Ankle and Foot

Question 1

How many bones and joints make up the ankle and foot?

Answer 1

26 bones, 34 joints.

Question 2

What is the function of the ankle and foot?

Answer 2

it is a mobile adaptor and rigid lever.

Question 3

What bones make up the anatomy of the foot and ankle?

Answer 3

Tibia, fibula, calcaneus, talus, cuboid, navicular, cuneiforms, metatarsals, and phalanges.

Question 4

What are the bony landmarks of the tibia?

Answer 4

medial malleolus and fibular notch.

Question 5

What are the bony landmarks of the fibula?

Answer 5

lateral malleolus and malleolar fossa.

Question 6

Where is the talus located?

Answer 6

Base of the tibia, can be palpated during dorsiflexion. It has no muscular attachments.

Question 7

What are bony landmarks of the calcaneus?

Answer 7

tuberosity and sustentaculum tali.

Question 8

What ligaments make up the lateral collateral ligament?

Answer 8

posterior talofibular ligament, calcaneofibular ligament, anterior talofibular ligament.

Question 9

What are the medial talocrural ligaments that make up the deltoid ligament?

Answer 9

posterior tibiotalar portion, tibiocalcaneal portion, anterior tibiotalar portion, and tibionavicular portion.

Question 10

What muscles aid in dorsiflexion?

Answer 10

Tibialis anterior, extensor digitorum longus(EDL), extensor hallucis longus, peroneus tertius

Question 11

What muscles aid in plantarflexion?

Answer 11

Gastrocnemius, soleus, tibialis posterior, flexor digitorum longus, flexor hallucis longus, peroneus brevis/longus, and plantaris.

Question 12

What muscles aid in inversion?

Answer 12

Tibialis anterior, tibialis posterior, extensor hallucis longus, extensor digitorum longus, flexor hallucis longus.

Question 13

What muscles contribute to eversion?

Answer 13

Peroneus longus, peroneus brevis, peroneus tertius, extensor digitorum longus.

Question 14

What kind of joint is the ankle?

Answer 14

hinge

Question 15

When is the ankle most stable?

Answer 15

dorsiflexion

Question 16

What are the degrees of motion for the ankle in dorsiflexion and plantar flexion?

Answer 16

10 degrees dorsiflexion to 50 degrees plantar flexion.

Question 17

What are functional tests for ankle injuries?

Answer 17

walk on toes, heels, lateral and medial borders of the feet, hop on injured ankle.

Question 18

What are inversion sprains?

Answer 18

most common and injures lateral ligaments. The anterior talofibular ligament is injured from inversion/plantar flexion/ internal rotation. Severity of sprain classified according to grade.

Question 19

What are the Ottawa ankle rules for? What are the criteria?

Answer 19

Used to determine if x-rays are needed.

• pain in malleolar or midfoot
• tenderness over inferior or posterior pole of either malleoli
• inability to bear weight
• tenderness along base of 5th metatarsal.

Question 20

What is a grade 1 ligament sprain etiology, sign/symptom, and management?

Answer 20

occurs with inversion/plantar flexion stretching the anterior talofibular ligament.
mild pain/disability, weight bearing minimally impaired.
RICE 1-2 days; tape, return to activity 7-10 days.

Question 21

What is a grade 2 ligament sprain? etiology, signs and symptoms, and management?

Answer 21

moderate inversion force causing disability and many days of lost time.
feel/hear pop/snap; moderate pain w difficulty weight bearing.
RICE for 72 hrs, x-rays to rule out fracture, crutches 5-10days; protective immobilization required but begin ROM exercises early; taping provides support.

Question 22

What is a grade 3 ligament sprain etiology, sign/symptoms, and management?

Answer 22

uncommon but disabling, significant force resulting in subluxation/reduction. Damages anterior/posterior talofibular and calcaneofibular ligaments.
severe pain/swelling, hemarthrosis, discoloration. No weight bearing.
-RICE, x-rays, splint 3-6 weeks, crutches after cast removal. Isometric exercise in cast, ROM, PRE, balance exercises out of cast.
Potential surgery to stabilize ankle.

Question 23

What are eversion sprains?

Answer 23

5-10% ankle sprains.

eversion force results in damage to deltoid ligament and potential fracture to fibula.

Question 24

Etiology, signs and symptoms and management of eversion sprains:

Answer 24

pronated, hypermobile or depressed medial longitudinal arch.
severe pain/unable to weight bear.
RICE; x-ray, NSAIDs, same course of treatment as inversion.
Grade 2 or higher may result in excessive pronation or fallen arch.

Question 25

What are syndesmotic sprains?

Answer 25

damage to anterior/posterior TIBIOFIBULAR ligament, injured with medial/lateral ligaments occurring in dorsiflexion.

Question 26

Etiology, signs and symptoms, and management of syndesmotic sprains:

Answer 26

excessive/forced dorsiflexion, external rotation of leg or combination of both. can be benign/assume ankle sprain, pain/tenderness over anterior syndesmosis, pain in dorsiflexion & eversion, joint weakness and inability to bear weight. Difficult to heal, may take months of treatment. Surgery may be required.

Question 27

What are the 3 rearfoot joints?

Answer 27

1. tibiofibular 2. talocrural 3. subtalar

Question 28

what is the purpose of the midfoot joints and how many are there?

Answer 28

allow for greater movement and adaption into many positions; made up of 6 separate joints.

Question 29

What are the six midfoot joints?

Answer 29

1.transverse tarsal joint(chopart's) 2. plantar calcaneonavicular (spring ligament) 3.dorsal talonavicular ligament 4. bifucated ligament 5/6. long/short plantar ligaments.

Question 30

How many forefoot joints are there and what are their names?

Answer 30

1. lisfranc's joint 2. intermetatarsals joints 3. metatarsophalangeal joints 4. interphalangeal joints.

Question 31

How many arches of the foot are there? What are they called?

Answer 31

1. medial longitudinal arch 2. lateral longitudinal arch 3. transverse arch.

Question 32

What is pes planus foot? What is the etiology, signs/symptoms and management?

Answer 32

known as flatfoot. -excessive pronation and forefoot varus -wearing tight shoes that weaken supportive structures -being overweight -excessive exercise. pain, weakness, fatigue in medial longitudinal arch, calcaneal eversion, bulging navicular, flattening of medial longitudinal arch, increases stress of muscles that control pronation. no pain requires no correction. if there is pain, use orthotics and taping.

Question 33

What is pes cavus? Etiology, signs and symptoms and management:

Answer 33

High arch foot. higher than normal arch, associated with excessive supination. rigid foot, poor shock absorber. associated with forefoot valgus, shortening achilles and plantar fascia. asymptomatic needs no correction. orthotics if problem occurs, stretching of achilles and plantar fascia.

Question 34

What is plantar fasciitis?

Answer 34

term used for pain in proximal arch and heel. common in athletes/non-athletes. attributed to heel spurs, plantar fascia irritation and bursitis.

Question 35

What is the etiology, signs and symptoms and management for plantar fasciitis?

Answer 35

increased tension/stress on fascia, change from rigid support to flexible footwear. poor running techniques, leg length discrepancy/excessive pronation/inflexible longitudinal arch, tight gastroc-soleus complex. pain in anterior medial heel, along medial longitudinal arch. increased pain am, forefoot dorsiflexion. orthotic therapy, simple arch taping, stretching, massage.

Question 36

What is a subungual hematoma?

Answer 36

occurs when direct pressure occurs on toe. accumulation of blood underneath toenail, often causes nail loss. RICE, relieve pressure within 12-24 hrs.

Question 37

What is required for athlete to return to activity after assessment?

Answer 37

full ROM, 90% strength and minimal pain.

Question 38

What should you determine when making sideline assessment decisions?

Answer 38

how serious injury is, what type of first aid is required, is there a need for immediate referral, will there be a type of transportation required to training room or hospital.

Question 39

What does HOPS stand for?

Answer 39

History Observation Palpation Special tests

Question 40

What should consider when asking about history?

Answer 40

events of injury and those leading up to it is there previous injuries to site, what treatments were used were there any sounds/sensations what kind of pain is it

Question 41

What kind of observations are you looking for?

Answer 41

deformity, swelling, skin discoloration. make sure to compare injured to non-injured side.

Question 42

What are the special tests for?

Answer 42

assessing injured tissue, checking integrity of joint

Question 43

What are the special tests for the foot and ankle?

Answer 43

tap test, compressions, ottawa ankle rule.