1
Q
Foot progression angle
A
- Evaluates limb position during gait
- Angular difference between foot axis (line through heel and 2nd metatarsal) and progression of gait
2
Q
Interaction of neuromuscular and skeletal systems during gait
A
- Dysfunction in either/both results in gait deviation
- Can involve single or multiple segments and/or joints
- Treatment ranges from conservative to surgical
3
Q
Gait analysis identifies
A
- Gait deviation and causes of abnormalities
- Track neuromuscular disease progression, surgical/conservative treatment planning and postoperative outcomes
4
Q
Potential surgical/conservative treatment planning and postoperative outcomes
A
- Muscle weakness
- Abnormal muscle tone and contracture
- Abnormal joint motion and range
5
Q
Joints do not function in isolation
A
- Movements are affected by movements and positions of other joints
- Adaptation may occur at other joints
6
Q
Common causes of rotational abnormalities
A
- 2⁰ to trauma
- Congenital
- Prior surgery
- Metabolic and neurological conditions
7
Q
Rotational deformities may cause
A
- In-toed gait (“pigeon-toed”)
- Out-toe gait
8
Q
In-toeing gait (“pigeon-toed”)
A
- Femoral anteversion
- Internal tibial torsion
- Metatarsus adductus
9
Q
Out-toeing gait
A
- Femoral retroversion
- External tibial torsion
- Pes planovalgus
- Tight hip external rotators
10
Q
Angular deformities (coronal/frontal plane)
A
- Genu varum
- Genu valgum
11
Q
Bowing deformities
A
- Excessive curve of a bone with respect to proximal and distal ends
12
Q
In-toeing and out-toeing gait indicates
A
- Potential torsional deformity
- Noticed in young children
- Most resolve over time as a part of development
- Compensations can develop that can mask abnormality
13
Q
Tibial/femoral rotation at birth
A
- Tibia is more internally rotated
- Femoral head/neck is anteverted
14
Q
Angle of femoral torsion (angle of declination)
A
- Angle between long axis of femur head/neck and coronal plane of condyles (bicondylar plane, transcondylar axis)
- View from transverse plane
15
Q
Typical values of angle of femoral torsion/declination
A
- ~40⁰ at birth, then decreases with age
- Normal range is between 8-15(20)⁰
16
Q
Anteversion
A
- Increased angle of femoral torsion (> 15⁰)
- Increased hip IR
- Decreased hip ER
17
Q
Retroversion
A
- Decreased angle of femoral torsion (<8⁰)
18
Q
Femoral anteversion
A
- Increased medial hip rotation/decreased lateral hip rotation
19
Q
Characteristics of femoral anteversion
A
- Sits in W position (hips flexed, internally rotated)
- Squinting patella: faces medially
- “Eggbeater” running pattern
20
Q
Craig Test (trochanteric prominence angle test)
A
- Determines the amount of anteversion (8-15⁰ is normal)
21
Q
Performing the Craig Test
A
- Patient prone, knee at 90⁰ flexion
- Hip rotated medially & laterally while palpating the greater trochanter
- Stop when greater trochanter is most prominent laterally (parallel to table)
- Measure the hip angle using the long axis of the tibia
22
Q
Internal tibial torsion (“pigeon-toed”)
A
- Normally internally rotated at birth, external rotates as one ages
- Normal (depends on age): wide range of values
- Evaluate transmalleolar axis or or thigh/foot angle
23
Q
Metatarsus adductus
A
- Adduction of the forefoot in the transverse plane at the tarsometatarsal joint (Lisfranc’s)
- “Bean-shaped” sole
24
Q
Foot borders in metatarsus adductus
A
- Convex lateral border
- Prominent tuberosity of 5th metatarsal
- Concave medial border
- Vertical skin crease at 1st metatarsocuneiform joint in more severe cases
25
Blecks classification (metatarsus adductus)
- Abnormal heel bisector line
| - Should pass through 2nd/3rd web space
26
Determination of treatment in metatarsus adductus
- Flexible vs. rigid
- The more flexible, the more conservative treatment
- Most (85-90%) resolve on their own
27
Metatarsus angle
- Angle between longitudinal axis of 2nd met and longitudinal axis of tarsal
28
Congenital MA foot deformity
- Attributed to intrauterine position
- Some evidence of family history
- Can be seen with other foot deformities
29
Treatment of MA depends on severity and age
- Stretching
- Corrective casting
- Surgery
- Tarsometatarsal Capsule Release
- Osteotomy
30
Uncorrected MA can result in other functional, anatomical problems
- 5th metatarsal frx
- Lateral foot pain
- Hallux valgus
- Development of skewfoot
31
Dislocation
- Displacement of bone from its natural position
- 2 bones that form a joint are not congruent
- Subluxation is partial dislocation
32
Traumatic (acute)
| posterior dislocation
- Axial load on femur with a flexed, adducted internally rotated hip
33
Traumatic (acute)
| anterior dislocation
- Occurs with hip abducted and externally rotated
- Anterior superior (pubic)
- Anterior inferior (obturator)
34
Dislocation can be associated with
- Acetabular wall and femoral head fracture
| - Ligament disruption
35
Non-traumatic (non-acute) dislocation
- Repetitive microtrauma
- Connective tissue disorders
- Dysplasia of bony surfaces
36
Joint capsule is stronger anteriorly due to
- Ligament support
37
Posterior dislocation (clinical)
- Dashboard injury during MVA is a more common cause
- 10-20% can have a sciatic nerve injury
- Affected limb is shortened, adducted, internally rotated, flexed
38
Anterior dislocation (clinical)
- Hyperextension injury against an abducted leg
| - Affected limb is abducted and externally rotated
39
Anterior dislocation (imaging)
- Femoral head is located medial or inferior to acetabulum
40
Posterior dislocation (imaging)
- Femoral head superimposes on acetabular roof
| - Lesser trochanter less visible
41
Developmental Dysplasia of the Hip (DDH)
- Abnormality in the size, shape, orientation of the femoral head, acetabulum or both
- Can cause congenital hip dislocation (or subluxation)
- Left hip affected more than right, but can be bilateral
42
Factors contributing to DDH
- Intra-uterine position
- Breech presentation
- Left occiput anterior positions left limb against moms spine
- More common in Female, Family history, Firstborn
43
Evaluation of DDH
- Asymmetric skinfolds
- Unequal leg length/femoral shortening (Galeazzi sign/Allis sign)
- Affected side lower than normal
- Limited hip abduction
- May see Trendelenburg gait
- Ortolani and Barlo maneuvers
44
Ortolani and Barlow maneuvers
- Only useful up to 3rd month
- Infant supine, hips flexed to 90⁰
- Index and middle finger placed over greater trochanter
45
Ortolani maneuver
- Gently abduct hip while exerting upward force through trochanter
- Palpable clunk is positive, dislocated hip is reduced
46
Barlow maneuver
- Infants hips are adducted and a gentle downward force is exerted
- Attempting to produce dislocation
47
Ultrasound vs. radiograph
- Ultrasound can be used in infants under 6 months
| - Radiographs are useful after 6 months
48
Hilgenreiner line
- Horizontal line through triradiate cartilages
49
Perkin line
- Line perpendicular to Hilgenreiner line
| - Intersecting lateral most aspect of acetabular roof
50
Shenton line
- Curved line along inferior border of superior pubic ramus and along the inferomedial border of femur neck
51
Acetabular index
- Angle between Hilgenreiner line and line passing through triradiate cartilage and lateral acetabular margin
- Can show acetabular dysplasia or overcoverage
52
Femoral head should lie within
- Inferomedial quadrant formed by Hilgenreiner and Perkin lines
- Shenton line should be uninterrupted
53
Acetabular index angel depends on
- Age
Lower Extremity Anatomy II
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