Which of the following ligaments does NOT assist in securing the STJ?
Lateral talocalcaneal ligament
Posterior talocalcaneal ligament
What is the average STJ joint ROM?
Which of the following is not a ligament of the MTJ?
Plantar calcaneonavicular ligament
Long and short plantar ligaments
What is the orientation of the Oblique axis of the MTJ?
57 degrees to the Sagittal plane, 52 degrees to the transverse plane
15 degrees to the Transverse plane, 9 degrees from the Sagittal plane
52 degrees to the Sagittal plane, 57 degrees to the transverse plane
9 degrees to the transverse plane, 15 degrees from the sagittal plane
How does MTJ ROM change with changes in rearfoot position?
It decreases with STJ pronation & Increases with STJ supination
It increases with STJ pronation & decreases with STJ supination
MTJ ROM doesn't change with respect to changes in rearfoot position
What is the orientation of the Longitudinal axis of the MTJ
57 degrees to the sagittal plane, 52 degrees to the transverse plane
15 Degrees to the Transverse plane, 9 degrees from the sagittal plane
52 degrees to the sagittal plane, 57 degrees to the transverse plane
Forefoot Varus (FFVR) is defined as; The Forefoot inverts with regards to the Rearfoot when the Subtalar joint is in neutral & the Mid tarsal joint is maximally pronated around both axes?
Forefoot Valgus (FFVL) is defined as: The forefoot everts with regards to the rearfoot when Subtalar joint is in neutral and the Mid tarsal joint is maximally pronated around both axes
Which of the following is NOT a potential cause of an acquired Plantarflexed first ray?
May result from uncompensated FFVR
Incorrect footwear worn for long periods of time.
The following are abnormal variations of the 1st ray: Metatarsus primus elevatus, Flexible plantarflexed 1st metatarsal, Rigid plantarflexed 1st ray.
The incidence of the most common variant of the 1st ray is Acquired by 20% of the population.
An Acquired Plantar flexed First ray usually has equal amounts of DF/PF (From resting position) and normal ROM
The following describes a clinical signs of a flexible Plantar flexed first ray:
- Medium to high MLA (Lowers on WB)
- Callus PMA 1-2
- Intermetatarsal bursitis/neuritis
- Dorsomedial 'bunion'
- Exostosis 1st met-cuneiform
- Sesamoid injury
- Plantar Fasciitis
The following describes the position of each joint when the foot is in the neutral position:
Ankle: 90 o to leg (Distal 1/3 of leg is vertical)
STJ: the calcaneus is perpendicular to the ground, and parallel to the distal 1/3 of the leg.
MTJ: The midtarsal joint is locked in its’ maximum position of pronation, and therefore the forefoot is locked against the rearfoot. The plantar forefoot plane parallels the rearfoot plane.
1st ray: The 1st metatarsal head moves above and below the level of the 2nd metatarsal head and the same distance when the subtalar joint is in neutral and the MTJ is fully pronated.
Which author describes the different modes of compensation for Forefoot varus and the affects of this on the Rearfoot as:
• Comp. FFVR- if FFVR<=3deg, STJ pronates same amount.
- If FFVR>3 deg STJ pronates to end ROM as body weight now falls medial to the STJ axis
• Partial comp: FFVR- deg of FFVR is greater than available STJ eversion, STJ pronates end ROM, 1st ray may PF or OA MTJ may pronate or LA MTJ may pronate to give 2-5 degrees compensation
• Uncomp- RF has no eversion beyond vertical remaining, - as above
Compensation for Forefoot varus occurs primarily at which joint?
Mid tarsal joint
Sub talar joint
A fully compensated Forefoot varus requires the _______________ to pronate during midstance?
Which of the following is NOT a sign of compensated forefoot varus?
Covexity of lateral malleolus
The definition and aetiology of forefoot valgus is: The forefoot everts with respect to the rearfoot with Subtalar joint neutral & Mid tarsal joint axes maximally pronated.
Which two Sub-phases of the stance phase are termed 'Propulsive'?
Loading response and mid stance
Midstance and terminal stance
Terminal stance and pre-swing
Pre-swing and loading response
Which of the following is NOT a termporospatial parameter?
Angle of Gait
Base of gait
Loading response is defined as: Heel strike to opposite toe off, 10% of the gait cycle or 80% stance phase
Which muscle is considered by far the strongest supinator of the Sub talar Joint?
Extensor Digitorum longus
Midstance is defined as: From opposite toe off to heel lift of the supporting foot. 20% of gait cycle or 30% of stance.
Rearfoot Valgus is defined as an everted position of the calcaneus relative to the ground in NCSP
What is the prevalence of Pes Cavus according to Burns 2005?
Which of the following biomechanical features does NOT describe Pes Cavus?
Plantar flexed and Adducted Forefoot
High calcaneal pitch
Low Midfoot (Defined by navicular height)
Which of the following muscle combinations leads to diminished ground contact of the lateral forefoot, placing the peroneals at a disadvantage, less able to pronate the Mid tarsal joint at the Oblique axis and allow the supinators to function unopposed?
Weak Extensor hallucis longus and extensor digitorum longus
Gastrocnemius and soleus tightness
Gastrocnemius and soleus weakness
Weak Extensor Hallucis longus, extensor digitorum longus and tibialis anterior
A STJ axis is classed as more than 42 degrees from the transverse plane. It allows less and more .
SIgns on a a lateral radiograph of a Pes Cavus foot type should include: calcaneal inclination angle (>30 degrees) and metatarsal declination angle ( degrees)
A rigid Pes Planus foot type is described as having a lower arch during weight baring and non weight baring, decreased or absence of STJ and mid foot ROM, symptomatic or asymptomatic, and usually has an underlying primary pathology.
What is the most common tarsal coalition?
Incidence of Flexible pes planus include: 15% simple flatfoot, 6% equinus, 2% tarsal coalition
Clinical features of Flexible Pes planus include:
- Bowing of Achilles tendon
- curvature observed under the lateral malleoli
- Forefoot abduction (Too many toes sign)
- Medial column/MLA collapse
- Medial talo-navicular bulge
Wheeless' textbook of orthopaedics states that adult flatfoot may occur in % of adults, most of which are flexible.
What are the three main types of ulcers in the lower limb?
The following factors contribute/influence impaired healing of ulceration: Tissue trauma, autoimmune diseases, Vascular disease, Sensory loss, malignancy, Haematological disease, Infection and drug therapies.
Which of the following is not one of the phases in the process of wound healing?
Inflammation: Increased blood flow, debridement (Phagocytosis)
Mast cell production
During the epithelialisation phase of wound healing, the migration proceeds much slower in a moist environment than in a dry wound.
Based on the university of texas wound classification system, '3A' describes which of the following:
Superficial - No bone, tendon capsule & non-infected-non-ischaemic
Involves tendon or capsule & Ischaemic
Involves bone or joint & Non-infected, non Ischaemic
Pre-post ulcer with epithelialisation and infection
The Wagners grading system classifies ulcers by depth.
Tollafield & Merriman describe one of their ideal wound dressing characteristics as ' Draws exudate away from the wound surface, but does not allow drying of the wound surface'.
The following clinical presentations would best relate to which condition?
• Collagen disorders
• Easy bruising/ scars
• Over-use syndromes present with greater intensity
• Joint and soft tissue pain
• Dislocation of joints
• Link with fibromyalgia in chronic cases
Without insulin the body produces a toxic by product from the burning of fats; this state is called
Late-onset autoimmune diabetes
In the pathophysiology and clinical manifestations of chronic venous disease of the lower limbs, the 'CEAP' classification stands for.
E = Etiology
P = Pathophysiology
A classic site for venous ulceration to occur is above the lateral malleolus around the area of perforators.
In regards to compression therapy, if you were treating lymphatic oedema, you would use a class 4 of 40-50mmHg compression.
Tinea pedis between the toes may produce a portal of entry for bacteria causing cellulitis
Stemmer's sign describes Lipoedema as a positive result, whereby pinching the skin on the upper surface of the toes results in only grasping a lump of tissue.Whereas, Lymphedema generally produces a negative result, which describes being able to grasp a thin fold of tissue.
The five developmental stages of diabetic neuropathic ulceration include:
1. Build up of hardened keratin over bony prominence
2. Sub-dermal tissue break down
3. Sub-dermal blister breaks surface of skin
4. Dermal ulceration
5. Infection of tendon and bone
Based on the traffic light system of risk stratification:
: People with no risk factors and no previous history of foot ulceration/amputation
: People with one risk factor (Neuropathy,PAD, or foot deformity) and no previous history of ulcer/amputation
: People with 2 or more risk factors (neuropathy, PAD, or foot deformity) and/or previous history of foot ulceration/amputation.
Decreased Posterior Tibialis strength or weakness could be the cause of:
Excessive Pronation/eversion in RCSP
Excessive supination in RCSP
In standard 'off the shelf' shoes the last shapes are:
A haemostatic agent is one that:
Lessens and relieves pain by removing the cause or changing response/perception of pain
Arrests or diminishes the flow of blood
Lessen sensitivity to pain by acting directly on nerve endings
A rubefacient is a medicament which produces a mild local inflammation when applied to the skin.
Anhydrotics are preparations that increase the flow of sweat
The compound benzoin tincture is made up of: 10% benzoin, 7.5% storax, 2.5% tolu balsam, 2% aloes, alcohol to 100%
Amorolfine is the active ingredient found in which topical antifungal agent?
Hallux Limitus is described as painful limitation of 1st MPJ motion with no other deformity.
The Manchester scale is used to grade the severity of hallux valgus. It is based of standardised photographs and is reliable and valid compared to x-rays. What would a grade of 2 represent?
The grading severity can also be classified into four stages, depending on the progression of pathology. What stage best describes 'Abduction of hallux which presses against toe'?
If a patient presents with hallux valgus and describes their type of pain as 'Numbness, tingling, and sharp' what could be the cause of this?
OA, sesamoid problems, transfer lesion related
The medial tubercle of the calcaneal tuberosity is an attachment site for the Flexor digitorum brevis, Abductor hallucis, Quadratus plantae and Plantar Fascia.
The baxter's nerve is also known as the:
Medial plantar nerve
Medial calcaneal nerve
Lateral plantar nerve
The windlass mechanism describes tension in the plantar fascia as increased with overpronation/pes planus.
Paratenonitis can be described as:
Inflammation of the tendon itself
Inflammation of the tendon sheath/paratenon
Tendon degeneration (No inflammation)
The following are areas commonly affected by Bursitis: Retrocalcaneal, 1st and 5th MPJ, Submetatarsal, Plantar Calcaneal area.
The reflex grading system is used in motor function assessment. Please fill in the blanks:
1 = Normal
3 = Clonus
The Insertion of the extensor hallucis longus is at the:
Dorsal surface of base of the 5th Metatarsal
Base of the distal phalanx of hallux
Plantar surface of distal phalanx of hallux
What is the origin of the Abductor Hallucis?
Tuberosity of the calcaneus
Medial surface of the calcaneus
Plantar surface of cuboid and lateral cuneiform