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Abnormal Midtarsal Joint Motion

Abnormal Midtarsal Joint Motion. Denise Freeman, DPM, MSE. Organizer. Review of normal midtarsal joint Longitudinal axis anomalies Oblique axis anomalies Medial deviation Superior deviation How the foot looks Signs and symptoms. Axes of Motion. There are two Independent axes:

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Abnormal Midtarsal Joint Motion

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  1. Abnormal Midtarsal Joint Motion Denise Freeman, DPM, MSE

  2. Organizer • Review of normal midtarsal joint • Longitudinal axis anomalies • Oblique axis anomalies • Medial deviation • Superior deviation • How the foot looks • Signs and symptoms

  3. Axes of Motion There are two Independent axes: The Longitudinal Axis (LMJA) The Oblique Axis (OMJA)

  4. Longitudinal Axis • The axis is oriented: • 15 degrees from the transverse plane • 8-9 degrees from the sagittal plane

  5. Oblique Axis • The axis is oriented: • 52 degrees from transverse plane • 57 degrees from sagittal plane

  6. Longitudinal Axis Anomalies • Long Axis abnormalities are rare. • Long Axis controls the position of the heel and leg to the ground • Can you explain how this happens?

  7. Oblique MTJ Axis (OMJA) • Sagittal Plane Deviation • Transverse Plane Deviation

  8. What is meant by deviation? Medial Deviation from the Sagittal Plane -Normal and Abnormal • This deviation would bring the OMJ Axis almost parallel to the ankle axis creating almost pure plantar/ dorsiflexion

  9. Medial Deviation from the Sagittal Plane • Because of this axis deviation the pronatory forces are increased at the OMJ • Midfoot breakdown occurs as OMJ approaches horizontal

  10. How does the foot look? • Medial arch is flat Where have we seen this foot type before?

  11. Medial Deviation from the Sagittal Plane - Signs and Symptoms • Heel lifts off ground early • Foot appears to have an equinus • Patient complains of arch fatigue and pain

  12. Superior Deviation from the Transverse Plane - Normal and Abnormal • This sometimes referred to as vertical oblique axis of the midtarsal joint • It is the most common type of deviation seen

  13. Superior Deviation from the Transverse Plane • Because of this deviation we will see more adduction and abduction • The midfoot and talar adduction cause the leg to medially displace over the calcaneus with body weight causing the STJ to pronate

  14. How does the foot look?

  15. Superior Deviation from the Transverse Plane- Signs and Symptoms • Medial collateral knee pain • Chondromalacia patellae due to the knee flexing easier than extending • Excessive strain on the PT Tendon • Prominent talar head medially • C--shape at the calcaneo-cuboid joint

  16. Treatment Implications -Orthotic Construction • Device must control all 3 cardinal planes • Medial deviation is easy to control with a very stiff orthotic that does not give way under body weight • Superior deviation (high axis) it is very difficult to control with an orthotic

  17. Summary • Longitudinal axis anomalies • Oblique axis anomalies • Medial deviation • Superior deviation • How the foot looks • Signs and symptoms • For more information: Hice, G.A.: Orthotic treatment of feet having a high oblique midtarsal joint axis JAPMA, 74(11):577-82. 1984

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