Ankle and Foot

Question 1

Special Tests: Ankle Sprain

Answer 1

AFL: Anterior drawer

AFL + CLF: Talar tilt

Question 2

Special Tests: Maisonneuve fracture

Answer 2

Fibular head palpation

Question 3

Special Tests: High ankle sprain

Answer 3

• Squeeze test
• External Rotation Test: Passivle DF + EROT of foot
• Fibular Drawer test: Pt on side → Anterior/posterior force placed on fibular w/ increased translation

Question 4

Special Tests: Tarsal Tunnel Syndrome

Answer 4

Tinel

Question 5

Special Tests: Stress fracture

Answer 5

Hop Test

Question 6

3 functional parts of foot

Answer 6

• Hindfoot: Calcaneus, talus
• Midfoot: Navicular, cuboid, cuneiform
• Forefoot: Phalanges, metatarsals

Question 7

Components of hindfoot

Answer 7

• Hindfoot: Calcaneus, talus

Question 8

Components of midfoot

Answer 8

• Midfoot: Navicular, cuboid, cuneiform

Question 9

Components of forefoot

Answer 9

Forefoot: Phalanges, metatarsals

Question 10

3 ligament complexes of the ankle

Answer 10

• Lateral: ATFL, CFL, PTFL
• Medial: Deltoid
• Interosseous: AITF, PITF, IO

Question 11

Sign for pes planus

Answer 11

Too many toes sign

Question 12

Special tests: Evaluates stability of ATFL

Answer 12

Anterior drawer test

Question 13

Special tests: Positive anterior drawer

Answer 13

3-5 mm increased translation

Question 14

Special tests: Evaluates ATFL and CFL

Answer 14

Talar tilt test

• ATFL: Inversion of foot w/ ankle plantar flexed
• CLF: Inversion w/ foot dorsiflexed

Question 15

Special tests: Morton’s Neuroma

Answer 15

Metatarsal squeeze test

Question 16

Moton’s neuroma

Answer 16

Neurofibroma of branch of tibial nerve between metatarsal heads

Question 17

Special tests: Positive metatarsal squeeze test

Answer 17

Pain + Paresthesias radiating to toes + Palpable click

Question 18

Special tests: Ruptured achilles tendon

Answer 18

Thompson

Question 19

Special tests: Peroneal subluxation test

Answer 19

Recurrent inversion ankle sprains

• Subluxation of peroneal tendons over lateral malleolus w/ active dorsiflexion and eversion against resistance

Question 20

Special tests: Distinguish between MTSS and Tibial stress fracture

Answer 20

Hop test

Question 21

Special tests: Areas of palpation w/ inversion ankle sprains

Answer 21

• Base of 5th Metatarsal: tuberostiy avulsion, jones fracture

Question 22

Special tests: Areas of palpation w/ eversion ankle sprains

Answer 22

• Proximal fibular: Maisonneuve fracture

Question 23

Types of 5th metatarsal fractures

Answer 23

• Avulsion Fracture
• Jones Fracture
• Stress Fracture

Question 24

Ottawa ankle rules (3)

Answer 24

1. Unable to ambulate 4 steps immediately after injury or in ER
2. Bony tenderness over distal 6 cm of tibia and fibula (includes malleoli)
3. Tenderness over navicular bone or base of 5th metatarsal

Question 25

Maisonneuve fracture

Answer 25

medial malleolus fracture/medial ligament complex injury + Fracture of proximal fibula ![]() ![]()

Question 26

Mechanism of high ankle sprain

Answer 26

Hyperdorsiflexion +/- Eversion

Question 27

* Burning/electrical pain on base of foot/heel * Paresthesia radiating to toes * Symptoms exacerbated w/ standing/walking/driving * (+) Tinel's at tarsal tunnel

Answer 27

Tarsal tunnel syndrome

Question 28

Contents of tarsal tunne l

Answer 28

* Tibial nerve * Tibialis posterior tendon * Flexor digitorum tendon * Flexor hallucis longus tendon

Question 29

Hallux rigidus

Answer 29

OA of 1st MTP

Question 30

Cause of turf toe

Answer 30

Hyperdorsiflexion injury to 1st MTP leading to stretching or tearing of soft tissue restraints on dorsal aspect * Soft shoes * Hard playing surfaces

Question 31

Lisfranc injury

Answer 31

Lisfrance ligament injury attaching medial cuneiform to 2nd metatarsal

Question 32

Causes of lisfranc injury

Answer 32

* MVC * Falls * Contact sports

Question 33

Lisfranc injury exam

Answer 33

* Swelling/tenderness over tarsal/metatarsal area * Inability to bear weight or stand on toes * Pain w/ passive abduction and pronation w/ hindfoot is stabilized ![]()

Question 34

Frieberg's infarction

Answer 34

AVN of metaphysis of 2nd/3rd metatarsal heads

Question 35

* Vague plantar foot pain w/ wt. bearing * pain/tenderness/decreased ROM of affected MTP joint * Woman * Younger

Answer 35

Freiberg infraction

Question 36

Common locations of foot arthritis

Answer 36

* **Posterior Heel:** Achilles tendon * **Media ankle:** Posterior tibialis, Flexor digitorum longus, Flexor hallucis longus * **Lateral Ankle:** Peroneous longus/brevis

Question 37

Achilles tendon bursas

Answer 37

* **Retrocalcaneal bursa:** between calcaneous and achilles * **Subcutaneous bursa:** between achilles tendon and skin

Question 38

Haglund's deformity

Answer 38

Prominence of posterior superior aspect of calcaneous

Question 39

Most common stress fractures in lower leg

Answer 39

Tibua metatarsal

Question 40

High risk stress fracture locations

Answer 40

* Superior Femoral Neck (Tension) * Pars interoarticularis of lumbar spine * Femoral head * Proximal 5th metatarsal shaft * Base of 2nd metatarsal * Anterior cortex of tibia * Medial malleolus * Talus * Tarsal Navicualr * Patella * Great toe sesamoid

Question 41

**Treatment:** 5th metatarsal stress fracture

Answer 41

Surgical: *Conservative treatment may be attempted in select pts but usually requries up to 20 wks protected wt bearing/NWB*

Question 42

* Young athlete/military recrute * Point tenderness over proximal 5th metatarsal * (+) Hop test

Answer 42

5th Metatarsal stress fracture: March Fracture

Question 43

* Track and field athlete * Point tenderness over posterior navicular (N spot) * (+) Hop test * Pain w/ toe raises

Answer 43

Tarsal navicular stress fracture ![]()

Question 44

Periostitis of medial border of tibia

Answer 44

Medial Tibial Stress Syndrome: Shin splints