12. Foot and Ankle Flashcards by Alexander Lee

self report outcome measures for foot and ankle (3)

Functional foot index (FFI)
foot and ankle disability Index (FADI)
foot and ankle OA outcome scale (FAOS)

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performance outcome measures

TUG
Timed LE Chair Rise Test
Wall Sit
Vertical Jump
LE Agility
Hop Test
Heel Raise Test
LQ YBT

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90% of lower extremity weightbearing is through what bone?

tibia

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what passive structures help dissipate forces and keep the tibia and fibula together?

anterior/posterior ligament of fibular head
interosseous membrane
anterior/posterior tibiofibular ligament

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where is the mortiose joint in the lower leg? what does it do?

distal tibia, receives the talus to give stability

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navicular

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medial cuneiform

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intermediate cuneiform

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lateral cuneiform

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cuboid

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tibia

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talus

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fibula

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calcaneus

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what tendon attaches to the base of 5th MT

fibularis brevis

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what calcaneal foot position is this?

valgus

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what calcaneal foot position is this?

varus

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windlass effect is involved with which ray?

1st ray!
tells you that the plantar fascia is there!

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what muscle counteracts the dorsiflexion moment

soleus

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line of gravity is ______ to lat mal, so at the _____________ joint

line of gravity is anterior to lat mal,
at the calcaneo-cuboid joint

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foot posture index: what to look at

calcaneal position
forefoot position
gastroc atrophy, swelling, tibial rotation, amount of toes visible (more = over pronation)

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tibial center is aligned with the __ ray

2nd

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pronation of the foot is what 3 movements

eversion
abduction
dorsiflexion

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supination of the foot is what 3 movements

inversion
adduction
plantarflexion

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the talus articular surface is narrow ______ and wide ________

narrow posteriorly wide anteriorly

dorsiflexion/plantarflexion happens at what joint

talocrural joint

main component of pronation is

dorsiflexion

main component of supination is

plantarflexion

hindfoot inversion and eversion happens at what joint

subtalar (5 and 5 degrees)

pronation and supination happens at waht joint

midtarsal and metatarsal joints

is normal position, calcaneus should be

vertical or slight valgus

hindfoot varus leads to

foot supination

hingfoot valgus leads to

foot pronation

in lateral ankle sprains, overplantarflexion and inversion leads to sprain of the

ATFL

in lateral ankle sprains, overdorsiflexion and inversion leads to sprain of the

CFL

in lateral ankle sprains, full dorsiflexion and inversion leads to sprain of the

PTFL

pt presentation of Lateral ankle sprain

brusing/swelling pain feeling of instability may progress to chronic ankle instability

subjective measures of lateral ankle sprain

MOI previous episode joint noises Ottawa ankle rules!

outcome measures of lateral ankle sprain

FFI FADI FAOS LEFS- general single leg heel raise SLB SLS YBT

objective measures for lateral ankle sprain

clear the spine! ankle AROM/PROM- check the other motions before doing the motion of injury palpation ankle girth MMT hop tests- not in acute phase

medial ankle sprain causes

forceful eversion of foot throughout a range of DF

what ligament in injured in a medial ankle sprain

deltoid ligament also maybe posterior tibiotalar

patient presentation of medial ankle sprain

swelling, pain, bruising

posterior tibialis tendinopathy causes

faulty foot biomechanics or overuse injury age- lower arches, more stretch

pt presentation fo posterior tibialis tendinopathy

tenderness on course of tendon pain with contraction pain with stretch- severe cases

CPG of posterior tibialis tendinopathy: 4 clinical tests

**pain** with palpation **swelling** around tendon pain/weakness with **contraction** inability/pain with **SLR** (most reliable!!)

subjective questions for posterior tibial tendinopathy

recent change in training, footwear, or terrain? age changes in arch height

outcome measures for posterior tibial tendinopathy

FFI FADI LEFS SLHR SLB/SLS

objective measures for posterior tibial tendinopathy

CTS ankle AROM/PROM feiss line palpation girth MMT YBT

when performing MMT/AROM/PROM for a patient with an injury, what motion/measurement should be performed last?

the one that is most painful based off of Dx! ex: post tib does plantarflexion and Inv, so for posterior tibial tendinopathy do PF + INV last

achilles' tendinopathy causes

faulty foot biomechanics overuse injury- wringing to the "watershed" area low blood

insertional achilles' tendinopathy

pain/issue at the heel bone

mid tendon achilles' tendinopathy

issue at the watershed area, mid tendon

achilles' tendinopathy pt presentation

pain along tendon pain with palpation- variable pain with contraction pain with muscle stretch- severe cases

achilles' tendinopathy subjective questions

change in training, footwear, or incile? age- changes in arch height

outcome measures for achilles' tendinopathy

VISA-A FAAM LEFS SLHR SLB hop tests single leg reach

objective measures for achilles tendinopathy

CTS AROM/PROM- DF- knee straight/bent Feiss line static arch height posture palpation MMT

T or F: achilles tendon rupture frequently occurs in a normal healthy tendon

causes of tarsal tunnel syndrome

over pronation rolling ankle medially

what runs through the tarsal tunnel medial to lateral?

tibialis posterior flexor digitorum longus tibial artery tibial vein tibial nerve flexor hallucis longus

what causes plantar fascitis

forceful plantarflexion of foot with great toe extension repeated microtrauma- overpronation or heel spur

pt presentation plantar fascitis

pain at medial arch, distal to calcaneus pain with initial steps, worse after prolonged WB

differential Diagnosis for plantar fascitis

can be irritation of medial or lateral plantar n spondyloarthritis- bone spur in the back

what spinal nerve level associated with the back of the heel

subjective questions for heel pain

change in training or footwear, how old are your shoes? how are your first steps in the AM? age and changes in arch height

outcome measures for heel pain

FFI FAAM LEFS SLHR SLB/SLS

objective measures for heel pain

CTS (!!) BMI AROM/PROM - (DF/PF & great toe F/E) Feiss line palpation of medial calcaneal windlass test girth MMT anterior single leg reach

2 types of heel pain

overweight OR overtrainers

great toe needs __ degrees of extension for normal walking. what happens if they dont have that?

70 degrees will overpronate, creating adduction

an angle between MT and proximal phalanxe greater than __ degrees is abnormal

15 degrees

hallux rigidus is what?

great toe joint is rigid joint inflammation and swelling of 1st MTP

hallux rigidus may be a cause of result of

plantar fascitis

what is a precursor to hallux rigidus

hallux limitus

all end feel of foot/ankle ROM is

firm

the first ray includes the

talus navicular medial cuneiform 1st MT 1st phalanx- distal and proximal sesamoids arch!