term 4 module 4 ankle review for assessment Flashcards
(46 cards)
1
Q
loading response
mid stance
terminal stance
toe off
mid swing
terminal swing
all have ….
A
single leg support ?
2
Q
heel strike
pre swing
both have….
A
double leg support?
3
Q
during gait ankle moves between ____ degrees
A
0>15>0
4
Q
during gait the knee moves between ____ degrees
A
5>60>5
5
Q
during gait the MTP moves between _____ degrees
A
0 > 30 > 60 > 0
6
Q
Primary functions include
A
- Shock absorption
- Adaptation (stance phase)
- Stability
- Ankle strategy
- Rigid Lever
- Torque distribution
- Windlass Mechanism
7
Q
Arches of the Foot
A
- Formed by three primary factors
- Articulation between tarsal and metatarsal
bones - Inert Ligamentous support (aponeurosis and
plantar ligaments) - Dynamic Muscle support
- Medial Longitudinal
- Lateral Longitudinal
- Transverse
8
Q
Arch Dynamic Stability
Provided By:
A
- Medial – Post Tib*, EHL, Tib Ant, FDL, FHL,
plantar fascia, boney congruency - Lateral – fibularis brevis/longus, plantar fascia,
boney congruency - Transverse – foot intrinsics, Post Tib, Flexor
digitorum
9
Q
Joints of the Foot/Ankle
A
- Distal Tibiofibular joint
- Talocrural joint
- Subtalar joint
- Midtarsal joints
- Metatarsophalangeal joints
10
Q
Ligamentous Stability
A
- Lateral Collateral Ligaments
- Anterior and posterior talofibular ligaments
- Calcaneofibular ligaments
- Medial Collateral Ligaments
- Deltoid ligament
- Distal TibioFibular Ligaments
- Anterior and posterior tibiofibular ligament
- Interosseous tibiofibular ligament
11
Q
Muscular Contribution
A
- Foot intrinsics- Review
- Muscles starting and ending in the foot
- Foot extrinsics – Review
- Muscles originating in the distal limb (tib/fib) and tendon insertion in the foot
12
Q
Additional structures to assess
A
- Plantar Fascia
- Windlass mechanism
- Has properties similar to a tendon
- Bursa
- Retrocalcaneal Bursa
- Nerves
- Medial/lateral dorsal cutaneous – branches
from? - Medial/lateral plantar nerve – branches
from?
13
Q
Lateral Ankle Pain
A
- Ankle sprain – ATFL, CFL
- Peroneal tendinopathy
- Fracture – 5th metatarsal
14
Q
Medial Ankle Pain
A
- Posterior tibialis tendon dysfunction
- Tarsal Tunnel Syndrome
- Deltoid ligament sprain
15
Q
Posterior Ankle Pain
A
- Achilles tendinopathy
- Retrocalcaneal bursitis
- Gastrocnemius Strain
16
Q
Heel Pain
A
- Plantar fasciitis
- Sever’s Disease
- Haglund’s Deformity
17
Q
Anterior Ankle Pain
A
- Anterior Impingement
- High ankle/syndesmotic sprain
18
Q
Midfoot pain
A
- Osteoarthritis
- Lisfranc
- Navicular Stress Fx
19
Q
Forefoot pain
A
- Metatarsalgia
- Morton’s Neuroma
- Hallux Deformities
- Toe Deformities
20
Q
- Lumbar Pathology – L4-S2
- Systemic
- Diabetes Mellitus (Peripheral Neuropathy)
- Osteomyelitis
- Gout
- Complex regional pain syndrome
- Peripheral vascular disease
- Rheumatoid Arthritis
A
Differential Diagnoses
21
Q
Common pain of ankle foot
A
- Sprains
- Fractures
- Inflammatory – ‘itis’
- Stress Fx
- Bunions – hallux valgus
22
Q
- Sharp stabbing
- Numb
- Ache
- Stiff
- Loose
A
Types of pain
23
Q
- Joint surface
- Joint capsule
- Ligamentous support
- Muscular support
- Tendon/insertion
- Nerve
- Bone
A
Tissues involved
24
Q
- Blunt trauma
- Repetitive/quick movements
- Muscle strain
- Overuse areas
- Nerve entrapment sites
A
MOI
25
What are you expecting with:
* Ankle swelling, stiffness – Decreased ROM DF
* Flat arches, pain in arch – TTP along post tib insertion/plantar fascia, Fx’nal - needs a lot of dynamic support
* High arch (soccer player/basketball player maybe) – prob rigid high arch Joint mobility more through great toe with DF than mid foot
* Toe deformity – Gait speed
26
RED FLAG SCREEN
*ANKLE
ottawa ankle rules
pain in malleolar region with any of the following:
bone TTP @ posterior edge of the distal _ cm or the tip of the lateral malleolus
bone TTP @ posterior edge of the distal 6 cm or the tip of the ________ malleolus
inability to bear weight for at least _ steps both immediately after injury and at the time of evaluation
6
medial
4
pain at any of these suggestions, get a radiograph
27
ottawa ankle rules
FOOT
get a radiograph if there is any pain in the midfoot region with any of the following:
bone TTP at ______bone (medial!)
bone TTP at base of ___ metatarsal (Lateral!)
inability to bear weight for at least _ steps both immediately after injury and at the time of _______
navicular
5th
evaluation
28
* Red flag - *Lumbar
* Cauda Equina
* Neurologic condition
* Myotomes/Dermatomes/Deep
Tendon Reflexes
* Straight Leg Raises – Nerve bias
Lumbar Screen
29
cauda equina
Cauda equina refers to the collection of spinal nerves at the bottom of the spinal cord, resembling a horse's tail. Cauda equina syndrome is a serious condition where these nerves are compressed or damaged, leading to symptoms like low back pain, leg weakness, and problems with bowel and bladder control
30
Objective
* Functional Assessment
* Peripheral Joint Scan
* AROM
* RIMS
* PROM
* Joint Play
* Special Testing
flow
31
* Observation/Posture
* Functional assessment (static
posture, gait, squat, single leg
stance, patient’s concordant
movement, etc.) *Be curious!
* Closed Chain ROM/strength
* Open Chain ROM/strength
* RIMS
* AROM/PROM assessment
* Joint mobility assessment
* Nerve integrity assessment
* Palpation
flow
32
* Swelling – girth measurement, edema, Well’s CPR DVT
* Bruising/skin integrity
* Muscle – asymmetry in girth/activation
* Overall fitness level and body type
* Shoe choice, wear patterns
* Job/recreational activities - demand of foot/ankl
review
33
Gait
* Deviations during:
* Loading response
* Stance phase (midstance -> terminal stance)
* Pre-swing phase
34
* Squat
* Starting posture
* Ending posture
* Control throughout
35
* Single leg stance
* Stability at the ankle and hip
* Response to sustained load
* Balance strategies
36
* Anterior lunge
* Response to load acceptance and transfer
37
* Heel raise
* Mechanics and reliance on inert stability versus
contractile stability
38
Foot in supination – rigid/locked
hindfoot, flexible/unlocked forefoot
Loading response
39
(midstance -> terminal stance)
* Foot transitioning to pronation –
unlocking hindfoot, transfer force through
arch, locking forefoot in prepation for
propulsion
Stance phase
40
Foot unloading to opposite limb -
Unlocking hindfoot, rigid forefoot and
maximal great toe extension for toe off
Pre-swing phase
41
ASSESSING
FUNCTIONAL
MOBILITY/ROM
Closed Kinetic Chain
* Squat
* Y-Balance –Anterior Reach
* Anterior/lateral lunge
* Knee to wall assessment for ROM
* Heel raise/gastroc soleus MMT
42
assessing
Open Kinetic Chain
* AROM/PROM c/ OP
* Dorsiflexion/plantarflexion
* Inversion/eversion
* Great toe extension
43
Peripheral Joint Scan
* Lumbar (with functional
movement)
* Hip (with functional
movement)
* Knee – AROM, RIMS
* Ankle/Foot – AROM, RIMS
44
Joint mobility of ....
* Distal Tibiofibular joint
* Talocrural joint
* Subtalar joint
* Midtarsal joints
* Metatarsophalangeal joints
45
Palpation
* Achilles tendon
* Retrocalcaneal bursa
* Plantar fascia insertion
* Metatarsals
* Extrinsic/Intrinsic musculature
46
PROBLEM LIST
Pain Generator
* *which tissue is directly
involved with the patient’s
pain.
Impairments
* Tie these directly to treatment
* AROM/PROM assessment
* RIMS
* Joint mobility assessment
* Nerve integrity assessment
* Palpation
