increased calcaneal inclination angle
  • Decreased Talar declination angle
  • Normal Meary’s line
  • Normal cyma line
  • Normal realtionship of the metatarsals
  • No FF or metatarsal adduction
  • Normal talocalcaneal angle
  • Normal relationship of the metatarsals
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15
Q

pes cavus deformities categorization

A
  • location of deformity
  • co-existing deformities
  • method of compensation
  • etiology
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16
Q

What does etiology mean?

A

cause

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17
Q

Types of Pes Cavus based on location type

A
  • Anterior cavus
  • Posterior Cavus
  • Combined/global cavus
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18
Q

what type of Pes Cavus is the most common

A

Anterior Cavus

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19
Q

What are some Anterior cavus

A
  • Metatarsus Cavus
  • Lesser tarsus cavus
  • FF cavus
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20
Q

Where does the apex of deformity located in metatrsus cavus?

A

at Lis Franc’s joint

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21
Q

In metatrsus cavus deformity what can you palpate at the area of 1st metatrsocuneiform joint?

A

Dorsal prominence

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22
Q

in metatrsus cavus , the talus, navicular and cuneiform will be all

A

collinear

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23
Q

What are some clinical appearance of metatrsus cavus?

A
  • High instep
  • 1st metatarsocuneiform exostosis
  • shoe fitting is difficult
  • Normal cuboid angulation
  • pseudoequnius may lead to pronation
  • claw toes with anterior displacement of the fat pad plantar to the met heads
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24
Q

With pes cavus what kind of hammer toe etiology you might see?

A

Extensor substitution

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25
Lesser tarsus Cavus
- The lesser tarsal bones are in a plantarflexed attitude - A generalized dorsal prominence may be noted in the lesser tarsal area - you might see planatarflexed 1st ray
26
In FF cavus , the FF is plantarflexed at?
Chopart's joint
27
in FF cavus , RF appears to be in what position?
dorsiflexed
28
in FF cavus where would you see dorsal prominence of the talar head
immediately anterior to the medial malleolus noted on an off weight bearing exam
29
In FF cavus , navicular, cuboid, 4th and 5th metatrsals are in what position
plantarflexed to the RF as compared to normal
30
what are some FF cavus findings on radiograph
- An increased calcaneal inclination angle but no FF adduction - Anterioly displaced cyma line - increased plantar declination of the cuboid - WIder talo-calcaneal angle - Plantarflexed and adducted talus
31
What are some symptoms of FF cavus ?
- Sagittal linear crease may be found between the 3rd and 4th metatarsals - Keratoma sub 2nd, 4th and /or 5th met heads - Adductovarus contractures 3rd, 4th and 5th digits - tailor's bunion - postural fatigue - HAV
32
Why do we have HAV in FF cavus?
because the 1st ray may be hypermobile
33
FF cavus variants
- Plantarflexed cuboid with dorsiflexed 4th and 5th metatrsals is more common that pf cuboid w/ df 5th and 5th metatrsals - No pronation is required for compensation
34
clinical findings fo FF cavus variants?
- Plantar prominence of the styloid process of 5th metatarsal - increased arch/ increased calcaneal inclination angle but no adduction of the FF - May cause apophysitis at the 5th met base - Tailor's bunion/splay foot appearance (secondary to dorsiflexed 5th ray)
35
posterior cavus may happen due to
as a result of pseudoequinus intrinsic muscle spasticity maybe a congenital deformity
36
Combined /global cavus
- both anterior and posterior cavus are present - rarest type - often used interchangeably anterior pes cavus
37
Structural deformities of Pes Cavus are
NOT associated with MTJ supination compensation
38
Acquired and Congenital forms of Pes Cavus are
Associated with MTJ supination ( particularly adduction of the FF )
39
What are some Infectious etiologies of Pes Cavus?
- poliomyelitis (viral) | - Syphylis ( bacterial)
40
What kind of gait to people with syphilis have?
Tebes dorsalis
41
What are some neoplastic etiologies for Pes cavus?
- Benign tumor pressing on the lumbar-sacral nerve roots | - malignant tumors ( rare) pressing on the lumbar-sacral nerve roots
42
What are some Neurogenic etiologies ?
Non congenital neurological diseases
43
What are some traumatic etiologies for Pes cavus ?
- head injuries | - Isolated nerve injuries
44
What are some biomechanical etiologies for Pes Cavus?
- plantarflexed 1st ray - uncompensated RF varus - Rigid FF valgus
45
What are some iatrogenic etiologies for Pes cavus ?
Prolonged bed rest | overcorrected flatfoot surgery
46
Endocrine Etiologies
-diabtetes mellitus -intrinsic muscle weakness
47
Pes cavus deformities are associated with
muscle imbalance
48
spasticity
Tonic spasticity | clonic spasticity
49
tonic spasticity-
Increased tone in the muscle belly
50
tonic spasticit is usually associated with
guarding due to pain
51
people who have tarsal coalition usually have
tonic spasticity
52
tonic spasticity may exhibit
cogwheel release
53
clonic spasticity usually associated with
Upper motor neuron deficit
54
Posterior weakness
- Tricep weakness - Tricep spasticity - Tibialis Posteiro Spasticity
55
in Tricep weakness, decreased pull on the calcaneus may lead to
increased calcaneal inclination angle
56
with Tricep weakness , deep posterior muscle groups have to work harder and that leads to
STJ supination and digital deformities
57
Tricep spasticity may lead to
toe-walking
58
tibialis posterior spastisity may lead to
constant and increased supination at the STJ | BC constant pull of arch
59
Anterior weakness
- Global anterior weakness | - Isolated muscle weakness
60
Global anterior weakness may lead to
- overpowering of the superficial and deep flexors | - equinus of both the ankle and the FF
61
Isolated muscle weakness may lead to
the result depends on which muscles were involved
62
PL and TA are
antagonists
63
If TA is weak
the PL will have to work harder at pull harder at the 1st ray causing a stronger plantarflexory pull
64
Lateral (PL ) spasticity may lead to
increase plantarflexory pull on the 1st ray
65
What is the function of intrinsic muscles
stabilize the digits
66
what happens if intrinsic muscles become weakened ?
- The digits will become dorsally contracted ( diabetic pt) | - The metatarsals then become increasingly plantarflexed, contributing to a cavus deformity
67
Compensation for the Pes cavus is dependent upon
the location of the deformity other associated pathology rigidity of the deformity
68
In general 4 changes will occur in Pes Cavus deformity
1. dosral contraction of the digits 2. plantarflexion of the metatarsals 3. relatibe df of the FF on the RF (with flexible deformity only) 4. pseudoequinus
69
What is the purpose of paulos-coleman block test
used to determine whether or not an inverted RF is as a result of a plantarflexed 1st ray
70
what is one rule for paulos-coleman block test
the first ray should be hanging off a block
71
Treatment for Pes Cavus
- determine if progressive - Take any associated muscle imbalance into considerations - treatment may range from orthoses and shoe modifications to bracing to surgical procesures -fusions , osteotomies - muscle, tendon surgeries to transfer or realign the muscle pull
72
When you do tendon transfer you have to take some things into considerations
- at least 1/2 to 1 full musle grade will be lost ( you are going to lose some muscle strength) - the tendon may or may not be transferred in phase
73
orthotic modifications with the claw toe deformity and plantarflexed metatarsals
FF extension to pad met head because fat pad is likely to be anteriorly displaced
74
What other deformities are associated with Pes cavus
lateral ankle stability
75
what do you do to fix lateral ankle stability
- Lateral flange on an orthosis may help prevent excessive inversion - lateral heel and or sole flare on the shoe may prevent lateral instability at heel strike and midstance
76
with pes cavus excessive weight might be on the
heel, 1st and 4th and /or 5th met heads
77
what do you do with the weight issue?
orthoses may need to be made to increase weight bearing on the remainder of the foot

Biomechanics exam 3 ( Armi) (10 decks)

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