618-Foot & Ankle Pe

Front 1

Foot and ankle joints

Back 1

1. Talocrural
2. Subtalar
3. Midtarsal (transverse tarsal, rearfoot-midfoot, Chopart's)
4. Tarsometatarsal
5. MTP & IP

Front 2

Talocrural joint orientation and motions

Back 2

- Joint axis: Not directly in frontal plane
- Motions: DF/PF

Front 3

Subtalar joint orientation and motions

Back 3

Joint axis:
- 42 from transverse plane
- 16 from mid-sagittal plane
Motions:
- Inversion
- Eversion

Front 4

Midtarsal joints

Back 4

1. Talonavicular joint
2. Calcaneocuboid joint

Front 5

Midtarsal joint motions

Back 5

Pronation:
- Parallel axes
- Joint is 'unlocked'
- Shock absorber
Supination:
- Non-parallel axes
- Joint is 'locked'
- Force transmitter

Front 6

Triplanar motion of Pro/Sup

Back 6

- Supination: PF, ADD, INV
- Pronation: DF, ABD, EV

Front 7

Pain Location-Lower leg

Back 7

Diffuse lower leg
- Shin splints (tibial periostitis)
- Compartment syndrome
- Medial tibial stress syndrome
Localized lower leg
- Stress fx

Front 8

Pain Location-Ankle

Back 8

Anterolateral
- Most common region
- ATF sprain
- Malleolar fx
Posterolateral
- Peroneal tendons
Medial
- Deltoid ligament sprain
- Tarsal tunnel syndrome
Posterior
- Achilles tendonitis
- Retrocalcaneal bursitis
- Sever's disease
Plantar
- Plantar fasciitis
Dorsal
- Uncommon as sole source of pain
- Paresthesias
- Fx

Front 9

Pain Behavior-Aggravates

Back 9

Activity
- Overuse: Pn at beginning of activity, goes away, returns after activity
Constant standing
- Ligamentous instability
Terrain changes
- Soft surfaces worsen: Excessive pronation
- Hard surfaces worsen: Excessive supination

Front 10

Pain Behavior-Alleviates

Back 10

Rest
- Typical pattern for musculoskeletal pain

Front 11

Gout-24 hr pain behavior

Back 11

- Men 40-50 yo
- Sharp pain in affected joint
- Worse with pressure
- Redness and swelling within a few hours
- Night pain

Front 12

Morning pain/stiffness

Back 12

- Plantar fasciitis
- Arthritis

Front 13

Acute onset

Back 13

- Ligament
- Muscle
- Fx

Front 14

Gradual/insidious onset

Back 14

- Achilles tendonitis
- Postural/kinetic chain syndromes
- Stress fx

Front 15

MOI-Inversion/Supination

Back 15

- Lateral ankle sprain
- Malleolar fx
- Superficial peroneal n. stretch
- Sural n. stretch
- Sinus tarsi syndrome
- Jones fx

Front 16

Pain pattern since onset-Gradual worsening

Back 16

- Stress fx

Front 17

Important past medical history

Back 17

- DM
- Polio
- Gout
- Other collagen disease
- Recent injuries to other regions (LE, spine)
- Recent growth spurt (children)

Front 18

Hx factors to consider with runners and athletes

Back 18

- Days/months/years running
- Distance/wk
- Distance/day
- Terrain/surface
- Warm-up and cool-down
- Change in training schedule
- Other activity
- Shoes

Front 19

Foot types

Back 19

1. Squared-Big toe and second toe same length
2. Morton's-Second toe longer
3. Egyptian-Big toe longer

Front 20

Toe deformities

Back 20

1. Claw toe-Callus on PIP and forefoot
2. Hammer toe-Callus on PIP
3. Mallet toe-Callus on DIP and toe tip

Front 21

Too many toes sign

Back 21

Due to:
- Increased calcaneal eversion
- Increased tibial ER
- Increased forefoot ABduction
If calcaneus does not invert when raise up on toes:
- STJ dysfunction
- Weak tibialis posterior

Front 22

Navicular drop test

Back 22

- Position pt in STN and measure navicular height
- Patient relaxes stance, measure navicular height
- Compare the difference, > 10 mm significant

Front 23

AROM/PROM/Overpressure on what joints?

Back 23

- Hip & knee
- Talocrural
- Subtalar inversion and eversion
- Midfoot joints
- Toe joints