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