Foot and Ankle II.

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Presentation transcript:

Foot and Ankle II

RF/Subtalar Joint Varus – Compensated ST Varus & FF Valgus – Flexible PF 1st Ray

RF/Subtalar Joint Varus - Pathomechanics Varus position of RF @ IC  magnitude of pronation  duration of pronation rapid supination following TO

RF/Subtalar Joint Varus - Compensation Excessive pronation at STJ

RF/Subtalar Joint Varus – Compensated ST Varus & FF Valgus – Flexible PF 1st Ray

RF/Subtalar Joint Varus - Pathology Chronic ankle sprains 20  calcaneal EV Plantar keratosis @ 2nd MET PL tendinitis 20 rapid supination TP tendinitis 20  deceleration of pronation Achilles tendinitis 20  active supination

Supination Closed-chain Calcaneus inversion (varus) Talus abduction (ER - vertical axis) Talus dorsiflexion Tibial ER

Abnormal Supination Excessive in magnitude Excessive in duration Occurs at wrong time Causes: Intrinsic deformities Extrinsic deformities

Abnormal Supination - Etiology FF valgus PF first ray FF equinus deformities

Abnormal Supination - Pathology Lack of shock absorption plantar lesions 1st and 5th ray trauma abnormal pronation during propulsion

Forefoot Valgus

Forefoot Valgus – Flexible PF 1st Ray

Forefoot Valgus – Rigid PF 1st Ray/Total

Forefoot Valgus - Rigid PF 1st Ray/Total 1st ray always p-flexed relative to other MET heads medial foot load prematurely lateral aspect of foot loaded prior to HO “abnormal supination”

Peroneus Longus Pulley lateral malleolus calcaneus - peroneal notch cuboid - peronal groove base of 1st MET and medial cuneiform

Peroneus Longus Pulley Pronated Foot

Peroneus Longus Pulley plantarflexor of 1st ray cinches tarsal-metatarsal articulations FF --> HO

Tibialis Posterior distal lateral tibia navicular attaches to all tarsals (except talus) attaches to base of MET 2-4

Tibialis Posterior Strong supinator HS --> FF late midstance --> HO inconsistent thru MSt IC LR MSt TSt PSw ISw MSw TSw IC

FHL medial malleolus talus 1st MET head (sesamoid) attaches to distal phalanx cinches foot assists w/ supination FF --> TO

FHL cinches foot assists w/ supination MSt --> TO IC LR MSt TSt PSw ISw MSw TSw IC

Conclusions Pronation - hypermobilities Supination - hypomobilities Either can cause a reduced ability to: attenuate forces convert torque adapt to terrain become a rigid lever

Tibial and Calcaneal Lines

Calcaneal Inversion

Calcaneal Eversion

Palpated Subtalar Neutral

Forefoot Varus Measurement

Tibial Varum Measurement

Standing Calcaneal Measurement

1st Ray Mobility

1st MTP Mobility

Identifying Important Bony Landmarks

Guidelines for Posting Maximal FF posting: males: 7 - 8 mm (10 = 1 mm) females: 5 - 6 mm shoewear dependent

Guidelines for Posting FF Varus Deformity: medial FF area If FF deformity > maximal FF posting allows  post RF  4mm) FF Valgus Deformity: lateral FF area

Guidelines for Posting Equinus Deformity: stretching w/ foot in STJN lift RF  50% of lacking range - maybe done initially in acute cases maximum in-shoe lift: 0.25” (7mm) balance out contralateral limb

Posting

Temporary Orthotic

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