Foot and Ankle Flashcards
(23 cards)
General ROM of foot
10-20 degrees dorsiflexion
40-55 degrees plantarflexion
30 degrees inversion
18 degrees eversion
Thompson’s Test
in prone with foot over bed
squeeze mid calf muscle belly
positive if there’s no passive plantarflexion on squeezing the muscle
Good specificity and sensitivity
Royal London Hospital Test (Achilles)
Assessing for achilles tendinopathy
High specificity
Patient in prone, foot over bench. ankle in neutral/slight plantarflexion. Palpate achilles for tenderness. Patient moves ankle into max dorsiflexion and palpate at previously tender spots. Patient moves ankle into max plantarflexion and palpate tender spots.
Test is positive if pain on palpation is absent in max dorsiflexed position
Plantarflexion/Dorsiflexion goniometer alignment and patient position
Patient position: sitting on edge of bed with feet hanging and knees at 90 degreees
Fulcrum: lateral malleolus
Measuring arm: 5th metatarsal
Stationary arm: head of fibula
Goniometer should be sitting at 90 degrees at start
End feel: firm
Anterior Drawer ankle
Testing ATFL laxity/integrity
Good Specificity and sensitivity
Grasp heel, foot along forearm
Stabilise tibia close to joint line
positive test: increased anterior translation compared to unaffected ankle and may observe a dimple on anterolateral aspect of talus
Talar Tilt Test
ATFL, CFL, Deltoid Ligament laxity
patient seated, foot over table
ATFL - Slight plantarflexion grab calcaneus and perform inversion
CFL - neutral, grab calcaenus and perform inversion
deltoid: neutral, grab calcaneus and perform eversion
positive if patient complains about pain or if there is excessive gapping/movement compared with unaffected side
Inversion ROM prompt for patient
point toes inwards
Eversion ROM prompt for patient
point toes outwards
although thompson test has good specificity and sensitivity, what other test could you use to test for achilles integrity
Gap palpation
Matles test
Inversion/Eversion goniometer alignment and patient postion
Patient position: sitting on edge of bed with feet hanging and knees at 90 degreees
Fulcrum: at joint line in between malleoli
Measuring arm: 2nd metatarsal
Stationary arm: tibial tuberosity
End feel: firm
Squeeze test
used to determine if there is a syndesmosis sprain
mechanism of injury is dorsiflexion and eversion
patient in supine, with knee flexed and foot over bed
place one hand on tibia and other on fibula and compress/squeeze down the leg. looking for and noting pain reproduction at any point
High specificity but low sensitivity
mechanism of injury for a syndesmosis sprain
dorsiflexion and eversion
Arc test
assess for achilles tendinopathy
patient in prone with foot over edge of bed
therapist palpates achilles tendon 2-6cm above insertion at calcaneus, looking for thickening and swelling of tendon. Keep fingers pinched where swelling/thickening is and get patient to plantarflex and dorsiflex.
Positive result if swelling moves up and down finger with plantar and dorsiflexion
Why might you use arc test for achilles tendinopathy
in a patient with a thickened tendon. This would be more common in high load athletes
Differential diagnosis for ankle sprain
fracture –> rule out with ottawa ankle rules
Differential diagnosis for achilles tendinopathy
Achilles rupture –> rule out with thompson test
Plantar fasciopathy –> windlass test
Tinel’s sign (Ankle)
poor clinical test (bad sensitivity/specificity)
elicited in two places around ankle. Tapping the tibial nerve as it goes through the tarsal tunnel
anterior tibial branch of the deep peroneal nerve - tap anterior to medial malleolus
posterior tibial nerve - tap behind medial malleolus
Positive sign: tingling and parasthesia felt distally is a positive sign
Windlass Test
Assessing for plantar fasciopathy
patient stands on stool and positions metatarsals over edge of stool
physio passively extends big toe
positive test: heel pain reproduced with passive extension of toes
High specificity
Can be done in non-WB, seated, knee flexed at 90 degrees
What is tarsal tunnel syndrome
Compression of posterior tibial nerve through tarsal tunnel
What is in the tarsal tunnel
- Tibialis posterior tendon
- Flexor digitorum longus tendon
- Posterior tibial artery & vein
- Tibial nerve
- Flexor hallucis longus tendon
What action would be weak in tarsal tunnel syndrome
Weakness in toe flexion, particularly flexor hallucis longus and flexor digitorum longus, which are innervated by branches of the tibial nerve which is in the tarsal tunnel
Goniometer alignment for toe flexion/extension
Fulcrum: over the dorsal aspect of the MTP joint.
Stabilising arm: over the dorsal midline of the metatarsal.
Measuring arm: over the dorsal midline of the proximal phalange.
Apart from a Windlass test, what assessments could you perform to diagnose plantar fasciopathy
AROM/PROM of toe extension/flexion
Will be pain in active toe extension
Normal ROM and normal MMT (might have weak intrinsic muscles) otherwise.
Can rule out other conditions –> Tarsal tunnel with tinels sign or achilles tendinopathy with royal london hospital test
