Flashcards in 04 Foot/Ankle Palpations: Medial Deck (39):
first MTP joint: clinical significance
- MTP sprain
- hallux valgus
- turf toe
During the propulsive phase of the gait cycle, the MTP needs this much extension
Why is the first metatarsal so big compared to the others?
- final propulsive push off is off the biggest bone during the gait cycle
- causes a lot of stress and pressure
joint between the first metatarsal and medial cuneiform: clinical significance
occasionally get OA changes
navicular: clinical significance
- Cohler's syndrome
- os navicularis
- landmark for navicular drop test
osteonecrosis of navicular
- accessory bone
- get stress fractures here and may be recalcitrant to healing
Which bone is the keystone of the medial longitudinal arch?
medial side of calcaneus: clinical significance
site of compression fracture
What landmark is located one body inch down from the medial malleolus?
sustentaculum tali: clinical significance
- acts as a fulcrum for Tom, Dick, and Harry
- rarely injured
How do you palpate the sustentaculum tali?
from medial malleolus, move down one body inch and push superiorly
Where is the talar tubercle?
from posterior tip of the medial malleolus, move to the posterior part of the talus
talar tubercle: clinical significance
- avulsion of the deltoid ligament
- occasionally gets injured with an eversion injury
Where is the head of the talus located?
- draw an imaginary line between medial malleolus and navicular
- press in between these two and that's the head
How do you make the head of the talus more prominent?
head of talus: clinical significance
possible (but not likely) distal tibial fractures
deltoid ligament: clinical significance
not common, but worth palpating if there was an eversion ankle sprain
deltoid ligament location
- runs from anterior to posterior medial malleolus
- head of talus along sustentaculum tali
- bac to the medial tubercle of talus
spring ligament: clinical significance
primary stabilizer for longitudinal arch
Where does the spring ligament run?
sustentaculum tali to navicular
What runs from the medial malleolus to the medial side of the calcaneus?
lancinate ligament (flexor retinaculum)
flexor retinaculum: clinical significance
- stabilizes Tom, Dick, and Harry
- tarsal tunnel syndrome
- landmark for Tinel's sign
- site of myositis, tendonitis/osis, etc.
tibialis posterior: palpation
- closest to posterior edge of medial malleolus
- follow down to navicular
tibialis posterior: actions
What happens when Tom actively contracts?
goes behind the malleolus
flexor digitorum longus
flexor digitorum longus: palpation
- inferior to medial malleolus
- won't jump out at you
how to isolate Dick
- hold big toe
- have pt PF and invert ankle and wiggle other toes
- should feel tendon rising up just inferior to posterior tip of the medial malleolus
flexor hallucis longus
FHL: how to isolate
- hold lateral 4 toes and have them flex the big toe while PF and inverting the ankle
- deepest of the tendons inferior to the medial malleolus
Where does the abductor hallucis run?
medial side of calcaneus to medial side of first metatarsal
abductor hallucis: actions
- medial dynamic stabilizer of the foot
- abducts the great toe
abductor hallucis: clinical significance
hypertrophies with overpronation to keep up with the arch
What is the nerve/artery that runs through the tarsal tunnel?
- posterior tibial n.
- posterior tibial artery.
Where do the posterior tibial n. and artery run?
posterior aspect of medial malleolus
palpating the posterior tibial artery
- fingers between where you visualize Dick and Harry
- may need to PF and evert the foot