Intro Lower Extremity Foot and Ankle

Question 1

Ankle PF and DF arthros for talus and fib

Answer 1

PF: Talus glides anterior and fib head glides inferior/anterior/IR

DF: talus glides posterior and fib head glides superior/posterior/ER

Question 2

Talocrural joint AROM
DF, PF

Answer 2

DF: 20
PF: 50

Question 3

Talocrural joint closed packed, resting, and capsular patter

Answer 3

Closed packed: max DF
Resting: 10 PF with mid between inv/eve
Capsular pattern: PF>DF

Question 4

Pronation vs supinator tri planar motions

Answer 4

Pronation: DF, ABD, EVE
Supination: PF, ADD, INV

Question 5

Open chain arthro in subtalar joint supination and pronation for calcaneus

Answer 5

Supination: calcaneus inverts and moves medial
Pronation: calcaneus everts and moves lateral

Question 6

Close chain arthro subtalar joint for supination and pronation
Tibia
Talus
Calcaneus

Answer 6

Supination: tibial ER, talus DF/ABD, calcaneus inverts
Pronation: tibial IR, talus PF/ADD, calcaneus everts

Question 7

Subtalar joint arom
Inv
Eve

Answer 7

Inv: 20-30
Eve: 5-10

Question 8

Subtalar joint closed packed and resting

Answer 8

Closed: supination
Resting: midway between inversion and eversion, 10PF

Question 9

Supination is a combination of

Answer 9

Supination: Inversion, PF, add
Pronation: eversion, DF, AND

Question 10

The hind foot during gait cycle

Answer 10

Needs to be able to transition from torque converter in stance phase to rigid lever in toe off (driven by subtalar joint)

Question 11

Heel strike and calcaneus and midfoot

Answer 11

Calcaneus everts to unlock midtarsal joints

Midfoot unlocks

Question 12

Toe off and calcaneus and midfoot

Answer 12

Calcaneus inverts to lock midtarsal joints

Midfoot locks

Question 13

What does subtalar dysfunction lead to and why

Answer 13

Leads to midfoot over pronation and forefoot abduction during toe off because there is no conversion and midtarsal joints stay unlocked

Question 14

Overpronation and forefoot abduction can lead to

Answer 14

Lateral column compression

Elongation and tension to medial side ankle

Question 15

Required amount of ankle extension for running and walking

Answer 15

15-20

Question 16

When Talocrural extension is limited, what happens

Answer 16

Tibial IR
Calcaneus eversion
Midfoot pronation

(Lateral column compression)

Question 17

MTP 1 flexion and extension AROM

Answer 17

Ext: 70 (60 required for gait)
Flx: 45

Question 18

When does the first day begins to plantar flex

Answer 18

20-30 degrees 1st MTP extension

Question 19

What has to happen for proper first ray PF

Answer 19

Heel lift, subtalar supination, normal seasons function

Question 20

As plantar flexion of first ray continues, what way to metatarsals move

Answer 20

Posterior direction on seasmoids

Question 21

MTP 1 closed packed position

Answer 21

Max extension

Question 22

MTP 2-5 closed packed position

Answer 22

Max flexion

Question 23

MTP resting position and capsular pattern

Answer 23

Resting: 10 degrees ext
Capsular; extension, flexion

Question 24

IP closed pack position

Answer 24

Max extension

Question 25

IP resting and capsular pattern

Answer 25

Slight flexion Flexion, extension

Question 26

IP 1 ext and flx AROM

Answer 26

Ext: 0 Flx: 90

Question 27

PIP 2-5 extension and flexion AROM

Answer 27

Ext: 0 Flx: 35

Question 28

DIP 2-5 extension and flexion AROM

Answer 28

Extension: 30 Flexion: 60

Question 29

What kind of joint is the inferior tibiofibular joint

Answer 29

Syndesmosis

Question 30

DF and PF Tib/fib interosseus membrane Fibula

Answer 30

DF: increased distance between medial and lateral malleolis, tension in membrane, fib ER and glides superior PF: decreased distance between medial and lateral malleolus, fibula glides inferiorly and IR

Question 31

Eversion and inversion Head of fibula Fibula

Answer 31

Eversion: fib head glides proximal and fibula medially rotates Inversion: fib head glides inferior and fibula lateral rotates

Question 32

Wells clinical prediction rule for DVT

Answer 32

Active cancer or within 6mos Immobilization, paralysis, paresis Bed>3 days or surgery in last 4 wks Center post calf tender, popliteal space, or along femoral vein in ant thigh/groin Entire LE swelling U/L calf swelling > 3cm than good side U/L pitting edema Nonvaricose veins Alternative diagnosis likely or more likely than DVT (-2, all others are 1)

Question 33

Points on wells

Answer 33

-2 to 0: low prob, med consult 1-2: mod, med referral 3 or more: high, med referral

Question 34

Ottawa ankle rules

Answer 34

Highly sensitive Distal 6cm of posterior edge of tibia or tip medial malleolus Distal 6cm of posterior edge of fibula or tip of lat malleolus Base of 5th met pain Navicular pain (ANY of the above warrant referral)