foot and ankle ii. rf/subtalar joint varus – compensated st varus & ff valgus – flexible pf...
Post on 20-Dec-2015
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Foot and Ankle II
RF/Subtalar Joint Varus – Compensated ST Varus & FF Valgus – Flexible PF 1st Ray
RF/Subtalar Joint Varus - Pathomechanics
Varus position of RF @ IC magnitude of pronation duration of pronationrapid supination following TO
RF/Subtalar Joint Varus - Compensation
Excessive pronation at STJ
RF/Subtalar Joint Varus – Compensated ST Varus & FF Valgus – Flexible PF 1st Ray
RF/Subtalar Joint Varus - Pathology
Chronic ankle sprains 20 calcaneal EVPlantar keratosis @ 2nd METPL tendinitis 20 rapid supinationTP tendinitis 20 deceleration of pronationAchilles tendinitis 20 active supination
Supination
Closed-chainCalcaneus inversion (varus)Talus abduction (ER - vertical axis)Talus dorsiflexionTibial ER
Abnormal Supination
Excessive in magnitudeExcessive in durationOccurs at wrong time
Causes:Intrinsic deformitiesExtrinsic deformities
Abnormal Supination - Etiology
FF valgusPF first rayFF equinus deformities
Abnormal Supination - Pathology
Lack of shock absorptionplantar lesions1st and 5th ray traumaabnormal pronation during
propulsion
Forefoot Valgus
Forefoot Valgus – Flexible PF 1st Ray
Forefoot Valgus – Rigid PF 1st Ray/Total
Forefoot Valgus - Rigid PF 1st Ray/Total
1st ray always p-flexed relative to other MET heads
medial foot load prematurelylateral aspect of foot loaded prior to
HO“abnormal supination”
Peroneus Longus Pulley
lateral malleoluscalcaneus - peroneal
notchcuboid - peronal
groovebase of 1st MET and
medial cuneiform
Peroneus Longus Pulley
Pronated Foot
Peroneus Longus Pulley
plantarflexor of 1st raycinches tarsal-metatarsal
articulationsFF --> HO
Tibialis Posteriordistal lateral tibianavicularattaches to all tarsals (except talus)attaches to base of MET 2-4
Tibialis PosteriorStrong supinatorHS --> FFlate midstance --> HOinconsistent thru MSt
IC LR MSt TSt PSw ISw MSw ICTSw
FHLmedial malleolus talus1st MET head (sesamoid)attaches to distal
phalanxcinches footassists w/ supinationFF --> TO
FHL
cinches footassists w/ supinationMSt --> TO
IC LR MSt TSt PSw ISw MSw ICTSw
Conclusions
Pronation - hypermobilitiesSupination - hypomobilitiesEither can cause a reduced ability to:attenuate forces convert torqueadapt to terrainbecome a rigid lever
Tibial and Calcaneal Lines
Calcaneal Inversion
Calcaneal Eversion
Palpated Subtalar Neutral
Forefoot Varus Measurement
Tibial Varum Measurement
Standing Calcaneal Measurement
1st Ray Mobility
1st MTP Mobility
Identifying Important Bony Landmarks
Guidelines for Posting
Maximal FF posting:males: 7 - 8 mm (10 = 1 mm)
females: 5 - 6 mm
shoewear dependent
Guidelines for Posting
FF Varus Deformity:medial FF areaIf FF deformity > maximal FF posting
allows post RF 4mm)
FF Valgus Deformity:lateral FF area
Guidelines for Posting
Equinus Deformity:stretching w/ foot in STJN lift RF 50% of lacking range -
maybe done initially in acute casesmaximum in-shoe lift: 0.25” (7mm)balance out contralateral limb
Posting
Temporary Orthotic