foot/ankle

Question 1

what major muscle is responsible for foot eversion?

Answer 1

peroneus longus

Question 2

what major muscle is responsible for plantarflexion?

Answer 2

gastroc/soleus

Question 3

what major muscle is responsible for dorsiflexion?

Answer 3

anterior tibialis

Question 4

what major muscle is responsible for foot inversion?

Answer 4

posterior tibialis

Question 5

this is what distal connection of the tibia to the fibula

Answer 5

syndesmosis joint (made up of AITFL, PITFL, and transverse ligament)

Question 6

nerve responsible for hip flexion

Answer 6

L2

Question 7

nerve responsible for medial hamstring reflex

Answer 7

L5

Question 8

Nerve responsible for cremasteric and Babinski reflexes

Answer 8

S2-S4

Question 9

positive anterior drawer sign of the ankle means what?

Answer 9

ATF sprain (anterior talofibular ligament)

Question 10

positive findings on the talar tilt test indicate what?

Answer 10

calcaneofibular ligament tear (lateral….pain with inversion)

Question 11

In the _______ test, the patient is prone with feet dangling over the edge of the bed. Provider squeezes the gastroc and looks for the foot to ________. If this does not happen, it may indicate rupture of the ___________

Answer 11

Thompson test, plantarflex (normal), absence = Achilles tendon rupture

Question 12

during this test, the patient will experience reproduction of pain at a point away from the site of pain and suggests a fracture of syndesmotic injury

Answer 12

compression test

Question 13

This view of the ankle in plain film is taken at 15 degrees internal rotation

Answer 13

Mortise view

Question 14

This view allows us to see tib/fib/talar joint

Answer 14

mortise

Question 15

What tendon is exclusively lateral ankle?

Answer 15

peroneal

Question 16

whenever you suspect an ankle sprain/inversion injury and there’s ttp of the peroneal nerve, what must you ALWAYS do?

Answer 16

palpate the insertion at the 5th metatarsal for avulsion/fx

Question 17

How do you tx ankle sprain? (medial or lateral)

Answer 17

1) walking boot

2) PT

Question 18

which ankle ligament is strongly a/w the medial malleolus?

Answer 18

deltoid ligament

Question 19

If you suspect a medial ankle sprain/eversion injury and there’s ttp to the deltoid ligament, what must you ALWAYS do?

Answer 19

palpate the proximal fibula for avulsion/fx

Question 20

Your patient has pain with dorsiflexion and resisted plantar flexion. There is ttp over the Achilles tendon. How will you treat?

Answer 20

Achilles tendonitis, tx with

1) walking boot with heel lift,
2) PT
3) NTG patch

Question 21

How do you know if it’s Achilles tendonitis vs Achilles rupture?

Answer 21

1) acute onset
2) defect/gap
3) THOMPSON TEST

Question 22

What is the tx for an Achilles rupture?

Answer 22

short leg cast x 4 weeks, then walking boot.

sx for young athletes

Question 23

What tests should you do if you suspect a low leg stress fx?

Answer 23

compression test, xrays usually negative, do MRI

Question 24

What is common in the history of pts with stress fx?

Answer 24

shin splints

Question 25

what is the tx for stress fx?

Answer 25

No wt bearing x 6 weeks

Question 26

Your young patient felt a "pop" when he twisted his ankle playing soccer. You detect ttp on the lateral retinaculum (tendon sheath). When you evert the foot you can feel subluxation.

Answer 26

subluxating peroneal tendon

Question 27

what kind of imaging will you order for the subluxating peroneal tendon?

Answer 27

xray to r/u avulsion

Question 28

how will you tx a subluxating peroneal tendon?

Answer 28

SLC x 6 weeks for older, Surgical fixation of sheath in young

Question 29

What are the 3 types of distal fibula tx?

Answer 29

1) Weber A, below syndesmosis 2) Weber B, at level of syndesmosis 3) Above syndesmosis

Question 30

How will you tx the Weber levels?

Answer 30

A--SLWBC x 6 wks B--non-displaced: SLC x 4 wks, WB x 4 wks B--displaced: sx C--sx

Question 31

This is a common foot fx, typically resulting from avulsion s/p inversion sprain (peroneus tendon)

Answer 31

proximal 5th metatarsal fx

Question 32

Where is the 5th metatarsal most likely to fx?

Answer 32

the styloid

Question 33

What do most pt's say when they have a 5th metatarsal fx?

Answer 33

that they have sprained their ankles

Question 34

How do you treat a 5th metatarsal fx?

Answer 34

firm soled shoe or WB

Question 35

What is the term for a fx of the metaphyseal/diaphyseal junction of the 5th metatarsal, which makes wt bearing nearly impossible?

Answer 35

Jones fx

Question 36

How do you tx a Jone's fx?

Answer 36

SLC x 6-10 wks or screw fixation

Question 37

This injury usually occurs in young athletes due to repetitive stress on lateral foot (bball, running). Characterized by gradual increase of pain. Poor healing w/out tx.

Answer 37

stress fx of 5th metaphyseal diaphysis.

Question 38

how would you tx the pseudo Jones fx (stress fx)?

Answer 38

SLC x 20 weeks or screw fixation

Question 39

Your patient is c/o terrible heel pain, especially bad in the morning. PE reveals ttp of the medial calcaneal tuberosity. How will you tx this patient?

Answer 39

Dx: plantar fasciitis, tx will heel cord stretching, inserts, overnight splints

Question 40

What is a history question you should be asking for any patient with plantar fasciitis?

Answer 40

Are they getting steroid injections, which cause atrophy of the fat pads

Question 41

What joint connects metatarsals to tarsals?

Answer 41

Lisfranc

Question 42

A Lisfranc injury typically occurs as a result of trauma/MVA/fall and will have a physical exam with significant ttp over the _______ joint causing pain/swelling on ___________ and ______ of the foot. Typically they have an inability to bear wt.

Answer 42

Lisfranc, plantar and dorsal

Question 43

How do you treat a Lisfranc Injury?

Answer 43

start with a non-walking boot, escalate to sx PRN

Question 44

Toe abnormality, commonly 2nd toe, that presents with flexion of PIP and exention of DIP

Answer 44

hammer toe

Question 45

How will you tx hammer toe and other "lesser toe" abnormalities?

Answer 45

footwear with wide toe, dorsal foot pad or RFL to sx

Question 46

This toe abnormality presents with flexion of the DIP

Answer 46

mallet toe

Question 47

This problem is genetic, commonly affects females, and involves the lateral deviation of the big toe

Answer 47

hallux valgus aka bunion

Question 48

How will you tx hallux valgus?

Answer 48

wide low shoes, orthotics, night splint, sx

Question 49

This condition results from the loss of the medial longitudinal arch of the foot. It is common in kids and typically resolves

Answer 49

pes planus (aka flat feet)

Question 50

When would pes planus necessitate sx?

Answer 50

If the foot looses flexibility

Question 51

Pes planus places you at higher risk for developing __________

Answer 51

tibialis tendonitis/rupture

Question 52

This condition causes burning and tingling between interspaces of involved toes (2nd-4th most common)

Answer 52

Morton's Neuroma compresses interdigital nerve

Question 53

The _______ sign is positive for patients with Morton's neuroma, and is characterized by palpable clicks and ttp in the intermetatarsal web space

Answer 53

Mulder's sign

Question 54

How do you tx a Morton's neuroma

Answer 54

change footwear, injections, sx RFL