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MSK > ANKLE > Flashcards

ANKLE Flashcards

1
Q

What is tissue impairment dx for

A

for when there is an acute issue and tissue is so inflammed that you cannot do your tests

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2
Q

Pronation syndrome goes with what 5 dx

A 
plantar fasciitis
neuroma/MT
shin splints
post tib issues
tarsal tunnel syndrome
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3
Q

with pronation syndrome, there is often generalized px where

A

midfoot

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4
Q

what motion of the calcaneus goes with pronation syndrome

A

eversion

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5
Q

Plantar fasciitis and metatarsalgia go with what 2 mvmt dx

A

pronation and supination

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6
Q

What are the dx associated with supination

A

MT/neuroma
plantar fasciitis
stress fx
peroneal pathologies

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7
Q

what pos test will you notice for supination (about the 1st ray)

A

will be PF

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8
Q

where might you see callous formation with supination

A

1st and 5th MT

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9
Q

which typically has a wider foot, pronation or supination

A

pro

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10
Q

supinaition occurs during what gait phases

A

heel strike to midstance

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11
Q

pathlogies associated with decreased dorsiflexion syndrome

A

shin splints
achillies tendon pathologies
bursitis

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12
Q

what 2 things are common to see with decreased dorsiflexion syndrome

A

toe out

knee hyper ext

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13
Q

decreased DF syndrome occurs during what gait phases

A

midstance to push off

and during swing

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14
Q

hypomobility syndrome of ankle is decreased mobility in all motions, this dx is associated with what pathologies

A 
anything that caused LT immobilization
DJD
OA
ORIF
Fx
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15
Q

With an inversion ankle sprain, where is the damage/px usually at

A

lateral ankle

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16
Q

What nerve can be injured with a severe lateral ankle sprain

A

superficial peroneal

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17
Q

where does tibial nerve run

A

with tom dick and harry on medial side

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18
Q

talar tilt tests for what

A

lateral ankle sprain (CF lig)

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19
Q

Kleigers tests for

A

deltoid ankle sprain (medial)

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20
Q

what outcome measure is good for all ankle

A

LEFS

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21
Q

what is cuboid syndrome

A

subluxation of the cuboid bone

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22
Q

how does cuboid syndrome usually occur

A

MOI is usually PF with inversion injury

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23
Q

cuboid syndrome is often confused and mis-dx as

A

lateral ankle sprain

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24
Q

what are differentiating factors with cuboid syndrome vs lateral ankle sprian

A

px is constant
they may feel like something is in their shoe
px lasts longer than lat ankle sprain

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25
Q

a big component of dx cuboid syndrome

A

palpation

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26
Q

explosive push off could cause what injury

A

achiilies tendon tear

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27
Q

who is most likely to tear achilies tendon

A

30-40 yr old men

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28
Q

what test is for achilles tendon

A

thompsons test (high sp)

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29
Q

explain some char of an achilies tendon pathology

A

may have a balled up palpable spot on calf

inability to do single leg raise

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30
Q

where is px often felt with a post tib tendonopathy

A

at the medial malleolus

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31
Q

tibial stress syndrome is aka

A

shin splints

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32
Q

sup or pronation can lead to tibial stress syndrome

A

pronation

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33
Q

if achilies tendon is tight, how can this effect the tibialis ant

A

the tibialis ant will overwork to compensate (during eccentric motions) this can cause tearing away of the interossius membranes

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34
Q

how to dx tibial stress fx

A

tuning fork and refer

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35
Q

how to possibly differentiate btwn tibial stress syndrome and stress fx

A

stress fx the px doesnt go away with rest and it lasts longer

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36
Q

characteristics of post tibial N pathologies

A

WB increases sx
sx are worse at end of the day
pos tinnel sign at medial malleolus
px, burning at sole of foot

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37
Q

plantar faciitis characteristics

A

px at heel
worse in AM
limited DF dt px

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38
Q

how much DF is needed for gait

A

10 degrees

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39
Q

px with bursitis is often where

A

tender to touch at calcaneous

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40
Q

cause of bursitits

A

rubbing at the heel (shoes or repetive motions)

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41
Q

what is the ROM loss dt bursits

A

there really is non, its just dt the px from rubbing

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42
Q

syndesmotic ankle sprain typically has what MOI

A

rotational force- more forceful (forced eversion with dorsi)

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43
Q

syndesmotic ankle sprain is located more

A

the px is more diffuse and superior to the ankle joint

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44
Q

mid foot consists of

A

Navicular
Cuboid
3 Cuneiforms

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45
Q

rear foot consists of

A

the true ankle (tib, fib, calcaneous, talus)

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46
Q

forefoot consists of

A

all toe bones

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47
Q

according to the article, what are predisposing factors to plantar faciitis

A

Clinicians should consider limited ankle dorsiflexion range of motion and a high body mass index in nonathletic populations as predisposing factors for the development of heel pain/plantar fasciitis

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48
Q

according to the article, what are good tests/observations for plantar faciitis

A 
palpate proximal plantar fascia
check DF
tarsal tunnel 
windless affect
long arch
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49
Q

interventions for plantar faciitis

A 
ionto with dexa
stretches
taping
ortho devices
sleep splints
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50
Q

what happens with the plantar fascia with prontation

A

with pronation it’s elongated

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51
Q

what happens with plantar fascia with supination

A

shortens

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52
Q

why may joint mobs not be effective for tx of plantar fasciitis

A

bc both pronation and supination can be a cause of, so just declaring one way of mobing would not take care of both issues (it would depend)

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53
Q

how to find cuboid

A

it should be btwn the 5th MT tuberosity and the calcaneous

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54
Q

function of forefoot

A

adapt to terrain

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55
Q

what makes up talocrural joint

A

tib
fib
talus

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56
Q

what makes up subtalar joint

A

calcaneous

talus

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57
Q

bending the knee joint and plantar flexing isolates the

A

soleus

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58
Q

keeping knee straight and plantar flexing isolates the

A

gastroc

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59
Q

in addition to tib post and ant, what muscles also invert pes

A

FHL

FDL

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60
Q

which is more distal, medial or lateral malleolus

A

lat

61
Q

dorsi and plantar happen at what joint

A

talocrural

62
Q

stability in WB is provided by ___, while in NWB it is (for talocrural joint)

A

WB - bone articulations

NWB - ligg

63
Q

pronation and supination occur at the __ joint

A

subtalar

64
Q

subtalar joint motions (asking about OKC, CKC)

A

OKC follows the rules - plantar flexion, inversion, adduction and then dorsi goes with eversion and abd.

CKC is different bc of the rotation of the tibia jacks everything up with standing - if the tibia ER then the talus dorsi and abd while the calcaneous inverts, if the tibia IR then the talus plantar flexes adducts and the calcaneous everts.

This concept is why some pt will only have px WB

65
Q

Subtalar CKC

A

TER
T DAB
CI

66
Q

inversion/eversion happens at

A

midtarsal joint region

67
Q

tibialis post has what attachment at foot

A

navicular

68
Q

peroneus longus has what attachment at foot

A

cuboid

69
Q

joint type calcaneocuboid

A

saddle

70
Q

what tarsal bones do 4th metatarsal articulate with

A

3rd cunieform and cuboid

71
Q

what tarsal bones does 5th metatarsal articulate with

A

cuboid only

72
Q

lisfranc joint is where

A

tarso metatarsal

73
Q

most important action with big toe

A

push off /dorsi

74
Q

she lists 2 main purposes of plantar fascia

A

aids in rigidity (windlas effect) and shock absorption

75
Q

most important arch in foot

A

med long (load bearing)

76
Q

weakest, most injured lig in angle

A

ATFL

77
Q

CF lig only resists

A

inversion

78
Q

these make up the deltoid lig structure

A

Posterior tibiotalar
Tibiocalcaneal
Tibionavicular
Anterior tibiotalar

79
Q

main fat pad is where - if injured what is best tx

A

heel - a shock absorbing pad

80
Q

nerve type sx btwn the big toe and first toe (on top of foot) would be what nerve

A

deep peroneal

81
Q

nerve sx to most of top of foot would be what nerve

A

superficial peroneal

82
Q

nerve supply to the peroneals

A

longus and brevis -sup fib nerve

tert - deep fib nerve

83
Q

rearfoot valgus goes with (inversion or eversion)

A

eversion

84
Q

at heel strike you want

A

a rigid foot

85
Q

pronation can stress what nerve

A

tibial (it’s on the medial side)

86
Q

pes planus can be associated with: (many)

A

Can be associated with leg length discrepancy, femoral anteversion, metatarsalgia, tibialis posterior tendonopathy, plantar fasciitis

87
Q

how might peroneals get injured with a supinated foot

A

they are getting stretched, or possibly uses for push off

88
Q

Abnormal prominance of posterior superior lateral border of calcaneus.

A

Haglands deformity

89
Q

a bunion on medial side of great toe

A

hallux valgus

90
Q

tx for hallux valgus

A

bunion pad, wider shoes

91
Q

hallux rigidus

A

like hallux valgus, but is on top of great toe and toe ext/dorsiflexion is limited

92
Q

Forced hyperdorsiflexion/ext of first MTP

A

turf toe

93
Q

if a muscle gets stretched or injured from stretch, you do what to the antagonist muscle

A

strengthen it to help pull the other muscle back into proper alignment

94
Q

strengthening of the ___ might be beneficial for reoccuring ankle sprain

A

peroneals

95
Q

syndesmotic sprains are more complicated, but may not have a lot of

A

swelling

96
Q

lis franc fxs are located

A

mid foot

97
Q

characteristics of lis franc injury

A

Bruising on both the top and bottom of the foot
Bruising on the bottom of the foot
swelling on top of foot
Pain worsens with standing

98
Q

MOI for cuboid syndrome is often associated with

A

uneven terrain

99
Q

cuboid syndrome often presents with (pro or sup foot)

A

pronated -which tightens peroneals

100
Q

tx for tendonosis should always include

A

cross friction massage and eccentric ex

101
Q

Most common overuse syndrome of lower leg

A

Achilles Tendonopathy

102
Q

pronators are likely to have ____ tendonopathy

A

achilles

103
Q

post tib eccentrically controls ___

A

pronation (eversion)

104
Q

post tibialis is stretched with (pro or sup)

A

pronation

105
Q

tibial stress fx most common where

A

Middle or distal 1/3 of tibia

106
Q

excessive pronation can lead to tibial stress __

A

fx

107
Q

px to lateral ankle with resisted eversion with popping/snapping

A

look into subluxed peroneal

108
Q

px to medial ankle with resited plantar and inversion with popping/snapping

A

post tib tendon

109
Q

good dx test for post tendon dysfunction

A

they can’t do a calf raise (tear or rupture)

look for navicular drop

110
Q

plantar fascitis can be associated with what type of arch

A

high or low

111
Q

most common cause of heel px in kids

A

severs

112
Q

apophysitis of heel (achilies)

A

severs

113
Q

fusion of one joint does what to surrounding

A

makes the others take up the new need for motion = alters biomechanics and can cause issues

114
Q

most common type of ankle fx

A

unimalleolar (lateral more)

115
Q

bi -malleolar fxs happen how

A

Usually from severe pronation/ abduction/ external rotation force
Shears lateral and avulses medial

116
Q

trimalleolar fxs happen by

A

medial lat and post forces

117
Q

MOI for talar dome fxs

A

Axial load with compression against talar head and tibia

Chondral fx

118
Q

calcaneal fxs typically only occur with

A

great force (landing on foot)

119
Q

most common stress fx MT

A

2nd and 3rd

120
Q

contributing factors to MT stress fxs

A

low body fat (bad bone density)

121
Q

fx to 5th MT, they are NWB for

A

6-8 weeks (poor circulation to that area)

122
Q

nerve sx on the bottom of the foot would be what nerves

A

lateral side -lateral plantar
medial side -medial plantar
heel -tibial nerve

123
Q

reporting that the bottom of the foot/feet can go numb or tingle with running (or activity that causes repetetive compression) could be

A

med or lat plantar nerve both can get compressed with running

124
Q

what foot placement could cause tarsal tunnel

A

pronation

125
Q

tarsal tunnel vs neuropathy

A

Tarsal tunnel vs peripheral neuropathy – with tarsal tunnel, mvmt would recreate sx, neuropathy it may just be constant (or you can do tinnels tap and see if tarsal tunnel sx return)

126
Q

tarsal tunnel sx are usually on the ___ of the foot

A

plantar surface

127
Q

Pain on plantar surface of foot between 3rd and 4th metatarsals; pain might be worse when walking with shoes vs barefoot (think what pathologies)

A

metatarsalgia, neuroma, stress fx

128
Q

Ottowa ankle rules

A

 Patient has bone tenderness at
• posterior edge or tip of lateral malleolus
• posterior edge or tip of medial malleolus
• base of 5th metatarsal
• or navicular bone
• or if the patient could not bear weight immediately after the injury or during the exam (4 steps regardless of limping)

129
Q

hammer toe vs claw toe

A

ext flex flex (claw)

ext flex ext (hammer)

130
Q

Tib fib joint play assessment, explain all

A 
supine for all
distraction - thumbs on top and you pull apart
post - use thenar eminance 
ant- use 1st ray
sup - use webbing
inf - use golf grip
131
Q

all joint mobs for tib fib joint are same as the assessment except for

A

anterior (this one they are prone)

132
Q

tib fib joint mobs, which ones help with plantar flexion

A

ant

inf

133
Q

tib fib joint mobs, which ones help with dorsi

A

post
sup
distraction

134
Q

make sure and put pt in slight ___ with a tib fib sup or inf glide

A

eversion

135
Q

Talocrural joint mobs motions

A

distract
post
ant

136
Q

explain all assessment of talocrural joint play

A

the mobs end up being the same as assessment
ALL supine
distraction - clasp hands above and you pull toward face
post - one hand on either side of joint and push post
ant- like ant drawer

137
Q

talocrural ant and distraction can also be done

A

prone
distraction you can bend knee and pull up
ant - you just push ant

138
Q

post glide of talocrural aids with

A

dorsi

139
Q

ant glide of talocrural aids in

A

plantar

140
Q

almost all ankle mobs are same as your assessment except for

A

tib fib ant glide

141
Q

sub talar assessment joint play

A

they are supine
distraction - C on top of midfoot and pull calcaneous apart from foot
eversion- hold at mid foot as you evert calc.
inverion - hold at midfood as you invert calc

142
Q

motions subtalar joint mobs help wih

A

primarily inversion or eversion

143
Q

primary decelerator of the tibia is the

A

soleus

144
Q

if pts have back probs, it might be good to check what part of the foot

A

great toe ext - if they aren’t getting proper push off

145
Q

mid tarsal mobs (explain)

A

these are when you try to mob the navicular or cuboid

pt is prone, and you use thumbs to push up on one of these bones as they slowly extend knee

146
Q

list all of the mvmt dx

A

pronation syndrome
supination syndrome
insufficient dorsi
hypomobility

147
Q

MOI for CF vs ATFL ligg sprains

A

CF -straight inversion

ATFL - inversion with PF

148
Q

superior glide of lat malleolus (tib fib joint ) helps with

A

dorsi

149
Q

bottom line with PF is you want to check their

A

dorsiflexion

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