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Lower Extremity Evaluation Lecture > Ankle & Lower Leg > Flashcards

Ankle & Lower Leg Flashcards

(62 cards)

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1
Q

What two bones make up the Ankle Mortise?

A

Tibia (medial) & Fibula (lateral)

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2
Q

The Ankle Mortise is comprised of what joint?

A
  • The Talocrural Joint
    ~ Articulation between Talus & Ankle
    Mortise
    ~ Talus relative to Ankle Mortise
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3
Q

Tibia

A
  • Primary weight bearing bone of lower leg
  • Forms roof & medial portions of Ankle
    Mortise
  • Distal portion known as Medial Malleolus
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4
Q

Fibula

A
  • Forms lateral portion of Ankle Mortise
  • Distal portion known as Lateral Malleolus
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5
Q

What are the classic movements for the Talocrural Joint?

A

Dorsiflexion & Plantarflexion

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6
Q

Which classic movement of the Talocrural Joint would offer the most stability & why?

A

Dorsiflexion is more stable because it causes the Talus to jam into the Ankle Mortise, leaving no space for movement. Movement at the Talocrural Joint causes injuries.

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7
Q

Functional Loading/Pronation: Planes of Motion at the TCJ

A

Sagittal: Dorsiflexion

Frontal: Eversion (very minimal due to lateral Malleolus)

Transverse: Adduction

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8
Q

Functional Unloading/Supination: Planes of Motion at the TCJ

A

Sagittal: Plantarflexion

Frontal: Inversion (very minimal)

Transverse: Abduction (very minimal)

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9
Q

Articulations: Proximal Tibiofibular

A

Articulation between Lateral Tibial Condyle & Head of Fibula

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10
Q

Movements: Proximal Tibiofibular

A

Anterior/Posterior & Superior/Inferior gliding

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11
Q

Articulations: Distal Tibiofibular

A

Articulation between Lateral Malleolus of the Fibula & Distal, Lateral portion of Tibia

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12
Q

Movements: Distal Tibiofibular

A

Anterior/Posterior & Superior/Inferior gliding

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13
Q

What muscles move the ankle?

A
  • Tibialis Posterior
  • Peroneus Longus
  • Gastrocnemius
  • Soleus
  • Plantaris
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14
Q

Tibialis Posterior Function during Functional Loading at the MTJ, STJ, & TCJ

A
  • MTJ
    ~ Decelerates Abduction & Dorsiflexion
  • STJ
    ~ Decelerates Eversion
  • TCJ
    ~ Decelerates Dorsiflexion
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15
Q

Peroneus Longus Function during Functional Loading at the MTJ and TCJ

A
  • MTJ
    ~ Decelerates Inversion & Dorsiflexion
  • TCJ
    ~ Decelerates Dorsiflexion
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16
Q

Gastrocnemius Function during Functional Loading at the STJ & TCJ

A
  • STJ
    ~ Decelerates Eversion
  • TCJ
    ~ Decelerates Dorsiflexion

Unhappy during Rearfoot Varus

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17
Q

Soleus Function during Functional Loading at the STJ & TCJ

A
  • STJ
    ~ Decelerates Eversion
  • TCJ
    ~ Decelerates Dorsiflexion

Unhappy during Rearfoot Varus

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18
Q

Gastrocnemius

A

Origin: Posterior Femur Proximal to Femoral Condyles

Insertion: Calcaneus

Nerve: Tibial

Action: Plantarflexion & Knee Flexion

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19
Q

Plantaris

A

Origin: Lateral Epicondyle of Femur

Insertion: Calcaneus

Nerve: Tibial

Action: Plantarflexion & Knee Flexion

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20
Q

Soleus

A

Origin: Posterior & Medial Border of Middle 1/3 of Tibia, Proximal 1/3 of Posterior Fibula

Insertion: Calcaneus

Nerve: Tibial

Action: Plantarflexion

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21
Q

Tibialis Posterior

A

Origin: Proximal 2/3 of Posterior Tibia, Fibula, & Interosseous Membrane

Insertion: Navicular, Cuneiforms, Cuboid, & Bases of 2-4 Metatarsals

Nerve: Tibial

Action: Inversion & Plantar Flexion & Supports Arch

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22
Q

Peroneus Longus

A

Origin: Proximal 2/3 of Lateral Fibula

Insertion: Base of 1st metatarsal & Medial Cuneiform

Nerve: Superficial Fibular

Action: Eversion & Plantar Flexion & Supports Arch

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23
Q

Things to notice during Anterior Inspection

A
  • Hip & Trunk Position
    ~ Fick’s Angle: 12-18 degrees of toe out
  • Foot Type
    ~ Pronated
    ~ Supinated
  • Swelling
    ~ Caveman Foot: foot looks obviously
    enlarged
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24
Q

Things to notice during Posterior Inspection

A
  • Gastrocnemius-Soleus Complex
  • Achilles
  • Calcaneus
  • Swelling (Caveman Foot)
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25
Things to notice during Lateral Inspection
- Peroneal Muscle Group - Distal Fibula - Swelling (Caveman Foot)
26
Things to notice during Medial Inspection
- Distal Tibia - Medial Longitudinal Arch - Swelling (Caveman Foot)
27
Where do most ankle sprains take place and why?
- Lateral ankle - The lateral ligaments are small and weak because they don’t have to deal with much stress
28
AROM Talocrural Joint Test
- Dorsiflexion & Plantarflexion measured with goniometer - Normal Dorsiflexion: 20 degrees - Normal Plantarflexion: 50 degrees
29
AROM Subtalar Joint Test
- Inversion & Eversion measured with goniometer - Normal Inversion: 20 degrees - Normal Eversion: 5 degrees
30
ROM Testing
- Passive - Resistive
31
Neurological Assessment
Lower Quarter Screen
32
What ligaments support the TCJ?
- Laterally: ~ Anterior Talofibular Ligament (ATF) ~ Calcaneofibular Ligament (CF) ~ Posterior Talofibular Ligament (PTF) - Medially: ~ Deltoid Ligaments > Anterior Tibiotalar > Tibiocalcaneal > Posterior Tibiotalar > Tibionavicular
33
Anterior Talofibular Ligament (ATF)
Origin: Anterolateral Surface of Lateral Malleolus Inserts: Talus near Sinus Tarsi Resists: Plantarflexion & Inversion
34
Calcaneofibular Ligament (CF)
Origin: Posterolateral portion of Lateral Malleolus Inserts: Calcaneus Resists: Inversion
35
Posterior Talofibular Ligament (PTF)
Origin: Posterior portion of Lateral Malleolus Inserts: Talus & Calcaneus Resists: Posterior translation of talus on Tibia or Ankle Mortise
36
ATF Ligament Test
- Anterior Drawer ~ Positive test indicated by Talus sliding anteriorly with excess laxity
37
CF Ligament Test
- Inversion Talar Tilt ~ Lengthens lateral ligaments ~ Positive test indicated by excessive Talar Tilt
38
Deltoid Ligaments
- Anterior Tibiotalar - Tibiocalcaneal - Posterior Tibiotalar - Tibionavicular - Used more and therefore, harder to rehab due their importance to daily life - Thicker and more supportive
39
Ankle sprain vs Deltoid ligaments?
- Listen to where pain is - Pt. will point to exactly where pain is
40
What ligaments & structure support the Distal Tibiofibular Joint?
- Anterior & Posterior Tibiofibular Ligaments - Interosseous Membrane ~ Keeps Tibia & Fibula from separating ~ Crural Interosseous Ligament > Extension of Interosseous Membrane
41
Distal Tibiofibular Joint Tests
- Kleiger’s Test (External Rotation): Ligaments ~ Positive test indicated by pain in anterolateral ankle at the site of the Distal Tibiofibular Joint - Squeeze Test: Fractures ~ Positive test indicated by pain at the site of the Distal Tibiofibular Joint
42
Ankle Sprains
- Usually caused by forceful inversion (lateral ankle sprain) or eversion (medial ankle sprain) - Signs & Symptoms: ~ Tenderness over ligament site ~ Swelling on side of sprain > High Ankle Sprain: all over ~ Discoloration ~ Increased laxity: grade 2 & 3 ~ Instability
43
Ankle/Lower Leg Fracture Test
- Stress or Gross - Squeeze Test ~ Positive test indicated by pain away from point of compression ~ Not needed if displaying typical signs for fracture - Bump/Thump Test ~ Positive test indicated by pain away from area being bumped
44
Other than fractures, what else could the Bump/Thump Test be used for?
High Ankle Sprains ~ Causes Fibula & Tibia to separate
45
Achilles Tendinitis
- Chronic inflammation due to limited blood supply especially in the Distal Portion 2-6 cm from insertion
46
Achilles Tendon Rupture
- Long term breakdown (inflammation or disuse) of tendon or one forceful event - Also occurs at 2-6 cm from insertion, therefore it’s common to have a Rupture & Tendonitis simultaneously - Very loud - Feels like you’ve been kicked - No obvious deformity, but obvious swelling: looks like ankle sprain
47
Achilles Tendon Rupture Test
- Thompson Test ~ Artificially making the Achilles contract ~ Positive test indicated by a lack of Plantarflexion when calf is squeezed > May still Plantarflex due to muscles
48
Compartment Syndrome
- VERY IMPORTANT TO NOT MISS! - Injury to a structure within a compartment in the leg that causes a build up of fluids (swelling) & compresses nerves, arteries, & veins ~ No blood flow = tissue death - Most common in the Anterior & Deep Posterior compartments
49
Anterior Compartment Contents
- Muscles ~ Tibialis Anterior ~ Extensor Hallucis Longus ~ Extensor Digitorum Longus ~ Peroneus Tertius - Nerve ~ Deep Peroneal (1st web space of foot) - If limited/dysfunction with Dorsiflexors & nerves along with calf pain: refer immediately
50
Deep Posterior Compartment Contents
- Muscles ~ Popliteus ~ Flexor Hallicus Longus ~ Flexor Digitorum Longus ~ Tibialis Posterior - Nerve ~ Tibial (bottom of foot & toes) - If limited/dysfunction with Plantarflexors along with calf pain: refer immediately
51
Signs, Symptoms, & Management for Compartment Syndrome
- Signs & Symptoms: ~ Complaints of pain and PRESSURE in affected compartment ~ Paresthesia/Anesthesia ~ Loss of function ~ Will be able to see and feel difference between unaffected leg - Management ~ Early diagnosis ~ Surgery > Cuts connective tissue, but causes scar tissue, ultimately bringing pt. back to square one ~ Not sure? Refer!
52
Exertional Compartment Syndrome
- Compartment syndrome only with activity ~ Causes blood to enter muscles & cause pressure ~ Goes away after some time
53
Deep Vein Thrombosis (DVT)
- VERY IMPORTANT TO NOT MISS! - Blood clot, usually post surgery or following trauma to lower leg - Causes: ~ Abnormalities in vessel wall ~ Abnormal Blood: increased coagulation factors ~ Decreased Plasma Volume: dehydration ~ Major Surgery or Trauma: cutting vessels ~ Slowing down blood flow: causes clotting
54
DVT Signs, Symptoms, & Management
- Signs & Symptoms ~ Calf tenderness ~ Swelling of leg ~ Increased warmth in leg ~ Discoloration of leg ~ Pain with Dorsiflexion - Management ~ Booties/compression sleeve: squeezes blood vessels & allows for blood to flow
55
DVT Test
- Homan’s Signs ~ Forced Dorsiflexion with calf squeeze ~ Positive test indicated by pain in calf
56
Subluxating Peroneal (Longus & Brevis) Tendons
- Tendons don’t stay behind Lateral Malleolus ~ Peroneals can’t Evert or Plantarflex - Cause ~ Forceful Dorsiflexion & Inversion causing tearing of Peroneal Retinaculum
57
Subluxating Peroneal (Longus & Brevis) Signs, Symptoms, & Management
- Signs & symptoms ~ Pain in lower leg/foot ~ Pain on site & popping of tendons ~ Dysfunction due to altered biomechanics - Management ~ Surgery ~ Deal with pain ~ Retire
58
Medial Tibial Stress Syndrome (“Shin Splints”)
- Soft tissue pain around medial aspect of Tibia ~ Tibialis Posterior or Soleus - Cause ~ New activity/changes in activity > Muscles need to build up edurance
59
Medial Tibial Stress Syndrome (“Shin Splints”) Signs, Symptoms, & Management
- Signs & symptoms ~ Stress fracture ~ Pain - Management ~ Compression sleeve can bring muscles closer to bone & relieve pain/tension
60
Talar/Tibial Osteochondral Lesions
- Bone & Cartilage defects ~ Piece gets knocked off - Cause ~ Excess inversion/eversion/rotation
61
Talar/Tibial Osteochondral Lesions Signs, Symptoms, & Management
- Signs & symptoms ~ Listen to complaints ~ Self limiting ~ Difficult to see on X-Ray - Management ~ May need surgery if serious
62
Deltoid Ligament Tests
- Eversion Talar Tilt ~ Lengthens the medial ligaments ~ Positive test indicated by excessive Talar tilt - Kleiger’s Test (External Rotation) ~ Positive test indicated by medial joint pain

Lower Extremity Evaluation Lecture (8 decks)

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