Ch 4-The Foot and Toes
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| The foot and toes provide what for the body? | A stable platform to balance and support the body.
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| What are the main phases of gait in regards to gait? | The toe-off phase and the Initial contact phase.
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| What does the foot and toes act as in the toe off phase? | A rigid lever.
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| What does the foot and toes act as in the initial contact phase? | A shock absorber.
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| During running the foot and toes dissipate the weight of the body how many times the normal body weight. | 3-8x the normal body weight.
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| What must the foot and toes be able to adapt to? | Uneven terrain
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| Where are the six locations that pain could be involved in the foot/toes? | Retrocalcaneal Pain/////Heel Pain/////Medial Arch Pain////Metatarsal Pain////Great Toe Pain////Lateral Arch Pain
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| What structures would be involved if we were talking about retrocalcaneal pain? | Inflammation of the retrocalcaneal bursae, Achilles tendon, or OS Trigonum pathology.
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| Heel pain consists of what? | plantar faciitis, heel spur, nerve pain
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| Medial arch pain consists of what? | tarsal tunnel syndrome, midfoot sprain, plantar faciitis, navicular fracture, tibialis posterior tendonitis
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| Metatarsal pain consists of what? | stres fx, nerve impingement, metatarsalgia
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| Great toe pain consists of what? | Hallux ridgidus, hallux abducto valgus, sesamoid fx, sesamoiditis, gout, ingrown toenail
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| Lateral arch pain consists of what ? | post. tibial nerve compression, radiating pain from peroneal tendinitis
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| What are the two things that need to be determined with history on the foot or toes? | whether it is acute onset or insidious onset
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| What are the eight bony structures that we would palpate on the medial aspect of the foot? | 1st Metatarsal bone, 1st MTP joint, 1st cuniform, Navicular tubercle, head of the talus, medial malleolus, sustentaculum tali, medial tubercle of the talus
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| What are the eight bony structures that we would palpate on the lateral aspect of the foot? | 5th MT bone, 5th MTP joint, calcaneus, peroneal tubercle, lateral malleolus, sinus tarsi, dome of the talus, inferior tibiofibular joint
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| What are the two bony structures that we would palpate on the hindfoot? | Dome of the calcaneus, Medial tubercle
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| What are the two bony structures that we would palpate on the plantar surface? | sesamoid bones, metatarsal heads
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| What are the eight key points to inspection of the foot? | 1. observe patient as they walk in 2. note bilateral gross deformity or swelling 3. inspect footwear 4. observe foot in non weigh bearing 5. compare foot in weight bearing, foot type(pro,sup,neutr) 6. irregular posture in lower extremities 7. calluses and
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| What are the two tests to test for foot pathologies? | Fiess line, Navicular drop
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| What is a positive test for navicular drop? | navicular that drops 2/3 or greater to the floor
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| What are the seven things you look for in inspection of the toes? | 1. claw toe 2. hammer toes 3. morton's toe 4. hallux abducto valgus 4. hard corns 5. soft corns 6. ingrown toenail 7. subungual hematoma
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| What do you look for when inspecting the medial structures? | Medial longitudinal arch/ pes planus-pes cavus
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| what do you look for when inspecting lateral structures? | fifth metatarsal/inspect length of the bone
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| What are you looking for when inspecting the dorsal structures? | long toe extensors, extensor digitorum brevis/swelling discoloration abnormal bone alignment
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| what are you looking for when inspecting the plantar surface? | callus,blisters/planters warts
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| What are you looking for when inspecting the posterior structures? | Achilles tendon alignment (WB)/Calcaneus, retrocalcaneal exotosis (Hauglands Deformity"pump bumps")
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| When doing non weight bearing inspection what are you trying to inspect and achieve? | Talar position/Subtalar neutral
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| What four things are being assessed in regards to foot alignment? | forefoot varus/forefoot valgus/rearfoot varus/rearfoot valgus
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| what is forefoot varus? | 1st MT is elevated relative to the 5th MT
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| what is forefoot valgus? | 5th MT is elevated relative to the 1st MT
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| what is rearfoot varus? | calcaneus is inverted relative to the tibia
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| what is rearfoot valgus? | calcaneus is everted relative to the tibia
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| what are the medial soft tissue structures? | Flexor hallucis longus/Flexor digitorum longus/Tibialis posterior
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| what are the lateral soft tissue structures? | Peroneal tendons
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| what are the dorsal soft tissue structures? | Extensor digitorum brevis/ Inferior extensor retinaculum/Tibialis anterior/Extensor hallucis longus/Extensor digitorum longus/Dorsal pedal pulse
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| What are the plantar soft tissue structures? | Plantar fascia/Intermetatarsal neuroma
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| When performing flexion RROM on the great toe what muscles are being tested? | flexor hall longus/Flex hall brevis/
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| When performing flexion RROM on the other four toes what muscles are being tested? | flexor dig long/ flex dig brevis/ flex digiti minimi brevis
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| When performing extension RROM on the great toe what muscles are being tested? | ext hall long/ ext hall brev
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| When performing extension RROM on thelateral four toes what muscles are being tested? | ext dig long/ ext dig brevis/
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| What do you do for ligametous and capsular testing in regards to the MTP and Interphalangeal joints? | Passive overpressure flexion/extension-valgus/varus stress test
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| What do you do for ligametous and capsular testing in regards to the Intermetatarsal joints? | Intermetatarsal glide test compared bilaterally
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| What do you do for ligametous and capsular testing in regards to the tarsometatarsal joints? | tarsometatarsal glide test compared bilaterally
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| what does decreased glide infer in regards to tarsometatarsal joint glide test? | joint adhesions or articular changes
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| What do you do for ligametous and capsular testing in regards to the midtarsal joints? | midtarsal glide test compared bilaterally
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| What nerve roots are supplied to the foot and toes? | L4 to S2 nerve roots
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| What symptoms will arise if there is neurological issues in the foot or toes? | numbness, muscle weakness, reflex deficits
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| What must we determine when assessing neuro problems in the foot or toes? | nerve root? peripheral nerve lesion?
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| What are common pathologies of neuro problems in the foot and toes? | Tarsal tunnel syndrome, interdigital neuroma, peroneal nerve trauma, anterior compartment syndrome
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| What is pes planus? | Flat feet
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| How do you get acute pes planus? | rupture or trauma to the medial longitudinal ligament, plantar fascia, spring ligament, tibialis posterior or anterior
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| What are the two classifications of pes planus? | rigid(structural), flexible(supple)
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| What is pes cavus? | High arch
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