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ATR 525: Advanced Injury Assessment of Lower Extremity > Chapter 8: Foot & Toe Pathologies > Flashcards

Chapter 8: Foot & Toe Pathologies Flashcards

(96 cards)

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1
Q

What bones make up the ankle mortise?

A

Talus, tibia & fibula

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2
Q

What is the only axial skeleton bone to not have a muscle attachment?

A

Talus

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3
Q

List the five functional articulations of the talus bone.

A

(1) superiorly with distal end of tibia (2) medially with medial malleolus (3) laterally with lateral malleolus (4) inferiorly with calcaneous (5) anteriorly with navicular

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4
Q

The navicular bone articulates anteriorly with which bone(s)?

A

Cuneiforms (medial, intermediate, lateral)

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5
Q

The navicular bone articulates laterally with which bone(s)?

A

Cuboid

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6
Q

What bones makes up the rear foot?

A

Talus & calcaneus

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7
Q

What bones makes up the mid foot?

A

Navicular, cuneiforms (medial, intermedius, lateral) & cuboid

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8
Q

What bones makes up the fore foot?

A

Metatarsals & phalanges (proximal, middle, distal)

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9
Q

What muscles make up the triceps surae muscle group?

A

Gastrocnemius & soleus

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10
Q

List all the articulations of cuboid bone.

A

(1) Anteriorly with 3rd & 4th metatarsal (2) medially with lateral cuneiform & navicular (3) posteriorly with calcaneus

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11
Q

How many sesamoid bones are in the foot?

A

2-3

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12
Q

Where are the sesamoid bones of the foot located

A

Two sesamoid bones are located on the flexor hallucis brevis tendon beneath the MTP & the other is often located on the plantar aspect of IP joint of first MT

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13
Q

Where is the subtalar joint located?

A

Between the inferior aspect of talus and superior aspect of calcaneus

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14
Q

How does a pronated foot influence the mechanics of the leg & thigh?

A

A pronated foot causes internal rotation of tibia, internal rotation of hip & knee flexion

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15
Q

How does a supinated foot influence the mechanics of the leg & thigh?

A

A supinated foot causes external rotation of tibia, external rotation of hip and knee extension

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16
Q

List the medial ligaments that go from talus to calcaneus.

A

Posterior talocalcaneal & medial talocalcaneal

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17
Q

List the ligaments that represent the junction between the rearfoot & midfoot.

A

Dorsal talonavicular, plantar calcaneonavicular (“spring”) & plantar calcaneocuboid

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18
Q

This ligament spans from the sustentaculum tali to the inferior surface of navicular.

A

Plantar calcaneonavicular (“spring”) ligament

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19
Q

What are the three primary weight-bearing points of the foot?

A

Head of 1st metarsal, Head of 5th metatarsal & medial tubercle of calcaneus

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20
Q

Where does the “spring” ligament originate and insert?

A

Originates on the sustentaculum tali of calcaneus & inserts on the inferior aspect of navicular

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21
Q

What bones form the medial longitudinal arch of foot?

A

1st metatarsal, medial cuneiform, navicular, calcaneus & talus

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22
Q

Describe the tripod theory.

A

It is the weight distributed between the head of 1st MT, head of 5th MT & calcaneus

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23
Q

What are some important things to ask during the history section of an ankle evaluation?

A

How did your symptoms arise?
Is this an acute onset?
Is this an insidious onset?
Have you changed the surfaces in which you have been playing on?
Have you increased the distance, duration, or intensity of your training?
Do you wear orthotics and if so why?
When was the last time you were fitted for orthotics?
During which activities do you use orthotics?
When was the last time they were fitted?
What action(s) aggravate it?
Have you had this type of injury before and if so is it similar to what you are experiencing now?
How long were you out for on the prior injury?
Who treated you?
What treatment did you receive and did it work?
Do you have a family history of rheumatoid arthritis?

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24
Q

List the characteristics of a pes cavus foot.

A

(1) Inverted rearfoot by more than 3 degrees from perpendicular (2) adducted forefoot (3) high medial longitudinal arch using Feiss Line

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25
Explain the Feiss Line special test and its purpose.
Line is drawn from the plantar aspect of 1st MT to the medial malleolus and the navicular tubercle postion is noted relative to the line. Navicular tubercle above line is pes cavus, below line is pes planus & intersecting the line is neutral. This special test assesses arch and foot type of an individual
26
Describe Morton's Toes.
1st metatarsal is shorter than 2nd metatarsal
27
Describe Hammer Toes.
Affects toes 2-4. Hyperextension of MTP & DIP joints & flexion of PIP joints
28
Describe Claw Toes.
Affects toes 2-4. Hyperextension of MTP joint & flexion of PIP & DIP joints
29
What mechanical factors can lead to a pes planus foot?
Weakness of tibialis posterior, tibialis anterior, flexor hallucis longus & brevis hallucis
30
A pes planus causes the talus to tilt _______ and the navicular to displace _______ , making the talus more prominent and susceptible to fracturing.
Medially | Inferiorly
31
What is the difference between a rigid and subtle pes planus?
A rigid pes planus is marked by the absence of a medial longitudinal arch when foot is weight bearing and non-weight bearing. A subtle pes planus is marked by the absence of a medial longitudinal arch only when weight bearing.
32
How can a pes planus foot affect the ACL of knee?
Pes planus causes tibia to internally rotate as navicular drops during pronation, causing the ACL to tighten as it wraps around PCL
33
List the phases of gait for right leg.
``` Initial contact Loading response Mid stance Terminal stance Pre swing Initial swing Mid swing Terminal swing ```
34
Which phases of the gait pattern are weight bearing?
Initial contact, loading response, mid stance, terminal stance & pre-swing
35
Which phases of the gait pattern are non-weight bearing?
Initial swing, mid swing & terminal swing
36
Where are heel spurs located?
On the medial tubercle of calcaneus
37
Define tarsal coalition.
A bony, fibrous, or cartilaginous union between two or more tarsal bones
38
Entrapment of the posterior tibial nerve or one of its medial or lateral branches as it passes through the tarsal tunnel can lead to which syndrome?
Tarsal tunnel syndrome
39
What is a Jone's fracture?
Fracture of the 5th metarsal 1 cm distal from the proximal diaphysis
40
What is the Haglund's Deformity ("pump bump")?
Retrocalcaneal exostosis
41
What is antalgic gait?
A limp or unnatural walking pattern
42
# Choose one. The long bone compression test is used if an (acute/chronic) fracture is suspected.
Acute
43
List some common mechanisms of injury for Lisfranc fracture?
(1) Rotational loading with a fixed foot (2) Axial load placed on the rearfoot while bearing weight on extended toes. (3) Crushing force
44
What arteries are located in the foot to take a pulse?
Dorsal pedis | Posterior tibialis
45
What is the PQRST of pain?
``` Provocation: what causes pain? Quality: What does it feel like? Region: Where does it hurt? Severity: How bad does it hurt? Timing: When does it hurt? ```
46
What are you inspecting during palpation during an ankle evaluation?
Tenderness, swelling, deformity, crepitus, spasm, symmetry, and temperature
47
The lateral and inferior aspect of first cuneiform and base of the 1st MT of foot serves as the insertion for the _______ muscle.
Anterior tibialis
48
The Posterior Tibialis inserts on the _______ bone of the foot.
Navicular
49
The talus shifts _______ during plantarflexion.
Anteriorly
50
The talus shifts _______ during dorsiflexion.
Posteriorly
51
Ankle inversion is often the mechanism of a fracture to the ______ .
5th metarsal
52
Exostosis on the medial calcaneal tubercle is referred to as a _______ .
Heel spur
53
_______ is a bony, fibrous or cartilaginous union between two or more tarsal bones.
Tarsal coalition
54
Which special test will reproduce the symptoms of tarsal tunnel syndrome?
Dorsiflexion eversion test
55
Patient complains of pressure on the inferior posterior aspect of leg. Has diffused pain, burning, paresthesia and numbness that increases with activity but decreases with rest. What pathology meets these characteristics?
Tarsal Tunnel Syndrome
56
Define Subungual Hematoma.
Bleeding underneath the nail
57
Posterior tibial nerve runs under which connective tissue structure?
Flexor retinaculum
58
The rearfoot is compromised of which joint(s)?
Subtalar joint
59
The midfoot is made up of which joint(s)?
Talocalcanenavicular, talonavicular, calcaneiocuboid, cuneocuboid and intercuneiform
60
The forefoot is made up of which joint(s)?
Tarsometatarsal, metatarsophalageal, proximal interphalangeal, distal interphalangeal
61
What are the three arches of the foot?
Medial longitudinal, transverse, lateral longitudinal
62
The medial longitudinal arch is supported by which bones?
Talus, calcaneal, navicular, cuneiform, 1st metatarsal
63
The medial longitudinal arch is supported by which ligamentous structures?
Plantar calcaneonavicular ("spring") ligament, long plantar ligament and deltoid ligament
64
The medial longitudinal arch is supported by which muscles?
Tibialis anterior, tibialis posterior, flexor digitorum longus, flexor hallucis longus
65
The transverse arch is made up by which muscles?
Tibialis anterior, tibialis posterior, peroneus longus
66
List the muscles of the anterior compartment of the leg.
Tibialis anterior, extensor digitorum longus, peroneus tertius, extensor hallucis longus
67
List the muscles of the deep posterior compartment of the leg.
Tibialis posterior, flexor digitorum longus, flexor hallucis longus
68
List the muscles of the superficial posterior compartment of the leg.
Gastrocnemius, soleus and plantaris
69
List the muscles of the lateral compartment of the leg.
Peroneus longus, peroneus brevis
70
List structures that you will palpate on the medial aspect of the foot during an evaluation.
``` 1st MTP joint 1st MT 1st cuneiform Navicular Navicular tuberosity Talar head Sustentaculum tali (calcaneus) Calcaneonavicular ligament Medial talar tubercle Calcaneus Medial Calcaneal Tubercle Tibialis posterior Flexor digitorum longus Flexor hallucis longus Posterior tibial pulse ```
71
List structures that you will palpate on the lateral aspect of the foot during an evaluation.
``` 5th MTP joint 5th MT Styloid process Cuboid Lateral calcaneal border Inferior peroneal retinacula Peroneal tubercle Peroneous Brevis Peroneus Longus ```
72
Dermatome of medial aspect of 1st metatarsal
L4
73
Dermatome of dorsal aspect of 3rd metatarsal
L5
74
Dermatome of base of 5th metatarsal
S1
75
Dermatome of popliteal space
S2
76
Afferent is to ______ as efferent is to _______.
Dermatomes : myotomes
77
What is the myotome of L4?
Dorsiflexion
78
What is the myotome of L5?
Toe extension
79
What is the myotome of S1?
Plantarflexion
80
L4 and L5 tests which reflex?
Patellar tendon reflex
81
S1 tests which reflex?
Achilles
82
Which test would you use to rule out intermetatarsal neuroma?
Mulder's Sign
83
What are some signs and symptoms for a neurological pathology?
Pain, numbness, paresthesia, burning
84
Explain Windlass Test
Used to verify if patient has a subtle pes planus foot type. Patient will have an absence of medial longitudinal arch while weight bearing but weight bearing plantarflexion will reproduce medial longitudinal arch.
85
The ausculatory percussion test it used to rule out which type of fractures?
Transverse fractures
86
What type of fractures is an ausculatory percussion test not good in identifying?
Avulsion or buckle fractures
87
Where should the stethoscope and tunning fork be placed when administering an ausculatory percussion test?
Stethescope should be placed on bony landmark proximal/above to the suspected site of fracture and tunning fork should be placed on bone distal to fracture site.
88
Compared bilaterally what will a positive ausculatory percussion test sound like?
There will be a diminished or absent sound due to the space created by the transverse fracture.
89
You would use this test if you suspect a distal phalanx fracture.
Tap Test/Flick Test
90
Greater than _______ degrees of 1st metatarsal joint abduction is a characteristic of hallucis ______ pathology.
20 degrees : valgus
91
_______ are the entrapment of nerves between the metatarsal heads.
Neuromas
92
Morton's neuroma is located between the ______ and _______ metatarsal heads.
3rd : 4th
93
The tarsal tunnel is bordered anteriorly by _______ and _______ and laterally by the _______ .
Tibia : talus : calcaneus
94
Retrocalcaneal exostosis is also referred to as _______ or _______ .
Haglund's Deformity : pump bumps
95
Degrees of flexion and extension of great big toes.
Flexion: MTP: 35-45°, IP: 90° Extension: MTP: 75-85°, IP: 0
96
Degrees of flexion and extension of rays 2-5.
Flexion: MTP - 40°, PIP - 35°, DIP - 60° Extension: MTP - 40°, PIP - 0°, DIP - 30°

ATR 525: Advanced Injury Assessment of Lower Extremity (4 decks)

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