Ankle Flashcards
does the ankle have more ROM in plantar flexion or dorsiflexion?
plantarflexion
Medial ligaments?
The deltoid ( 4 ligaments)
lateral ligaments?
ATF - anteriortalofibularCF- calcaneofibularPTF - posteriortalofibular
anterior ligaments
anterior tibiofibular
Posterior ligaments
posterior tibiofibular
Interosseus membrane
between tibia and fibula
Arteries (2)
dorsal pedalposterior tibial artery
Anterior Drawer. how many versions? what doe it test?
- regular and modified. test Anteior talofibularmodified- hip at 45, knee at 90, stabilize foot, push back on distal leg
Talar tilt. how many versions?
- inversion and eversion
inversion talar tilt. what does it test? how is it done?
talus instability. foot held in slight dorsiflexion, pull talus into inversion.tests: involvement of CF ligament, possibly with ATF and PTF ligaments
Kleiger’s. what does it test? how is it done?
hold ankle in neutral position or dorsiflexed, stabilize distal tibfib jointneutral positoin: tests deltoid ligamentdorsiflexed: tests syndemosiscan imply: deltoid injury, syndemosis pathology, or fibular fracture
Subtalar joint play (Cotten Test)
external rotation test identifies syndesmosis pathology by forcing the talus and calcaneus against the lateral malleolus, causing it to be displaced laterally and posteriorly stressing the syndesmosis.
Cotten test (how to)
side lying. stabilize talus, the other hand cups calcaneus, force moves talus laterally or medially. positive test is increased or deceased lateral or medial talus translationmedial glide commonly associated with lateral ankle sprains
Eversion talar tilt
ankle in neutral position. tests for deltoid sprainstabilize distal leg. pull talus into eversionlooking for gapping or pain
Squeeze and bump
squeeze = syndesmosis, fracturebump = fracturethompson test = achilles ruptured
Long Bone Compression Test
compression force on bones, looking for fracture, pain
Valgus/Varus stress test
tests medial and lateral ligaments of toes, generally the 1st toe.
Muddler’s sign
tests for interdigital neuroma. between 3&4 (normally - Morton’s neuroma)squeeze met heads together without forming an arch.look for pain.
what is a bunion
extra bone growth on the side of 1st or 5th toe. often due to over pronation or supination, shoe wear, valgus toe
what is Morton’s toe
when the 2nd ray is longer than the 1st.-changes walking dynamics, shoe size issues
Claw toes
hyper extension of MTPflexion of PIP/DIP joint
Hammer toes
hyper extension of MTPflexion of PIPextension of DIP
Pes planus
lack of medial longitudinal archmay have pn in arch or ankleneed orthotics
Pes Cavus
high, rigid archclaw toe is commonpn in arch - need cushioning
Jones fracture
base of 5th MTP
Avulsion fracture
5th MT styloid fractures
March fracture
fracture of 2, 3, or 4.stress fracture of distal 1/3 of tes.he metatarsal
Lis franc injury
fracture in the tarsals (could be sprain or dislocation)usually on toes, landed on with axial force
hallux valgus causes..
bunion
turf toe
1st MTP, sprain, MOI: repeated hyper extension of toe. foot planted, forced into dorsiflexion.extreme pn, can be very disabling
sesamoiditis
Inflamed sesamoidscommon in ballet dancers or from wearing high heels
Lateral Ankle Sprain symptoms
pn in all motions, mostly plantar flexion and inversiontest with anterior drawer or inv talar tilt
Syndesmosis sprain (high ankle sprain)
MOI:external rotation of foot, hyper dorsiflexion/plantarflexion, -some swelling-end ROM causes increase in pn-positive Kleiger’s
Medial Ankle Sprain
-pain on deltoid-usually causes a fracture of fibula 1/3 of the way up-eversion talar tilt-squeeze test
Tibial fracture
overuse pathology of the shaft
fibular fracture
usually not from direct hitcomes with specific ankle pathologieslower 1/3
malleoli fracture
associated with ankle sprainsavulsion or direct hit
L1-S2 sensory
L1, L2, L3 - descending diagonally on anterior thighL4 - knee, medial lower leg, medial footL5 - lateral lower leg, down and across top of footS1 - lateral foot, bottom of foot, achilles, (1/2 up lower leg)S2 - popliteal space, up back of leg into hamstrings
Reflexes
L4 - patellar tendonsome say L1-L4 play in this reflex
Achilles tendon
S1 -also S2
Knee extension
Knee Extension - L3, L4
Knee flexion
L5, S1
Ankle dorsiflexion
L4, L5
ankle plantar flexion
S1, S2
Great toe extension
L5
hip flexion
L1, L2, L3
hip extension
L4, L5
what order to perform neural eval?
dermatome, myotones, reflex