1. Foot and Ankle II

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

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

4. RF/Subtalar Joint Varus - Compensation
Excessive pronation at STJ

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

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

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

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

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

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

11. Forefoot Valgus

12. Forefoot Valgus – Flexible PF 1st Ray

13. Forefoot Valgus – Rigid PF 1st Ray/Total

14. 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”

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

16. Peroneus Longus Pulley
Pronated Foot

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

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

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

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

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

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

23. Tibial and Calcaneal Lines

24. Calcaneal Inversion

25. Calcaneal Eversion

26. Palpated Subtalar Neutral

27. Forefoot Varus Measurement

28. Tibial Varum Measurement

29. Standing Calcaneal Measurement

30. 1st Ray Mobility

31. 1st MTP Mobility

32. Identifying Important Bony Landmarks

33. Guidelines for Posting
Maximal FF posting:
males: mm (10 = 1 mm)
females: mm
shoewear dependent

34. 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

35. 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

36. Posting

37. Temporary Orthotic