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211 exam 2
Ankle and Foot
| Question | Answer |
|---|---|
| review bones of ankle and foot | |
| Dorsiflexion and Plantarflexion happen at what Ankle joint? | talocrural joint |
| Inversion and Eversion happen at what Ankle joint? | subtalar joint |
| dorsiflexors of ankel | anterior tib |
| evertors of ankle | fib longus and brevis |
| inverters of ankle | tib posterior |
| plantar flexors of ankle | Gastrocnemius Soleus tib posterior |
| toe flexors | Flexor digitorum longus Flexor hallucis longus |
| toe extensors | Extensor hallucis longus and brevis Extensor digitorum longus and brevis |
| pressure under fibular neck puts pressure on which nerve? | common fibular --> foot drop |
| what nerve can get trapped in the tarsal tunnel? | posterior tibial --> tarsal tunnel syndrome |
| overpronation can trap what nerves? | plantar and calcaneal traps nerve under medial aspect of foot in opening in abductor hallucis |
| signs and symptoms of plantar and calcaneal nerve entrapment | Similar to those of acute foot strain (heel, posteromedial plantar aspect, and pes cavus pain) |
| medial ligament of ankle | Deltoid Ligament (medial collateral) |
| lateral ligament of ankle | Anterior talofibular Calcaneofibular Posterior talofibular ligament |
| what does sinus tarsi contain? | Richly endowed by neural receptors and nerve fibers traced to the cerebellum proprioceptive subtalar center |
| proprioceptive subtalar center | responsible for rapid reflex responses to closed chain motions (helps with balance—so problems with swelling). |
| retrocalcaneal bursa | between the Achilles tendon and superior portion of calcaneus |
| subcutaneous bursa | most posterior aspect of the calcaneus. |
| symptoms of bursitis in ankle | pn at insertion, decrease Dfle, abnormal subtalar ROM, decrease Pflex strength, increased pronation |
| open and closed packed of talocrural (ankle) joint | Open-packed: plantarflexion Close-packed: dorsiflexion |
| foot open and closed pack | Open-packed: pronation Close-packed: supination |
| About how many degrees of plantar flexion should the ankle be in prior to performing joint mobilizations? | 10 degrees PF (open pack) |
| capsular pattern of talocrural | PF --> DF |
| capsular pattern of subtalar | limitation of varus ROM |
| capsular pattern of midtarsal | DF--> PF--> adduction --> medial rotation |
| capsular pattern of 1st MTP | Extension --> Flexion |
| L3 nerve root reflex and MMT | patellar reflex, knee extension (quad MMT) |
| S2 nerve root MMT | knee flexion (HS) |
| S1 nerve root reflex and MMT | Achilles reflex, ankle PF (gastroc, soleus) |
| L4 nerve root MMT | DF and inversion (anterior tib) |
| L5 nerve root reflex and MMT | HS reflex, extension of great toe |
| pes planus | Flat foot Forefoot pronation/ rearfoot valgus |
| pes cavus | Abnormally high arch Usually seen w/ clawed/hammer toes Rearfoot varus |
| hallux valgus | May develop bunion usually asymptomatic |
| hammer toes | extended MTP, flexed PIP, extended DIP |
| claw toes | extended MTP, flexed PIP and DIP |
| mallet toes | flexed DIP |
| valgus alignment | Forefoot: eversion of metatarsal heads Rearfoot: Pes Valgus-pronation/eversion looks flat footed |
| varus alignment | Forefoot: inversion of metatarsal heads Rearfoot: Pes Varus- supination/inversion |
| medial tibial torsion causes what | Genu Varum --> Pes Cavus --> Supination |
| lateral tibial torsion causes what | Genu Valgum --> Pes Planus --> Pronation |
| genu varum | (goes with internal torsion): Bowing of the knees, hip ABD, Femur ER, Tibia medial torsion, pes cavus |
| genus valgum | (goes with external torsion): Knock kneed, Hip ADD, Femur IR, Tibia lateral torsion, patella subluxation, pes planus |
| what 3 ankle motions are associated with pronation? | eversion, abduction, dorsiflexion |
| what 3 ankle motions are associated with supination? | inversion, adduction, plantarflexion |
| foot slap is caused by | weak DF, paralysis |
| toe down instead of heel strike is caused by | plantar flexors spasticity/contracture, weak dorsiflexors, leg length discrepancy |
| clawing of toes is caused by | toe flexor spasticity, positive support reflex |
| heel lift at midstance is caused by | insufficient dorsiflexion, spasticity |
| no toe off is caused by | pain, weak toe flexors, weak plantar flexors |
| pt history for ankle eval | Exact mechanism of injury Acute: Chronic: check footwear – high heels?, worn out shoes? |
| assessments for ankle eval | Medical tests – x-ray Prior level of function Pain Level Level of function with ADL’s Social/Home situation – ie stairs, someone to help Equipment needs – walker, crutches, Brace, Tape, orthotics |
| L3 reflex | patellar reflex |
| L5 reflex | HS reflex |
| S1 reflex | Achilles reflex |
| functional assessments for ankle | Bed mobility Transfers Sit --> stand Gait Squat- full, ½ Stairs One leg standing Running – back/forth Jumping Twisting |
| circumferential meas for ankle | Atrophy/Bulk noted – weak calves, swelling in foot/ankle/calf |
| palpitation for ankle | crepitus, end feel, tightness, discomfort, temp, mobility of tissues, swelling, plantar facia tenderness, pulses |
| 2 common pulse sites on the foot/ankle | dorsalis pedis and posterior tibial |
| ankle and foot standardized tests | LEFS |
| anterior drawer tests what ligament | Anterior talofibular |
| talar tilt tests what ligament? | Calcaneofibular |
| Homan's sign | DVT |
| great toe extension test is for | Plantar fasciitis |
| pain tx | Modalities, Manual, RICE, rest |
| stiffness tx | Modalities, Manual, RICE, rest Stiffness Low grade mobs, gentle stretching, PROM and AROM |
| weakness tx | Isometrics, progressive strengthening |
| subacute --> chronic ankle tx | Exercise: Isometrics closed chain ROM/Mobs Modalities for pain and swelling Plyometrics Foot biomechanics Orthotics, taping Strengthening and ROM along entire chain |
| grade 1 ankle sprain | Minimal swelling, tenderness; -anterior drawer, -talar tilt; little/no limp, difficulty hopping 2-10 day recovery |
| grade 2 ankle sprain | Some hemorrhage, localized swelling; +anterior drawer, +talar tilt; limp, inability to hop, heel raise 10-30 day recovery |
| grade 3 ankle sprain | Peroneal nerve maybe damaged; diffuse swelling, +anterior drawer, +talar tilt; NWB 30-90 day recovery |
| acute ankle sprain tx | RICE, ace wrap, NWB, e-stim, AROM, isometrics |
| subacute ankle sprain tx | Full WB, taping, HS stretching, proprioception ex., strengthening, functional activity |
| chronic ankle sprain tx | Protect joint during exercise, running, jumping, plyometrics, progress strengthening |
| turf toe | Metatarsophalangeal (MTP) sprain caused by hyperextension of big toe Seen often in sprinters, contact sport players Localized pain, swelling, bruising, tenderness, possible subluxation/dislocation |
| grade 1 turf toe | taping, shoe inserts, rest; generally quick return to PLOF |
| grade 2 turf toe | immobilization in boot, rest initially; progress strength, ROM, manual therapy |
| Grade 3 turf toe | possible surgery for fracture, cartilage damage, and/or rupture |
| metatarsalgia | Pain in the lateral four metatarsal heads |
| what causes metatarsalgia | altered biomechanics during WBing and/or gait |
| mortons syndrome | metatarsalgia between 3rd and 4th met head caused by a pinched nerve |
| tx for metatarsalgia | Proper shoes, metatarsal pad/taping Surgery |
| shin splints | Anterior tib tendinitis or stress fx Overuse of anterior tib is common, also weakness Compartment syndrome |
| what causes shin splints | Could have rigid foot Tight gastroc/soleus complex (Pn w/ active DF and stretch of PF) Inadequate shock absorption Increase in training can precipitate |
| medial tibial stress syndrome | Inflamed Posterior tibialis Soleus and flexor digitorum longus/hallucis longus involved Can also be medial gastroc |
| causes of medial tibial stress syndrome | May be overpronator Difficulty with deceleration of entire chain Poor footwear Tight gastroc-soleus Pain with passive pronation at end range or with overpressure |
| symptoms of tibia stress fx | "deep" pain main patient complaint |
| what is tibia stress fx caused by? | repetitive motions or osteoporosis |
| tx for tibia stress fx | NWBing ~12 weeks Can do TTWB, PWB earlier if tolerated AROM, strengthening Stationary bike for ROM |
| what may achilles tendonitis lead to? | Haglund’s deformity: chronically inflamed bursae |
| what is achilles tendonitis caused by? | overuse, microtears |
| tx for achilles tendonitis | Rest, NSAIDs, heel lift, modalities, stretching, strengthening |
| what causes plantar fasciitis | excessive loading of the foot, stressing the plantar fascia |
| how does plantar fasciitis present? | as heel or arch pain, typically worse in the morning |
| what test indicates plantar fasciitis | Windlass test/Great toe extension- pain |
| tx for plantar fasciitis | Orthotics, Lodye taping, analgesics, anti-inflammatories Stretching, strengthening (foot, ankle, post. Tib) joint mobilizations Fasciotomy if conservative treatment fails |
Created by:
bdavis53102
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