Term
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Definition
At sagittal plane
MTPJ dorsiflexion
PIPJ plantarflexion
DIPJ dorsiflexion |
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Term
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Definition
Sagittal plane
MTPJ Dosiflexion
PIPJ Plantarflexion
DIPJ Plantarflexion |
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Term
| What does EDL do during the swing phase and end at heel contact? |
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Definition
| Dorsiflexion have the slips slit and insert into middle and distal phalanges. |
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Term
| Where does EDB insert to? |
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Definition
| Into fibrous expansions on the long extensor tendon at the level of the MTPJ at second, third and fourth digits. |
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Term
| What is the character of extensor hood apparatus? |
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Definition
| At the level of MTPJ, its medial and lateral fibers unite plantarly with capsule, deep transverse metatarsal ligament, the flexor tendon shealth, thereby functional inserting into the MTPJ. |
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Term
| How strong EDL and EDB pull on the joints? |
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Definition
| Strongly dorsiflex at MTPJ, but weakly at PIPJ and DIPJ, and lead to claw toes |
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Term
| How does Claw toes move during swing phase? |
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Definition
| toes do not claw due to plantarflexory stabilizaiton of the MTPJ by the lumbricals |
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Term
| Where does FDL insert to and work on that? |
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Definition
| on the distal phalanx and causing plantarflexion of MTPJ and IPJs |
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Term
| Where doese FDB insert to and how does it work? |
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Definition
| insert into the middle phalanx and cause plantarflexion of MTPJ and PIPJ |
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Term
| How does hammer toes form? |
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Definition
| FDB pull the middle phalanx against the ground resulting in passive extension of the DIPJ |
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Term
| What is the most common cause of the digital deformity? |
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Definition
| Flexor stabilization, intrinsic muscle, which are also supinators of the midfoot, may become fatigued in the pronated foot. |
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Term
| What is the least common cause of digital deformity? |
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Definition
| Flexor substitution, in the case, flexor able to work over the interossei when the deep posterior and lateral muscle attempt to substitue for a weak triceps surae muscle |
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Term
| Which is chosen between flexor and extensor FDB arthroplasty to treat hammer toes? |
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Definition
| Correcting flexor-induced hammer toes by effectively shortens the distance of origin to insertion of the FDL and FDB, thereby causing weakness of the flexor tendons. |
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Term
| What is the additional procedure need to be done along with correcting extensor digital deformity arthroplasty? |
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Definition
| often required extensor tendon release |
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Term
| When is arthroplasty is used? |
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Definition
For rigid or semirigid deformities caused by overpowering of the flexor tendons.
Or elongated digits can be corrected. |
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Term
| When is arthrodesis used over arthroplasty? |
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Definition
| when there are significant deforming forces, particular when all digits are involved. By converting the toe to a rigid lever arm, the FDL and FDB tendons are able to provide plantarflexory stability at the MTPJ, augmenting the intrinsic muscles, thereby eliminating flexor-induced dorsiflexion of the MTPJ by retrograde buckling of the toe |
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Term
| Interphalangeal arthrodesis is required procedure when multiple digital procedures are required by maintaining structural stability of the toes |
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Definition
| Interphalangeal arthrodesis is indicated in those patients with flexor and extensor-induced deformities |
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Term
| What is the flexor tendon transfer? |
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Definition
| transferring the FDL and FDB tendons dorsally to the proximal phalanx functionally converts the flexor tendons into plantarlfexors of the MTPJ during weight-bearing |
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Term
| When is flexor tendon transfer used? |
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Definition
| used when all digital deformities with a flexible PIPJ, has a similar mechanical effect as arthrodesis of the PIPJ |
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Term
| When is Extensor tenotomy used for? |
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Definition
| For mild , flexible extensor hammer toes to remove deforming extensor forces, and used in conjunction with a more distal osseous procedure |
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Term
| Medial and lateral tubercles attachment of |
|
Definition
collateral ligs and metatarsoglenoid
suspensory ligs |
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Term
| groove for capsule attachment |
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Definition
| groove for flexor tendons plantarly |
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Term
| Distal phalanx supports the geminal |
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Definition
| matrices of the overlying nail |
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Term
| distal interphalangeal joint |
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Definition
|
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Term
|
Definition
thick fibrocartilagenous structure
Absorbs compressive load of WB (provides cushion)
Stabilizes lesser MPJ's plantarly |
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Term
|
Definition
the main stabilizing force of the MPJ
Inserts distally on the proximal phalanx
and proximally on the plantar fascia |
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Term
| Plantar plate dysfunction |
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Definition
toes off stress
chronic hyperextension
rupture with subluxation
dislocation
hammer toe |
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Term
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Definition
second most powerful stabilizer of the
MPJ's |
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Term
| There are collateral ligaments and plantar plates at the PIPJ's and DIP's |
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Definition
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Term
| Accessory collateral ligament |
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Definition
Phalangeal collateral ligament
Plantar plate |
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Term
| Deep transverse metatarsal ligament |
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Definition
| Plantar metatarsophalangeal ligament |
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Term
| Plantar plate/Extensor sling |
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Definition
Extensor sling helps keep the tendon in
a central position
The tendon is not attached to the proximal phalanx dorsally, but via the sling plantar
Action to dorsiflex the proximal phalanx
Acts to extend the PIPJ only when the proximal phalanx is flexed or in neutral |
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Term
|
Definition
|
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Term
| Extensor digitorum longus |
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Definition
Extensor hallucis longus
Extensor hallucis capsularis |
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Term
| EDL and EDB function in the propulsive phase of gait to |
|
Definition
stabilize the proximal phalanx against
the metartarsal heads |
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Term
|
Definition
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Term
|
Definition
| of the sling mechanism, which wraps around the proximal phalanx and can lift the PP like a sling |
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Term
|
Definition
Related to intrinsic function
Through the hood dorsiflexes the MPJ &
thus causes the PIPJ to plantarflex
Extension of the PIPJ only occcurs when the MJP is held in flexion by the intrinsics
If the intrinsics don;t function we see PF of the PIPJ |
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Term
|
Definition
| The interosseous tendons are dorsal to tranverse metartarsal ligament and lumbricles are plantar. Both are plantar to the MTPJ axis and aid in plantarflexion |
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Term
|
Definition
Four dorsal
Three plantar
Sagittal stability
Dorsal to the Deep Transverse Metatarsal Ligament |
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Term
| Dorsal and Plantar Interossei |
|
Definition
Directly attach to the base of the proximal phalanx
Stabilizers on the sagittal plane
Weakly attach to the extensor wing
If interossei can't plantarflex the MPJ's then the extensor cannot dorsiflex the IPJ's |
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Term
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Definition
Origin off the FDL tendon
Deep to the intermetattarsal ligament
Excessive pull of the FDL creates increase tension in the lumbricles, further potentiating their action on the middle and distal phalanx |
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Term
|
Definition
Plantarflex the toe at the MTPJ
Extended the IPJ |
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Term
|
Definition
Origin from the calcaneus
Insertion middle phalanx
Fifth toe variable
Flexes the PIPJ |
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Term
|
Definition
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Term
| Cause of MPJ Hyperextension? |
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Definition
Mucle imbalance?
Paralysis of intrinsics
Pronated foot-requires greater intrinsic activity to stabilize the STJ & MTJ
Age related elongation of the plantar plate |
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Term
|
Definition
Static stability of MPJ plantar plate
Dynamic stabillity of MPJ extrinsic & intrinsic muscles
The ability of the intrinsics & extrinsics to stabilize is dependant on the integrity of the plantar plate
Imbalance b/w the strong extrinsics |
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Term
|
Definition
With MPJ in neutral or flexed extensors can dorsiflex the MPJ through the extensor hood apparatus
However with rupture of the plantar plate the proximal phalanx is in a DF positioin and the extensors cannot extend the PIPJ or DIPJ |
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Term
|
Definition
FDL & FDB are efficient PF of PIPJ & DIPJ but inefficient at MPJ.
On WB they stabilize the toes against the ground.
Thus the flexors cannot stabilize a dorsally subluxed toe. |
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Term
|
Definition
Interossei provide most of the flexion at MPJ.
With dorsal migration of MPJ these interossei migrate dorsal to axis of the MPJ losing their mechanical advantage to PF |
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Term
|
Definition
Lumbricles stabilize the IPJ's in the extended position and maintain the MPJ's in plantarflexion during WB.
Like the interossei they lose their normal function when MPJ is dorsiflexed |
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Term
|
Definition
Inflammation-Arthritis
Shoe-heel heigh, small toes box
Long 2nd metatarsal
HAV
Cavus foot
Trauma |
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