Foot & Ankle Flashcards
(214 cards)
1
Q
Muscles of the anterior compartment of the lower leg
A
Tibialis anterior
Extensor digitalis longus
Extensor hallucis longus
Fibularis tertius
2
Q
Innervation of the anterior compartment
A
Deep fibular
3
Q
Muscles of the lateral compartment of the lower leg
A
Fibularis longus
Fibularis brevis
4
Q
General actions of the lateral compartment of the lower leg
A
Eversion, plantarflexion
5
Q
Innervation of the lateral compartment of the lower leg
A
Superficial fibular nerve
6
Q
Muscles of the posterior compartment of the lower leg
A
Soleus
Gastrocnemius
Plantaris
7
Q
What innervates the posterior compartment?
A
tibial nerve
8
Q
Muscles of the deep posterior compartment?
A
Popliteus
Tibialis posterior
Flexor digitorum longus
Flexor hallucus longis
9
Q
What innervates the muscles of the deep posterior compartment?
A
tibial nerve
10
Q
Tom, Dick & Harry (anterior)
A
Tibialis anterior
Extensor Digitorum longus
Extensor hallucis longus
11
Q
Tom, Dick & Harry (posterior)
A
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
12
Q
Intrinsic muscles of the dorsal foot:
A
Extensor digitorum brevis
Extensor hallucis brevis
13
Q
Intrinsic plantar muscles: 1st layer
A
Abductor hallucis (medial arch)
Abductor digiti minimi pedis (lateral arch)
Flexor digitorum brevis
14
Q
Intrinsic plantar muscles: 2nd layer
A
(Quad Lum)
Quadratus plantae (inserts into FDL) Lumbricals pedis (arises from tendon of FDL)
15
Q
Intrinsic plantar muscles: 3rd layer
A
(FlexAddFlex)
Flexor Hallucis brevis
Adductor Hallucis
Flexor Digiti Minimi brevis
16
Q
Intrinsic plantar muscles: 4th layer
A
Plantar interossei pedi (adduction)
Dorsal interossei pedii (abduction)
17
Q
The tibial nerve innervates
A
Posterior compartment Plantar intrinsics (medial and lateral plantar)
18
Q
The superficial fibular nerve innervates
A
Lateral compartment
Dorsal cutaneous nerves (lateral and medial)
19
Q
The deep fibular nerve innervates
A
Anterior compartment
Dorsal intrinsic muscles
20
Q
Inferior Tibiofibular Joint
A
Fibrous syndesmosis
Fibular notch articulates with medial surface of tibia, separated by fat pad
21
Q
Inferior TibFib joint: movement
A
Minimal.
Spreads 1-2mm, allowing for dorsi and plantarflexion
Fibular moves superiorly with dorsiflexion, inferiorly with plantarflexion
With dorsiflexion carries 17% more axial load
22
Q
Inferior TibFib joint: ligaments
A
Interosseous tibiofibular (strongest) Anterior and posterior tibiofibular (prevent excess gapping of joint and posterior glide) Transverse tibiofibular (lined with cartilage). Articulates with talus in extremem plantarflexion
23
Q
Talocrural Joint
A
Synovial, modified hinge
inferior articular surface of the tibia and malleolar surfaces of tibia and fibula (concave) with trochlea of the body of the talus (convex)
one degree of freedom (dorsi/plantarflexion)
Resting: 10º dorsiflexion
Capsular pattern: plantar>dorsi
Firm end feel
24
Q
Ligaments of the medial talocrural joint
A
Deltoid ligament (anterior and posterior tibiotalar, tibiocalcaneal, tibionavicular).
Collectively check eversion
25
Ligaments of the lateral talocrural joint
Anterior talofibular
Calcaneofibular
Posterior talofibular
Collectively check inversion
26
Most commonly sprained ligament
Anterior talofibular
27
What does the anterior talofibular ligament check?
inversion and plantarflexion
28
What does the calcaneofibular ligament check?
inversion and dorsiflexion
29
What does the posterior talofibular ligament check?
inversion and dorsiflexion
30
What ligament tends to get taken out with grade three ankle sprains?
Calcaneofibular.
| Becomes vertically aligned with dorsiflexion
31
Talocalcaneal Joint
AKA subtalar
Synovial plane joint with gliding and rotational movements
Movements: inversion/eversion
Corresponding facets of the talus and calcaneus
anterior and middle facets share joint capsule with talocalcaneonavicular joint
Closed pack: inversion
32
Subtalar ligaments
Talocalcaneal (medial and lateral)
Interosseus
Talocalcaneal
Cervical
33
Midfoot
Refers to midtarsal joints between navicular, talus, cuboid, calcaneus, as well as between the cuneiforms
34
Talocalcaneonavicular Joint
compound ball and socket, synovial joint
Ball: head of talus
Socket: navicular + spring ligament
Closed pack position: supination
35
Spring ligament
AKA plantar calcaneonavicular ligament
Ant/med sustentaculum tali to the inferior/inf-med navicular
Maintains the arch of the foot.
When lax, medial separation; forefoot abducts from hindfoot, talar head moves inferiorly, arch drops
36
All midfoot joints closed packed in:
supination
37
Calcaneocuboid Joint
Saddle (sellar) joint
Has its own joint capsule
Calcaneus: concave superiorly, convex mediolaterally
Cuboid: convex superiourly, concave mediolaterally
38
What ligaments reinforce the calcaneocuboid joint capsule
Short and long plantar
39
Cuboideonavicular Joint
Fibrous syndesmosis, sometimes synovial
Closed pack in supination, with slight gliding, rotational movement
Supported by planter and dorsal cubonavicular and interosseus ligaments,
40
Cuneonavicular Joints
Plane synovial
Closed pack in supination, with slight gliding, rotational movement
41
Intercuneiform Joints
plane synovial
Closed pack in supination, with slight gliding, rotational movments
42
Cuneocuboid Joints
Plane synovial
Closed pack in supination, with slight gliding and rotational movements
43
Lisfranc's joints are also known as
Tarsometatarsal joints
44
Tarsometatarsal joints
Plane synovial
Closed pack: supination, with slight rotation and gliding
Supported by dorsal and plantar ligaments
45
Cuneiform Mortise
At TMT2. In the tarsometatarsal/lisfrancs joint, the 2nd MT lies 2-3 mm proximally
Increases stability
46
Tarsometatarsal joint capsules
One capsule for TMT 1
One capsule for TMT 2 & 3
One capsule for TMT 4,5 and cuboid
47
Midline of the foot
MT2 (hand: MC3)
48
Intermetatarsalphalangeal Joints
Plane synovial joints
| Closed packed in supination, with slight gliding
49
Metatarsalphalangeal Joints: dorsal capsule reinforced by:
Extensor hood expansion
50
MTP Joints: reinforced laterally by
Collateral ligaments
51
Plantar plate
Fibrocartilageous plantar MTP ligament
Continuous with the plantar aponeurosis
Toe dorsiflexion tenses plantar aponeurosis through it, stabilizing longitudinal arch.
52
MTP closed pack
extension
53
Interphalangeal Joints: closed pack
extension
54
Interphalangeal joints: reinforced laterally by
collateral ligaments
55
Plantar Fascia
Planter surface of calcaneal tuberosity, branches at MTP joints into 5 bands (one per toe)
medial, central and lateral compartments
56
Which plantar fascia compartment is more prone to pain?
Central
57
Plantar fascia and foot stability
MTP hyperextension loads into plantar fascia
| Increases longitudinal arch, hindfoot inversion, and lateral rotation of low leg
58
The plantar fascia supports stability in what part of the gait cycle?
Supports stability and supination during pre-swing/toe-off
59
Tibialis Anterior
O: Lateral tibial condyle, proximal 2/3 anterior tibia, proximal 2/3 of the interosseous membrane
I: 1st cuneiform and 1st metatarsal
Crosses in front of medial malleolus
Dorsiflexion and inversion/supination
Deep fibular nerve (L4,5)
Anterior tibial artery
60
Fibularis Tertius
O: distal 1/3 of anterior fibula and interosseous membrane
I: Dorsal base of MT5
Dorsiflexion, eversion
Deep fibular nerve (L4,5)
Anterior tibial artery
Actually the most distal belly of the EDL
61
Fibularis Longus
O: fibular head and prox 1/2 of the lateral fibula
I: First cuneiform and MT1
Plantarflexion and eversion
Superficial fibular nerve (L5, S1)
Fibular artery
62
Fibularis Brevis
O: Distal 1/2 of lateral fibular
I: lateral base of MT5
Eversion and plantarflexion
Superficial fibular nerve (L5, S1)
Fibular artery
63
Gastrocnemeus
Medial and lateral femoral condyles
to the calcaneus via achilles tendon
Plantarflexion, knee flexion, inversion
```
Tibial Nerve (S1-2)
Popliteal artery
```
64
Soleus
Soleal line of the tibia, head and prox 1/3 fibula
to the calcaneus via achilles tendon
Plantarflexion, inversion
```
Tibial nerve (S1-2)
Popliteal artery
```
65
Plantaris
Lateral condyle and distal lateral supracondylar line of the femur
to posterior calcaneus
Plantarflexion, knee flexion, inversion
```
Tibial nerve (S1-2)
Popliteal artery
```
66
Tibialis Posterior
Proximal 2/3 of tibia, fibula, interosseous membrane
to
Navicular tuberosity
Plantaflexion, inversion
```
Tibial nerve (L4,5)
Posterior tibial artery
```
67
Extensor Digitorum Longus
O: Proximal 2/3 fibula, 1/3 interosseous membrane, lateral tibial condyle
I: Dorsal toes 2-5
Extends toes 2-5 @ MTP and IP, dorsiflexion, eversion
Deep fibular nerve (L5, S1)
Anterior tibial artery
68
Extensor Hallucis Longus
Middle 1/3 anterior fibula and interosseous membrane
to Dorsal big toe
Extends big toe at MTP and IP, dorsiflexion, inversion
Deep fibular nerve (L5, s1)
Anterior tibial artery
69
MMT Tibialis anterior
Supine or seated.
Support just above ankle
Starting: dorsiflexion, inversion (without big toe extension)
Pressure: against medial dorsal surface, towards plantarflexion and eversion.
70
MMT Tibialis posterior
Supine
Support just above ankle
Starting: Inversion, plantarflexion
Pressure: against medial and plantar side, toward dorsiflexion and eversion
71
MMT Fibularis longus
Supine, with leg medially rotated, or side-lying
Support just above ankle
Starting: plantarflexion, eversion
Pressure: against lateral border and sole, toward inversion and dorsiflexion
72
MMT soleus
Prone, knee flexed to at least 90º
Support proximal to ankle
Starting: plantarflexion, neutral in/eversion
Pressure: against calcaneus, pulling heel caudally
73
Supination
Subtalar: inversion
Forefoot: adduction
Talocrural: plantarflexion
Leg: laterally rotated (vis a vis the foot)
Increases medial long arch
Subtalar joint more stable, so less muscle work required
74
Pronation
Subtalar: eversion
Forefoot: abduction
Talocrural: dorsiflexion
Leg: medially rotated (vis a vis the foot)
Decreases medial long arch
Subtalar joint less stable, so more muscles need to maintain stance stability
75
During subtalar pronation/eversion, what happens at the midtarsal joints?
ROM is increased, creating flexibility
| Occurs with midstance, allows adaptation to adapt to ground
76
During subtalar supination/inversion, what happens at the midtarsal joints?
ROM is decreased, creating rigidity
| Occurs with toe-off to allow for stability and propulsion
77
Progressive stabilization describes events at what joints?
talocrural
superior tibfib
inferior tibfib
78
Progressive stabilization describes events at what points of the gait cycle?
```
initial contact (heel strike)
load response (footflat)
midstance
```
79
Progressive stabilization
1. Initial contact: ankle in dorsiflexion -- very stable.
2. Load response: ankle plantarflexes as body moves forward. Talocrural joint less stable.
3. Body continues to move forward, increases dorsiflexion, which increases stability.
4. The talus is wedge shaped -- as the tibia and fibula move forward they spread apart 1-2mm at the inferior TibFib joint.
5. At the same time the fibular moves superiorly, checked by interosseous membrane
6. Taut interosseous membrane creates more stability for the superior and inferior tibfib joints, creating a stable leg for MidStance.
80
The arches allow for:
Shock absorption
Adjustment to the terrain, balance
Propulsion
81
The arches of the feet are maintained by what three mechanisms:
1. wedging of the interlocking tarsal and metatarsal bones
2. tightening of plantar ligaments
3. intrinsic and extrinsic muscles of the foot and their tendons, which helps to support the arches
82
Longitudinal Arches of the foot
Medial and longitudinal
Form a cone as a result of the angle of the MT bones in relation to the floor (the medial arch more evident)
Lateral arch: more stable and less adjustable
83
Medial Longitudinal Arch: structures
Calcaneal tuberosity, talus, navicular, three cuneiforms, and MT1-3
84
Medial longitudinal arch: stabilized by
1. Muscles: tibialis anterior, tibialis posterior, FDL, FHL, Abductor hallucis, FDB
2. Spring ligament
3. Plantar fascia
85
Lateral longitudinal arch: structures
Calcaneus, cuboid, MT4&5, talus
86
Lateral longitudinal arch: stabilized by
1. Muscles: fibularii, ADMin, FDB
2. Short and long plantar ligaments
3. plantar fascia
87
Keystone of the lateral longitudinal arch
Cuboid
88
Transverse arch of the foot: structures
Navicular, cuneiforms, cuboid, metatarsals
89
Transverse arch of the foot: stabilized by
Tibialis posterior, tibialis anterior, fibularis longus
| Plantar fascia
90
Gait cycle
Sequence of movements between two consecutive initial contacts of the same foot.
91
Step
1/2 of a gait cycle (foot contact of one foot to the foot contact of the other foot)
92
Stride length
linear distance between successive point of foot-to-floor contact of the same foot
93
Two phases of gait cycle
```
Swing phase (35-40% -- double leg)
Stance phase (60-65% -- single leg)
```
94
Phases of Stance (traditional/RLA)
```
Heel strike/Initial Contact
Foot flat/Loading Response
Midstance
Heel-off/Terminal Stance
Toe-off/Preswing
```
95
Phases of Swing (traditional/RLA)
Acceleration/Initial Swing
Midswing
Deceleration/Terminal swing
96
Heel contacts the ground
Heel strike/initial contact
97
Plantar surface of the foot in contact with the ground
Foot flat
98
From entire foot making contact with the ground to the opposite foot leaving the ground
Loading response
99
Point of which the body passes over the weight-bearing leg
Midstance (traditional)
100
From opposite foot leaving the ground to body being directly over the weight bearing limb
Midstance (RLA)
101
Heel leaves the ground, while toes remain in contact
Heel off
102
From weight bearing heel rising, to initial contact of the opposite foot.
Terminal stance
103
Toes leave ground
Toe-off
104
From initial contact and weight shifting onto the opposite leg, to just before toes of the weight-bearing leg leave the ground
Preswing
105
Swing leg begins to move forward
Acceleration
106
From toes leaving the ground to swing foot being opposite the weight bearing foot, with knee in maximum flexion
Initial swing
107
Swing of the non-weightbearing leg is directly under the body
Midswing (traditional)
108
From swing foot being opposite weight-bearing foot, to the swing leg being in front of the body and the tibia being vertical
Midswing (RLA)
109
Leg slowing down in preparation for heel strike
Deceleration
110
From the vertical tibia to just prior to initial contact
Terminal swing
111
Initial contact: joint action
Hip: flexion
Knee: full extension
Ankle: dorsiflexion moving into plantarflexion
Foot: supinated,
112
Loading Response: joint action
Hip: decreasing flexion
Knee: flexion
Ankle: plantarflexed
Foot: pronated
113
Midstance: joint action
Hip: neutral
Knee: slightly flexed
Ankle: slight dorsiflexion
Foot: neutral
114
Terminal stance: joint actin
Hip: extension
Knee: flexion
Ankle: dorsiflexion moving toward plantarflexion
Foot: Supination
115
Pre-swing: joint action
Hip: extension
Knee: slight flexion
Ankle: plantarflexion
Foot: supination
116
Initial contact: muscle action
Hip: Glute max -- eccentric
Knee: Quads -- eccentric
Ankle/Foot: anterior compartment -- eccentric
117
Loading Response: muscle action
Hip: glute max -- concentric
Knee: quads -- concentric (prep for extension)
Ankle/Foot : Deep posterior compartment -- eccentric
118
Midstance: muscle action
Hip: Iliopsoas -- eccentric; IL glute med -- concentric
Knee: Gastrocs -- eccentric (prevents terminal knee extension)
Ankle/Foot: Gastrocs -- eccentric (because of slight dorsiflexion)
119
Terminal stance: muscle action
Hip: iliopsoas -- eccentric
Knee: Gastrocs --concentric (start of knee flexion)
Ankle/Foot: Gastrocs -- concentric
120
Preswing: Muscle action
Hip: iliopsoas -- eccentric (resist hip extension); ADD MAG (to control and stabilize pelvis)
Knee: quads -- eccentric
Ankle/Foot: Gastrocs -- concentric
121
Initial Swing: Joint Action
Hip: slight flexion moving towards increased flexion
Knee: increasing flexion
Ankle: plantarflexion moving into 20º dorsiflexion and slight pronation
122
Midswing: joint action
Hip: flexion
Knee: flexion
Ankle: neutral
Foot: slight supination
123
Terminal swing: joint action
Hip: increased flexion
Knee: decreased flexion to almost full extension, slight lateral rotation
Ankle: dorsiflexion
124
Initial Swing: Muscle action
Hip: Hip flexors -- concentric; CL glute med -- concentric
Knee: Hamstrings -- concentric
Ankle: Dorsiflexors -- concentric
125
Midswing: Muscle action
Hip: hip flexors -- eccentric; IL glute med -- eccentric
Knee: quads -- concentric; hammies -- eccentric
Ankle: dorsiflexors -- isometric
126
Terminal swing: muscle action
Hip: glue max -- eccentric
Knee: quads -- concentric; hammies -- eccentric
Ankle: dorsiflexors -- isometric
127
Hindfoot varus
Inversion of the calcaneus when the subtalar joint is neutral
Hindfoot rigid --> decreased pronation ROM
128
Hindfoot varus presents as
pec cavus (increased medial long. arch)
129
Hindfoot varus may result in _______ at the knee
Genu varum
130
Hindfoot varus may contribute to what pathologies?
Plantar fasciitis
Shin splints
Hamstring strain
Knee pathologies
131
Hindfoot valgus
Eversion of the calcaneus when the subtalar joint is neutral
* less problematic than hindfoot varus *
Hindfoot mobile --> excess pronation and decreased supination ROM
132
Hindfoot valgus presents as
pes planus (decreased medial long. arch)
133
Hindfoot varus may result in _____ at the knee
Genu varum
134
Hindfoot varum may contribute to what pathologies?
tibialis posterior tendon insufficiency
135
Forefoot varus
```
Inversion of the forefoot (vis a vis the hindfoot)
Metatarsal abduction
Medial longitudinal arch decreases
Occurs with hindfoot valgum, pes planus
In stance, completely pronated
```
136
Forefoot valgus
Eversion of the forefoot (vis a vis the hindfoot)
Medial longitudinal arch increases
Occurs with hindfoot varus, pes cavus
In stance, completely supinated
137
Pes planus: observation
```
decreased medial longitudinal arch
Hindfoot valgus (calcaneal eversion)
Metatarsal abduction (forefoot varus)
Subtalar dorsiflexion
```
Common with genu valgum, anteverted hip, PFPS (**movie theatre sign**)
138
Rigid vs Flexible flatfoot
Congenital vs Acquired
Rare, boney changes, soft tissue contracture
vs
Mobile, rarely involves soft tissue contractures
139
Pes planus: associated muscle,soft tissue, etc
Lax spring ligament
| Weak tib post, abdHalbrev (decreased inversion)
140
Differentiating between Rigid and Flexible flat foot
Observe standing
Ask client to stand on tiptoes
Observe effect on arch
If arch appears --> flexible
141
Pes Cavus: observation
Longitudinal arch accentuated
Plantar soft tissue shortened, bones may alter in shape
Leads to rigid foot -- very little ability to adapt to stress and absorb shock
142
What pathologies may result from pes cavus?
Claw toes
| OA at tarsus
143
Bunion
Bony exostosis/spur
Increase in bone mass at the site of irritation (usually MTP #1 joint line)
Occurs with valgus toe
144
Tailor's Bunion
Bunion on the 5th digit (little toe)
145
Pump Bump/Runner's Bump
Bunion on the 1st digit (big toe)
146
Abnormal gait occurs for what three reasons?
1. pathology or injury in a specific joint
2. compensations for IL injury/pathology
3. compensations for CL injury/pathology
147
Antalgic Gait
Protective
Injury to pelvis, hip, knee, ankle, foot
Stance phase on affected leg shorter
On unaffected side, shorter swing phase and shorter step length
148
Steppage Gait
Pathologies involving doriflexors, deep fibular N --> lack of dorsiflexion --> knee lifts higher in midswing
149
Circumducted/Trendelenburg's Gait
AKA Lurching Gait
Weak glute med --> leg swing out and around
Common with advanced OA
150
Gait: lack of plantar flexion
Excess plantarflexion on unaffected side
151
Gait: tight hip flexors
Forward lean
152
Hemiplegic Gait
AKA neurogenic or flaccid gait
Swings leg outward and ahead; leg medially rotated
Affected upper limb carried across body
153
Scissor Gait
Spastic paralysis of hip adductors
154
Festinating Gait
AKA Parkinsonian Gait
Shuffling or short rapid steps
Arms held stiffly
155
Functional tests for foot and ankle:
Squat (SL, BL)
SL balance progression
Proprioception
156
L4 Dermatome
Over patella to big toe
157
L5 Dermatome
down tibialis anterior
158
S1 Dermatome
Lateral side of foot
159
L4 Myotome
Dosiflexion
160
L5 Myotome
Extension of big toe
161
S1 Myotome
Eversion of foot
162
S1 Reflex
Achilles tendon
163
Pain in foot/ankle may refer from
```
Glute Min
TFL
Piriformin
Extrinsic calf mm
Locally from instrinsic mm
```
164
To rule out the knee as a source of ankle/foot pain
AF flexion, extension, with POP
165
To rule out superior TibFib as source of ankle/foot pain
PR anterior/post glide, looking for movement at ankle
166
To rule out MTP as source of pain
AF flexion, toe extension, followed by POP
167
DDx Fracture
Tuning fork, tapping bone along length
168
What three conditions can fall under the category "shin splints".
Compartment syndrome
Tibial stress fracture
Periostitis
169
Acute compartment syndrome.
Buildup of pressure on all four compartments.
Medical emergency
Can follow trauma.
170
Acute compartment syndrome: Sx
Shiny, hot, hard, blanched, taut skin
Paresthesia
Motor loss
Pain with passive stretch.
171
Chronic exertion all compartment syndrome
Overuse
Buildup of pressure in anterior (45%) or deep posterior compartment
Exercise induced
172
Compartment syndrome
Inflammation and hypertrophy in muscles creating abnormally high intramuscular pressure within fibro-Osseous space
--> ischemia
173
CECS (anterior): Sx
Anterior/lateral tibial pain that increase with activity (at constant interval), decreases with rest
Ache, tightness
Poss: paresthesia
174
What does stress do to postural muscles (like the Gastrocs)?
Short and tight
175
What does stress do to the phasic muscles (like tib ant)?
Long and weak
176
CECS (anterior compartment) special tests
MMT tib ant, gastroc, gastroc length
177
Gastroc length test
A/PROM greater than 20° dorsiflexion with knee extension
178
CECS: hallmark sign
Pain occurs at same interval of activity.
179
CECS (posterior): Sx
Pain along post-Med tibia
Swelling and palpable tenderness along tendon
Weak plantarflexion and inversion
180
Anterior CECS: contributing factors
Hard surfaces
Imbalance between weak ant tib and short superficial posterior compartment
181
Posterior CECS: contributing factors
Valgus subtalar joint
Running terrain
Poor flexibility
Overpronation (overworked tib post)
182
CECS (posterior) special tests
MMT tib post
| Observe pronation vs supination (tiptoe test)
183
Tibial stress fracture: Sx
Pain and discomfort -- initially with activity, relived with rest, progresses to longer duration with possible nocturnal pain.
184
Tibial stress fracture: special tests
Tuning fork (2-3 inches above med mall)
Knock test
Lever test
185
Tibial Periostitis
Inflammation of tibial periosteum near tib post origin
18% running injuries
May progress to stress fracture
186
Tibial Periostitis: Sx
Pain local to distal postmed tibia
Often BL and accompanied by over pronation
Pain in the morning and with exercise, decreases with activity. Returns with fatigue and continues afterward. As it progresses pain continues through activity
187
Tibial Periostitis: special tests
Stress fracture tests
MMT
Foot alignment
188
Tibial Periostitis: hallmark
Morning pain
189
Tibial stress fracture: hallmark sign
Nocturnal pain
190
Achilles tendonitis
Overuse injury of the Achilles' tendon
Commonly at avascular zone (1-4" above insertion), or insertion
Forced dorsiflexion (eccentric contraction + excess pronation), tight calves, high impact sports.
191
Tibialis posterior tendinitis: Sx
Pain along medial border of tibia (mid-distal 1/3), especially with loading response in gait
Weak and painful plantar flexion and inversion
Crepitus, swelling, nodular tendon
Pain in tarsal tunnel
192
Dynamic stabilizers of longitudinal arch
Tib post
FHL
FDL
193
Tib post is important in what phases of gait?
Load response
| Mid stance
194
Tarsal tunnel is outlined by
Medial malleolus
Calcaneus
Flexor retinaculum
Talus
195
What travels through the tarsal tunnel?
Tib Post, FDL, FHL
Post Tib artery
Post tib vein
TIbial nerve
196
Plantar Fasciitis
Acute strain or chronic overuse condition caused by repetitive plantarflexion + MTP extension
May cause development of boney spurs at origin
197
Plantar Fasciitis: pes planus/cavus
Pes planus may cause microtears
Pes cavus -- chronically shortened fascia unable to dissipate force
198
Plantar Fasciitis: Sx
Unilateral or bilateral
Pain at anterolateral surface of calcaneus, along medial border toward metatarsal head.
Pain worse first thing in the morning, and with activity (esp pre-swing/toe off)
199
What muscle would you strengthen after an inversion sprain?
Fibularii
200
What muscle would you strengthen after an eversion sprain?
Tib Post
201
Most commonly sprained ligament
anterior talocrural
202
Ankle sprains: POP
Grade 1 no instability
Grade 2 no instability
Grade 3 no end range ---> severe pain, instability (chronic: pain free and unstable)
203
Syndesmotic Ankle Sprain
AKA high ankle sprain
Overstretch of sydesmotic ligaments of distal tibfib joint
MOI: rotation of lower leg and foot
204
Syndesmotic Ankle Sprain: Sx
dull or sharp pain in ant-lat lower leg; sharper when twisting
Pain increases with ankle rotation
205
Stable vs unstable high ankle sprain
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Stable = Grade 1/2. Tib and fib maintain positions
Unstable = Grade 3. Two or three of the three ligaments torn; tibia fibula move freely
```
206
Pes Planus
Flat foot
Decreased medial longitudinal arch;
Functional: lax spring ligament
Hindfoot valgus
Knee valgus
Forefoot varus
Possible anteversion, coxa varum;
207
What other paths tend to accompany pes planus?
PFPS
Tib post tendinopathy
Achilles tendonitis
208
HT/short muscles with pes planus
fibularii
gastrocs/soleus
(decreased dorsiflexion; evertors compensate)
209
Long and weak muscles with pes planus
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Deep posterior:
Popliteus
Tibialis posterior
Flexor digitorum longus
Flexor hallucus longis
```
210
Pes Cavus
Excessive inversion of the foot; high medial arch
Due to increased supination of the foot
Hindfoot varus, calcaneal inversion
211
What muscles are shortened in pes cavus?
tibialis anterior, posterior, toe flexors
212
Morton's Neuroma
Swelling of interdigital nerves of the foot
Usually between 3rd and 4th metatarsal
Sx; cramping pain up side of foot to tip of affected toe
Compression pain when weight bearing; exacerbated by tight shoes
(yoga toes)
213
Tarsal Tunnel Syndrome
AKA joggers foot
Tibial nerve compressed within tarsal tunel
214
Tarsal Tunnel Syndrome: Sx
Pain in medial ankle (mimics plantar fasciitis)
Weak toe flexion
** night pain
Altered sensation over sole of foot and toes
Increased Sx with forces eversion and/or dorsiflexion
