Ankle/Foot Examination (Lecture 1)

Question 1

Do we have lots of mobility in the foot?

Answer 1

Yes

Question 2

Which two parts of the foot go in the same direction (supination/pronation)

Answer 2

Reer foot and mid foot go in the same direction

While the forefoot goes in the opposite direction

Question 3

What joint(s) make up the rearfoot?

Answer 3

Talocrural (talus + crual [fibula / tibia])

Subtalar (Talus + calcaneous)

Remember the talus sits ontop of the calcaneous so the joint under that would be denoted as “subtalar”

Question 4

What bones make up the rearfoot?

Answer 4

Calcaneous + talus

Question 5

What bones make up the midfoot?

Answer 5

Navicular / cuboid / cuniform 123

Question 6

What does the cuboid articulate with posterily?

Answer 6

Calcaneous

Question 7

What does the navicular articulate w/ posteriorly?

Answer 7

Talus

Question 8

KNOW: The main two midfoot joints are the navicular + talus and cuboid + calcenous (midtarsal joint)

Answer 8

Question 9

What bones make up the forefoot?

Answer 9

metatarsals / phalanges

Question 10

If theres locking in the foot what 2 things am I thinking?

Answer 10

Loose body (rare)
Fracture

Question 11

Get Ottawa ankle rules

Question 12

pt presents w/ pain with walking what grade sprain is it?

Answer 12

Grade 2

Question 13

Patient presents w/ pain w/ running but not walking. What grade sprain is it?

Answer 13

Grade 1

Question 14

Two outcome measures to know:
* Foot and ankle measurements (FAAM): general leg, foot, and ankle-related disorders
* LEFS (not specific to ankle)

Question 15

What 2 arteries do we check to see if theres a loss of pulse in the foot?

Answer 15

Dorsal pedal / posterior tibia arterys

Question 16

Redflags of foot (not all of them) = fracture / blood flow loss / numbness (use filament for sensation loss - bend till it becomes a C) / cancer (think bottom of foot because nobody puts sunscreen there [basal cell carcinoma]) / DVT
* 5.07

Yellow flags = more psycological symptoms.
* fear avoidance patterns - think chronic ankle insatbility and scared to do something
* Tampa scale of kinesaphobia
* FABQ
* Fear of moving foot

Question 17

What from the knee might refer to the foot?

Answer 17

Gastroc / soleus / fibularis longus / brevis / anterior tibia

Most of these actually connect in the foot which is why they refer there

Question 18

What 2 muscles of the hip refer to the foot?

Answer 18

Glute med / glute min

NOTE: Glute min looks like an L5/S1 radiculopathy

Question 19

How do you differeinate a L5/S1 radiculopathy from a glute min refferal?

Answer 19

Numbness tingling (muscle doesnt do this)

Mobilize the back and if that brings on symptoms im thinking radic (because you’re not touching glute min)

Poke on glute med/min and if that brings on lateral thigh pain = thinking glute med/min

DTR absense = radiculopthy (dont lose these w/ muscle pathologies)

Mytome weakness = radiculopthy

Dermatonal sensation loss = radic

Question 20

KNOW: if pt has had chronic back problems and got lateral ankle pain out of the blue w/o an MOI im thinking its probs coming from the back (could easily be on final practical)

Question 21

its for if pt needs x-rays

100% sensitivity (if you get a negative rule out fractures)

He’s going to have test questions on this for if they need plain film radiography (much like clin med)

Question 22

How to do tuning fork test
* what does it test for?

Answer 22

stethascope on fibular head and tuning fork on latearl malleolus or like anywhere on there foot and see if the vibrations are bringing on pain

tests for fracture

lack of sound = fracture

So you tap the fibula then put the stethascope on it comparing the sound side to side

Question 23

Wells criteria for DVT

need more than 3 to rule it in

Question 24

Signs of DVT (4)

Answer 24

Pittingedema

Tight shiny skin

Bruising

Swelling

(often happens after recent surgery)

Question 25

KNOW: differiniate compartment syndrome and DVT by injury * they look the same but department syndrome is normally a crush style injury while DVT is not * DVT = normally after surgeries

Question 26

IR or ER of the hip elevates the medial longitudinal arch of the foot?

Answer 26

ER

Question 27

IR or ER of the hip causes the medial longitudinal arch to flatten?

Answer 27

IR

Question 28

KNOW: external rotation of the hip makes you hang out on the outside of your feet while internal rotation of the hip makes you hang out on the inside of your foot

Question 29

What is pes caves? what makes you go into it?

Answer 29

Pes caves = increasing that medial longitudinal arch ER of hip makes you go more into it

Question 30

What is pes planis? What motion makes you do it?

Answer 30

Pes planes = flat foot = decreased medial longitudinal arch IR of the hip makes you do it

Question 31

Does bad posture = disfunction?

Answer 31

No

Question 32

What causes pigeon toes?

Answer 32

Its toes in so IR of the hip causes this

Question 33

To many toes sign tests for what? * what motion being increased causes this?

Answer 33

Pt looks behind pt to see if to many toes are showing laterally Checks for ER of the hip

Question 34

KNOW: Where calluses are on the feet can indicate abulation abnormailties (and wear and tear on the shoes)

Question 35

KNOW: Bad toe nails can indicate poor blood flow or infection "window to your health"

Question 36

What does this indicate?

Answer 36

Venous insufficency causes wheeping wounds. Such bad circulation that the skin gets so thin that the lymph / seris fluid starts seeping out * very tender / easily brusied

Question 37

KNOW: Ray = metatarsal

Question 39

Elevated1st ray, hypermobile 1st ray and long second metatarsal have been linked with the development of what 3 things

Answer 39

1) 1st MTP joint OA 2) Hallux valgus 3) Midfoot OA

Question 40

What does foot supination do to the medial longitudinal arch? What about pronation?

Answer 40

Increases it Pronation decreases it

Question 41

Is pes planis pronation or supiantion? * does what to medial longitudinal arch?

Answer 41

Pronation Decreases medial longitudinal arch

Question 42

If you decrease your medial longitudinal arch (think walking in more pronation / pes planis) which bone is required to have more movement and inturn more muscle work is required for stability (more bone movement = more muscle activation for proper stability)

Answer 42

Talus is hypermobile in pronation = more muscle activation required for stability * Can lead to talus OA

Question 43

What are exostoses?

Answer 43

External bone growth at the foot * often causes by abnormal loading * Think a bunion

Question 44

tibial shape will affect joint mechnicaics If the pts right tibia is shorter than the left what will they do at the right foot to try and make that limb longer (what will they do at the foot?)

Answer 44

Supination becaue it will make the foot seem taller (making that medial longitudinal arch bigger)

Question 45

KNOW: Supination makes you seem taller on one side (more plantar flexion)

Question 46

KNOW: Thicker achilies tendon indicates pathology

Question 47

Measuring subtalar lets us diliniate between varus and valgus

Question 48

If your foot is in supination are you in varus or valgus? is most of your pressure lateral or medial?

Answer 48

Varus lateral

Question 49

If you're in rear foot / midfoot supination whats happening at forefoot?

Answer 49

Pronation

Question 50

if you see wear and tear on the lateral aspect of someones shoe are they in varus or valgus

Answer 50

Foot is in supination which means they're in varus

Question 51

**If your in over pronation of the foot whats happening up the chain**

Answer 51

tibial external rotation and femoral internal rotation do it seated and see the movement NOTE: this is a valgus moment at the knee

Question 52

In valgus what happens to the tibia and femur?

Answer 52

Femur = IR Tibia = ER

Question 53

What motions happen at the femur / tibia in varus?

Answer 53

Femur = ER Tibia = IR

Question 54

If someone measures a average arch of 140 in non weight bearing. Then in weight bearing their foot becomes much more flat (the arch collapses). Would we expect that angle to increase or decrease with this lower arch? Why?

Answer 54

Decrease Because that navicular tuberosity drops making it closer to a right angle than being completely horizontal He said dont memorize: * High arch = 150 * Medium arch = 130-150 * Low arch = <130

Question 55

What 3 points is the medial longitudinal arch measured by?

Answer 55

1st metatarsal medial malleolus navicular tuberosity

Question 56

**What is medial / latearl longitudinal arch maintained by? (3)**

Answer 56

Wedging of tarsal and metatarsals Tightening of plantar ligaments (spring us back up) Instrinisc and extrensic muscles of foot + their tendons

Question 57

Diliniate between the intrinisc and extrinsic muscles of the foot

Answer 57

Intrinsic = start and end in the foot Extreinsic = start outside the foot and end inside the foot

Question 58

Would someone doing large motor motions at the foot / ankle be hitting more intrinsic foot muscles or extrinsic foot muscles? Why?

Answer 58

Extrinsic because those larger movements are hitting those attachment points that originate outside of the foot. Whereas the intrinsic ones are all within the foot

Question 59

Would a foot pt benefit from intrinsic foot m EX or extrinsic?

Answer 59

Both - they both help to support those longitudinal arches

Question 60

are fine motor motions or stabilizations motions at the foot more intrinsic or extrinsic foot muscles?

Answer 60

Intrinsic think toe stretchs / marbel pick up (however this even hits some of the extrinsic muscles as well)

Question 61

pes planis or pes cavis?

Answer 61

Pes cavis

Question 62

Pes planis or pes cavis

Answer 62

Pes planis

Question 63

What is a good break in schedule?

Answer 63

wearing the new shoes one hour a day and not all day (because this will cause pain)

Question 64

Whats special about an earth shoe? * what position does it put you in at the knee?

Answer 64

It has a negative heel Puts you into hyperextension of knee

Question 65

High heels put more pressure in what part of the foot (from squeezing it)? * what 4 things does this positioning lead 2?

Answer 65

Puts more perssure on the forefoot Leads 2: 1) Hallxus valgus 2) Bunions 3) March fracture 4) Morton's metatarsalgia

Question 66

Answer 66

Question 67

Question 68

What position does this person walk in?

Answer 68

Supination

Question 69

Swelling on one side of the achilles tendon is intra or extracapsular?

Answer 69

Extra moves all to one side | swelling on just one side

Question 70

Swelling on both sides of the achilles is intra or extra capsular?

Answer 70

Intra it just balloons out | left foot = intracapsular (swelling on both sides)

Question 71

**Capsular pattern for the talocrural joint (joint capsule tightness)** **What would the benefit from?**

Answer 71

PF > DF Benefit from mobilization EX

Question 72

What joint does the most PF/DF

Answer 72

Talocrural

Question 73

**1st MTP capsular pattern of resitrction**

Answer 73

EXT > flexion

Question 74

IP joints capsular pattern of restriction

Answer 74

Flexion > extension (less worried about us knowing this one)

Question 75

is soleus or gastroc a 2 joint muscle?

Answer 75

Gastroc

Question 76

Make sure you touch up on thomas test

Question 77

Which muscle is most likely to limit great toe extension (which affects push off and our ability to ambulate)

Answer 77

Flexor hallasos longus

Question 78

Special test high ankle sprains: * External rotation stress test (Kleiger) * Squeeze Test * Cross Leg test Lateral ankle sprains * Anterior drawer - ATFL * Talar Tilt - CFL Talocrural impingement (feels like a pincching sensation) * Impingement sign + TIC Achilles Rupture * Thompson test (squeeze gastroc and if they plantar flex it isnt ruptured) Plantar Fasciitis * Windlass test * However, the best test is subjective pain --> first few steps such --> palpate on medial calcaneoal tubericle and it ligths them up Tarsal tunnel * Tinel's test (more medial) Morton's Neuroma / Stress Fracture * Squeeze test * You are squeezing the metatarsals togther and seeing if this recreautes your pain. Numbness / tingling = mortons neuroma. Sharp pain = fx

Question 79

What two ligaments are most likely ruptured w/ lateral ankle sprains?

Answer 79

anteriortalofibular ligament calcaneofibular ligament

Question 80

**How much extension at the MTP do you need for walking?**

Answer 80

65 degrees

Question 81

**How much extension do you need at the MTP for running?**

Answer 81

85 degrees (you're now really loading into the MTP)

Question 82

CT scan is used for what? (6)

Answer 82

Bone tumors Fractures: acute and stress fractures Non-unions or delayed unions degrenative and rhematoid arthritits Post op monitoring avascular necrosis

Question 83

MRI is used for what in the foot? (4)

Answer 83

**Tendinopathies and tears (however ultrasound is better if a skilled pro is using it)** Show areas of subtle changes within the substance of the tendon Ligament disruption Osteochondral fractures of the talar dome