Foot, Shoes, and Orthotic Interventions Flashcards Preview

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Flashcards in Foot, Shoes, and Orthotic Interventions Deck (63)
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1

Initial Contact

Eccentric anterior tib/long toe extensors, concentric quad, eccentric hamstrings, glut maximus eccentric activity

2

What controls decent of the foot during loading response?

pretibial regulates ankle PF, Quads regulated knee flexion eccentrically

3

What prevents hip flexion?

Gluts, hamstring and adductor magnus prevent hip flexion via eccentric actions. Highest ground force reactions seen at this stage

4

What controls tibial advancement during mid stance?

Eccentric soleus and gastroc (lesser degree)

5

What decreases late midstance?

Glut max decreases in late mid stance due to vertical alignment of pelvis over the femur.

6

What is in highest demand during terminal stance?

body weight vector approaches MTP’s, Highest demands on the triceps surae (eccentrically) due to large dorsiflexion moment at ankle

7

Foot clearance during initial swing:

Concentric pretibial muscle activity for foot clearance. Short head of biceps femoris flexes knee concentrically

8

What assists with hip and knee flexion during initial swing?

iliacus advances hip to 20 d of flexio. Gacilis and Sartorius assist hip and knee flexion concentrically

9

Disorders of the Hindfoot

Achillies Tendinosis
Sever’s Disease
Retrocalcaneal Bursitis
Peroneal Tendinosis
Ankle OA/Subtalar Joint arthritis
Ankle Impingement
Tarsal Tunnel Syndrome

10

Tendinosis

mucoid degeneration of Achilles Tendon
degeneration with deposit of myelin and lecithin in the cells.
Active DF and PF is painful +/-­‐ painful arc

11

Paratendinopathy

inflammation of the paratendon (membrane that surrounds the tendon or fascial plate (insertional point

12

Achilles Tendinopathy

Graston Technique modified
Eccentrics
Stretch – multidirectional
ICE with Stretch

13

Exerises for mid portion achilles tendinopathy:

Responds to eccentrics with ankle in plantarflexion and dropping into extreme dorsiflexion – three sets of 15

14

What do insertional achilles tendinopathy need to avoid?

extreme DF

15

Severe's Disease

a traction apophysitis to the insertion of the Achilles tendon
boys 7-15

16

Cause of severe's disease"

shear stresses applied to the unossified apophysis.

17

Whee is pain with Severe's Disease?

Pain in posterior heel that is worse With activity and weight bearing
Pain on squeezing posterior calcaneus near growth plate

18

Treatment and Orthotics for Sever’s Disease

Heel Cups
Heel Lifts
Orthoses with Medial Longitudinal Arch (MLA) and medial Posting
Taping
Rest
Stretching Achilles

19

Retrocalcaneal Bursitis

Describe by location of pain and swelling
May exist as a constellation of symptoms
May exist with Achilles tendinopathy
Often associated with Haglund’s
Radiographs help with location

20

Assessment of Retrocalcanel Bursitis

Passive dorsiflexion may be painful
Two finger pinch test anterior to achilles
MRI and Ultrasound form gold standard to determine soft tissue swelling.

21

Haglund’s Deformity

Presents as a constellation of symptoms
Painful soft tissue swelling at Achilles tendon
Describes as an enlarged area of Post lateral calcaneus
bony deformity

22

Haglund’s Syndrome

includes pathology of Achilles tendon and the Achilles bursa

23

Posterior Impingement of Ankle

Caused by overuse or trauma
Dancers have overuse
Trauma cause forced pf with running/soccer Plantar flexed and then impact. Os trigonum (accessory bone in the ankle) will cause pain.
Bony spurs
Slightly displaced os Trigonum (Accessory Talus), hypertrophy of post talus or loose body

24

Assessment of Posterior Impingement of Ankle

Complaints of pain in posterior lateral ankle
Pain increased with passive plantarflexion
Pain increased with repeat active plantarflexion
Posterior lateral pain on palpation
Morning stiffness
These people are on their toes a lot. Mobilizing the patient into plantar flexion is always painful

25

Physical Therapy for Posterior Impingement

Treat hypomobility at Talocrural joint
Talocrural mobilization-­ distraction
Talocrural manipulation-­‐ distraction
Talar glides posterior – for df
Mulligans mobs with movement for df
Maitland physiological mobs – subtalar,TC
Active stretching of the ankle
Active movements of the anterior compartment in conjunction with stretch of the posterior compartment: Shuffle Gait/moon walk gait exercise

26

When is preoneus longus active during gait?

Active through midstance to late stance
Decelerates speed and amount of supination at STJ
Helps the midfoot and forefoot relatively pronates

27

Disorders of the Midfoot

Arthritis of the Midfoot and Lisfranc
Plantar Fasciitis
Cuboid Syndrome
PTTD

28

What is Lisfrance associate with?

rheumatology
(Rheumatoid or Osteoarthritis)

29

Lisfrance injury:

Associated with Sporting Injury or axial load
May occur with foot structure and indirect injury
Pronation and abduction or dorsiflexion with abduction elicits pain

30

Plantar fasciitis

Pain with first step in the am or after a period of inactivity
Relieved by activity until stress increase
Pain on palpation at medial calcaneal tubercle
Pain usually unilateral
No burning or numbness