Section 3 -- Structural Flashcards
Hallux Valgus (bunion)
Definition Site Etiology What does rate of development depend on? Complications > primary > secondary
Hallux = big toe. Valgus = a lateral deviation in which part of a limb is bent outward.
Metatarsophalangeal joint of the hallux
May be d/t MULTIPLE causes: Excessive weight bearing (work, obesity, pregnancy); Hyperpronation; Skeletal conditions (e.g., arthritis); Improper fitting footwear; Inherited anatomy which influences gait, leading to biomechanical problems inherent to that anatomy
Rate of development = dependent on amounts of mechanical stress (shoe pressure) and activity over time
PRIMARY
If left unattended, the area will soon become tender, red and inflamed
As the deformity becomes more pronounced, the friction force of the shoes on the medial dorsal aspect of the joint will often lead to a swollen painful bursa
Occasionally, a sinus may form with accompanying discharge of fluid
Finding appropriate fitting footwear becomes difficult as the bunion and its complications become more severe
SECONDARY
Normal forefoot function is disturbed with subsequent overlapping of the metatarsal heads. Due to overlapping of the toes, a common side effect is development of hyperkeratotic lesions, like corns or calluses, usually under the second or third metatarsals
Due to the hallux impinging on the second toe, a bunion predisposes to the development of a hammertoe
Secondary osteoarthritis of the first metatarsophalangeal joint is common
Ingrown toenails and sulcus (callused nail grooves) may occur
Hyperpronation
When the ankle bone turns inward and the rest of the foot turns outward, and too much body weight is placed on the inside of the foot when walking or running
When the ankle bone turns inward and the rest of the foot turns outward, and too much body weight is placed on the inside of the foot when walking or running
Hyperpronation
Overlapping Toes
Definition
Etiology
Presentation
Complications
One toe overlies or underlies an adjacent toe
When hallux valgus is present, the lateral shift causes the second toe to overlap the great toe. Pressure from tight footwear can result in the fifth toe shifting medially and overlapping the fourth toe.
One toe rests on top of another.
Pain and erythema, Corn formation on the dorsum of the toe or interdigitally, Ulceration may be present if the overlap is not addressed, Claw toe or dislocated MTP joints may result
One toe overlies or underlies an adjacent toe
Overlapping toes
MTP – Metatarsophalangeal Joint
Joint bw the metatarsal bones of the foot and the proximal phalanges of the toes
PIP – Proximal Interphalangeal Joint
Joint bw the first and second (intermediate) phalanges
DIP – Distal Interphalangeal Joint
Joint bw the second (intermediate) and third (distal) phalanges
Joint bw the metatarsal bones of the foot and the proximal phalanges of the toes
MTP – Metatarsophalangeal Joint
Joint bw the first and second (intermediate) phalanges
PIP – Proximal Interphalangeal Joint
Joint bw the second (intermediate) and third (distal) phalanges
DIP – Distal Interphalangeal Joint
Mallet Toe
Definition Site Etiology: Presentation Complications
Flexion deformity of the distal interphalangeal joint (DIP)
With mallet toe, the joint nearest the tip of the toe is bent
2nd and 3rd toes are most commonly affected
Same as claw toe.
Persistent impact/constriction from ill-fitting footwear (multiple claws common d/t slip-on shoes); Changes r/t neuromuscular dysfunctions that occur with diabetes, Rheumatoid arthritis,
Also, is commonly assoc. with having a long second toe
May be flexible, semi-flexible or rigid
Callus formation may be noted on the distal aspect of the toe. The client may complain of pain.
Flexion deformity of the distal interphalangeal joint (DIP)
Mallet Toe
Hammertoe -
Definition Site Etiology Presentation Complications
Flexion deformity of the proximal interphalangeal joint (PIP) along with a hyperextension of the distal interphalangeal joint (DIP). The MTP joint is neutral or extended.
With hammertoe, the middle joint is bent
Hammertoes can occur in any of the three middle toes, with the second being most commonly affected
Short shoes, pointed toe shoes, high heels (excessive force on fore foot); Trauma; Neuromuscular and congenital anomolies; Rheumatoid arthritis
May be flexible, semi-flexible or rigid
Pain at the site; Apex of the toe, which is extended, becomes affected by concentrated pressure as it bears weight; Erythema; Corns calluses to plantar and dorsum surfaces as result of friction between toe and shallow toe box
If cause of the friction is not removed, ulceration can occur
Flexion deformity of the proximal interphalangeal joint (PIP) along with a hyperextension of the distal interphalangeal joint (DIP). The MTP joint is neutral or extended.
Hammertoe
Claw Toe
Definition Site Etiology Presentation Complications
Hyperextension of the MTP, a flexion deformity at both the proximal interphalangeal joint (PIP) and the distal interphalangeal joint (DIP)
With claw toe, the joint at the base of the toe is bend up. The middle joint is bent down.
Usually involves one or more of the lesser toes
Same as mallet toe.
Persistent impact/constriction from ill-fitting footwear (multiple claws common d/t slip-on shoes); Changes r/t neuromuscular dysfunctions that occur with diabetes, Rheumatoid arthritis
May be flexible, semi-flexible or rigid
Painful and persistent corns on the dorsum and/or callusing on the apex of the toes, Erythema on the dorsum and distal aspects of the toe, Hypertrophic/discoloured nail d/t flexion of the DIP joint causing increased pressure on distal toe, Toenail may separate from the nail bed (onycholysis)
Hyperextension of the MTP, a flexion deformity at both the proximal interphalangeal joint (PIP) and the distal interphalangeal joint (DIP)
Claw Toe
Hallux Rigidus
Definition
Site
Etiology
Presentation
Restricted range of motion of the 1st metatarsal phalangeal joint of the hallux
1st metatarsal phalangeal joint of the hallux
A degenerative arthritis of the first metatarsal phalangeal joint, which may or may not be related to specific trauma
Restricted dorsiflexion, characterized by pain on movement, redness, swelling and crepitus. There may be some joint deviation.
Restricted range of motion of the 1st metatarsal phalangeal joint of the hallux
Hallux Rigidus
Planus (flat foot)
Definition
Etiology
Presentation
Complications
Flattening of the medial longitudinal arch usually involving the talus, navicular and associated tendons and ligaments
Biomechanical abnormalities which may be congenital or may be related to other medical conditions (RA, calcaneum trauma, spastic muscles)
the foot is fucking flat
Pressure on unprotected weight bearing areas will result in soft tissue pathologies (calluses)
Alteration in the position of the talus and the navicular cause overstretching of ligaments and strain on the plantar fascia producing foot pain
Flattening of the medial longitudinal arch usually involving the talus, navicular and associated tendons and ligaments
Planus (flat foot)
Pes Cavus (high arch)
Definition
Etiology
Presentation
Complications
An increase in the height of the medial longitudinal arch. The subtalar joint (Articulation b/w the talus and calcaneus) is hyperflexed. There is an alteration in the position of the talus and the navicular.
Biomechanical abnormalities may be congenital. Often associated with muscular imbalance.
Joint alteration may cause the foot to become rigid.
Increased pressure on the 1st and 5th metatarsal heads, Overstretched plantar ligaments leading to retracted toes, corns and calluses are a result
An increase in the height of the medial longitudinal arch. The subtalar joint (Articulation b/w the talus and calcaneus) is hyperflexed. There is an alteration in the position of the talus and the navicular.
Pes Cavus (high arch)
Varus
Deformity that is an excessive medial (inward) angulation of the distal segment of a bone or joint.
Deformity that is an excessive medial (inward) angulation of the distal segment of a bone or joint.
Varus
RUM
