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Ankle/Foot tests

Orthopedic exams

Deep Venous Thrombosis (DVT) Risk factors: prolonged immobility-post-surgery/trauma, chronic venous insufficiency, OCPs, cancer, diabetes
Homan's Sign passive, supine -dorsiflex foot and squeeze calf +pain at posterior leg/calf= thrombophlebitis
Intermittent claudication Sx of peripheral artery dz d/t insufficient blood flow causing pain during exercise relieved by rest
Claudication test active standing -walk a rate of 120 steps/minute for 60 secs (treadmill) +leg cramp or pallor =PVD or chronic arterial occlusion
Neurological claudication pain feels better with moving upper body
Buerger's test passive, supine -elevate leg to 45deg, dorsiflex, hold for 2 mins, then pt sits up and dangles legs +immediate blanching when elevated or more than 2 mins for color to return=arterial compromise to lower extremity
Compartment syndrome painful condition that results when pressure w/in muscle builds to dangerous levels and prevents nourishment from reaching nerve/muscle cells
Acute compartment syndrome causes direct trauma (fracture/fall/crush injury/surgical complication/circulation blockage/change in activity level)
Acute compartment Syndrome classic signs pain out of proportion w/ passive stretch, pressure, paresthesia, loss of pulses, pallor (SURGICAL emergency)
Chronic (exertional) compartment syndrome muscle swelling from intensive exercise; aching/throbbing pain w/ activity that subsides after hours of rest (Tx: non-urgent surgery)
Calf circumference test passive, supine -measure circumference of bellies of gastronemius and soleus muslces b/l and compare +dec size of affected leg=loss of muscular tone/atropy +inc size of affected leg=muscular comprement pressure/hypertrophy
Complex Regional Pain Syndrome intense pain w/ dramatic changes in color/temperature of skin of affected part (burning, sensitivity, sweating, swelling)
Tarsal Tunnel Syndrome compression of posterior tibial nerve in tarsal tunnel (caused by scar tissue, post fracture callus, tendon sheath inflammation, excessive foot pronation)
Tinel's foot sign passive, prone -tap area of posteror tibial nerve +paresthesia of foot=tarsal tunnel syndrome
Ankle sprain lateral ligaments commonly involved (anterior talofibular-strain when planterflexed + inverted, calcaneo-fibular, posterior talofibular)
Ankle sprain classifications Grade 1=ligaments stretched, not torn. Grade 2=partial ligament tears. Grade 3=complete ligament tears
Lateral (inversion) ankle sprain more common then medial, X-ray (mortise, AP, lateral)
Ankle sprain Tx RI (20mins every 2 hrs) CE (above heart level)
Lateral stability test passive, supine -adduct (invert, supinate, varus) +inc gapping=tear of anterior talofibular or calcaneofibular ligament
Drawer's foot sign passive, supine -anterior:stabilize tibia and pull calcaneus, posterior:stabilize foot dorsum and pull tibia +anterior: inc. gapping=tear of anterior talofibular ligament +posterior: inc. gapping=tear of posterior talofibular ligament
Peroneal tendon injury persistent pain after sprain, elicited by resisted eversion of foot
Medial (eversion) sprain less common (more severe injuries)
Medial stability test passive, supine -abduct (evert, pronate, valgus) +inc gapping =deltoid ligament tear
Syndesmosis injury separation of tibia from fibula (preceded by deltoid ligament tear) from forced external rotation
Ankle fracture Refer if fibula fracture proximal to talar dome or w/ medial tenderness
Metatarsal fracture acute plantar flexion or direct injury (common in runners), focal pain/swelling. -Refer if fracture displaced, non-displaced (3-4 weeks in walking cast/boot)
Phalangeal fractures common, w/ rotational deformity. Tx: buddy tape and hard-sole shoe for comfort 2-3 weeks
Morton's Test passive, supine -transverse pressure across heads of metatarsals +pain in forefoot= neuroma between metatarsals/metatarsalgia
Morton's Interdigital Neuroma abnormal function of foot that leads bones to squeeze nerve causing discomfort/extreme sharp/buring pain typically btw 3rd and 4th metatarsal heads.
Pes Planus acquired flatfoot deformity, tender along course of tendon -weak inversion treated w/ orthotics
Supple flat feet test (aka navicular drop test) passive/active seated/standing -measure height of navicular seated + standing +>10mm=inc risk of pronated foot
Hallux valgus (bunion) lateral deviation w/ pronated phalanges (strong family tendency w/ shoe wear implication)
Achilles Tendon rupture acute event often occurs in chronic tendonitis
Achilles Tendinosis/Tendinopathy Chronic injury in less vascular area of tendon d/t overuse injury in men >40
Thompson's test passive, prone -flex knee and squeeze calf muscles +lack of plantar flexion=Achilles tendon rupture
Gout Uric acid (monosodium urate crystal) deposition w/ sudden joint pain associated w/ heavy alcohol use, obesity, CAD, hypertriglyceremia
Pseudogout calcium pyrophosphate deposition dz associated w/ metabolic d/o (hemochromatosis, hyper parathyroidism, DM)
Shin Spints Periostitis of tibia-inflammation of muscle attachments d/t training improper footwear, low bone mass/density
Plantar Fasciitis inflammation of the plantar fascia d/t tight achilles tendon w/ point tenderness at plantar fascia origin worse in morning or after rest and w/ dorsiflexion of toes
Hallux Rigidus Stiffness osteoarthritis of the great toe MP joint -pain w/ dorsiflexion
Claw toes/hammer toes Flexion deformity of PIP joints w/ hyperextension of MP joint causing painful calluses, metatarsalgia.
Retinacular test seated, passive -flexion of DIP and repeated w/ PIP flexed +No flexion in neutral=tight collateral or joint capsules +No flexion w/ flexed PIP=tight collaterals
Bounce Home test supine w/ knee flexed -pt relaxes/drops knee +inability to fully extend or “rubbery” feeling on full extension =possible torn meniscus
Tibial Torsion test (-)the line drawn btw the two malleoli is rotated externally 15deg from a perpendicular line drawn from tibial tubercle to ankle (+)the malleolar line faces directly anterior=internal tibial torsion
Created by: phdinh33