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ECOS I Exam 1 > Ankle And Foot Complaint > Flashcards

Ankle And Foot Complaint Flashcards

1
Q

What should be palpated on the foot?

A

Anterior ankle joint, medial and lateral malleolus, Achilles’ tendon, MP joint and heads, heel

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2
Q

What is normal muscle strength?

A

5/5

Active motion against gravity and full resistance without evidence of fatigue

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3
Q

What is the talar tilt test?

A

Lateral ankle sprain

Calcaneofibular ligament or anterior talofibular ligament injury

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4
Q

What is the eversion test?

A

Medial ankle sprain

Deltoid ligament injury

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5
Q

Anterior drawer test can also test for what injury?

A

Lateral ankle sprain

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6
Q

What is the squeeze test?

A

High ankle sprain

Distal tibiofibular syndesmosis injury

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7
Q

What does Homan’s sign test for?

A

DVT

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8
Q

What are the three main types of ankle sprains?

A

Lateral ankle sprain, medial ankle sprain and syndesmosis ankle sprain (aka high ankle sprain)

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9
Q

What is the most common ankle sprain?

A

Lateral ankle sprain

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10
Q

Describe lateral ankle sprains

A

Mechanism of injury is foot inversion and/or plantar flexion
Most likely ligaments injured include anterior talofibular ligament* and calcaneofibular ligament

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11
Q

What positive special tests are associated with lateral ankle sprains?

A

Talar tilt test (inversion test) and anterior drawer

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12
Q

Describe medial ankle sprains

A

Mechanism of injury is forced eversion
Most likely ligament involved is the deltoid ligament
Associated positive special test is eversion test

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13
Q

What is a grade 1 ankle sprain?

A

No laxity in the joint = minimal ligament damage

Manage conservatively with NSAIDs, RICE, PT

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14
Q

What is a grade 2 ankle sprain?

A

Mild to moderate laxity in the joint

Manage conservatively

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15
Q

What is a grade 3 ankle sprain?

A

Complete disruption of the ligament

Conservative management with immobilization x3 weeks (if unstable surgery is likely needed)

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16
Q

What is a syndesmodic/high ankle sprain?

A

Mechanism of injury is forced external rotation of a dorsiflexed ankle
Most likely ligament involved tibiofibular syndesmosis
Associated positive test: squeeze test

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17
Q

What are the most common Achilles diagnoses?

A

Tendinitis, Achilles rupture and Sever’s disease (calcaneal apophysitis)

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18
Q

What is Achilles tendonitis?

A

Inflammation of the Achilles tendon
Repetitive motions create micro tears in the tendon resulting in inflammation
Most commonly associated with competitive/recreational activites

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19
Q

What are signs and sx for Achilles tendonitis?

A

Pain/stiffness at tendon insertion
Recent increase in exercise/activity level
Pain is worse with activity and goes away with rest
NEGATIVE Thompson test

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20
Q

What is Achilles’ tendon rupture?

A

A tear of the Achilles’ tendon

Most commonly associated with competitive/recreational athletes

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21
Q

What are the signs and sx for Achilles’ tendon rupture?

A

80% occur during high impact recreational sports
Pts report a popping sensation at their heel
+/- pain
Associated special test: positive Thompson test

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22
Q

What is Sever’s disease (calcaneal apophysitis)?

A

An inflammation or stress injury to the areas on and around an apophysis (growth plate)
Active children going through growth spurts are affected

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23
Q

What are sings and sx for Sever’s disease?

A

Chronic heel pain in growing children
Pain is related to increased activity
Pain is reproduced with direct palpation over the apophysis

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24
Q

What is tibiotalar effusion?

A

An abnormal accumulation of fluid in or around a joint

Can be caused by a number of things including injury, arthritis, infection or hemearthrosis

25
Q

What is pes planus?

A

A loss of the longitudinal arch of the foot

Flat feet

26
Q

What is pes cavus?

A

An exaggeration of the longitudinal arch of the foot

27
Q

What is hallux valgus (aka a bunion)?

A

Very common foot malformation
Defined by the lateral deviation of the big toe
Progressively leads to the development of a prominence on the medial aspect of the MP joint (a bunion)
Presence of hallux valgus can lead to inflammation and irritation at the first MTP joint

28
Q

What is plantar fasciitis?

A

Inflammation of plantar fascia

The result of repetitive biomechanical use resulting in micro tears of the fascia

29
Q

What are the signs and sx of plantar fasciitis?

A

Sharp stabbing plantar/heel pain
Pain is worse with first few steps in the morning and improves as the day goes on
Pain is made worse by prolonged standing
Pain reproduced with forced dorsiflexion

30
Q

What is Morton’s neuroma?

A

Inflammation and thickening of tissue that surrounds the nerve between the toes
Pt will report feeling like they are walking on a marble*
Palpable in web space which will replicate burning pain
Can have radiation of pain and numbness of toes

31
Q

What is the relevant special test of Morton’s neuroma?

A

Mulder’s sign - a palpable clicking sensation between the third web space as the transverse arch is compressed

32
Q

What is fibular nerve compression?

A

When the fibular nerve gets compressed leading to dysfunction of the distal nerve
Most commonly compressed at the point it wraps around the lateral aspect of the fibular head (prolonged lying, crossing legs, ankle sprains, prolonged immobilization in a cast)

33
Q

What is Charcot foot?

A

A consequence of chronic foot inflammation that ultimately results in mid foot deformities and a collapse of the longitudinal arch
Always associated with neuropathy of the foot (diabetic neuropathy)

34
Q

What are the signs and symptoms of Charcot foot?

A

Visible collapse of the longitudinal arch
Warmth, redness and edema over the joint
History of minor trauma
Long term history of peripheral neuropathy

35
Q

What is diabetic neuropathy?

A

A common complication of uncontrolled diabetes
When the pts blood sugar remains elevated peripheral nerves are damaged which no longer function well and pts will lose sensation
As a result pts frequently develop injures in their feet

36
Q

What is gout?

A

An inflammatory arthropathy caused by the deposition of monosodium urate crystals in the joints

37
Q

What are the signs and sx of gout?

A

Most commonly occurs in the first MTP joint
Diet high in purines
Pts frequently have past exacerbation
Joint aspiration reveals negatively birefringement needle shaped crystals

38
Q

Because the distal fibula is attached to the talus and calcaneus, motion of the ankle will cause what?

A

Motion of the fibula

39
Q

Injures at the ankle will frequently cause dysfunction in what?

A

The knee due to the linked motion at the fibular head

40
Q

What is supination of the foot?

A

Plantar flexion + inversion + adduction

Pronation is opposite

41
Q

Motion at the foot/ankle can both be what?

A

A modality to create and treat SD at the fibular head

42
Q

What is dorsiflexion of the tibiotalar joint?

A

Posterior glide of the talus is the minor motion with dorsiflexion
Makes the ankle stable

43
Q

What occurs with plantar flexion of the tibiotalar joint?

A

Anterior glide of the talus is the minor motion

Makes ankle less stable

44
Q

What is the minor motion with eversion of the tibiotalar joint?

A

Anteromedial glide of the talus

45
Q

What is the minor motion with inversion?

A

Posterolateral glide of the talus

46
Q

As the calcaneus moves into eversion the talus will do what?

A

Glide anteriorly and medially 5-10 degrees

47
Q

As the calcaneus moves into inversion, the talus will do what?

A

Glide posteriorly and laterally 5-10 degrees

48
Q

What is plantar glide?

A

A sliding motion (along an axis) of a tarsal bone toward the plantar surface in relation to surrounding bones

49
Q

What is dorsal glide?

A

A sliding motion along an axis of tarsal bones toward the dorsum of the foot in relation to surrounding bones

50
Q

The plantar glide of the cuboid and navicular bones are coupled with what?

A

Rotation about an AP axis which creates an eversion of the cuboid and an inversion of the navicular during plantar glide

51
Q

What motion does the cuboid prefer?

A

Eversion glide with plantar glide

52
Q

What motion does the navicular prefer?

A

Inversion glide with plantar glide

53
Q

What motion do the cuneiforms prefer?

A

Plantar glide only

54
Q

Describe metatarsal motions

A

The metatarsals will glide toward the plantar and dorsal surface as they articulate with their respective tarsal bones
Motion is named for the direction of the metatarsal head
Thus the motions that we evaluate at the metatarsals are dorsal and plantar glide

55
Q

What are the three motions of the MTP, PIPs and DIPs?

A

Dorsal/plantar glide (flexion/extension)
Rotatory glide (internal/external rotation)
Abduction/adduction (medial/lateral glide)

56
Q

What are the Ottawa ankle rules?

A

The guidelines for when to order X rays on a pt with an ankle injury

57
Q

What do the Ottawa ankle rules when a pt has pain in the malleolar zone?

A

Must have at least one of the following:
Bone tenderness at the posterior tip of the medial and lateral malleolus
Unable to bear weight immediately after injury and unable to walk 4 steps in the office

58
Q

What do Ottawa ankle rules state when a pt has pain in the mid foot region?

A

Must have at least one of the following:
Bone tear depress at 5th metatarsal or the navicular
Unable to bear weight immediately after injury and unable to walk 4 steps in the office

59
Q

What are the two types of pain that should make you consider an X-ray?

A

Pain in the malleolar zone or pain in mid foot region

ECOS I Exam 1 (26 decks)

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