LOWER LEG, ANKLE, & FOOT: DEFORMITIES

Prominent lateral aspect of 5th metatarsal head

Bunionette (tailors bunion)

Bunionette (tailors bunion): If associated with hallux valgus =

splayed foot

Bunionette (tailors bunion) is often c __ foot (position)

pronated

Hyperextension of MTP jts + Flexion of PIP & DIP

Claw toe

Claw toe: Usually from defective actions of __ and _ muscles = cause the toes to be functionless

Lumbrical and interosseous

Claw toe: Unilateral or bilateral

BOTH

Claw toe is associated with

pes cavus

fallen metatarsal arch

spina bifida

neurological problems

Clubfoot: most common type

Talipes equinovarus

Cause of clubfoot

unknown but can be genetic

Clubfoot is usually c

spina bifida and cleft palate

T or F: ROM is limited in club foot

True

D/t weakening of LCL of MTP jt & insufficiency of plantar plate c pull of extrinsic muscles

Crossover toe

Crossover toe: Medial or lateral deviation

medial (2nd or 3rd most common)

Crossover toe usually associated with

hallux valgus

Flexion deformity of PIP & DIP jts

Curly toe

Curly toe: MTP position

Neutral or flex c rot

Curly toe is d/t

FDP & FDL tendon contracture

Most common toe in curly toe

5th toe in children

Limited DF (__) @ talocrural jt

Equinus deformity (talipes equinus)

<10º

Cause of equinus deformity (talipes equinus)

d/t gastroc/soleus or achilles contracture

d/t structural deform (talus), trauma, inflamm

Equinus deformity (talipes equinus) causes __ to forefoot & can lead to _

Inc stress

Rocker bottom foot & excessive pronation @ subtalar jt

Equinus deformity (talipes equinus) can contribute to

• Plantar fasciitis

• Metatarsalgia

• Heel spurs

• Talonavicular pain

Abnormal bony outgrowth

Exostosis (bony spur)

Exostosis is an increase in __ @ site of _

bone mass

irritative lesion

Exostosis is a response to

overuse, trauma, excessive pressure

Common areas for exostosis

Tarsometatarsal jt (dorsal)

5th metatarsal head

Calcaneus (pump bump/runners bump)

Insertion of plantar fascia

Superior to navicular bone

Structural midtarsal deviation c eversion of forefoot on hindfoot when subtalar is in neutral position

Forefoot valgus

What explains the eversion of forefoot in forefoot valgus

normal valgus tilt of head and neck of talus to trochlea is increased

Normal valgus tilt of head and neck of talus to trochlea

35-45º tilt

Forefoot valgus: during WB phase of gait,

Midtarsal is supinated

lat foot contacts ground

Forefoot valgus: Like hindfoot valgus, contributes to __ med long arc

dec

Forefoot valgus: Clinically resembles

Planus foot

Forefoot valgus: Prolonged supination can contribute to

Lat ankle sprain

ITB syndrome

Plantar fasciitis

Ant tarsal tunnel syndrome

Toe deform

Sesamoiditis

Leg & thigh pain

Structural midtarsal deviation c inversion of forefoot on hindfoot when subtalar is in neutral position

Forefoot varus

What explains the inversion of forefoot in forefoot valgus

normal valgus tilt of head and neck of talus to trochlea is not reached

Forefoot varus: contributes to __ med long arch & resembles _

dec

pes planus

Forefoot varus: During WB phase of gait,

Midtarsal: complete pronation

1st metatarsal head contacts ground

Forefoot varus: Prolonged rot contributes to

Tibialis pos paratenonits

Patellofem syndrome

Toe deformities

Medial lig stress

Shin splints

Plantar fasciitis

Postural fatigue

Mortons neuroma

Limited big toe DF or ext

Hallux rigidus

Cause of hallux rigidus

OA of 1st mtp

Hallux rigidus: Can also be d/t

Anatomic abnorm

Abnorm long 1st metatarsal (index plus type forefoot)

pronation of forefoot

trauma

Hallux rigidus: types

Acute/adolescent

Chronic (MORE COMMON)

Hallux rigidus: Acute type

In young ppl

Long narrow pronated feet

Hallux rigidus: Acute type more common in

boys

Hallux rigidus: Acute type: Pain

Pain and stiffness in big toe

Constant burning, throbbing, aching

Hallux rigidus: Acute type: tenderness over

MTP

Hallux rigidus: Acute type: When is stiffness felt

initially held stiff d/t spasm

Hallux rigidus: Acute type: 1st metatarsal head characteristics

elevated, large, tender

Hallux rigidus: Chronic type

Adults -Men

Hallux rigidus: Chronic type: Unilat or bilat

frequently bilat

Hallux rigidus: Chronic type: d/t

repeated minor trauma = OA changes to 1st MTP

Hallux rigidus: Chronic type: Stiffness

gradual

Hallux rigidus: Chronic type: pain

Persisting

Hallux rigidus: Chronic type: CC of pt

pain @ base of 1st toe when walking

Common condition where theres a medial deviation of head of 1st Metatarsal in relation to center

Hallux valgus

Hallux valgus: More common in

women

Hallux valgus: d/t

hereditary (often familial)

shoes

Hallux valgus: As metatarsals move medial, __ moves c it

base of proximal phalanx

Hallux valgus: Mvmt of phalanx

pivots around adductor hallucis

Hallux valgus: what happens when the phalanx pivots around adductor hallucis

distal end & distal phalanx deviates laterally (in relation to center of body)

Hallux valgus: Long flex & ext m.s create what effect

bowstring effect

Explanation of bowstring effect

since the muscles are displaced to the lateral side of the jt = inc stress on proximal phalanx

Hallux valgus: Callus on

Medial side of metatarsal head

Hallux valgus: Bunion consists of

Callus

Bursa inflamed or thickened

Exostosis

Hallux valgus: __ MTP angle

Inc

MTP angle & normal value

angle bw longitudinal axis of metatarsal & proximal phalanx

8-20º normal

Hallux valgus: types

Congruous hallux valgus

Pathological hallux valgus

Hallux valgus: Congruous type

simple exaggeration

doesnt progress

valgus bw 20-30º

opposing jt surf are congruent

little treatment (cosmetic problem)

Hallux valgus: Pathological

Progressive

20-60º

incongruent jt surfaces (can go into sublux)

Hallux valgus: Pathological type can occur in

Deviated (early) stages

Subluxed (late) stages

Hallux valgus: __ Intermetatarsal angle

increased

Intermetatarsal angle

gap bw 1st & 2nd metatarsals

Hallux valgus: __ deflection of phalanx @ MTP

lateral

Hallux valgus: Jt capsule

Medial

Lateral

Lengthened

Contracted

Hallux valgus: Toes rotate on __ axis

Long

Hallux valgus: Toenails face __ d/t

medial

adductor hallucis pull

Hallux valgus: Can lie over or under __ toe

2nd

Hallux valgus: __% caused by

80%

Metatarsus primus varus

Hallux valgus: Metatarsus Primus Varus

Abd deformity of 1st metatarsal

Med border of foot is curved

Inc metatarsal or intermetatarsal angle (>15º) (normal: 0-15º)

Usually seen in only 1 toe (2nd toe)

Hammer toe

Hammer toe characteristics

MTP:

PIP:

DIP:

Extension contracture

Flexion contracture

Can be flexed, straight, or hyperext

Hammer toe: __ are unable to hold _ in neutral position = lost _

Interosseous m.s

Proximal phalanx

flex effect

Hammer toe: Lost flex effect results in __ by _

Clawing of toe

Long flexors and extensors accentuating the deformity

Causes of hammer toe

Imbalance of synergic m.s

Hereditary

Mechanical

Poorly fit shoes

Hallux Valgus

Callus or corns in hammer toe (location)

Over dorsum of flexed jt

T or F: hammer toe is often symptomatic

FALSE

Asymptomatic

Types of hammer toe & symptomatic or asymptomatic

Flexible - Asymptomatic

Semi flexible - Asymptomatic

Rigid - Symptomatic

Type of hammer toe likely to cause greatest problems

Rigid

Eversion of calcaneus c neutral subtalar

Hindfoot valgus (subtalar/rearfoot valgus)

Hindfoot valgus: Mobile hindfoot

Excessive:

Limited:

Pronation

Supination

Hindfoot valgus: Can be from

Genu valgum

Hindfoot valgus: Appearance of __

Pes planus (med long arch flattened)

T or F: Hindfoot valgus: Bc of inc mobility it is less likely to cause problems than hindfoot varus

FALSE

more likely

Hindfoot valgus: associated c

Tibia varus

Pos tibial tendon insufficiency

Inversion of calcaneus when subtalar is in neutral position

Hindfoot Varus (Subtalar/Rearfoot varus)

Hindfoot varus: limited (supination or pronation)

Pronation

Hindfoot varus: Limited pronation is d/t

Mildy rigid hindfoot c calcaneal eversion

Hindfoot varus: Appearance of __

Pes cavus (med long arch accentuated)

Hindfoot varus: Can be a result of

Genu varum

Hindfoot varus: Bc of extra __ necessary @ beginning of the stance, normal _ during early propulsion can be prevented

Subtalar pronation

Supination