Foot and Ankle Flashcards by Kyle Zbornik

3 Needs at the foot and ankle

30 deg DF (fxnl), 30 deg 1st MTP extension
Wall lunge = 4-6 cm from wall
Arthrokinematics (MTP, tib-fib, CMC, etc.)

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Ottawa Ankle Rules

4 Items total

Pain in malleolar or midfoot area AND EITHER
Inability to bear weight immediateley after injury (4 steps)

Bone tenderness at the posterior edge of tibia or fibula or tip of medial or lateral meniscus.
Bone tenderness at the navicular or proximal base of the 5th metatarsal.

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West Point Ankle Sprain Grade 1 by location

Anterior talofibular ligament

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West Point Ankle Sprain Grade 2 by location

Anterior talofibular ligament and calcaneofibular ligament

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West Point Ankle Sprain Grade 3 by location

Anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament

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West Point Ankle Sprain Grade 1 by edema and ecchymosis

Slight and local

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West Point Ankle Sprain Grade 2 by edema and ecchymosis

Moderate and local

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West Point Ankle Sprain Grade 3 by edema and ecchymosis

Significant and diffuse

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West Point Ankle Sprain Grade 1 by weight-bearing ability

Full or partial

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West Point Ankle Sprain Grade 2 by weight-bearing ability

Difficult without crutches

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West Point Ankle Sprain Grade 3 by weight-bearing ability

Impossible without significant pain

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West Point Ankle Sprain Grade 1 by ligament damage

Stretched

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West Point Ankle Sprain Grade 2 by ligament damage

Partial tear

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West Point Ankle Sprain Grade 3 by ligament damage

Complete tear

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West Point Ankle Sprain Grade 1 by instability

None

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West Point Ankle Sprain Grade 2 by instability

None or slight

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West Point Ankle Sprain Grade 3 by instability

Definite

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How many toes is abnormal for the “too many toes sign”?

3-5

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Identify the joint associated with the phase of stance:

Loading response

Subtalar joint

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Identify the joint associated with the phase of stance:
Mid stance

Lateral midtarsal joint axis

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Identify the joint associated with the phase of stance:
Terminal stance

Oblique midtarsal joint axis

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When the foot makes full contact with the ground, the foot begins PRONATING/SUPINATING and the entire LE EXTERNALLY/INTERNALLY rotates.

Pronating; internally rotating

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During mid stance the foot is at max PRONATION/SUPINATION, it begins PRONATING/SUPINATING, and the LE begins INTERNALLY/EXTERNALLY rotating.

Pronation; supinating; externally

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5 functional measures for Foot and ankle:

FAAM
LEFS
FAI
Star excursion or Y-balance test
Lateral hop for distance

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Y-Balance test criteria

4cm difference is ~2.5x more likely to sustain an injury.

Lateral hop for distance criteria

20% difference side-to-side is suggestive of a longer recovery and slower return to function.

Normal range for Fick angle

5-18 degrees

Plantar flexion normal ROM

50 deg

Dorsiflexion normal ROM

20 deg?? Most people 10-12ish

Supination normal ROM

45-60 deg

Pronation normal ROM

15-30 deg

Hindfoot inversion normal ROM

20 degrees

Hindfoot eversion normal ROM

10 deg

For normal gait, how much foot eversion is required?

4-6 deg

For normal gait, how much inversion is required?

8-12 deg

# Identify The angle at which the ratio of calcaneal inversion vs eversion is 2:1

STJ neutral

# Identify the special test: Identifies laxity at the ankle, also look for tibia rotation

Anterior Drawer

# Identify the special test: Tests the calcaneofibular ligament and deltoid legament depending on position.

Talar tilt test

# Identify the special test: Tests for syndesmosis sprain (high ankle sprain) by assessing for pain/laxity

Kleiger Test

# Identify the special test: Tests for pain at the end range of MTP extension

Windlass Test

# Identify the special test: Examines integrity of achilles tendon by squeezing the calf

Thompson Test

What results in a positive Thompson test?

No apparent plantar flexion when calf is squeezed.

# Identify the special test: Assesses for tibial stress fracture

Heel thump test

Two possible positive results with a heel thump test and their interpretations:

* Pain along tibial shaft - stress fracture indication * Pain in ankle indicates syndesmosis injury

# Identify the special test: Tap posterior tibial nerve on medial side

Tinel's test

# Identify the special test: Compress foot at medial and lateral aspects at MTP joints.

Morton's test

# Identify the special test: Forcefully dorsiflexes heel while knee is in extended position. Pain elicited in popliteal region and calf is a positive test.

Homan's test

# Identify the special test: BP cuff is wrapped around thigh and inflated to 40 mmHg. Pressure maintained for 2 minutes. Increase in pain and inability to tolerate sustained pressure is a positive test.

Ramirez's test

When measuring for edema using figure 8, what finding is minimally clinically significant?

2-2.5 cm difference between uninvolved and involved side.

Identify all 9 components of Well's criteria

* Active cancer * Bedridden recently >3 days, OR major surgery within 4 weeks * Calf swelling >3cm * Entire leg swollen * Localized tenderness along deep venous system * Pitting, edema, greater in symptomatic leg * Paralysis, paresis, or recent plaster immobilization of lower leg * Previous DVT * Alternative diagnosis more likely (-2)

# Identify: MAY be associated with pes planus, rearfoot valgus, forefoot varus, and ankle joint equinus

Overpronation

A less rigid lever for push off is associated with UNDERPRONATION/OVERPRONATION.

Overpronation

Two PT management options for overpronation:

* Improve dynamic support * Provide external support

PT management for ankle equinus:

Mobilize and/or stretch

# Identify: Foot is in plantarflexed position with ankle dorsiflexion limited to <10 degrees.

Ankle Equinus

Identify 4 potential reasons for Pes Planus:

* Trauma * Muscle weakness * Ligamentous laxity * Overpronated feet

With rearfoot varus, what compensatory action takes place?

Excessive pronation at the STJ

Underpronation may be associated with these two foot positions:

* Pes Cavus * Forefoot valgus

Management of MSK condiitons assoc. with underpronation | 2 items

* Footwear * Stretching/joint mobilizations

3 MSK conditions associated with underpronation:

* Lateral ankle sprain and chronic instability * Tibial stress fractures (shin splints) * Lumbosacral pathologies

What's more common? Lateral or medial ankle sprains?

Lateral - 75% of the time

MOI for foot and ankle sprain

PF with inversion and supination

A complete tear of the ATFL is graded:

Grade 2 ankle sprain

Partial tear of ATFL and CFL is graded:

Grade 2 ankle sprain

Non surgical intervention for grade 3 ankle sprain | 2 items

* PRICE * Functional bracing, may cast 4-6 wks in slight DF

What fracture is commonly associated with inversion rotational sprains?

Fracture of the fibular neck

At the foot and ankle, at what point is chronicity defined?

Over 6 months

Two types of ankle instability:

* Functional * Mechanical

# Identify: Recurrent ankle sprains or sensation of the ankle giving way

Functional ankle instability

# Identify: Differentiated due to evidence of ankle ligament laxity

Mechanical ankle instability

Treatment for functionaly ankle instability

* Balance exercises * Isometric/isokinetic training * Bidirectional pedaling

# Identify: Inflammation of the tendon's outer layer

Paratendonitis

# Identify: Inflammation of the tendon's substance

Tendinitis

# Identify: Degenerative condition related to aging, microtrauma, vascular compromise

Tendinosis

# Identify: A disorder involving the attachment of a tendon/ligament to a bone

Enthesopathy

Identify 4 common contractile structures involved in foot/ankle pathologies:

* Tibialis posterior * Fibularis longus * Achilles * Compartment syndromes

Treatments for Achilles tendinopathy | 2 best and 4 maybes

Heel lift Active rest Stretching (?) Modalities (?) Steroid injection (?)

What is one treatment that is contraindicated with achilles tendinopathy?

Steroid injection

Identify two stages of achilles tendinopathy:

* Reactive * Degenerative

4 components of treatement for reactive tendinopathy:

* Load management * Inflammation * Isometrics (70-100% max) * Exercise/rest

4 components of treatment for degenerative tendinopathy:

* Know what aggravates S/Sx * Active recovery * Graded exposure to activity * Eccentric training

Hallmark sign of plantar fascitis:

Pain with first step in the morning

5 best interventions for plantar fascitis:

* Therapeutic exercises * Manual therapy * Taping * Foot orthoses * Night splints

Foot and Ankle Flashcards

(83 cards)