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Foot and Ankle II

Foot and Ankle II. RF/Subtalar Joint Varus – Compensated ST Varus & FF Valgus – Flexible PF 1 st Ray. RF/Subtalar Joint Varus - Pathomechanics. Varus position of RF @ IC  magnitude of pronation  duration of pronation rapid supination following TO. RF/Subtalar Joint Varus - Compensation.

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Foot and Ankle II

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  1. Foot and Ankle II

  2. RF/Subtalar Joint Varus – Compensated ST Varus & FF Valgus – Flexible PF 1st Ray

  3. RF/Subtalar Joint Varus - Pathomechanics • Varus position of RF @ IC •  magnitude of pronation •  duration of pronation • rapid supination following TO

  4. RF/Subtalar Joint Varus - Compensation • Excessive pronation at STJ

  5. RF/Subtalar Joint Varus – Compensated ST Varus & FF Valgus – Flexible PF 1st Ray

  6. RF/Subtalar Joint Varus - Pathology • Chronic ankle sprains 20  calcaneal EV • Plantar keratosis @ 2nd MET • PL tendinitis 20 rapid supination • TP tendinitis 20  deceleration of pronation • Achilles tendinitis 20  active supination

  7. Supination Closed-chain • Calcaneus inversion (varus) • Talus abduction (ER - vertical axis) • Talus dorsiflexion • Tibial ER

  8. Abnormal Supination • Excessive in magnitude • Excessive in duration • Occurs at wrong time Causes: • Intrinsic deformities • Extrinsic deformities

  9. Abnormal Supination - Etiology • FF valgus • PF first ray • FF equinus deformities

  10. Abnormal Supination - Pathology • Lack of shock absorption • plantar lesions • 1st and 5th ray trauma • abnormal pronation during propulsion

  11. Forefoot Valgus

  12. Forefoot Valgus – Flexible PF 1st Ray

  13. Forefoot Valgus – Rigid PF 1st Ray/Total

  14. Forefoot Valgus - Rigid PF 1st Ray/Total • 1st ray always p-flexed relative to other MET heads • medial foot load prematurely • lateral aspect of foot loaded prior to HO • “abnormal supination”

  15. Peroneus Longus Pulley • lateral malleolus • calcaneus - peroneal notch • cuboid - peronal groove • base of 1st MET and medial cuneiform

  16. Peroneus Longus Pulley • Pronated Foot

  17. Peroneus Longus Pulley • plantarflexor of 1st ray • cinches tarsal-metatarsal articulations • FF --> HO

  18. Tibialis Posterior • distal lateral tibia • navicular • attaches to all tarsals (except talus) • attaches to base of MET 2-4

  19. Tibialis Posterior • Strong supinator • HS --> FF • late midstance --> HO • inconsistent thru MSt IC LR MSt TSt PSw ISw MSw TSw IC

  20. FHL • medial malleolus • talus • 1st MET head (sesamoid) • attaches to distal phalanx • cinches foot • assists w/ supination • FF --> TO

  21. FHL • cinches foot • assists w/ supination • MSt --> TO IC LR MSt TSt PSw ISw MSw TSw IC

  22. Conclusions • Pronation - hypermobilities • Supination - hypomobilities Either can cause a reduced ability to: • attenuate forces • convert torque • adapt to terrain • become a rigid lever

  23. Tibial and Calcaneal Lines

  24. Calcaneal Inversion

  25. Calcaneal Eversion

  26. Palpated Subtalar Neutral

  27. Forefoot Varus Measurement

  28. Tibial Varum Measurement

  29. Standing Calcaneal Measurement

  30. 1st Ray Mobility

  31. 1st MTP Mobility

  32. Identifying Important Bony Landmarks

  33. Guidelines for Posting Maximal FF posting: • males: 7 - 8 mm (10 = 1 mm) • females: 5 - 6 mm • shoewear dependent

  34. Guidelines for Posting FF Varus Deformity: • medial FF area • If FF deformity > maximal FF posting allows  post RF  4mm) FF Valgus Deformity: • lateral FF area

  35. Guidelines for Posting Equinus Deformity: • stretching w/ foot in STJN • lift RF  50% of lacking range - maybe done initially in acute cases • maximum in-shoe lift: 0.25” (7mm) • balance out contralateral limb

  36. Posting

  37. Temporary Orthotic

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