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Orthopedic Assessment > Foot And Ankle > Flashcards

Flashcards in Foot And Ankle Deck (58):
1

What are the single plane movements of the foot & ankle? (4)

1. Dorsiflex πŸ‹
2. Plantar flexion πŸ‘Ÿ
3. Inversionβ†ͺ️
4. Eversion ↩️

⭐ toes: 1. Flexion πŸ’ͺ🏻2. Extension πŸƒπŸ»

2

MULTI-PLANAR MOVEMENTS

Describe pronation as a multi-planar movement.

DorsiflexionπŸ‹, adbuction, eversion

3

MULTI-PLANAR MOVEMENTS

Describe supination as a multi-planar movement.

Plantar flexion, adduction, inversion

4

ANKLE - TALOCRURAL JOINT

What muscles dorsiflex? (4)

1. Tibialis Anterior
2. Extensor Hallucis Longus
3. Extensor digitorum Longus
4. Peroneus Longus

5

ANKLE - TALOCRURAL JOINT

What muscles plantarflex? (8)

1. Gastrocnemius
2. Soleus
3. Tib. Posterior
4. Peroneus Longus
5. Peroneus brevis
6. Plantaris
7. Flexor Hallucis Longus
8. Flexor Digitorum Longus

6

ANKLE - SUBTALAR JOINT

What muscles invert the foot? (5)

1. Tib. Post
2. Tib. Ant
3. Extensor Hallucis Longus
4. Flexor Hallucis Longus
5. Flexor Digitorum Longus

7

ANKLE - SUBTALAR JOINT

What muscles evert the foot? (3)

1. Peroneus Longus
2. Peroneus brevis
3. Peroneus Tetrius

8

TOES

Which muscles flex the toes? (4)

1. Flexor Digitorum Longus
2. Flexor Digitorum brevis
3. Lumbricales
4. Quatratus plantae

9

HOPRS METHOD

CALCANEAL VARUS

πŸ—“H: foot pain or unaware.
πŸ‘€O: calcaneus deviates medially. Check footwear.
πŸ‘πŸΌP: no specific findings / may present hypertonicity, TRPs in invertor muscles.
AROM: possible eversion restriction. Mostly unimpaired. PROM too.
MRT: no findings

10

HOPRS METHOD

CALCANEAL VALGUS

πŸ—“H: may report foot pain or unaware.
πŸ‘€O:"peek-a-boo heel"; observe angle b/w calcaneus & Achilles tendon.
πŸ‘πŸΌP: no specific findings; may present HT perineal mus. Or tender tib. P
AROM& PROM: mostly unimpaired; possible restriction of inversion
MRT: no specific findings

11

HOPRS METHOD

EXCESSIVE SUPINATION

πŸ—“H: mostly unaware.
πŸ‘€O: subtalar inversion. Note shoe wear pattern.
πŸ‘πŸΌPalpation: tender peroneals & tib. P. May have callus formation.
AROM& PROM: possible eversion limitation.
MRT: no findings.

12

HOPRS METHOD

EXCESSIVE OVERPRONATION

πŸ—“H: P in foot, ankle, leg, or knee. Aggravated w/ repeated stress.
πŸ‘€O: subtalar eversion, note shoe wear pattern.
πŸ‘πŸΌP: exaggerated body landmarks. Tender tib. p.
AROM & PROM: possible inversion limitation.
MRT: no unusual findings.

13

HOPRS METHOD

PES PLANUS

πŸ—“H: P in foot
πŸ‘€O: medial side of foot comes to the ground
πŸ‘πŸΌP: may have calluses or skin irritations
AROM & PROM: no specific findings.
MRT: possible tibialis post weakness.

14

HOPRS METHOD

PES CAVUS

πŸ—“H: may be asymptomatic; possible foot P @ metatarsal heads, calcaneus, or lat. foot.
πŸ‘€O: ⬆️ space under metatarsal arch.
πŸ‘πŸΌP: prominent metatarsal heads or navicular; possible calluses.
AROM, PROM, & MRT: no specific findings.

15

HOPRS METHOD

MORTON'S FOOT

πŸ—“H: may be asymptomatic; P from altered biomechanics.
πŸ‘€O: 2nd toe extend further than Hallux
πŸ‘πŸΌP: possible calluses; palpate length of metatarsals
πŸ’ͺ🏻AROM, PROM, & MRT: no specific findings.
SPECIAL TESTS: metatarsal head evaluation.

16

HOPRS METHOD

HALLUX VALGUS

πŸ—“H: ask about shoes; family & medical history.
πŸ‘€O: distal end of hallux deviates laterally.
πŸ‘πŸΌP: P, Infl., tenderness on outside edge of 1st metatarsal edge
AROM: possible limited Hallux flexion/extension.
PROM: ⬇️ aBduction of Hallux; " " .
MRT: possible weak Hallux flexion/extension.

17

HOPRS METHOD

HAMMER TOES

πŸ—“H: pain in PIP & metatarsal heads.
πŸ‘€O: clearly visible.
πŸ‘πŸΌP: HT toe flexors & extensors; possible calluses.
AROM: limited MTP extension & flexion.
PROM: limited MTP.
MRT: pain unlikely; weak MTP and IP extension.

18

HOPRS METHOD

LATERAL ANKLE SPRAIN

πŸ—“H: reports sudden motion that caused pain on lat. ankle. Immediate P & swelling that ⬆️.
πŸ‘€O: swelling; walks w/ limp; possible bruising.
πŸ‘πŸΌP: tender to touch; puffy; possible HT of peroneals.
AROM: P w/ all movements, especially inversion.
PROM: " ", if grade 3- possible ⬇️ P signals.
MRT: possible P w/ inversion.
SPECIAL TESTS: 1. ankle drawer test 2. Talar tilt test

19

HOPRS METHOD

MEDIAL ANKLE SPRAIN

πŸ—“H: reports excessive force/ sports injury. Inquire about prior injuries.
πŸ‘€O: swelling, limp, bruising. Possible fracture or dislocation.
πŸ‘πŸΌP: tender, inflamed, puffy. Possible altered bony contours.
AROM: pain will all movements, especially eversion.
PROM: " ", if grade 3- possible ⬇️ P signals.
MRT: possibly weak due to other injured structures.

20

HOPRS METHOD

SYNDESMOSIS ANKLE SPRAIN

πŸ—“H: reports extreme dorsiflexion &/or rotation. Difficulty pinpointing site of pain.
πŸ‘€O: minor swelling, possible bruising.
πŸ‘πŸΌP: possible tenderness at Anterior or posterior tibiofibular ligaments.
AROM: P w/ aBduction; possible P w/ dorsiflexion.
PROM: P w/ aBduction & dorsiflexion.
MRT: no pain, possible weakness.
SPECIAL TESTS: 1. squeeze test 2. External rotation stress test.

21

HOPRS METHOD

MORTON'S NEUROMA

πŸ—“H: sharp, shooting pain, numbness, paresthesia in forefoot & toes. Aggravated w/ shoes & walking. Relief when barefoot or massaged.
πŸ‘€O: no visible signs.
πŸ‘πŸΌP: pain w/ pressure on nerve.
AROM: usually asymptomatic, possible P @ end of dorsiflexion & toe extension.
PROM: possible P w/ toe hyperextension.
MRT: no specific findings.
SPECIAL TESTS: 1. Morton's test 2. Interdigital squeeze

22

HOPRS METHOD

PLANTAR FASCIITIS

πŸ—“H: sharp point at heel or sole of foot; worse in AM & repetitive on hard surfaces.
πŸ‘€O: no visible signs.
πŸ‘πŸΌP: tenderness on sole of foot; possible HT/MTRps in triceps surae, or bone spur
AROM& PROM: possible P &/or w/ dorsiflexion; P when standing on ball of foot.
MRT: no pain; possible weak plantarflexion.

23

HOPRS MERHOD

STRESS FRACTURES

πŸ—“H: P @ fracture w/ activity. Subsides w/ rest.
πŸ‘€O: no specific visual findings.
πŸ‘πŸΌP: point tenderness; possible periosteal thickening.
AROM & PROM: possible tenderness in weight-bearing.
MRT: possible pain if muscles attaches near fractures.
SPECIAL TESTS: 1. Bone percussion

24

HOPRS METHOD

TARSAL TUNNEL SYNDROME

πŸ—“H: sharp, shooting pain @ medial ankle & plantar surface of foot. Paresthesia, numbness, motor weakness.
πŸ‘€O: no visible signs.
πŸ‘πŸΌP: pressure on tunnel reproduces symptoms.
AROM & PROM: possible pain @'end of dorsiflexion, eversion, and inversion.
MRT: weakness if nerve supply is affected.
SPECIAL TESTS: 1. dorsiflexion- eversion test 2. Tinel's sign

25

HOPRS METHOD

RETROCALCANEAL BURSITIS

πŸ—“H: P on post. heel; worse w/ walking/ running shoes.
πŸ‘€O: inflamed, enlarged, red posterior heel.
πŸ‘πŸΌP: post. calcaneus tender
AROM& PROM: possible P @ end of dorsiflexion.
MRT: no significant findings.

26

HOPRS METHOD

ACHILLIES TENDON DISORDER

πŸ—“H: Pain on calcaneus or distal 1/3 of tendon.
πŸ‘€O: Tendon is thick & enlarged.
πŸ‘πŸΌP: tender to pressure; may feel nodules; feel for crepitus.
AROM: P w/ weight-bearing plantar flexion; P @ end of dorsiflexion.
PROM: P @ end of dorsiflexion.
MRT: P & possible weakness w/ resisted plantar flexion.
SPECIAL TESTS: 1. Achilles' tendon pinch test

27

HOPRS METHOD

ACHILLES TENDON DISORDER

πŸ—“H: sudden pain, trouble walking, sometimes popping sound.
πŸ‘€O: gastrocnemius/soleus bunching, bruising, antalgic gait.
πŸ‘πŸΌP: enlarged mass where gastrocnemius has gathered; palpable gap.
AROM: fibers intact: painful dorsiflexion; full rupture: weak plantar flexion.
ROM: fibers intact: painful dorsiflexion; full rupture: ⬆️ dorsiflexion ROM.
MRT: weak & painful dorsiflexion.
SPECIAL TESTS: 1. Thompson test

28

HOPRS METHOD

ANTERIOR COMPARTMENT SYNDROME

πŸ—“H: extertional: describes repetitive/ ⬆️ activity. Acute: describes direct blow or injury. May have neurological or vascular symptoms.
πŸ‘€O: no visible signs.
πŸ‘πŸΌP: extreme pain; possibly no pain if long after activity.
AROM & PROM: if severe, pain w/ dorsiflexion & plantar flexion.
MRT: if severe, pain w/ dorsiflexion; weakness if nerve is compressed.

29

HOPRS METHOD

SHIN SPLINTS

πŸ—“H: history of repetitive activity/ sudden ⬆️; Anterior: pain proximal Anterior lateral tibia; MTSS: pain distal medial tibia.
πŸ‘€O: no specific visual findings; possible over pronation.
πŸ‘πŸΌP: Anterior: diffuse pain in prox. ant. tibia; MTSS: diffuse pain in post. medial tibia.
AROM: P w/ dorsiflexion and plantar flexion.
PROM: ant: possible P @ end of plantar flexion; MTSS: possible P @ end of dorsiflexion.
MRT: ant: P w/ Doris; MTSS: P w/ inversion & plantar flexion.
SPECIAL TESTS: tibialis post. compression test

30

HOPRS METHOD

STRESS FRACTURE: TIBIA

πŸ—“H: localized pain ⬆️ w/ activity; night pain.
πŸ‘€O: N/A
πŸ‘πŸΌP: exaggerated point tenderness directly on bone.
AROM, PROM, & MRT: N/A
SPECIAL TESTS: 1. Bone percussion test

31

What are possible regions of nerve entrapment of the PERONEAL NERVE? (2)

1. Near the fibular head
2. Within the Anterior compartment in the leg

32

What are the possible regions of nerve entrapment of the SURAL NERVE? (1)

1. In the superficial posterior compartment

33

What is the region of possible nerve entrapment of the TIBIAL NERVE? (2)

1. Within the deep posterior compartment of the leg
2. At the tarsal tunnel

34

What are the possible regions of nerve entrapment for the MEDIAL and/or LATERAL PLANTAR NERVES? (1)

1. Passing b/w the metatarsal heads, underneath the transverse metatarsal ligaments

35

(Table 1)

EXTENSOR DIGITORUM BREVIS
List the MRT used and the possible nerve involvement

MRT: extension of the toes (resist proximal phalanx)

Nerve: deep peroneal nerve (L5, S1)

36

(Table 1)

EXTENSOR DIGITORUM LONGUS
List the MRT used & the possible nerve involved

MRT: extension of the toes (resist distal phalanx)

Nerve: deep peroneal nerve (L4, L5, S1)

37

(Table 1)

EXTENSOR HALLUCIS LONGUS
List MRT used & possible nerve involved

MRT: extension of the hallux (resist distal phalanx)

Nerve: deep peroneal nerve (L4, L5, S1)

38

(Table 1)

FLEXOR DIGITORUM BREVIS
List MRT & possible nerve involved

MRT: flexion of toes (resist proximal phalanx)

Nerve: medial plantar nerve (L4, L5)

39

(Table 1)

FLEXOR DIGITORUM LONGUS
List MRT & possible nerve involved

MRT: flexion of toes (resist distal phalanx)

Nerve: Tibial nerve (L5, S1)

40

(Table 1)

FLEXOR HALLUCIS BREVIS
List MRT & possible nerve involved

MRT: flexion of hallux (resist proximal phalanx)

Nerve: medial plantar nerve (L4, L5, S1)

41

(Table 1)

FLEXOR HALLUCIS LONGUS
List MRT & possible nerve involved

MRT: flexion of Hallux (resist distal phalanx)

Nerve: tibial nerve (L5, S1, S2)

42

(Table 1)

GASTROCNEMIUS
List MRT & possible nerve involved

MRT: plantarflexion w/ knee extended

Nerve: tibial nerve (S1, S2)

43

(Table 1)

PERONEUS BREVIS
List MRT & possible nerve involved

MRT: foot eversion

Superficial peroneal nerve (L4, L5, S1)

44

(Table 1)

PERONEUS LONGUS
List MRT & possible nerve involved

MRT: foot eversion

Superficial peroneal nerve (L4, L5, S1)

45

(Table 1)

PLANTARIS

MRT: plantar flexion

Tibial nerve (L4, L5, S1)

46

(Table 1)

SOLEUS
List MRT & possible nerve involved

MRT: plantar flexion w/ knee partially flexed

Tibial nerve (S1, S2)

47

(Table 1)

TIBIALIS ANTERIOR
List MRT & possible nerve involved

MRT: dorsiflexion πŸ‹

Deep peroneal nerve (L4, L5, S1)

48

(Table 1)

TIBIALIS POSTERIOR
List MRT & possible nerve involved

MRT: foot inversion

Tibial nerve (L5, S1)

49

(Table 2)

ANKLE - TALOCRURAL JOINT
What motions (2) and on what plane (1) does this joint move?

1. Dorsiflex - Sagittal plane
2. Plantar flex - sagittal plane

50

(Table 2)

ANKLE - TALOCRURAL JOINT
What is the axis of rotation and average ROM degrees of the talocrural joint?

Dorsiflexion: Medial-lateral, 20-30'

Plantar flexion: medial-lateral, 30-50'

51

(Table 2)

ANKLE - SUBTALAR JOINT
What motions (2) and on what plane (1) does the subtalar joint move?

1. Inversion - Frontal plane
2. Eversion - Frontal plane

52

(Table 2)

ANKLE - SUBTALAR JOINT
What is the axis of rotation and average ROM degrees of the subtalar joint?

Inversion: Anterior-posterior, 20'

Eversion: anterior-posterior, 15'

53

(Table 2)

TOES
What motions and on what plane of motion do the toes move?

1. Flexion - Sagittal plane
2. Extension - sagittal plane

54

(Table 2)

TOES
What is the axis of rotation and average ROM degrees of the toes?

Flexion: medial-lateral, 30-40'

Extension: medial-lateral, 59-60'

55

What two special tests would you use to test for TARSAL TUNNEL SYNDROME?

1. Dorsiflexion-eversion test
2. Tinel's sign

56

What special test would you use to test for a stress fracture?

Bone percussion

57

What two special tests would you use to test for Morton's Neuroma?

1. Morton's test
2. Interdigital squeeze

58

What two special tests would you use to test for a Syndesmosis Ankle Sprain?

1. Squeeze test
2. External rotation stress test