Flashcards in Foot, Shoes, and Orthotic Interventions Deck (63)
Eccentric anterior tib/long toe extensors, concentric quad, eccentric hamstrings, glut maximus eccentric activity
What controls decent of the foot during loading response?
pretibial regulates ankle PF, Quads regulated knee flexion eccentrically
What prevents hip flexion?
Gluts, hamstring and adductor magnus prevent hip flexion via eccentric actions. Highest ground force reactions seen at this stage
What controls tibial advancement during mid stance?
Eccentric soleus and gastroc (lesser degree)
What decreases late midstance?
Glut max decreases in late mid stance due to vertical alignment of pelvis over the femur.
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
Foot clearance during initial swing:
Concentric pretibial muscle activity for foot clearance. Short head of biceps femoris flexes knee concentrically
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
Disorders of the Hindfoot
Ankle OA/Subtalar Joint arthritis
Tarsal Tunnel Syndrome
mucoid degeneration of Achilles Tendon
degeneration with deposit of myelin and lecithin in the cells.
Active DF and PF is painful +/-‐ painful arc
inﬂammation of the paratendon (membrane that surrounds the tendon or fascial plate (insertional point
Graston Technique modiﬁed
Stretch – multidirectional
ICE with Stretch
Exerises for mid portion achilles tendinopathy:
Responds to eccentrics with ankle in plantarﬂexion and dropping into extreme dorsiﬂexion – three sets of 15
What do insertional achilles tendinopathy need to avoid?
a traction apophysitis to the insertion of the Achilles tendon
Cause of severe's disease"
shear stresses applied to the unossiﬁed apophysis.
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
Treatment and Orthotics for Sever’s Disease
Orthoses with Medial Longitudinal Arch (MLA) and medial Posting
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
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.
Presents as a constellation of symptoms
Painful soft tissue swelling at Achilles tendon
Describes as an enlarged area of Post lateral calcaneus
includes pathology of Achilles tendon and the Achilles bursa
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.
Slightly displaced os Trigonum (Accessory Talus), hypertrophy of post talus or loose body
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
These people are on their toes a lot. Mobilizing the patient into plantar flexion is always painful
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
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
Disorders of the Midfoot
Arthritis of the Midfoot and Lisfranc
What is Lisfrance associate with?
(Rheumatoid or Osteoarthritis)
Associated with Sporting Injury or axial load
May occur with foot structure and indirect injury
Pronation and abduction or dorsiﬂexion with abduction elicits pain