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