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therex test 2
210: Management of foot and ankle disorders
| Question | Answer |
|---|---|
| dorsiflexion is in the ___ plane | sagittal |
| inversion is in the ____ plane | frontal |
| •ABD/ADD is in _____ plane | transverse |
| pronation is a combo of what 3 movements? | •DF/EVE/ABD |
| supination is a combo of what 3 movements? | •PF/INV/ADD |
| what makes up the talocrural joint? | •Distal tibia and fibula with talus |
| what motions occur at the talocrural joint | PF and DF |
| what ligaments is the talocrural joint supported by? | •Supported by deltoid ligament medially and anterior & posterior talofibular ligaments laterally |
| closed packed position of talocrural joint | DF |
| what makes up the subtalar joint | talus and calcaneus |
| what motions occur at subtalar joint | inversion and eversion |
| what ligaments support the subtalar joint? | •deltoid and lateral collateral ligaments |
| what ligament is most often involved in an ankle sprain | anterior talofibular ligament (limits inversion) |
| is deltoid ligament frequently injured? | not injured very frequently (limits eversion) |
| what is second most injured ankle ligament | calcaneofibular (limits inversion) |
| what ligament in often only injured in severe ankle sprains or dislocations | posterior talofibular |
| Supination of the subtalar joint is caused by ______ rotation of tibia | lateral |
| Pronation of the subtalar joint is caused by _____ rotation of the tibia | medial |
| when during gait do we see supination? | at beginning and end during toe off |
| supination creates a ___ foot | rigid |
| during loading response: Heel strike in neutral or ____ | supination, |
| the LE rotates ____ during loading response | inward |
| during loading response the ____ conforms to ground contour and absorbs forces | foot |
| DF occurs as the ____ moves over the _____ | tibia, ankle |
| what occurs at the tibia during midstance? | ER |
| what occurs at the foot from midstance --> terminal stance | supination (closed pack) and windlass effect |
| *when do dorsiflexors fire in gait?* | - during heel strike to foot flat - during swing phase |
| *when do plantar flexors fire in gait?* | - eccentrically early in stance to control forward mvmt of tiba - Concentric to initiate push off |
| 2 keys for reducing fall risks | DF ROM and PF strength |
| Overuse (Repetitive Trauma) Syndromes | •Tendinitis/Tenosynovitis/Tendinosis |
| what can cause Achilles tendinitis | •Changes in footwear or poor footwear •Changes in training •Repetitive stresses such as jumping, running **decreased DF ROM and posterior chain flexibility** |
| what position of the foot shortens the calf muscles | pronation - ppl with limited DF often pronate to help advance tibia over talus |
| non operative tx for Achilles tendinitis in protection phase | •Rest •Heel lift - not permanent, can help take load off for a short time •Taping •modalities •Activity modification •AROM, gentle stretching •Isometrics |
| therex for Achilles controlled motion/return to function phase | progress stretching and strengthen - Wall stretches, dynamic stretches - Double calf→single→from stretched position - Closed chain gastroc/soleus exercise, eccentrics - Teach proper warm up - Low impact activities, progress activity level |
| shin splints | •Anterior tib tendinitis or stress fx |
| shin splints can be a ____ syndrome | compartment |
| what causes shin splints | - Overuse of anterior tib is common, also weakness - rigid foot - tight gastroc/soleus complex - inadequate shock absorption - increase in training can precipitate |
| why is a rigid foot a cause of shin splints | rigid foot can't absorb shock properly so it is directed up the chain |
| symptoms of shin splints | - pain with active DF - pain when stretched into PF |
| what mm are involved in Medial/Posterior Shin Splints (Medial tibial stress syndrome) | •Inflamed Posterior tibialis •Soleus and flexor digitorum longus/hallucis longus involved •Can also be medial gastroc |
| what can cause Medial/Posterior Shin Splints | •May be overpronator •Difficulty with deceleration of entire chain •Poor footwear •Tight gastroc-soleus |
| symptoms of Medial/Posterior Shin Splints | •Pain with passive pronation at end range or with overpressure |
| protection phase of shin splint tx | rest, taping, modalities, activity modification, AROM and gentle stretching, Isometrics |
| a ___ may help with shin splints | orthotic - but it cannot be soft |
| shin splints Controlled Motion Return to Function Phase | Progress stretching and strengthening - Wall stretches - Dynamic stretches - Dorsiflexion exercises - Hip exercises to decelerate IR/Pronation - Teach proper warm up - Teach proper warm up - Low impact activities, progress activity level |
| plantar fasciitis | - Pain at medial tubercle of calcaneus |
| what causes plantar fasciitis | - Tight gastroc/soleus complex - Hyperpronation |
| what can develop in plantar fascitis? | heel spur |
| symptoms of plantar fasciitis | Pain in a.m. upon arising or after long periods of sitting |
| plantar fasciitis protection phase | Rest, taping, modalities, activity modification, AROM, gentle stretching, isometrics, night splint, OTS orthotics |
| controlled motion/ return to function phase for plantar fasciitis | Progress stretching and strengthening, wall stretches, dynamic stretches, - Double calf→single→progress to a stretched position, foot intrinsic strengthening, Closed chain gastroc/soleus exercise, eccentrics, Low Impact Activities, teach proper warm up |
| what ligaments are involved in inversion ankle sprain | - Anterior talofibular ligament primary involvement - Posterior talofibular torn with massive inversion stress |
| - Instability of mortise joint if ____ torn | tibiofibular ligaments |
| what motion at tibia causes inversion ankle sprain | forced DF and ER (tibial) |
| therex in ankle ligamentous injury protected motion phase | - RICE - grade 1 mobs - PROM, AROM - assistive devices - bracing or taping (horseshoe or kinesiotape- pic 23) |
| therex in controlled motion phase of ankle ligamentous injury | - Friction massage - Grade II Mobilization - AROM - Gentle Stretching gastroc/soleus - Isometrics - Light PREs - Bicycle - Balance Board in sitting, progress to PWB, FWB |
| therex in return to function phase of ankle ligamentous injury | - progress PRE - proprioceptive exercise - CKC - toe raise progression - return to sport activities |
| general considerations for ankle injuries | - address swelling: circulation can be poor -joint mobs grade 1 and 2 - braces: be careful, injury can still occur - shoe or no shoe |
| what should you generally start with for treating ankle injuries | - start with ROM and progress |
| - Long periods of immobilization can be followed by _____pain when WB is begun | plantar surface foot |
| when should a pt wear their shoes during tx? | - if they can't control foot motions - if they have orthotics |
| indications for Total ankle arthroplasty | •Severe arthritis that has failed conservative treatment •Post traumatic arthritis •RA •Avascular necrosis of the talus |
| TAA May be accompanied by lengthening procedure of ____ if decreased DF | Achilles |
| TAA May be accompanied by ____ fusion if significant hindfoot deformity | subtalar |
| max protection phase for TAA | •WB may be restricted from 3-6 weeks •Progression of WB will start in a boot or some type of immobilizer •Work ROM - begin mm setting |
| what motion is no longer available after hindfoot fusion | inversion and eversion |
| TAA post op guidelines | - Progress ROM especially for DF and PF •Progress strengthening, particularly mm endurance •Begin balance/proprioceptive activities |
| how long does non weight bearing last after TAA | varies - generally 12-16 weeks |
| •**NO _____ FOR TRIPLE ARTHRODESIS—PF/DF ONLY | INV/EVE |
| you may not see a TAA pt until ___ weeks | 6 - start from ground zero/ max protection phase |
| thompson test is for the ___ | Achilles tendon |
| anterior drawer test is for ____ | ACL |
| talar tilt test is for ___ | calcaneal fibular ligament |
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bdavis53102
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