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ortho test 2
foot and ankle
| Question | Answer |
|---|---|
| how many bones articulate in the foot for WB and ambulation? | 26 |
| bones of the foot and ankle | Talus, calcaneus, navicular, cuboid, 3 cuneiforms, 5 metatarsals, 14 phalanges |
| joints of the foot and ankle | distal tibfib, talocrural, talocalcaneal |
| talocrural joint | mortise joint/ 'ankle' joint. Made up of the distal tib/fib and talus - Dorsi/Plantarflex |
| talocalcaneal joint motions | pronation and supination |
| how does the talus move in the talocalcaneal joint? | The head of the talus* of this joint moves opposite of the rest of the bones of the foot |
| loose pack position of the foot | pronated |
| how does talus and calcaneus move in pronation? | •Head of talus: adducts and plantarflexes • Calcaneus: everts (valgus) |
| rigid position of the foot | supination |
| how does talus and calcaneus move in supination? | •Head of talus: abducts and dorsiflexes •Calcaneus: inverts |
| midtarsal joint motions | In isolation, little movement; Together significant movement; Primary movement is slight gliding and rotation |
| midtarsal joints | Talocalcaneonavicular, Cuboideonavicular, Intercuneiform, Cuneocuboid, Calcaneocuboid |
| tarsal metatarsal joints are made up of what 3 bones | Cuboid, cuneiforms, and metatarsals |
| what joints make up the tarsal metatarsal joints? | •Metatarsalphalangeal joints: MTP •Interphalangeal: PIPs, MIPs, and DIPs •First Ray: First metatarsal and hallux |
| extrinsic mm of foot | Originate away from the foot and act on the foot |
| intrinsic mm of foot | Originate and insert on the foot, consist of 4 layers |
| intrinsic mm of foot function | Muscles of the sole of the foot and strengthen the arch |
| extrinsic mm of the foot | •Peroneus Longus and Brevis •Extensor Hallux and Digitorum longus and Flexor hallux and digitorum •Tibialis anterior and posterior •Gastroc and Soleus |
| what action do foot intrinsic have? | ABD and ADD toes, flex toes, extend toes |
| medial collateral ligament (deltoid) | •Supports the medial ankle • It is stronger than the lateral collateral |
| lateral collateral ligament | •supports the ankle laterally and is made up of the 3 major ligaments |
| 3 major ligaments that make up LCL | • anterior talofibular • calcaneofibular • posterior talofibular |
| spring ligament | •Supports the longitudinal arch (along with the post tib tendon). |
| what is ligaments is spring ligament made up of? | •Long and short plantar •Plantar calcaneonavicular •Plantar aponeurosis |
| arches of the foot | •Medial longitudinal •Lateral longitudinal •Transverse arch - medial to lateral |
| plantar fascia function | •Supports the sole of the foot |
| windlass effect | Arch elevates with dorsiflexion of great toe, helps propel motion of foot |
| how many degrees of great toe DF needed for windlass | 55-60 |
| calcaneal fat pad function | accepts large force loads at heel strike and reduces the impact forces with weight bearing |
| what happen if calcaneal fat pad is injured? | becomes herniated and is quite painful and splayed |
| primary/congenital deformities | •Commonly seen with neurological conditions such as Cerebral palsy |
| secondary/biomechanical deformities | •Commonly seen in runners and other active individuals |
| talipes equinovarus | congenital clubfoot, or a secondary neuromuscular dysfunction |
| adducted forefoot | 'pigeon toes' must rule out internal rotation from the hip, can be secondary or primary |
| pes planus | Flat foot or fallen arches; Forefoot pronation and/or rearfoot valgus |
| pes cavus | •Abnormally high arch •Usually seen with clawed/hammer toes |
| Forefoot Varus | (first ray is elevated compare to the fifth ray or supination) may be part of everted calcaneus or over pronated foot with weight bearing |
| rearfoot valgus | everted calcaneus and usually causes an over pronated foot in weight bearing. Pes Planus |
| forefoot valgus | (fifth ray is elevated compare to the first or pronation) usually is with a inverted calcaneus or over supinated foot with weight bearing |
| rearfoot varus | same as an inverted calcaneus and usually causes an over supinated foot in weight bearing. Pes Cavus |
| hallux valgus | Secondary condition usually asymptomatic, but may develop bunion |
| tx for hallux valgus | surgical intervention option, plus wide toe box shoe |
| hammer toes | extended MTP, flexed PIP, extended DIP |
| claw toes | •extended MTP, flexed PIP and DIP |
| mallet toes | flexed DIP |
| treatment for congenital foot deformities | •Treatment usually requires significant medical management •Serial casting •Surgery - fixative or stabilizing: •Triple arthrodesis |
| triple arthrodesis | •Fusion of subtalar joint, talonavicular joint, and calcaneocuboid joint (also called hindfoot fusion) |
| what is triple arthrodesis used for? | correct deformity, eliminate instability. |
| when (age) is triple arthrodesis performed? | after growth is complete because future growth will be disturbed |
| treatment for secondary deformities | •Serial casting - to increase ROM •Surgery- Arthrodesis, or pinning •Joint excision for toe deformities •Tendon transplant if muscle imbalance is contributor |
| goal of orthotic intervention | •stabilize flexible deformity, increase function, decrease pain or discomfort |
| orthotics can be ___ or ____ material | flexible, rigid |
| posting | material added to orthotic to maintain the anatomical alignment that has been built into the orthotic with casting. |
| what is posting used for? | Used for correction of forefoot valgus or varus and hind foot valgus or varus |
| rheumatoid arthritis | •Severe pain and deformity •Stability issues as digression of ligaments occur |
| secondary OA of foot | very common secondary to previous injuries |
| what is common with osteoporosis of foot | stress fx |
| tx goals for degenerative conditions | •Decrease pain and inflammation •Increase circulation •Splinting/orthotics to relieve weight bearing stresses and protect joints from further damage •Teach careful self inspection for open sores •Change shoes |
| gout | Uric acid crystal deposition disorder with painful inflammation |
| treatment of gout | Diet, NSAIDS, Medication to stop uric acid production - Allopurinol, Surgical removal of osteophytes→ arthroplasty or arthrodesis if joint destruction has occurred |
| diabetic foot | Secondary conditions occur such as PVD, neuropathy, osteoporosis and infection |
| fractures of foot/ankle usually are ____ (simple/complex) because of the many bones and joints of the foot | complex |
| Pott's fracture | a severe twisting injury accompanied by ligament strain or avulsion, usually an external rotation |
| what motion causes pott's fx? | foot is planted and the body ERs above it, May involve a fall |
| how is unimalleolar pott's fx treated? (lateral malleolus- fibula) | •immobilize in walking cast |
| how is bimalleolar pott's fx treated? (both tibia and fibula) | •ORIF/Cast |
| trimalleolar potts fx | Includes two fractures on medial and lateral posterior tip of distal tibia and fracture of the fibular malleolus; Usually includes a dislocation |
| tx for trimalleolar pott's fx | ORIF/cast |
| Distal tib/fib fractures especially will affect the ankle joint due to _____ | malalignment |
| symptoms of distal tib/fib fx | Decreased ROM after immobilization, biomechanical change results in compensatory ankle/foot motions, OA results |
| tx of distal tib/fib fx | ORIF of displaced fractures is necessary, Closed reduction if the fracture is stable, Full body conditioning during immobilization , Strengthening uninjured limb for crossover benefit, Progressive ROM, isometrics, cycling, proprioception, function |
| Long term sequelae of major ankle fracture includes: | pain, sensitivity to cold weather, swelling after standing, bluish discoloration after standing, joint doesn't "feel right" for many years, decreased agility, gastroc weakness and atrophy, slight limping |
| what causes calcaneal fx? | fall from a height; the calcaneus is mostly cancellous bone that will crush into many fragments; it may involve the articular surface of subtalar joint |
| complications of calcaneal fx | •Disability may be extreme due to complications •Avascular necrosis - severe pain •Significant degeneration of the articular cartilage in the subtalar joint - pain |
| tx for calcaneal fx | Treatment to follow physician's protocol; Strengthen peroneus longus; Gait retraining |
| most common areas for stress fx | tibia, metatarsals, navicular |
| what causes stress fx | •Repetitive motions or osteoporosis |
| symptoms of stress fx | deep pain |
| stress fx tx | •Usually heals after restricted activity for 1-3 months, return to activity must be guarded |
| tarsal tunnel syndrome | Impingement of the posterior tibial nerve that runs along with Tom, Dick and Harry |
| what does deltoid ligament protect? | tarsal tunnel area |
| tendons in tarsal tunnel | Tibialis Posterior Tendon, Flexor Digitorum Longus Tendon, Flexor Hallucis Longus Tendon (tom, dick, and harry) |
| symptoms of tarsal tunnel | Complaints of burning pain with paresthesia of the heel; Sometimes confused with plantar fasciitis |
| is medial or lateral ankle sprain more common? | 95% are lateral sprains with inversion sprain of the lateral collateral ligament |
| Complete rupture may be candidate for ____ | reconstruction |
| Loss of _____ occurs after an ankle sprain and the patient is 5x more likely to reinjure it than someone who never sprained | proprioception |
| acute phase ankle sprain tx | RICE, ankle-wrap(protect), NWB, electrical stimulation, AROM, isometrics |
| subacute phase ankle sprain tx | comprehensive rehabilitation: Full WB, taping, HS stretching, proprioception, strengthen, function |
| plantar fasciitis symptoms | presents as heel pain or arch pain |
| what causes plantar fasciitis | repetitive traction stress of the plantar fascia on the periosteum of the calcaneus or heel spur. Involves micro tears of fascia |
| plantar fasciitis tx | Proper orthotic intervention to alleviate tension on fascia and supportive shoes, Lodye taping, Analgesics, Anti-inflammatories, Stretching, Strengthening (foot, ankle- eccentric, posterior tibialis, hip), Joint mob, Fasciotomy if conservative fails |
| medial tibial stress syndrome (MTSS)/ shin splints | Overuse with pain distal tibia |
| what causes MTSS (shin splints) | excessive pronation of the foot that leads to internal rotation of the tibia and stress on the muscles and fascia of the tibia (especially posterior tibialis) |
| differential diagnostics for MTSS | Stress fracture, ischemia, compartment syndrome. Need imaging |
| tx for MTSS | RICE, taping, possible orthotics, modified activity |
| tendonitis is considered to be associated with | muscle weakness especially with eccentric contractions necessary for anti-gravity motions in ambulation/running |
| what can cause tendinitis | overpronation, and in the posterior tibialis tendon can eventually lead to rupture |
| what causes Achilles tendinopathy | overuse microtears |
| tx for Achilles tendonopathy | Rest, NSAIDS, heel lift, modalities, flexibility, eccentric strengthening |
| who is Achilles rupture most common in? | Men 30-50 yr, sudden contraction, degenerative changes |
| what antibiotic can cause spontaneous tendon rupute? | Levaquin, used for UTI and other bacterial infections. can cause spontaneous rupture of Achilles or patella tendon. |
| diagnostics for Achilles rupture | •(+) Thompson Test, imaging |
| Thompson Test | compression of the calf muscle while observing for plantar flexion to assess the stability of the Achilles tendon |
| is Achilles rupture initially painful? | no, may feel like someone hit them in the back of leg |
| tx for Achilles tendon rupture | Surgical and non surgical. Slow and variable depending on MD |
| metatarsalgia | pain in the lateral four metatarsal heads |
| what causes metatarsalgia | •result of altered biomechanics in WB and/or gait |
| tx for Morton's syndrome | Proper shoe ware, metatarsal pad or taping to provide a metatarsal arch, Surgery - successful in 83% cases |
| Morton's syndrome | metatarsalgia between 3rd MET head and 4th MET head, pinched nerve |
| what does anterior drawer test for ankle test? | anterior talofibular lig |
| what does talar tilt test? | calcaneofibular lig |
Created by:
bdavis53102
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