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Ankle/Foot tests
Orthopedic exams
| Question | Answer |
|---|---|
| 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
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