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Ankle And Foot Examination part 3 Flashcards

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1
Q

What is the common MOI for musculotendinous injury?

A

Poor footwear, tight musculature, overuse, muscle imbalance

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2
Q

What are some signs/symptoms of musculotendinous injuries?

A

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

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3
Q

What are signs and symptoms for longitudinal fibularis muscle tendonitis/subluxation?

A

Swollen, tender, painful posterior to lateral malleolus. Pain with AROM eversion, minimal response to PT intervention

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4
Q

When is longitudinal fibularis muscle tendonitis/subluxation a differential diagnosis possibility?

A

Any group of injuries that have “giving way” as chief complaint, however there is likely pain without occurrence of inversion injury

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5
Q

What observations do we expect to see with posterior tibialis tendon dysfunction (PTTD)?

A

No inversion of calcaneus during heel raises
Too many toes sign
Medial talar bulge

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6
Q

How many stages of PTTD are there?

A

4

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7
Q

What is seen in stage 1 of PTTD?

A

Pain with ankle inversion, tendon length normal, swelling and tenderness inferior to medial malleolus

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8
Q

What is seen in stage 2 of PTTD?

A

Evolving for months-years, tendon elongated, no rearfoot inversion during single limb heel raise, passive rearfoot mobility normal

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9
Q

What is seen in stage 3 of PTTD?

A

Fixed rearfoot deformity (valgus calcaneus) with a compensated forefoot (varus)=flat foot, minimal tendon pain, compressive pain in lateral foot/sinus tarsi

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10
Q

what is seen in stage 4 of PTTD?

A

Further talocrural joint degeneration and fractures

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11
Q

How do we treat stage 1 of PTTD?

A

Rest the tendon, modalities, walking brace se progressive resistive exercise

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12
Q

how do we treat stage 2 of PTTD?

A

Walking brace for 4 weeks and orthotics (6 months), use progressive resistive exercise

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13
Q

How do we treat stage 3 of PTTD?

A

Triple arthrodesis (fusion), heel cord lengthening procedure

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14
Q

what is the MOI for plantar fasciitis?

A

Direct repetitive microtrauma, pes planes or cavus foot, increased BMI, prolonged standing, reduced DF ROM

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15
Q

what are signs and symptoms of plantar fasciitis?

A

Pain/stiffness in the morning and after prolonged sitting, recent change in frequency or distance of running, may worsen at end of the day or when walking in bare feet, point tenderness over medial calcaneal tubercle

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16
Q

What percent of patients will get better within 10 months if they have acute planar fasciitis?

A

85%

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17
Q

what is the treatment for acute plantar fasciitis?

A

NSAIDS, DF (toes and ankle best), night splints, OTC insoles and stretching program

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18
Q

What is chronic plantar fasciitis?

A

Repetitive partial tear and chronic irritation at the insertion point on the medial calcaneal tubercle

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19
Q

When are patients consider chronic heel pain?

A

When they have symptoms past the 10 month period.

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20
Q

What do we need to do for chronic plantar fasciitis?

A

Need to continue differential diagnosis and rile out entrapment syndromes

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21
Q

What joint mobilization can we do to improve talocrural dorsiflexion?

A

STM to plantar fascial, gastric/soleus trigger points

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22
Q

What can we do to treat grade a plantar fasciitis/ heel pain?

A

Plantar fascia stretching and gastroc/soleus stretching
Joint mobilization to improve talocrural DF
Application of anti pronation taping
Foot or those s and night splints

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23
Q

What are the recommendations for grade f therapeutic exercise for plantar fasciitis and heel pain?

A

Clinicians may prescribe strengthening exercises and movement training for muscles that control pronation and attenuate forces during weightbearing activities. Studies show that therapeutic exercise that focuses on muscles that ER and pronate the LEs may decrease plantar pressure during gait/running

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24
Q

What is the MOI for lateral ankle sprains?

A

Trauma inversion with a PF foot

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25
What symptoms may we see with lateral ankle sprains?
Difficulty in activity depends on grade of sprain, history of sprains s functional instability Lateral ankle pain, medial ankle pain “kissing lesion”, tenderness, swelling, ecchymosis Functional complaints: painful WBing and ROM
26
what are the special tests for lateral ankle sprains?
Anterior draw Reverse anteriolateral drawer test Talar tilt Posterior draw
27
When is the anterior draw test positive?
If pain is reproduced laterally or excessive gapping between the distal lateral malleolus and calcaneus
28
How do we stabilize for the anterior draw test?
10-15º PF, stabilize distal anterior tibia/fibula
29
what is the movement for the anterior draw test?
Examiner provides a P-A glide through the calcaneous and talus to translate it anteriorly
30
What does a positive anterior draw test indicate?
Excessive motion, ATFL injury suspected
31
When is a reverse anteriolateral drawer test positive?
If pain is reproduced laterally or with lateral force, there is lateral rotation of the tib/fib during post glide; and gapping between the distal and lateral malleolus and calcaneus
32
Where do we stabilize during the reverse anteriolateral drawer test?
Heel is on the table, knee is flexed, stabilize over the dorsum, keeping the ankle in 10-15º PF (towel under the forefoot)
33
What is the movement during the reverse anteriolateral drawer test?
Examiner provides a A-P glide through the tibia to translate it posteriorly (and possibly into ER) with the calcaneus and thereby talus fixed on table
34
What does a positive reverse anteriolateral draw test indicate?
Excessive motion, accompanied by lateral rotation of the distal tib/fib on talus
35
When is the talar tilt test positive?
If pain is reproduced or excessive gapping between the distal and lateral malleolus and calcaneous
36
How do we stabilize for the talar tilt test?
Stabilize the distal tib/fib and palpate test ligament
37
What movement is the movement for the talar tilt test?
Examiner provides a varus stress to displace talus
38
what positions is the talar tilt test performed in?
20º PF for ATFL Neutral for CFL Dorsiflexed for PTFL
39
What does a positive talar tilt test indicate?
Excessive motion or reproduction of cc, lateral ligament injury
40
When is a posterior draw test positive?
If pain is reproduced or excessive gapping between the distal lateral malleolus and calcaneous
41
How do we stabilize during the posterior draw test?
Patient is hooklying with foot PF at 20º stabilize the distal tib/fib and palpate test ligament
42
What is the movement during posterior draw test in OKC?
Post mobilization of the talus on a stabilized tibia in TC 20º PF
43
What is the movement during posterior draw test in CKC?
Examiner pulls the tib fib anteriorly while continuing to stabilize the calcaneous/talus
44
what does a positive posterior draw test indicate?
Excessive motion, PTFL injury or deltoid ligament (post fibers) injury suspected
45
What is seen with a grade 1 (mild) acute ankle sprain?
Mild effusion, no hemmorrhage Negative anterior drawer, negative varus laxity Pain with inversion and PF Function; little or no limp but has trouble with hopping
46
What is seen with a grade 2 (moderate) acute ankle sprain?
More swelling, hemorrhage likely present + anterior drawer, no varus laxity at neutral Function: limping with walking, unable to raise on toes/hop/run
47
What is seen with a grade 3 (severe) acute ankle sprain?
Immobilization 1-10 days, and 8-10 weeks of rehab Diffuse swelling, hemorrhage Significant instability, complete tears of ATFL or CFL Function: unable to weight bear completely, decreased ROM
48
Recap how to measure figure 8 for swelling?
begin mid way between the tibialis anterior tendon and lateral malleolus draw tape medially across instep and placed distal to navicular tubercle draw tape across plantar foot placing it proximal to the styloid of 5th metatarsal continue to draw tape across the talus towards the distal medial malleolus move tape posteriorly behind and aim for the other distal lateral malleolus return to the start of the tape to take measurement
49
what counts as potentially significant swelling?
2.5 cm increase compared to other side serial measurements over time are a better way to monitor change
50
what is some grade A evidence for an acute/protected motion phase intervention for lateral ankle sprain and the goals?
early mobility and protected activities. goal: progressive weight bearing onto the affected limb
51
what are some intervention examples for an acute/protected motion phase grade A evidence for lateral ankle sprains?
early weight bearing with bracing or AD support cryotherapy (no additional evidence for US) therapeutic exercise
52
what is some grade B evidence in an acute/protected motion phase for an intervention for lateral ankle sprain and the goals?
manual therapy goal: reduction of swelling and pain, normalization of gait pattern
53
what are some intervention examples for grade B evidence in an acute/protected motion phase for lateral ankle sprains?
talar a-p glides manual lymphatic drainage soft tissue mobilization and trigger point release in surrounding tissues (gastroc/soleus)
54
what are some therapeutic exercise in the acute/protected motion phase (grade A) for lateral ankle sprains?
AROM open chain (PF, DF, inversion, eversion) AROM ankle alphabet AROM toe curls AROM isometrics (inversion, eversion, DF, PF) ankle theraband- resisted isokinetics- open chain (inversion, eversion, DF, PF) ankle free weight resisted isokinetics- open chain (eversion, inversion, DF in short sit, PF in prone)
55
what is some grade B evidence in a progressive loading/sensiomotor training phase for an intervention for lateral ankle sprain and the goals?
manual therapy goal: improve ankle DF ROM
56
what are some intervention examples for grade B evidence in a progressive loading/sensiomotor training phase for lateral ankle sprains?
thrust and non thrust manipulation mobilization with movement activities (in various WBing) activities to improve proprioception and weight bearing tolerance (balance ex, including manual perturbations)
57
what is some grade C evidence in a progressive loading/sensiomotor training phase for an intervention for lateral ankle sprain and the goals?
therapeutic exercise goal: improve mobility, strength, coordination, and postural control in the postacute period
58
what are some intervention examples for grade C evidence in a progressive loading/sensiomotor training phase for lateral ankle sprains?
weight bearing functional exercises single limb balance activities using unstable surfaces balance and sport-related activity training to reduce the risk for recurrent ankle sprains
59
how can we progress the SLS balance?
single leg stand eyes open single leg stand eyes closed single leg stand eyes open, toes extended so only the heel and metatarsal heads are in contact with the ground single leg stand, eyes closed, toes extended
60
what is sport-related activity training?
involves multiple planes of motion involves both UE/LE and trunk unexpected, quick and corrective movement requirements cardiovascular training
61
what is the MOI for medial ankle sprains?
rare usually due to overexertion of deltoid ligament due to chronic ankle instability (lateral ankle sprain) severe trauma resulting in outward twisting of the ankle, which is usually accompanied by a fibula fracture
62
what is the subjective for medial ankle sprains?
medial ankle pain
63
what are the special tests for medial ankle sprains?
eversion stress test Kleiger/ER stress test
64
what is the MOI for syndesmosis injuries?
trauma, leg rotation upon a planted foot, ankle in a neutral or DF position
65
what are signs and symptoms of a syndesmosis injury?
pain in anterior distal shin, difficulty with ambulation and decreased ROM (DF>PF)
66
what are functional complaints with syndesmosis injuries?
painful WBing and ROM
67
what are special tests for syndesmosis injuries?
fibular translation test cross legged test Kleiger test
68
what is the MOI for osteochondral injuries?
OCD s/p traumatic ankle sprain most common in the talus
69
what are signs and symptoms of osteochondral injuries?
pain during terminal stance (closed pack position, decreased standing tolerance, aching during rest)
70
what are some special tests or interventions for osteochondral injuries?
blind stance ability vs FTPO (flatfoot and forefoot) treadmill tolerance test step up tolerance test step down tolerance test unilateral roe raise tolerance test balance tests
71
what is the criteria for diagnosis for osteoarthritis?
age >50 y/o stiffness > 30 minutes crepitus bony tenderness bony enlargement no palpable warmth
72
what is the prescription for osteoarthritis?
self limiting, medications, PT (progressive loading, cyclic loading, bracing, orthodics), surgery
73
how is the diagnosis made for hallux limitus?
usually made by clinical examination and or xray
74
hallux limitus is classified into grades what determines the grades?
loss of DF ROM overtime
75
what are some tests and measures for hallux limitus?
joint mobility, ROM, gait analysis
76
what are some strengthening activities for hallux limitus?
toe curls, flexor intrinsic, great toe abduction, pain free range calf raises, standing arch raising
77
what are some stretching activities for hallux limitus?
gastrocnemius/soleus stretch, plantar fascia stretch
78
what is some manual therapy that could be done for hallux limitus?
first MTP dorsal/plantar and medial/lateral glides and rotation, second MTP dorsal glides, PIP plantar glides
79
what is some soft tissue mobilization for hallux limitus?
abductor hallucis, first and second lumbricals/dorsal interossei, plantar fascia, gastrocnemius/soleus
80
what is important to do for patient education for hallux limitus?
appropriate footwear. show with a rocker bottom to limit extension of first ray. orthotics with first ray cut out. this allows the 1st ray to PF more which requires less hallux DF
81
what is a good hallux limitus prognosis?
pain reduction with PT, though structural anomalies will not be changed
82
what is an arthroplasty hallux limitus prognosis?
surgery for joint replacement and can expect restoration of ROM and structure
83
what is an arthrodesis hallux limitus prognosis?
surgery to fuse joint if joint is completely degraded
84
what is cheilectomy for hallux limitus?
surgery that removes the bone spurs and part of bone post surgical recovery may take many months
85
what is the MOI for capsular restriction?
post ankle immobilization; develops over time due to lack of movement through range
86
what is the presentation for the capsular restriction?
capsular pattern presents during A/PROM assessment c/o stiffness
87
what is the common restriction pattern at the talocrural joint?
PF is limited greater than DF
88
what is the common restriction pattern at the subtalar joint?
limited varus/valgus PROM translation
89
what is the common restriction pattern at the transverse tarsal joint?
DF>PF>Add>MR
90
what is the common restriction pattern at the the 1st MTP joint?
extension is limited greater than flexion
91
what is the definition of anteriorlateral synovitis?
impingement of hypertrophic synovium due to scarring after lateral ankle sprain
92
what is the etiology for hallux abducto-valgus?
inflamed and eventually thickened bursa inferior to MTP
93
what is the progression for hallux abducto-valgus?
flexor and extensor tendons are misaligned, creating more angular stress on the joint
94
what is the progression for hallux abducto-valgus?
flexor and extensor tendons are misaligned, creating more angular stress on the joint
95
what is the progression for hallux abducto-valgus?
flexor and extensor tendons are misaligned, creating more angular stress on the joint
96
what is the further progression for hallux abducto-valgus?
enlargement of the MTP joint which then malaligned, moving laterally toward the second toe
97
what is the management for hallux abducto-valgus?
wear correctly fitting shoes with a wide toe box wear an appropriate orthotic to correct a structural forefoot varus variation place a felt or sponge rubber doughnut pad over the first and or fifth metatarsophalangeal joint wear a tape splint and wedge placed between the great toe and second toe engage in daily foot exercises to strengthen the intrinsic and extrinsic muscles of the foot ultimately, surgical procedure called a bunionectomy may be necessary to correct the problem
98
what is the etiology of turf toe?
hyperextension (DF) of the MTP joint 1st digit, the distal digit is in weightbearing
99
what is the grading of turf toe?
similar of ankle sprains (1,2,3)
100
what are the symptoms of turf toe?
pain, bruising, joint laxity, antalgic gait with decreased terminal stance
101
what tissues could potentially be affected with turf toe?
MTP plantar capsule, plantar fascia and other plantar tissues, flexor hallux brevis, sesmoid bones, MTP collateral ligaments
102
what is the management for turf toe?
grade 1: rest, gradual return to activities grad 2: rest, gradual return to activities, mobilization prn, foot orthoses grade 3: rest, immobilization, prolonged absence from activities, foot orthoses, surgical repair
103
what are some peripheral nerve injuries?
tarsal tunnel syndrome distal tarsal tunnel syndrome
104
what is the moi for tarsal tunnel syndrome?
insidious, RA
105
what are the signs and symptoms for tarsal tunnel syndrome?
difficulty localizing pain, diffuse burning, worse at night or when rest at end of the day
106
what is the MOI for distal tarsal tunnel syndrome?
>9 month history of plantar fascia type pain that does not respond to typical treatment
107
what are the signs and symptoms of distal tarsal tunnel syndrome?
pain at medial calcaneal tubercle (similar to plantar fasciitis), decreased sensation at lateral heel

musculo (19 decks)

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