SHANKMAN CHP 17 ANKLE, FOOT, TOES pg 232

Question 1

defintion:

a calcaneus fracture that heals in a varus positon locks the subtalar joint in inversion, crating a rigid transverse tarsal joint

Answer 1

calcanueus fracture

Question 2

definition

rupture results in planovalgus, or flatfoot

Answer 2

posterior tibialis tendon

Question 3

definition

ligaments responsible for maintaing stability of the distal tibiofibular articulation

Answer 3

syndesmosis

Question 4

definition

tests integrity of both anterior talofibular ligament and calcaneofibular ligament. both must be dirupted to be postive.

Answer 4

Talar tilt test

Question 5

definition

no muscle attachmetn origin or insertion. has a tenuous blood supply

Answer 5

Talus

Question 6

definition

passes behind the medial malleolus

Answer 6

tibial nerve

Question 7

chronic instablility may follow an inverison ankle sprain. Name the two types of instablilties associated with chronic ankle sprains.

Answer 7

mechanical and functional

pg 238

Question 8

Name the 3 major ligaments that represent the lateral ligament comlex of the ankle.

FAP

Answer 8

Anterio Talofibular

Posterio talofibular

Fibulocalcaneal

PG 233

Question 9

NAME the 3 distinct types of lesser toe deformities

Answer 9

• Hammer toe
• Mallet toes
• claw toes

pg 254

Question 10

toe deformity characterized by deformity of the mtatarsophalangeal joint proximal interphalangeal joint, and distal interphalangeal joint

the MTP joint is either in neutral postion or extension. the PIP jt is held in flexion with the DIP jt in either flexion or extension

Answer 10

HAMMER TOE

Question 11

toe deformity characterized by a neutral MTP jt, a neutral PIP jt, and a flexed DIP jt

bending at the DIP

Answer 11

Mallet toe

Question 12

toe deformity often associated with neuromuscular disease and are similar in appearance to hammer toes.

distinguished by MTP hyperextension, PIP flexion, and DIP flexion. Usually results from simultaneous contraction of the extensors and flexors.

Answer 12

Claw toes

Question 13

TRUE/FALSE

during the early recovery (acute phase) period of an inversion ankle sprain, it is imperative to instruct the pt to write the alphabet with the injured ankle

Answer 13

FALSE

Question 14

TRUE OR FALSE

Complete deltoid ligament sprains occur in combination with ankle fractures.

Answer 14

TRUE

Question 15

TRUE OR FALSE

Mechanical instability may require surgery to stabilize the ankle.

Answer 15

TRUE

Question 16

TRUE OR FALSE

. Treatment for a ruptured Achilles tendon is always with surgery.

Answer 16

FALSE

Question 17

TRUE OF FALSE

The loss of strength is less if the ruptured Achilles tendon is treated nonsurgically.

Answer 17

FALSE

Question 18

TRUE OR FALSE

The initial management of pilon fractures usually involves an open reduction with internal fixation procedure, external fixator, or skeletal traction.

Answer 18

TRUE

Question 19

TRUE OR FALSE

In severe cases of plantar fasciitis, the physician may inject a local corticosteroid to reduce pain and swelling.

Answer 19

TRUE

Question 20

TRUE OR FALSE

n cases of plantar fasciitis where all conservative measures fail to bring significant results, the physician may elect to perform a fasciotomy or excision of a calcaneal exostosis.

Answer 20

TRUE

Question 21

TRUE OR FALSE

Treatment of Morton neuroma is always with surgical excision.

Answer 21

FALSE

Question 22

TRUE OR FALSE

The removal of tight shoes may significantly reduce painful symptoms associated with hallux valgus.

Answer 22

TRUE

Question 23

TRUE OR FALSE

Lesser toe deformities are characterized as either rigid or flexible.

Answer 23

TRUE

Question 24

What percentage of all ankle sprains occurs to the lateral ligament complex?

A. 50%
B. 65%
C. 95%
D. 85%

Answer 24

C. 95%

Question 25

What is the primary mechanism of injury (MOI) to the lateral ligament complex of the ankle? ## Footnote A. Eversion and plantar flexion B. Plantar flexion, adduction, and eversion C. Inversion, plantar flexion, and adduction D. Dorsiflexion, abduction, and eversion

Answer 25

* C. Inversion, plantar flexion, and adduction

Question 26

The anterior drawer test is used to clinically examine which ligaments of the ankle? ## Footnote A. Posterior talofibular B. Anterior talofibular C. Fibulocalcaneal D. Deltoid E. All of the above

Answer 26

B. Anterior talofibular

Question 27

Which of the following represents potential pathologies that may be seen in conjunction with an inversion ankle sprain that is produced by inversion plantar flexion and adduction? ## Footnote A. Subluxing peroneal tendons B. Fracture of the base of the fifth metatarsal C. Malleolar fractures D. Sprains of the midfoot E. All of the above

Answer 27

E. All of the above

Question 28

Using the injury classification model described by Leach, which of the following describes a second-degree lateral ligament complex sprain of the ankle? ## Footnote A. The anterior talofibular ligament is completely torn. B. The anterior talofibular ligament and fibulocalcaneal ligaments are completely torn. C. All three ligaments are partially torn. D. The anterior talofibular and fibulocalcaneal ligaments are partially torn.

Answer 28

B. The anterior talofibular ligament and fibulocalcaneal ligaments are completely torn.

Question 29

classification of sprains single ligament is completel torn

Answer 29

First degree sprain

Question 30

classification of sprain double ligament rupture. Both the Anterior talofibular ligaments and fibulocalcaneal ligaments are completely torn.

Answer 30

second -degree sprain

Question 31

classificatin of sprain all three lateral ankle ligaments (ATF, posteror talofibular, and fibulocalcaneal) are completely torn

Answer 31

third - degree

Question 32

initial management of acute inversion ankle sprians calls for what

Answer 32

RICE

Question 33

Clinically the most effetive means to reduce swelling are what

Answer 33

Elevation and compression

Question 34

Protecting the torn ligaments from unwante stress is the cornerstone of what protection phase?

Answer 34

maximum

Question 35

PTs IE outline for the clinical assessmetn of inversion ankle sprain includes:

Answer 35

* History * Observation * Palpation * ROM * Strength * Clinical stabiltiy tests

Question 36

TRUE OR FALSE an AROM program must be used cautiously during the max -protect phase

Answer 36

true

Question 37

what type of exerxises are initiated as soon as the pts pain tolerance allows.

Answer 37

Isometric strengthing exercises DF and eversion 2 to 3 sets of 10 holding for 10 secs

Question 38

When does the Moderate phase begin?

Answer 38

* once the pt can bear weight on the injured limb without crutches * perform all ROM and isometric exercises without undue complaints of pain * control the swelling

Question 39

In the moderate protection phase of lat ankle sprian what can you graudally add in as pain allows.

Answer 39

* inversion and PF * stationary bicycling w/ seat height lowered(encourage more neutral ankle) * proprioception exercises * balancing on injured limb(balance board, mini tramp)

Question 40

When can the minimum protection phase begin?

Answer 40

* Once the pt can perform all resistive exercises (ankle weights, thera-band, and manual resistance) * ambulate without pain or limping * swellin is reduced

Question 41

Does removal of all supportive devices imply minimum protection phase?

Answer 41

**no** maturatin of the injured ligaments can take as long as 6-12 months. * threfore it is critical to encourage pt compliance with the use of either tape or a semirigid brace during all running activities

Question 42

Depending on the physician's choice tx, a grade III sprain can be tx by either of what 2 ways?

Answer 42

1. surgically 2. early controlled motion and superviese PT

Question 43

Fractures of the medial or lateral malleolus may cause disruption of what ligament?

Answer 43

Deltoid ligament

Question 44

name the 7 parts to Phase I: Max-protection phase

Answer 44

1. RICE 2. EGS-electrical galvanic stim 3. WBAT 4. joint protection (plastic, hinged orthosis, tape, air cast, semirigid braces) 5. AROM- (DF and eversion) 6. isometric exercises 7. general fitness exercises

Question 45

Name the 9 parts to Mod protection phase

Answer 45

1. RICE 2. FWB 3. concentri and eccentric contractoer 4. continued joint protection 5. heel cord stretching 6. stationary cycling 7. proprioception exercises 8. general fitness exercises 9. avoidance of unwanted stresses(inv, PF)

Question 46

name the 8 parts to Min protection phase

Answer 46

1. joint protection during activities 2. running 3. jumping 4. plyometrics 5. proprioception exercises 6. general fitness 7. isotonic ex 8. isokinetic ex

Question 47

When the ankle is forced into DF or rotation with the foot in a Weight bearing position,where does the injury commonly occur?

Answer 47

ankle SYNDESMOSIS

Question 48

definition laxity of the ankle ligaments

Answer 48

Mechanical instabliltiy

Question 49

With mechanical insablilties surgery may be necessary to stabliize the ankle joint. procedures are common reconstructive surgical procedures used to help stabilize what ligaments

Answer 49

the lateral ligament complex of the ankle In general, the peronues brevis

Question 50

T/F the healing time for ligaments is slightly longer and more tenuous than that for muscle and tendon reconstruction?

Answer 50

True

Question 51

when subluxation of the peroneal tendons occurs what is happening? /

Answer 51

the peroneal tendons normally dislocate anteriorly over the lateral malleolus with ankle DF

Question 52

An overuse injury resulting from repetitive microtrauma and accumulative overloading ofthe tendon

Answer 52

Achililes Tendinopathy

Question 53

Complete ruptures of the achilles tendon can occur with sudden what?

Answer 53

eccentric-concetric contraction of the gastroc and soleus

Question 54

What test * the pt lies prone with feet extending off end of table. the entire lower leg is exposed from knee to toe. the belly of the calf uninvolved lim is grasped and squeezed so that the foot PF. * If the achilles tendon is ruptured on the involved limb when the calf is squeezed what indicates a positive thomas test?

Answer 54

no PF motion results pg 243

Question 55

Generally most pts after an achilles tendon rupture are able to return to full activiry after how long?

Answer 55

6-9 months

Question 56

after an achilles tendon rupture and immobilization strength training can usually begin as early as?

Answer 56

2-4 weeks pg 245

Question 57

Surgical complication following achilles tendon repair or reconstruction include what?

Answer 57

* sural nerve dysfunction * infection * skin sensitivity * adhesions * rerupture * tendon necrosis

Question 58

definition ## Footnote either acute or chronic elevated tissue pressure within a closed fascial space, resulting in occlusion of vessels and compromised neuromuscular function

Answer 58

Compartment syndromes of the lower leg

Question 59

Acute compartment syndromes of the leg are most commonly associated with what? And considered a medical emergency

Answer 59

1. tibial fractures 2. direct trauma to the area 3. muscle rupture 4. muscle hypertrophy 5. circumferential burns

Question 60

chronic compartment syndromes are also referred t as?

Answer 60

exertional compartment syndrome or exercise-induced compartment syndrome

Question 61

Clinical symptoms of acute compartment syndrome include what?

Answer 61

1. pain 2. palpable swelling or tenderness 3. paresthesias 4. skin may be warm, shiny, and tense 5. passive stretching may produce severe pain

Question 62

1. what is the most widely acceptedclassificatin of ankle fx called? 2. and another type is called?

Answer 62

1. Lauge-Hansen classifitcation 2. AO

Question 63

ankle fractures include

Answer 63

1. lateral malleolar fx 2. medial malleolar fx 3. bimalleolar fx 4. trimalleolar fx

Question 64

Many ankle fx are repaired with what?

Answer 64

ORIF

Question 65

after an ankle fx. when is a walking cast applied?

Answer 65

when the pt can acheive full PF and DF

Question 66

after a cast removal following an ORIF procedure for a medial malleolar fx. When should the PTA recongnize when to stop tx and inform PT?

Answer 66

1. increase swelling 2. c/o crepitus when strengthening exercises were increased 3. stressing inversion of the ankle

Question 67

What is a pilon fx

Answer 67

Distal tibia comression fx- occurs as a result of veritcal or axial loads that drive, or compress, the tibia into the talus.

Question 68

intraarticular depression fx that usually caused by falls from a height and resul in compression of the calcaneus from the talus

Answer 68

Calcaneal fx

Question 69

name the 7 common patterns of calcaneal fx

Answer 69

1. vertical fx of the calcaneal tuberosity 2. horizontal fx 3. fractures of the sustentaculum tali 4. anterior calcaneal fx 5. fracture of the body of the calcaneus without involvement of the subtalar jt 6. calcaneal fx with lateral fisplacemtn and involvement of the subtalar jt 7. central calcanues crushing fx

Question 70

what are the types of fractures of the Talus?

Answer 70

TYPE I- talar neck fx without displacement TYPE II- talar fx with subtalar subluxation (evidence of avascualr necrois is as high as 50%) TYPE III-talar fx with subtalar subluxation ( incidnec of avascular necrosis is as high as 85%) TYPE IV- talar head dislocates from the navicular in assoc... with a type III injury

Question 71

A partial or complete fx of bone caused by unrelenting stress and force that do not allow for osteoblastic repair of bone and in turn cause accelerated bone resorption

Answer 71

stress fx

Question 72

musculoskeletal overuse injuries of the lower leg involving the distal third of the posterior medial border of the tibia have historically been referred to as what?

Answer 72

shin splints

Question 73

WHAT SYNDROME ? pain over the distal and middle thirds of the tibia along the posterior medial border. Can include * stress fx of fibula and tibia * ischemic disorders * deep compartment syndromes of the lower leg

Answer 73

medial tibial stress syndrome

Question 74

chronic inflammation of the plantar aponeurosis with or without an associated calcaneal heel spur?

Answer 74

plantar fasciitis (heel spur syndrome)

Question 75

Pts with plantar fasciitis frequently complain of what?

Answer 75

1. pain along the medial border of calcaneus on plantar surface 2. pain is worse in the morning 3. palpation reveals tenderness at the medial tuberosity 4. DF may provoke pain

Question 76

radiating pain thru the toes and proximally to the dorsal or plantar surface of the foot

Answer 76

morton neuroma

Question 77

where does a mortons neuroma usually occur

Answer 77

1. 3-4 interspace 2. less frequently the 2-3 interspace

Question 78

A lateral or valgus deviation of the great toe with both soft tissue and bony deformity. Can be exacerbated by improper footwear.(narrow toe box)

Answer 78

Hallux Valugs