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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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rf subtalar joint varus pathomechanics
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
RF/Subtalar Joint Varus - Compensation
  • Excessive pronation at STJ
rf subtalar joint varus pathology
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
supination
Supination

Closed-chain

  • Calcaneus inversion (varus)
  • Talus abduction (ER - vertical axis)
  • Talus dorsiflexion
  • Tibial ER
abnormal supination
Abnormal Supination
  • Excessive in magnitude
  • Excessive in duration
  • Occurs at wrong time

Causes:

  • Intrinsic deformities
  • Extrinsic deformities
abnormal supination etiology
Abnormal Supination - Etiology
  • FF valgus
  • PF first ray
  • FF equinus deformities
abnormal supination pathology
Abnormal Supination - Pathology
  • Lack of shock absorption
  • plantar lesions
  • 1st and 5th ray trauma
  • abnormal pronation during propulsion
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 prematurely
  • lateral aspect of foot loaded prior to HO
  • “abnormal supination”
peroneus longus pulley
Peroneus Longus Pulley
  • lateral malleolus
  • calcaneus - peroneal notch
  • cuboid - peronal groove
  • base of 1st MET and medial cuneiform
peroneus longus pulley17
Peroneus Longus Pulley
  • plantarflexor of 1st ray
  • cinches tarsal-metatarsal articulations
  • FF --> HO
tibialis posterior
Tibialis Posterior
  • distal lateral tibia
  • navicular
  • attaches to all tarsals (except talus)
  • attaches to base of MET 2-4
tibialis posterior19
Tibialis Posterior
  • Strong supinator
  • HS --> FF
  • late midstance --> HO
  • inconsistent thru MSt

IC

LR

MSt

TSt

PSw

ISw

MSw

TSw

IC

slide20
FHL
  • medial malleolus
  • talus
  • 1st MET head (sesamoid)
  • attaches to distal phalanx
  • cinches foot
  • assists w/ supination
  • FF --> TO
slide21
FHL
  • cinches foot
  • assists w/ supination
  • MSt --> TO

IC

LR

MSt

TSt

PSw

ISw

MSw

TSw

IC

conclusions
Conclusions
  • Pronation - hypermobilities
  • Supination - hypomobilities

Either can cause a reduced ability to:

  • attenuate forces
  • convert torque
  • adapt to terrain
  • become a rigid lever
guidelines for posting
Guidelines for Posting

Maximal FF posting:

  • males: 7 - 8 mm (10 = 1 mm)
  • females: 5 - 6 mm
  • shoewear dependent
guidelines for posting34
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
guidelines for posting35
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