what 5 factors should be considered when assessing a shoe and why are these important?
- push and squeeze heel counter, not collapse
- twist and bend shoe through midfoot, no twisting
- weight
- only bend at toes
- is the shoe appropriate for activity
uncompensated forefoot varus signs and symptoms?
- forefoot is held in inverted position
- lateral loading –>late progression to hallux
- callus sub met 1-5
- partial compensation may have effects
detail what should ideally happen in midstance in gait?
- limb externally rotates
- knee extended
- AJ DF as trunk moves over the foot until 10 deg DF
- STJ supinates until neutral
- MTJ : OA pronated, and LA achieves max pronation due to STJ neutral
what are the 6 of the classic signs and symptoms associated with rearfoot varus?
- slight lowering of a medium medial arch on EB
- mild callus sub2,3 MPJs
- increase lateral heel wear
- Haglund’s syndrome
- inadequate shock absorption in part/uncomp
- lateral instability
- taliors bunion
what are the 5 rules for RCSP calculation?
- STJ compensation occurs first then forefoot
- STJ will go to 0deg if possible, everted no comp.
- forefoot compensation STJ then MTJ 5deg
- 0-3 of rearfoot valgus will have little effect
- 4-10 of rearfoot valgus will cause STJ pronate end ROM, pronation symptoms
- 10deg or more talar head contacting ground, quite stable 0-3 deg xs pronation
Describe the 4 categories of forefoot valgus. What are the signs and symptoms and associated pathomechnics of a rigid forefoot valgus?
Four categories
- functional, PF 1st
- total, eversion of all mets
- flexible, enough MTJ to compensate
- rigid, STJ supination needed to compensate
Rigid Signs and symptoms
- high arch in WB and non WB
- Haglunds
- callus sub met 1st and 5th
- tenosynovitis of peroneals
- Neuromas
- clawing/hammering of 4th and 5th
- inversion sprains
- shock related symptoms
How is foot dorsiflexion assessed in a normal clinical setting and how do we identify the problematic area? what are the possible signs of an uncompensated equinus?
DF assessment
- Pt prone STJ neutral or slightly supinated
- test in knee extended and flexed to differentiate between gastroc and soleus
- spongy means muscular, hard is bony block
Uncompensated equinus signs and symptoms
- bouncy type gait
- loading at forefoot leading to callus
- secondary hamstring contracture
- proximal compensation, knee recurvatum, forward posture, increase lordosis, abd/add gait
what are the categories of LLD and how do hey commonly occur? how are the internal categories differentiated clinically?
Structural-difference in actual length of tibia and/or femur.
Functional-bony aspect equal but function asymmetrically e.g pelvic tilt
environmental-uneven surface or shoewear
Function, ASIS to floor in NCSP and RCSP
The knee is comprised of which joints? what ligaments support the knee and what are their function?
Joints
-Tibiofemoral and patello femoral
Ligaments
ACL-prevents tibia moving forward on femur and controls rot motion
PCL-prevents femur from sliding forward on the tibia
MCL-medial stability
LCL-lateral stability
what is the definition of a forefoot Varus? What is the theorized etiology
forefoot varus- a structural abnormality in which the forefoot in inverted relative to the rearfoot when STJ neutral and MTJ is locked at both axes
Etiology
- failure of valgus torsion of talar head and neck
- PF of cuboid, PF of 4th and 5th met
- PF of 5th met
What are the compensation mechanisms for sagittal plane blockage?
Altered heel lift
- MTJ compensates for lack of DF at hallux
- MTJ breaks –>pronated foot
Vertical toe off
- delayed heel lift prior to propulsion leads to apropulsive gait
- elderly population, very slow and laborious
Inverted step
- failure of medial to lateral
- results in increase lateral load, wearing of shoe
Abducted and adducted toe off
- body follow path of least resistance
- bias of poximal structures
- internally rotated bias ->adducted toe off
Flexion compensation of the body
- abnormal torso flexion due to knee not extending
- changed in spine, head forward, chronic changes
