ANKLE Flashcards
What is tissue impairment dx for
for when there is an acute issue and tissue is so inflammed that you cannot do your tests
Pronation syndrome goes with what 5 dx
plantar fasciitis neuroma/MT shin splints post tib issues tarsal tunnel syndrome
with pronation syndrome, there is often generalized px where
midfoot
what motion of the calcaneus goes with pronation syndrome
eversion
Plantar fasciitis and metatarsalgia go with what 2 mvmt dx
pronation and supination
What are the dx associated with supination
MT/neuroma
plantar fasciitis
stress fx
peroneal pathologies
what pos test will you notice for supination (about the 1st ray)
will be PF
where might you see callous formation with supination
1st and 5th MT
which typically has a wider foot, pronation or supination
pro
supinaition occurs during what gait phases
heel strike to midstance
pathlogies associated with decreased dorsiflexion syndrome
shin splints
achillies tendon pathologies
bursitis
what 2 things are common to see with decreased dorsiflexion syndrome
toe out
knee hyper ext
decreased DF syndrome occurs during what gait phases
midstance to push off
and during swing
hypomobility syndrome of ankle is decreased mobility in all motions, this dx is associated with what pathologies
anything that caused LT immobilization DJD OA ORIF Fx
With an inversion ankle sprain, where is the damage/px usually at
lateral ankle
What nerve can be injured with a severe lateral ankle sprain
superficial peroneal
where does tibial nerve run
with tom dick and harry on medial side
talar tilt tests for what
lateral ankle sprain (CF lig)
Kleigers tests for
deltoid ankle sprain (medial)
what outcome measure is good for all ankle
LEFS
what is cuboid syndrome
subluxation of the cuboid bone
how does cuboid syndrome usually occur
MOI is usually PF with inversion injury
cuboid syndrome is often confused and mis-dx as
lateral ankle sprain
what are differentiating factors with cuboid syndrome vs lateral ankle sprian
px is constant
they may feel like something is in their shoe
px lasts longer than lat ankle sprain
a big component of dx cuboid syndrome
palpation
explosive push off could cause what injury
achiilies tendon tear
who is most likely to tear achilies tendon
30-40 yr old men
what test is for achilles tendon
thompsons test (high sp)
explain some char of an achilies tendon pathology
may have a balled up palpable spot on calf
inability to do single leg raise
where is px often felt with a post tib tendonopathy
at the medial malleolus
tibial stress syndrome is aka
shin splints
sup or pronation can lead to tibial stress syndrome
pronation
if achilies tendon is tight, how can this effect the tibialis ant
the tibialis ant will overwork to compensate (during eccentric motions) this can cause tearing away of the interossius membranes
how to dx tibial stress fx
tuning fork and refer
how to possibly differentiate btwn tibial stress syndrome and stress fx
stress fx the px doesnt go away with rest and it lasts longer
characteristics of post tibial N pathologies
WB increases sx
sx are worse at end of the day
pos tinnel sign at medial malleolus
px, burning at sole of foot
plantar faciitis characteristics
px at heel
worse in AM
limited DF dt px
how much DF is needed for gait
10 degrees
px with bursitis is often where
tender to touch at calcaneous
cause of bursitits
rubbing at the heel (shoes or repetive motions)
what is the ROM loss dt bursits
there really is non, its just dt the px from rubbing
syndesmotic ankle sprain typically has what MOI
rotational force- more forceful (forced eversion with dorsi)
syndesmotic ankle sprain is located more
the px is more diffuse and superior to the ankle joint
mid foot consists of
Navicular
Cuboid
3 Cuneiforms
rear foot consists of
the true ankle (tib, fib, calcaneous, talus)
forefoot consists of
all toe bones
according to the article, what are predisposing factors to plantar faciitis
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
according to the article, what are good tests/observations for plantar faciitis
palpate proximal plantar fascia check DF tarsal tunnel windless affect long arch
interventions for plantar faciitis
ionto with dexa stretches taping ortho devices sleep splints
what happens with the plantar fascia with prontation
with pronation it’s elongated
what happens with plantar fascia with supination
shortens
why may joint mobs not be effective for tx of plantar fasciitis
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)
how to find cuboid
it should be btwn the 5th MT tuberosity and the calcaneous
function of forefoot
adapt to terrain
what makes up talocrural joint
tib
fib
talus
what makes up subtalar joint
calcaneous
talus
bending the knee joint and plantar flexing isolates the
soleus
keeping knee straight and plantar flexing isolates the
gastroc
in addition to tib post and ant, what muscles also invert pes
FHL
FDL
which is more distal, medial or lateral malleolus
lat
dorsi and plantar happen at what joint
talocrural
stability in WB is provided by ___, while in NWB it is (for talocrural joint)
WB - bone articulations
NWB - ligg
pronation and supination occur at the __ joint
subtalar
subtalar joint motions (asking about OKC, CKC)
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
Subtalar CKC
TER
T DAB
CI
inversion/eversion happens at
midtarsal joint region
tibialis post has what attachment at foot
navicular
peroneus longus has what attachment at foot
cuboid
joint type calcaneocuboid
saddle
what tarsal bones do 4th metatarsal articulate with
3rd cunieform and cuboid
what tarsal bones does 5th metatarsal articulate with
cuboid only
lisfranc joint is where
tarso metatarsal
most important action with big toe
push off /dorsi
she lists 2 main purposes of plantar fascia
aids in rigidity (windlas effect) and shock absorption
most important arch in foot
med long (load bearing)
weakest, most injured lig in angle
ATFL
CF lig only resists
inversion
these make up the deltoid lig structure
Posterior tibiotalar
Tibiocalcaneal
Tibionavicular
Anterior tibiotalar
main fat pad is where - if injured what is best tx
heel - a shock absorbing pad
nerve type sx btwn the big toe and first toe (on top of foot) would be what nerve
deep peroneal
nerve sx to most of top of foot would be what nerve
superficial peroneal
nerve supply to the peroneals
longus and brevis -sup fib nerve
tert - deep fib nerve
rearfoot valgus goes with (inversion or eversion)
eversion
at heel strike you want
a rigid foot
pronation can stress what nerve
tibial (it’s on the medial side)
pes planus can be associated with: (many)
Can be associated with leg length discrepancy, femoral anteversion, metatarsalgia, tibialis posterior tendonopathy, plantar fasciitis
how might peroneals get injured with a supinated foot
they are getting stretched, or possibly uses for push off
Abnormal prominance of posterior superior lateral border of calcaneus.
Haglands deformity
a bunion on medial side of great toe
hallux valgus
tx for hallux valgus
bunion pad, wider shoes
hallux rigidus
like hallux valgus, but is on top of great toe and toe ext/dorsiflexion is limited
Forced hyperdorsiflexion/ext of first MTP
turf toe
if a muscle gets stretched or injured from stretch, you do what to the antagonist muscle
strengthen it to help pull the other muscle back into proper alignment
strengthening of the ___ might be beneficial for reoccuring ankle sprain
peroneals
syndesmotic sprains are more complicated, but may not have a lot of
swelling
lis franc fxs are located
mid foot
characteristics of lis franc injury
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
MOI for cuboid syndrome is often associated with
uneven terrain
cuboid syndrome often presents with (pro or sup foot)
pronated -which tightens peroneals
tx for tendonosis should always include
cross friction massage and eccentric ex
Most common overuse syndrome of lower leg
Achilles Tendonopathy
pronators are likely to have ____ tendonopathy
achilles
post tib eccentrically controls ___
pronation (eversion)
post tibialis is stretched with (pro or sup)
pronation
tibial stress fx most common where
Middle or distal 1/3 of tibia
excessive pronation can lead to tibial stress __
fx
px to lateral ankle with resisted eversion with popping/snapping
look into subluxed peroneal
px to medial ankle with resited plantar and inversion with popping/snapping
post tib tendon
good dx test for post tendon dysfunction
they can’t do a calf raise (tear or rupture)
look for navicular drop
plantar fascitis can be associated with what type of arch
high or low
most common cause of heel px in kids
severs
apophysitis of heel (achilies)
severs
fusion of one joint does what to surrounding
makes the others take up the new need for motion = alters biomechanics and can cause issues
most common type of ankle fx
unimalleolar (lateral more)
bi -malleolar fxs happen how
Usually from severe pronation/ abduction/ external rotation force
Shears lateral and avulses medial
trimalleolar fxs happen by
medial lat and post forces
MOI for talar dome fxs
Axial load with compression against talar head and tibia
Chondral fx
calcaneal fxs typically only occur with
great force (landing on foot)
most common stress fx MT
2nd and 3rd
contributing factors to MT stress fxs
low body fat (bad bone density)
fx to 5th MT, they are NWB for
6-8 weeks (poor circulation to that area)
nerve sx on the bottom of the foot would be what nerves
lateral side -lateral plantar
medial side -medial plantar
heel -tibial nerve
reporting that the bottom of the foot/feet can go numb or tingle with running (or activity that causes repetetive compression) could be
med or lat plantar nerve both can get compressed with running
what foot placement could cause tarsal tunnel
pronation
tarsal tunnel vs neuropathy
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)
tarsal tunnel sx are usually on the ___ of the foot
plantar surface
Pain on plantar surface of foot between 3rd and 4th metatarsals; pain might be worse when walking with shoes vs barefoot (think what pathologies)
metatarsalgia, neuroma, stress fx
Ottowa ankle rules
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)
hammer toe vs claw toe
ext flex flex (claw)
ext flex ext (hammer)
Tib fib joint play assessment, explain all
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
all joint mobs for tib fib joint are same as the assessment except for
anterior (this one they are prone)
tib fib joint mobs, which ones help with plantar flexion
ant
inf
tib fib joint mobs, which ones help with dorsi
post
sup
distraction
make sure and put pt in slight ___ with a tib fib sup or inf glide
eversion
Talocrural joint mobs motions
distract
post
ant
explain all assessment of talocrural joint play
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
talocrural ant and distraction can also be done
prone
distraction you can bend knee and pull up
ant - you just push ant
post glide of talocrural aids with
dorsi
ant glide of talocrural aids in
plantar
almost all ankle mobs are same as your assessment except for
tib fib ant glide
sub talar assessment joint play
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
motions subtalar joint mobs help wih
primarily inversion or eversion
primary decelerator of the tibia is the
soleus
if pts have back probs, it might be good to check what part of the foot
great toe ext - if they aren’t getting proper push off
mid tarsal mobs (explain)
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
list all of the mvmt dx
pronation syndrome
supination syndrome
insufficient dorsi
hypomobility
MOI for CF vs ATFL ligg sprains
CF -straight inversion
ATFL - inversion with PF
superior glide of lat malleolus (tib fib joint ) helps with
dorsi
bottom line with PF is you want to check their
dorsiflexion
