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44 Cards in this Set
- Front
- Back
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What are the important ligaments on the lateral ankle?
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Anterior talofibular (Always tears first)
Calcaneofibular Posterior talofibular Tibiofibular |
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What is the order of an encounter for foot & ankle inspection?
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Inspection
Palpation (sensory, vascular, ROM) Special Tests Differential Diagnosis Treatment Plan |
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What do you need to pay attention to when inspecting the foot?
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How the foot contact the floor (pressure points - callus at weight bearing areas)
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What gives strength to the medial ankle? What is it made of?
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Deltoid ligament
Anterior Tibiotalar Ligament, Tibiocalcaneal Ligament, Posterior Tibiotalar Ligament, and Tibionavicular Ligament |
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The relationship of the medial and lateral ______ cause the ankle articulation to be held in a position of 15 degrees toeing out
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malleoli
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What is responsible for maintaining the width of the ankle mortis? What happens if this is torn?
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Tibiofibular syndesmosis
The mortis can widen & talus becomes unstable (may see ecchymosis) |
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Unilateral swelling usually means ... while bilateral swelling of the ankle is indicative of ...
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Unilateral - trauma
Bilateral - Cardiovascular Problems (CHF, venous insufficiency) |
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What makes up the lateral longitudinal arch? Purpose?
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Calcaneus, cuboid, 4th & 5th metatarsal bones
Low arch with limited stability - transmits weight & thrust to the ground |
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What makes up the medial longitudinal arch?
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Calcaneus, talus, navicular, cuneiforms & 1st - 3rd metatarsals
Higher arch, much more mobile. Sustained by the skeletal structures & plantar fascia |
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What will you see with spastic flat foot?
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Foot will dorsiflex and evert, while a normal foot will plantar flex and invert
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Who will do better with arch supports, people with supple or rigid flat feet?
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Supple - arch supports may cause increased pain in rigid flat feet (remain flattened upon inspection)
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What is pes planus? What kind of shoes should they wear?
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Flattening of the longitudinal arches - near complete foot print in the sand
Causes over-pronation Medial support posts |
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What is pes cavus? What kind of shoe should they wear?
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High Arches (increased curve in medial longitudinal arch)
teardrop shape heal & toes separate Tends to cause supination Recommend cushioning shoes |
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If you see the lateral aspects of a pts shoes worn think .. If you see the medial aspects of their shoes worn think ...
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Lateral - high arches
Medial - flat feet |
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What do you suspect if you see an oblique crease in the shoes rather than a transverse crease?
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Hallux Rigidus - no motion of the 1st MTP joint
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What neurological condition do you suspect if you see scuff marks on the toe box and front part of shoes?
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Foot drop
Dorsiflexors are paralyzed |
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Normal Plantar Flexion
Normal Dorsiflexion |
P -50 degrees
D- 20 degrees Excessive motion can cause fibular/tibial dysfunction |
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What is the calcaneal motion with Inversion of the foot?
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Calcaneal adduction, navicular rotation & glide on the talus
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What is the calcaneal motion with Eversion of the foot?
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Calcaneal abduction, navicular rotation, glide on talus
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What are the combined motions with supination?
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plantar flexion, inversion & adduction
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What are the coupled motion with pronation of the foot?
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Dorsiflexion, eversion & abduction
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Why is the ankle more mobile in plantarflexion than dorsiflexion?
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The talus is wider anteriorly than posteriorly
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What two pulses do you inspect in the lower extremity?
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Posterior tibial pulse & dorsal pedal pulse
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What is normal for the tibial-fibular space?
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les than 5 mm
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If someone has sudden severe calf pain "like a gunshot wound" think ... confirm with which test?
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Achilles tendon rupture
Thompson test middle aged "weekend warriors" often present with this |
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What is the treatment for an achilles tendon rupture?
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casting in plantar flexion
Surgical repair & casting Do not delay treatment beyond a few days |
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Name some of the common causes of ankle pain
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Tendon Injury (tenosynovitis, subluxation, rupture)
Ligamentous injury Fracture Compartment syndrome |
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What are the early & late symptoms of compartment syndrome? What pressure does the compartment need to exceed?
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Compartment pressures exceed 40 mmHg
E- pain w/passive stretch, tenderness & extreme tightness of compartment L- hypesthesia of nerves, weakness of muscles of involved compartment |
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What is in the anterior compartment? Lateral?
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A- tibialis anterior, extensor digitorum longus, extensor hallicus longus, peroneus tertius, deep fibular nerve
L- Fibularis longus & brevis, superficial fibular nerve |
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What is in the superficial compartment? Deep?
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S- Gastrocnemius, soleus, sural nerve, lesser saphenous nerve
D- posterior tibialis, flexor hallicus longus, flexor digitorum longus, saphenous nerve, tibial nerve |
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What is the treatment for compartment syndrome?
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Remove rigid circular dressings
Position leg at the level of the heart Decompressive fasciotomy if not prompt resolution of symptoms within 6-8 hours of onset |
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Describe the three grades of ankle sprains ... treatment?
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1- no laxity, minimal ligament tear
2- mild to moderate laxity 3- complete disruption of ligament 1&2 - conservative management - RICE, NSAIDs, rehab 3- immobilization, surgery if unstable |
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What commonly happens in ankle sprains with:
Fibular head? Tibial plateau & tibia? Hip? Innominate? Sacrum? L5? |
FH- Posterior
Anteromedial glide of tibial plateau - external rotation on tibia H- Internal rotation Inn - Posterior rotation S- forward on ipsilateral axis (R on R) L5- flexes & sb toward involved sacral axis - rotates to opposite side |
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What is a Lizfranc injury?
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Disruption of the tarsometatarsal joint (partial or complete)
Twisting motion or extreme plantar flex or Dorsiflexion of the midfoot |
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What does a march fracture usually involve?
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Shaft of the 2nd or 3rd metatarsal bone
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This causes lateral deviation of the proximal phalanx of the first toe ...
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Hallux Valgus (bunion)
Soft tissue damage & inflammation at the medial aspect of the head of the 1st metatarsal - angles medially |
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Localized pain at the 1st MTP joint, motion severely limited (1st toe push-off lost) ...
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Hallux rigidus - osteoarthritis of the 1st metatarsophalangeal joint
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Fixed flexion of PIP joints - hyperextension of MTP joint
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Claw toe
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Fixed flexion of PIP joints - hyperextension of MTP & DIP joints
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Hammer toe
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Plantar heel pain arising from medial calcaneal tuberosity ... worse upon awakening or rising from resting position ...
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Plantar Fasciitis
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What is the treatment for plantar fasciitis?
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95% cured with conservative treatment
"Off the shelf" orthotic device Stretching Corticosteroid injection Night splint Surgery |
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T/F Calcaneal bone spurs are always associated with plantar fasciitis ... treatment?
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False - do not!
Pain with heel strike Oral anti-inflammatories, corticosteroid injection, bilateral heel padding |
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Metatarsalgia 2ndary to a short 1st metatarsal bone
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Morton's Syndrome
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Fibroneuromatous reaction b/t the heads of the 3rd & 4th metatarsal bones ... often needs to be excised
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Mortons neuroma
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