Approach to Ankle and Foot Complaint

Question 1

When testing muscle strength, if a patient has active movement against gravity, how would you grade it?

Answer 1

3/5

Question 2

when testing muscle strength, if a patient has a flicker or trace of contraction, how would you grade it?

Answer 2

1/5

Question 3

when grading muscle strength, if a patient has active motion against gravity and full resistance without evidence of fatigue, how would you grade it?

Answer 3

5/5

Question 4

when testing muscle strength, if a patient has active motion of the body part achieved with gravity eliminated, how would you grade it?

Answer 4

2/5

Question 5

when testing muscle strength, if no contraction is detected, how would you grade it?

Answer 5

0/5

Question 6

when testing muscle strength, if a patient has active motion against gravity and some resistance, how would you grade it?

Answer 6

4/5

Question 7

what is the talar tilt test used for?

Answer 7

to test for lateral ankle sprains, calcaneofibular ligament or anterior tabofibular ligament injury

Question 8

what is the anterior drawer test in the ankle/foot used for?

Answer 8

to test for a lateral ankle sprain

Question 9

what is the eversion test used for?

Answer 9

medial ankle sprain or a deltoid ligament injury

Question 10

what is the squeeze test used for?

Answer 10

to test for a high ankle sprain or a distal tibiofibular syndesmosis injury

Question 11

what is Homan’s sign used for?

Answer 11

to test for a DVT

Question 12

What are the three main types of ankle sprains?

Answer 12

lateral ankle sprain, medial ankle sprain, syndesmotic ankle sprain (aka high ankle sprain)

Question 13

What is the most common ankle sprain?

Answer 13

lateral ankle sprain

Question 14

what is the mechanism of injury of of a lateral ankle sprain?

Answer 14

foot inversion and/or plantar flexion

Question 15

what is the most likely ligaments injured in a lateral ankle sprain

Answer 15

anterior talofibular ligament*** and calcaneofibular ligament

Question 16

if there is a lateral ankle sprain, which tests are positive?

Answer 16

talar tilt test (aka inversion test) and anterior drawer test

Question 17

what is the mechanism of injury of a medial ankle sprain?

Answer 17

forced eversion

Question 18

what is the most likely ligament injured in a medial ankle sprain?

Answer 18

deltoid ligament

Question 19

what test is positive if there is a medial ankle sprain?

Answer 19

eversion test

Question 20

how are ankle sprains graded?

Answer 20

grading scale 1-3; 3 most severe

Question 21

What is the mechanism of injury of a syndesmotic or high ankle sprain?

Answer 21

forced external rotation of a dorsiflexed ankle

Question 22

what is the most likely ligament involved in a syndesmotic/ high ankle sprain?

Answer 22

tibiofibular syndesmosis

Question 23

what test is positive if there is a high ankle sprain?

Answer 23

squeeze test

Question 24

What are 3 common pathologies of the achilles tendon?

Answer 24

tendonitis, achilles rupture, Sever’s disease

Question 25

what are the signs and symptoms of achilles tendonitis?

Answer 25

pain/stiffness at tendon insertion, recent increase in exercise/activity, pain is worse with activity and goes away with rest

Question 26

what test is used for achilles tendonitis?

Answer 26

thompson test

Question 27

how is achilles tendonitis diagnosed

Answer 27

by a NEGATIVE thompson test

Question 28

symptoms of an achilles tendon rupture?

Answer 28

patients report a popping sensation at their heel

Question 29

what test is used to diagnose an achilles tendon rupture?

Answer 29

thompson test

Question 30

how is an achilles tendon rupture diagnosed?

Answer 30

a POSITIVE thompson test

Question 31

an inflammation or stress injury to the areas on and around an apophysis (growth plate) near the calcaneus

Answer 31

Sever's disease

Question 32

who gets sever's disease?

Answer 32

active children going through growth spurts

Question 33

What are the signs and symptoms of sever's disease?

Answer 33

chronic heel pain in growing children, pain with increased activity, pain is reproduced with direct palpation over the apophysis

Question 34

a loss of the longitudinal arch of the foot

Answer 34

pes planus

Question 35

an exaggeration of the longitudinal arch of the foot

Answer 35

pes cavus

Question 36

What is the common sign/symptom of plantar fasciitis?

Answer 36

pain is worse with first few steps in the morning and then improves

Question 37

inflammation and thickening of tissue that surrounds the nerve between toes

Answer 37

morton's neuroma

Question 38

how does morton's neuroma present?

Answer 38

the patient will most likely report feeling like they are walking on a marble

Question 39

what is the relevant special test used for morton's neuroma?

Answer 39

Mulder's sign

Question 40

How is morton's neuroma diagnosed?

Answer 40

Positive Mulder's sign: a palpable clicking sensation between the third web space as the transverse arch is compressed

Question 41

what causes steppage gait or foot drop?

Answer 41

fibular nerve compression

Question 42

what are the common signs of fibular nerve compression?

Answer 42

weakness of dorsiflexion and eversion, steppage gait, sensory loss over dorsal foot/lateral shin

Question 43

a consequence of chronic foot inflammation that ultimately results in mid foot deformities and a collapse of the longitudinal arch

Answer 43

Charcot foot

Question 44

who typically gets charcot foot?

Answer 44

diabetic neuropathy patients

Question 45

gout is an inflammatory arthropathy caused by what?

Answer 45

deposition of monosodium urate crystals in joints

Question 46

what types of foods may lead to gout flare up?

Answer 46

diet high in purines (meat, shellfish, and alcohol)

Question 47

joint aspirations in gout patients reveal what?

Answer 47

negatively birefringent needle shaped crystals

Question 48

ankle injuries will frequently cause dysfunction in the knee due to what?

Answer 48

the linked motion at the fibular head

Question 49

what causes the fibular head to glide anteriorly?

Answer 49

foot pronation

Question 50

what causes the fibular head to glide posteriorly?

Answer 50

foot supination

Question 51

what causes supination of the foot?

Answer 51

plantar flexion+inversion+adduction

Question 52

what causes pronation of the foot?

Answer 52

dorsiflexion+eversion+abduction

Question 53

What is the normal range of motion of dorsiflexion of the foot?

Answer 53

15-20 degrees

Question 54

what is the normal plantar flexion of the foot?

Answer 54

55-65 degrees

Question 55

what is the minor motion associated with dorsiflexion?

Answer 55

posterior glide

Question 56

what is the minor motion associated with plantar flexion?

Answer 56

anterior glide

Question 57

does dorsiflexion or plantar flexion make the ankle more stable?

Answer 57

dorsiflexion

Question 58

what is the normal range of motion of eversion of the tibiotalar joint?

Answer 58

10-20 degrees

Question 59

what is the normal range of motion of inversion of the tibiotalar joint?

Answer 59

20 degrees

Question 60

what is the minor motion associated with eversion?

Answer 60

anteromedial glide of the talus

Question 61

what is the minor motion associated with inversion?

Answer 61

posterolateral glide of the talus

Question 62

What is the normal range of motion of the talocalcaneal joint eversion/anteromedial glide?

Answer 62

5-10 degrees

Question 63

what is the normal range of motion of the talocalcaneal joint inversion/posterolateral glide?

Answer 63

5-10 degrees

Question 64

As the calcaneus moves into eversion, the talus will glide?

Answer 64

anteriorly and medially

Question 65

as the calcaneus moves into inversion, the talus will glide?

Answer 65

posteriorly and laterally

Question 66

a sliding motion (along an axis) of a tarsal bone toward the plantar surface in relation to surrounding bones

Answer 66

plantar glide

Question 67

a sliding motion (along an axis) of tarsal bones toward the dorsum of the foot in relation to the surrounding bones

Answer 67

dorsal glide

Question 68

the plantar glide of the cuboid and navicular bones are couples with?

Answer 68

rotation about an AP axis

Question 69

rotation of the cuboid and navicular bones creates what?

Answer 69

eversion of the cuboid and inversion of the navicular during plantar glide

Question 70

most likely preferences of the cuboid bone

Answer 70

eversion glide with plantar glide

Question 71

most likely preferences of the navicular bone

Answer 71

inversion glide with plantar glide

Question 72

most likely preferences of the cuneiforms

Answer 72

plantar glide only

Question 73

how is motion of the metatarsals named?

Answer 73

for the direction of the metatarsal head

Question 74

what are the motions that we evaluate at the metatarsals?

Answer 74

dorsal glide and plantar glide

Question 75

what are the motions that we evaluate at the MTPs, PIPs, and DIPs?

Answer 75

dorsal/plantar glide, rotatory glide, abduction/adduction

Question 76

what is the name of the guidelines for when to order X-rays on a patient with an ankle injury?

Answer 76

Ottawa Ankle Rules

Question 77

If a patient has pain in the malleolar zone, they must have at least one of?

Answer 77

1. bone tenderness at the posterior tip of the medial or lateral malleolus or 2. Unable to bear weight immediately after injury AND unable to walk 4 steps in the doctor's office or ER

Question 78

if a patient has pain in the midfoot region, they must have at least one of?

Answer 78

1. bone tenderness at the FIFTH metatarsal or the NAVICULAR 2. Unable to bear weight immediately after injury AND unable to walk 4 steps in the doctor's office/ER