ankle and foot examination part 2

Question 1

what are some common sites for foot and ankle fractures?

Answer 1

calcaneous
5th metatarsal (jones fx)
stress fractures of metatarsals (march fx)
distal fibula avulsion fx (traumatic)
fibular stress fracture

Question 2

what is a common MOI for foot and ankle fractures?

Answer 2

trauma vs repetitive stresses/overuse

Question 3

what are some symptoms of a fracture in the foot and ankle?

Answer 3

swelling, tenderness, gait change, reproduction of CC by performing activity

Question 4

what are some special tests for foot and ankle fractures?

Answer 4

ottawa foot and ankle rules
metatarsal compression test
tuning fork

Question 5

what is the purpose of the ottawa foot and ankle rules?

Answer 5

to determine which patients who have experienced trauma may need radiographs

Question 6

what are some benefits of the ottawa foot and ankle rules?

Answer 6

this may help to decrease unnecessary exposure to radiation and reduce costs

Question 7

what are some limits to the ottawa foot and ankle rules?

Answer 7

can only be used in skeletally mature patients and only if within 10 days of traumatic event

Question 8

according to the ottawa foot and ankle rules what is the criteria for an xray required for the ankle?

Answer 8

upon palpation pain in malleolar region
bone tenderness distal 6cm of post med/lat malleolus
inability to bear weight on limb

Question 9

according to the ottawa foot and ankle rules what is the criteria for an xray required for the foot?

Answer 9

upon palpation pain in metatarsal region
bone tenderness at base of 5th metatarsal or navicular
inability to bear weight on the limb

Question 10

what is the metatarsal compression test (Moton’s test)

Answer 10

pos test if pain with metatarsal fracture or neuromas
proactive test
88% sensitive
false positive in patients with metatarsalgia
unclear evidence to support this test

Question 11

what is the tuning fork test for a fibular fracture?

Answer 11

patient lays supine, stethoscope is placed on fibular head, and a hit tuning fork on the lateral malleolus
pos test if there is a different sound in bilateral comparison
83% sensitive and 80-92% specific
minimal evidence to support this test

Question 12

what is the MOI for an achilles tendon rupture?

Answer 12

trauma, often when jumping or landing, prolonged steroid of h/o certain antibiotic use

Question 13

what are some symptoms of an achilles tendon rupture?

Answer 13

“hit” in the back of the ankle, report hearing a loud “pop”

Question 14

what age and sex is typically affected by an achilles tendon rupture?

Answer 14

typically males >40 years old

Question 15

what activities commonly cause achilles tendon ruptures?

Answer 15

“weekend warrior” explosive activities

Question 16

what medications can cause achilles tendon ruptures?

Answer 16

fluoroquinolones (antibiotics), systemic corticosteroids

Question 17

what can we as PTs look for when looking to determine an achilles tendon rupture?

Answer 17

palpable defect, severe loss of function

Question 18

what is the thompson test?

Answer 18

pos test if nonresponsive ankle PF during the test
40% sensitivity
unclear evidence to support this test
recommend using concurrent patient history

Question 19

what should you look for with the bilateral toe raise?

Answer 19

cant see the tendon connected on one side may see slight bulge

Question 20

are all achilles tendon ruptures surgical?

Answer 20

no

Question 21

what is the MOI for a DVT?

Answer 21

insidious onset, after recent surgery or immobilization, oral contraceptives

Question 22

what are some signs and symptoms of a DVT?

Answer 22

calf pain, ankle swelling
antalgic gait

Question 23

what are some special tests for a DVT?

Answer 23

Homan’s sign
Calf swelling
Well’s criteria for DVT

Question 24

what is Homans sign?

Answer 24

a + test is popliteal and/or calf pain when squeezed
many presentations lead to false positives
minimal evidence to support this test

Question 25

how is calf swelling used as a special test for DVT?

Answer 25

+ test if bilateral comparison reveals difference of 15 mm for men or 12 mm for women 90% sensitive, 92% specific minimal evidence to support this test

Question 26

what is well's criteria for a DVT?

Answer 26

asking questions related to recent events = test is related to score on test 78% sensitive, 98% specific evidence strongly supports the use of this test

Question 27

what is the common MOI for musculotendinous injuries?

Answer 27

poor footwear tight musculature overuse muscle imbalance

Question 28

what are some signs and symptoms for a musculotendinous injury?

Answer 28

pain with active contraction of muscle and passive lengthening of the muscle (STT testing) + Biomechanical examination (WBing and NWBing)

Question 29

How should you inspect a musculotendinous injury when the patient is NWB?

Answer 29

Short sitting or prone

Question 30

How should you inspect a musculotendinous injury when the patient is NWB short sitting?

Answer 30

Inspect the foot health View transverse arch: most evident in this position Measure tibial torsion

Question 31

What would you inspect a musculotendinous injury when the patient is NWB prone?

Answer 31

Passive hip rotation Subtalar joint neutral- measurement of forefoot and rear foot valgus/valgus

Question 32

How would you inspect a musculotendinous injury when the patient is WB?

Answer 32

Anterior- proximal to distal observation and Posterior

Question 33

What would you inspect a musculotendinous injury when the patient is WB on the anterior side?

Answer 33

Inspection of how the arches change NWB to WB- medial longitudinal arch change usually most evident

Question 34

What would you inspect a musculotendinous injury when the patient is WB on the posterior side?

Answer 34

Calf symmetry Achilles shape Haglunds deformity Tibial garum Rearfoot vargus/valgus

Question 35

What are some musculotendinous that could be in the posterior leg?

Answer 35

Achilles tendonitis Achilles tendon rupture

Question 36

What are some musculotendinous that could be in the lateral leg?

Answer 36

Longitudinal fibularis tendonitis/subluxation

Question 37

What are some musculotendinous that could be in the medial leg?

Answer 37

Posterior tibialis tendon insufficiency (PTTI)

Question 38

What are some musculotendinous that could be in the heel?

Answer 38

Plantar fasciitis

Question 39

What is the MOi for Achilles tendonitis?

Answer 39

Overuse, increased running frequency or distance, Change in shoewear

Question 40

What are some signs and symptoms of Achilles tendonitis?

Answer 40

Symptoms improve with mild activity, mild ache in posterior leg after activity, more severe pain after prolonged activity, pain with stair climbing, tenderness or stiffness, especially in AM

Question 41

What are the two types of Achilles tendonitis?

Answer 41

Insertional and noninsertional

Question 42

Where is non insertional achilles tendonitis located?

Answer 42

Midsubstance of the tendon, 2-6 cm proximal to insertion, zone of decreased vascularity

Question 43

What are some types of non-insertional Achilles tendonitis?

Answer 43

Paratendonitis- inflammation of the lining around the tendon Tendonosis- noninflammatory, age related degeneration of the tendon itself Paratendonitis with tendonosis- Paratendonitis inflammation with introtendinous degeneraton

Question 44

What is a key point with non insertional Achilles tendinitis?

Answer 44

Bulbous area mid-tendon with or without pain

Question 45

Where is non insertional achilles tendonitis located?

Answer 45

At Achilles distal insertion on calcaneous

Question 46

What are some types of insertional Achilles tendonitis?

Answer 46

Haglunds deformity Pretend on bursitis (“pump bump”) Retrocalcaneal bursitis

Question 47

What is a key point of insertional Achilles tendonitis?

Answer 47

Tenderness, swelling over insertion at calcaneous

Question 48

What are some key things to look at when examinating for Achilles tendonitis?

Answer 48

History (SOH), observation AROM/PROM Resisted tests (MMT vs FTPO vs STT) Palpación

Question 49

what are some special tests for Achilles tendonitis?

Answer 49

SLS heel raises for PF strength and FTPO Confirm Achilles tendon integrity (Thompson test) Foot/ankle biomechanical exam

Question 50

How many grades of Achilles tendonitis treatment are there?

Answer 50

3: grade a, grade b, grade c

Question 51

What is grade a Achilles tendonitis treatment?

Answer 51

Eccentric exercise for the gastrocnemius and soleus helps reduce pain and restore function in patients with id-portion Achilles tendinosis

Question 52

What is grade b Achilles tendonitis treatment?

Answer 52

Modalities (laser) and modified eccentric exercises for gastrocnemius and soleus may help reduce pain and restore function in patients with insertional Achilles tendinosis

Question 53

What is grade c Achilles tendonitis treatment?

Answer 53

Gastroc/soleus stretching Long sit- knee flex, knee ext Standing- knee flex, knee ext

Question 54

What is recommended for a midsubstance lesion?

Answer 54

Heavy load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Continued sports activities using a pain monitoring model during rehabilitation

Question 55

How does eccentric calf training work for midsubstance lesions?

Answer 55

Increases collagen synthesis rate in those that are injured (but not healthy controls) Normalize tendon size or thickness Proposed that the forces generated during the eccentric loading destroy new blood vessel and nerve formation, leading to decreased pain

Question 56

What is suggested for an insertional lesion of the Achilles tendonosis?

Answer 56

Patient stands on uninvolved leg and plantarflexes to elevate the body in order to avoid concentric plantarflexion on involved leg, next shift their weight to the involved right leg to begin eccentric lowering of the body only to the level of the floor surface