Foot/ankle

Question 1

Which position of ankle is there more joint play, PF or DF?

Answer 1

PF. trochlea is wider anterior than posterior, leading to tighter fit

Question 2

What is function of spring ligament in regards to medial longitudinal arch?

Answer 2

supports arch via preventing talar head dorsiflexion.

Due to this, it is frequently involved in flat foot deformity

Question 3

What is the Lisfranc joint?

Answer 3

the first set of joints between tarsals and metatarsals

Question 4

Lisfranc ligament

Answer 4

Strong connection between 2nd metatarsal and medial cuneiform, linking them with 1st ray

Question 5

Triceps Surae moment arm

Answer 5

much larger than other PF muscles, leading to them contributing majority of force despite only being 40% of muscle mass

Question 6

Muscles of deep posterior compartment of lower leg

Answer 6

flexor hallucis longus, flexor digitorum longus, tibialis posterior.

Question 7

Function of tibilias posterior?

Answer 7

support medial longitudinal arch by attachment to medial navicular/cuneiforms

Question 8

Tib posterior contribution to supination

Answer 8

• primary supinator

- long moment arm and large size means that other muscle unlikely to functionally substitute if muscle is compromised

Question 9

Tib anterior contribution to supination

Answer 9

Low compared to posterior.

Smaller moment arm

Question 10

Average subtalar axis

Answer 10

superior 42 degrees, medial 16 degrees

Question 11

Mechanics of midfoot when hindfoot is pronated

Answer 11

axes of calcaneocubiod and talonavicular joints line up, allowing increased mobility

Question 12

Which ligament is at risk of failure following PF release

Answer 12

Spring ligament

Question 13

Which motion of tibia raises medial longitudinal arch of foot?

Answer 13

ER

Question 14

What is source of tibial motion during gait

Answer 14

Proximal sources (hip/knee musculature)

Question 15

What is primary source of force for forward progression

Answer 15

Plantarflexors

Question 16

Subtalar motion during gait

Answer 16

moves into pronation from IC to foot flat.

Then rapidly supinates

Question 17

At what point is anterior tib more important with controlling hindfoot motion?

Answer 17

following initial contact.

Tib posterior becomes active just before foot flat

Question 18

Percentage of force from digits during running

Answer 18

25-50%

Question 19

In pes planus, the talus PF, loading, and potentially compromising which ligament

Answer 19

calcaneonavicular (spring)

Question 20

Foot kinematics in pes planus

Answer 20

hindfoot eversion
forefoot abduction
forefoot DF

Question 21

Risks for runners with high arch

Answer 21

increased ankle sprains and 5th met fx

Question 22

peek a boo sign

Answer 22

when medial heel is visible from anterior.

Indicatvie of pes cavus

Question 23

Navicular drop test assessment

Answer 23

change in height from neutral to standing

greater than 10mm difference is risk factor for MTSS

Question 24

What is tested with single leg heel raise

Answer 24

PF endurance.

Often doesn’t capture peak forces, therefore not a true strength test.

typical repetitions: 25

Question 25

Correlation between static foot position and dynamic foot position

Answer 25

fairly high

Question 26

Subtalar joint ROM assessment reliability

Answer 26

Poor inter rater, good intrarater

Question 27

Hallux limitus ROM

Answer 27

less than 40 degrees

Question 28

Anterior drawer test

Answer 28

ATFL. positive if pain reproduced anterior/inferior of lateral malleolus, or if 3mm greater excursion.

Question 29

Talar tilt test

Answer 29

ATFL or CFL either in 10 degrees DF (CFL) or 20 degrees PF (ATFL). May not differentiate b/w ligaments

Question 30

Dorsiflexion external rotation test

Answer 30

for syndesmotic ankle sprain good Sn (71%), moderate Sp (63%)

Question 31

Squeeze test

Answer 31

for syndesmotic ankle sprain. pain reproduction with squeezing tibia and fibula together at mid calf. Low Sn (26%), high Sp (88)

Question 32

syndesmotic ligament palpation

Answer 32

high Sn (92%), Low Sp (29%)

Question 33

Cotton test

Answer 33

translation of talus in ankle mortise High Sn (71), Low Sp (29)

Question 34

Thompson test

Answer 34

AT tear High Sn and Sp (96,93)

Question 35

AT palpation

Answer 35

for AT tendinopathy High Sp, mod Sn

Question 36

Royal London Hospital test

Answer 36

For AT tendinopathy palpate AT at tender portion. If pain is decreased with active DF, ATendinopathy is likely

Question 37

Arc sign

Answer 37

Identify area of swelling. PF and DF foot. if swollen area moves, tendinopathy high Sp, mod Sn

Question 38

Windlass test

Answer 38

Reproduction of symptoms with DF of 1st ray in weight bearing. High Sp, low Sn