Additional ankle/ Foot notes

When sitting foot should be relaxed into a position of:

Plantar flx, inversion, adduction

Pronated foot:

Calcaneus

Everts

Pronated foot:

Talar bridge

Present

Pronated foot:

Navicular tuberosity

Closer to support surface

Pronated foot:

Medial Longitudinal arch

Flattened

Supinated foot:

Calcaneus

Inverts

Supinated foot:

Talar bulge

Absent

Supinated foot:

Navicular tuberosity

Elevated

Supinated foot:

Medial longitudinal arch

Prominent arch

Tibial Torsion

Distal tibia is ER

20-30 deg of tibial torsion = normal

Standing position on a level surface

- metatarsal heads are twisted _______________w/ respect to the calcaneus

twisted 90 deg

Pronated foot =

pes planus ( flat foot)

Supinated foot =

Pes cavus (arched foot)

Hypersensitivity can be one of the signs of

complex regional p! syndrome but may occur after HV surgery

pts w/ inc. foot pronation typically have

inc. mobility of the joints of foot & dec. talocrural joint mobility

Foot hypomobility is common in the

Supinated foot & following a fx, immobilization, & edema

Should palpate for

swelling

hydration (moist or dry)

temp

pulse

-Dorsalis pedis: lateral to EHL; Dorsum of foot

- posterior tibial artery: behind FDL & FHL; posterosuperior to medial malleolus

tenderness

leg

tibia and fibula

rearfoot

talus and calcaneus

midfoot

navicular, cuboid, cuneiform

Forefoot

Metatarsal, phalanges, & sesamoids

Common lesions Ankle =

generally acute & Traumatic onset

Common lesions Foot =

Chronic disorders - usually stress overload

L4, S1, S2 often refers P! to

ankles & foot

W/O proper footwear a pt w/ suboptimal boney alignment, such as forefoot varus or ligamentous laxity, will require _____________ & ______________________

- This can cause intrinsic muscle fatigue, added tension to the plantar ligaments, and ultimately may lead to P!

inc. foot intrinsic strength

endurance

Tissue hypertrophy, such as _______ & _____________, may in itself, lead to p! by allowing localized areas of stress concentration

corns, calluses

A supple or mobile flatfoot will have signs of ___________

excessive pronation in standing but will take a normal configuration in sitting w/ the force of WB relieved

Feiss line can also be used to asses for

Pronation

Feiss line

Line from __________ to _________

then measure distance from ____ to floor

Medial malleolus

Plantar aspect of 1st metatarsophalangeal joint

navicular

If the navicular head is more than __________ to the floor, the pt has a pronated (flat foot)

1/3 of the distance

Excessive pronation means the _________ of the foot are not doing their share of the work and increases the demands on the __________

bony structures, soft tissues

If supination is excessive, unable to _________ or ____________

absorb shock well, adapt to terrain changes

Which of the following ligaments restricts eversion?

Deltoid ligament

3 multiple choice options

A patient's active ankle eversion is 5° and painful, but passively the patient has 15° eversion. What is your assessment?

Fibularis strain

3 multiple choice options

Sensory test to do on all diabetic patients

Monofilament testing

If a patient has NO navicular drop and/or under pronates, what is the foot unable to do?

Absorb shock.

3 multiple choice options

Closed Kinetic Chain Pronation

Function:

shock absorption

Closed Kinetic Chain Pronation

Calcaneus

everts

Closed Kinetic Chain Pronation

Talus:

PF and adducts

Closed Kinetic Chain Pronation

Tibia:

internally rotates

Closed Kinetic Chain Pronation

Knee:

unlocks/flexes

Closed Kinetic Chain Pronation

Femur:

internally rotates

Closed Kinetic Chain Pronation

During pronation, the forefoot does a ______________ to keep in contact with the support surface

supinatory twist

Closed Kinetic Chain Supination

Function

rigid lever

Closed Kinetic Chain Supination

Calcaneus

inverts

Closed Kinetic Chain Supination

Talus

DF/abducts

Closed Kinetic Chain Supination

Tibia

ER

Closed Kinetic Chain Supination

Knee

extends/locks

Closed Kinetic Chain Supination

Femur

externally rotates

Closed Kinetic Chain Supination

• During supination, the forefoot does a ____________ to keep in contact with the support surface

Pronatory twist

1st MTP ext ROM

Normal:

70 deg

1st MTP ext ROM

Needed for gait

60 deg

1st MTP ext ROM

Runing: need

approx. 90 deg

1st MTP ext ROM

Some of this motion comes from

PF of the first metatarsal

First RayFunction

• Assists with shock absorption

• Stabilizes the medial longitudinal arch

• When stable extends the lever arm of the Achilles

• Ideally, WBing push off should be off of 1st MTP

Hallux valgus ➔ increased foot pronation ➔________________ ➔ knee valgus.

tibial internal rotation

Pronation causes ________________ and _____________________________

calcaneal eversion (heel tips outward), internal rotation of the tibia (shin bone).