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Updated: Jan 22 2024

Foot Muscle Forces & Deformities

Images
https://upload.orthobullets.com/topic/7054/images/silverskiold_moved.jpg
  • Introduction
      • Simple Deformities
      • Deformity
      • Strong Muscle
      • Weak Muscle
      • Equinus
      • Gastroc-soleus complex
      • Dorsiflexors
      • Cavus
      • Plantar fascia, intrinsics
      • Dorsiflexors
      • Varus
      • Posterior tib, anteiror tib
      • Peroneal brevis
      • Supination
      • Anterior tibialis
      • Peroneus longus
      • Flatfoot
      • Peroneus brevis
      • Posterior tibial tendon
      • Complex Deformities
      • Deformity
      • Strong Muscle
      • Weak Muscle
      • Equinovarus + supination
      • Gastroc-soleus complex, posterior tibialis, anterior tibialis
      • Peroneus brevis & longus
      • Equinovalgus
      • Gastroc-soleus complex, peroneals
      • Posterior tibialis, anterior tibialis
      • Calcaneovalgus
      • Foot dorsiflexors/evertors (L4 and L5)
      • Plantar flexors /inverters (S1 and S2)
  • Introduction
    • Equinovarus foot
      • most common deformity following stroke
        • use AFO and physical therapy for at least 6 months to await for possible neuro recovery
        • overactivity of the tibialis anterior, with contributions from the FHL, FDL, and tibialis posterior
      • treatment
        • nonoperative
          • AFO fitting
          • physical therapy
          • Phenol or botox injections
        • surgical
          • split anterior tibial tendon transfer (SPLATT)
          • flexor hallucis longus tendon transfer to the dorsum of the foot and release of the flexor digitorum longus and brevis tendons at the base of each toe
          • gastrocnemius or achilles lengthening
    • Foot drop
      • Inability to dorsiflex at the ankle and/or toes
      • Commonly result from peroneal nerve palsy
        • Multiple etiologies
          • central nervous system (brain, spinal cord, nerve roots)
          • peripheral nervous system (sciatic nerve, peroneal nerve)
          • traumatic (knee dislocation, laceration, blunt trauma)
          • compressive (compressive mass, deformity correction)
          • systemic (diabetic polyneuropathy, mononeuropathy)
          • Iatrogenic (laceration, casting, positioning, surgical injury)
          • Mechanical (muscle debridement, tumor excision, etc.)
      • Presentation - variable depending on location of nerve injury
        • Motor
          • Loss of ankle/toe dorsiflexion (DPN)
          • Loss of ankle eversion (SPN)
        • Sensory
          • Loss of first dorsal webspace sensation (DPN)
          • Loss of lateral leg/dorsal foot sensation (SPN)
      • Treatment
        • Nonoperative
          • Observation
          • AFO bracing
          • Therapy - stretching and supple joints
        • Operative
          • Acute injury
            • Laceration - repair, grafting, or nerve transfer
          • Chronic injury
            • Tendon transfer
              • Posterior tibial tendon transfer to lateral cuneiform +/- gastroc or Achilles tendon lengthening
  • Physical Exam
    • Silfverskiöld test
      • equivalent ankle dorsiflexion with knee flexion and extension= achilles tightness
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