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PTA Ortho > ANKLE > Flashcards

ANKLE Flashcards

(63 cards)

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1
Q

Motions

A

DF/PF

Inversion/Eversion

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2
Q

Tibia and Fibula bound together by

A

interossous membrane

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3
Q

Hind foot

A

talus and calcaneus

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4
Q

mid foot

A

navicular
cuboid
3 cuniforms

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5
Q

forefoot

A

5 metatarsals

14 phalanges

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6
Q

Distal tibiofibular Joint

A

CONVEX fibular head with CONCAVE fibular notch on TIBIA

fibrous joint

small amount of gliding occurs with ankle motions

**W/ full ankle DF there is gliding with this joint

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7
Q

Talcrural Joint-Ankle Mortise

A

Distal tibia, distal fibula and talus

Hinge Joint

DF/PF motion

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8
Q

Open/Closed pack of Talocural joint

A

Open: 10 degrees of PF
Closed=full DF

End feels: FIRM

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9
Q

Open and Closed Chain movement of Talocrural Joint

A

CONVEX talus on CONCAVE tibia/fibula

OPEN: Talus on Tib/Fib
PF: anterior
DF-posterior

CLOSED: Tib/Fib on Talus
DF:anteriorly
PF: Posteriorly

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10
Q

Deltoid ligament

A

Talocrural joint ligament
medial malleolus to navicular, talus and calcaneus

Mantains medial stability and prevents eversion injuries

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11
Q

Lateral ligaments of Talocrural joint

A

-Mantains lateral stabiliity, prevents inversion injuries

  1. anterior talofibular lig=from tibia to fibula
    - ant. side
    - lateral malleolus to ant. talus
  2. posterior talofibular lig.= tibia to fibula
    - post. side
    - lateral malleolus to pos. talus

3.calcaneofibular lig.= from lateral malleolus to calcaneus

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12
Q

subtalar joint

A

supination/pronation=standing position= CK
eversion/inversion=open chain

  • planar joint
  • calcaneus articulates with Talus
  • pronation/supination
  • eversion/inversion

OPEN/CLOSED PACK

O: Neutral
C: Full Supination

**CONVEX calcaneus on CONCAVE talus

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13
Q

Transverse Tarsal Joint

A

Planar Joint

Between talus and: Navicular, calacneous and cuboid

Transverse Arch= Cuboid-> cuneiform 3-> cuneiform 2 -> cuneiform 1

Position:
Pronation/supination

P: transverse arch flattens
S: transverse arch raises

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14
Q

MTP JOINTS

A

condyloid joint
CONVEX distal metatarsal head on CONCAVE proximal portion of proximal phalanx

Flex/ext
Abd/add

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15
Q

IP PIP DIP joints

A

Hinge joint

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16
Q

Medial Longitudinal arch

A

longer and higher arch

RUNS FROM:
medial metatarsals to:
-cuneiforms
-navicular
- talus
-calcaneus

Supported by spring lig., plantar aponeurosis and long/short plantar lig.

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17
Q

Lateral Longitudinal arch

A

Lateral Metatarsals to:
cuboid
calcaneus

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18
Q

Transverse longitudinal arch

A

cuboid to cunieform 3
to Cunieform 2—-which is HIGHEST
to cuneiform 1

Lateral to medial

supported by spring ligament

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19
Q

windlass effect

A

during heel off in gait::
MTPs extend

  • increases tension on plantar aponeurosis
  • helps increase the arch
  • provides more rigid foot during push-off as foot Plantarflexes and supinates
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20
Q

Prontation

A

foot/heel ABDUCTED
Foot EVERSION

flexible foot to accommodate to ground surfaces during foot flat-> midstance

overpronation effect:
internally rotates leg with flexion
SHORTENS LIMB
-everything drops down and in

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21
Q

Supination

A

Foot/hee ADDUCTIONs
Foot INVERSION

rigid foot to develop force for push-off

Oversupination effect:
Externally rotates leg with extension
everything goes up and out

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22
Q

Gait: SWING PHASE

A

when foot is not in contact with the ground “swing through”

3 stages:
acceleration, midswing and deceleration-> opp. muscles are working to slow everything down

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23
Q

Gait: Stance phase

A

when foot is in contact with the ground

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24
Q

heel strike

A

when heel contacts the ground and foot is slowly lowered to the ground

eccentric control

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25
foot flat
when entire foot is in contact with the ground
26
midstance
body passes over WB foot
27
heel off
heel raises off the ground
28
toe off
period just before and after toes leave the ground
29
DF muscles
anterior tibialis extensor digitorum longus and brevis needed for pure DF Gait Function: -controls food as it lowers to the ground after heel strike--eccentric -keeps foot from dragging during swing phase--concentric
30
Plantarflexor muscles
attach to calcaneus by way of achilles tendon Gastrocnemeus-2 joint muscle soleus-1 joint muscle GAIT FUNCTION: - Heel-off : raise heel before push off---concentric - powerful concentric contraction for PUSH OFF-concentric
31
Evertors
evert the foot and support the arches peroneus longus-EV//PF Peoneus bevis-EV
32
Invertors
anterior tibialis posterior tibialis-slows down foot so when we heel strike the foot doesnt roll into eversion GAIT FUNCTION heel strike to midstance controls movement of foot into pronation-eccentric
33
Anterior Drawer sign
identifies tear in anterior talofibular ligament pt. supine with leg relazed and ankle in 10-20 degrees plantarflexion therapist stabilizes distal tib& fib and draws the talus anterior on the mortise += anterior translation is greater than univolved side
34
Talar tilt test
identifies tear in calcanofibular ligament pt. supine w/ leg relazed and ankle in neutral therapist tilts the talus medially while palpating the calcanofibular lig. += excessive inversion compared to uninvolved side
35
Thompson test
identifies rupture of achilles tendon pt. prone with knee extended and feet over the edge of plinth therapist squeezes the middle 1/3 of gastroc muscle belly += normal plantar flexion response is not elicited
36
Homan's sign
identifies DVT signes of DVT= calf swelling, erythema, warmth therapist passively DF ankle while squeezing pts. calf += pt. c/o sudden increase in pain
37
Lateral ankle complex
anterior talofibular lig calcaneal fibular lig posterior talofibular lig **most common ankle sprain**
38
Lateral ankle complex causes
inversion with PF-stepping off curb, stepping on another persons foot medial malleolus is not able to stop inversion because it does not extend distally
39
Clinical signs of lateral ankle complex injury
tenderness over ligaments swelling of lateral ankle/bruising painful gait weakness
40
tests for lateral ankle complex injury
anterior drawer | talar tilt
41
Phase 1 : inversion sprain rehab
``` Max protextion RICE modalities joint protextion-bracing AROM isometrics general fitness ```
42
Phase 2: inversion sprain rehab
``` Moderate Protection RICE PREs bands, weights joint protection achilles/calf stretching proprioception exercises general fitness/cycling avoid inversion/PF ``` **Need to reteach muscles how to properly fire in correct sequence
43
Phase 3: inversion rehab
minimal protection ``` joint protection during activities advanced proprioception exercsies functional progression running, jumping plyometrics ```
44
Medial Ankle Complex
Deltoid ligament injury less common CAUSE: eversion with DF **deltoid ligament can avulse-tearing off a piece of tibia due to the strength of tendon distal fibula may fracture from eversion force
45
achilles tendonITIS
inflammation of tendon CAUSE: oceruse-increase in training/running changes in running surfaces decreased flexibility of gastrocnemius/soleus-->possibly hamstrings too **acute and located where achilles inserts
46
Achilles tendinOSIS
fibrotic changes of tendon-->pain and issue more along muscle portion of achilles CAUSES: impairment of blood supply to tendon with resultant tendon degeneration achilles tendon does not normally have good circulation
47
Clinical signs of achilles tendinopathy
pain with resisted PF pain with stretch of gastrocnemues, soleus tendon site tender to palpation antalgic gait with poor heel rise/push-off
48
achilles tendon rupture
occurs as sudden DF injury *often due to recreational sport tear typically occurs 2 inches above instertion most common in men from 20-50 y.o
49
clinical signs of achilles rupture
audible pop when rupture occurs severe pain when rupture occurs gait changes-no heel up or push off TEST: Thompson test
50
surgical management of achilles rupture
open surgical repair by non essential muscle-plantaris s/p surgery ankle will be casted or put in boot different MDs and procedures will determine exercise progression cast will be in PF to keep plantarflexors on slack slow return to DF and PF ROM **start with isometrics**
51
Plantar fasciiitis
longitudinal arch flattens, pulling and inflaming on the plantar fascia chronic inflammation of the plantar fascia/aponeurosis results
52
causes of plantar fasciitis
repetitive microtrauma to plantar fascia-jumping, running etc ``` can include heel spur obesity age-40-60 occupational-standing long periods of time poor arch support ```
53
clinical signs of plantar fasciitis
pain at heel pain along longitudinal arch ``` antalgic gait: pain with push off pain with WB pain worse in morning, especially first few steps heel spur-point tenderness ```
54
Hallux Valgus and Bunion deformity
transverse arch has flattened distal portion of metatarsals have moved away from each other proximal phalanx of great tos is held in place by adductor hallucis can be exacerbated by improper footware surgical management: Bunionectomy=surgical relocation of phalanx with pin/screws *more common in women*
55
Shin Splints
inflammation and micro damage to the periosteum of the tibia near origin of posterior or anterior tibialis muscle **caused by muscles trying to slow down the foot at heel strike*** Outside of leg pain= ant. tib inside of leg pain= post. tib
56
Clinical signs of shin spints
``` pain along medial or lateral lower leg pain with acitivity/ running pain with resisted : DF= ant. tib Inversion=post. tib ```
57
Overprontation issue with shin splints
tight PF and weak Ant. tib
58
Stress fracture
overuse and unrelenting stress to tibia, fibula and metatarsals usually due to running *can be caused by shin splints
59
Pylon fracture
distal tibia compression fracture when forced into talus usually fibula breaks too CAUSES: - auto accident - fall from a height - skiing accident **Extensive surgical management
60
Malleolar fractures
Lateral Malleolar-distal fib fracture medial malleolar-distal tib fracture bimalleolar-both distal tib/fib fracture trimalleolar-distal fib/tib and posterior margin of distal tibia fractured
61
protection phase rehab
``` follw MD protocol alter activity to protect motion braces/splinting/taping decrease stress on area with altering WB -AD if needed well joint mobility strength&flexibility pain free ROM multi-angle isometrics supportive modalities ```
62
Controlled motion phase rehab
CRITERIA - decreased edema - full pain-free WB ``` Maximize ROM Maximie strength-OKC,CKC resolve gait deviations maximize flexibility of entire chain balance return to functional acitiivities ```
63
Return to function phase
Criteria: - full pain free ROM - good strength&balance - no gait deviations Functional training adapt return to function to prevent reinjury If appropriate: -plyometrics speed drills

PTA Ortho (5 decks)

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