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OMS Peripheral > Ankle > Flashcards

Ankle Flashcards

1
Q

What type of joint is the inferior tibiofibular joint?

A

Syndesmosis because the firm union between the two bones is because of the interosseous membrane.

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2
Q

What reinforces the inferior tibfib joint?

A

1- Anterior ligament

2- Posterior ligament

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3
Q

What makes up the inferior transverse tibiofibular ligament?

A

It is the deep part of the posterior tibiofibular ligament, it passes under the the ligament into the malleolar fossa of the fibula.

This forms part of the articulating surface of the ankle joint

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4
Q

What type of joint is the ankle/talocrural

A

Uniaxial, synovial hinge joint –> distal ends of the tibia and fibula, their malleoli and the dome of the talus

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5
Q

What stabilises the ankle joint? (3)

A

1- Congruency of the articulating surfaces during loading
2- Static ligamentous control
3- Dynamic control of the musculotendinous units

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6
Q

What are the ranges for dorsiflexion and plantarflexion?

A

Dorsi - 20 degrees

Plantar - 35 degrees

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7
Q

Which is the closed pack position of the talocrural joint?

A

Dorsiflexion

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8
Q

What are the attachments for the medial collateral ankle ligament (deltoid)?

A

It starts on the medial malleolus and forms a conjoined line from the navicular to the sustentaculum tali and then talus

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9
Q

Does the deltoid ligament easily damage?

A

No, traumatic injuries tend to fracture or disrupt the syndesmosis

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10
Q

What consists of the lateral collateral ligament in the ankle? (3)

A

1- Anterior talofibular ligament (ATFL) –> width of a patient’s finger
2- Calcaneofibular ligament
3- Posterior talofibular ligament

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11
Q

What are the two movements that put the most strain on the ATFL?

A

1- Plantarflexion

2- Inversion

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12
Q

What are the two movements that put the most strain on the calcaneofibular ligament?

A

1- Dorsiflexion

2- Inversion

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13
Q

What is the tibiofibular syndemosis comprised of? (3)

A

1- Interosseous membrane
2- Posterior inferior tibiofibular ligament
3- Anterior inferior tibiofibular (weakest of the three)

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14
Q

How many bones are in the foot?

A

26

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15
Q

What are the main joints of the foot?

A

1- Subtalar (talocalcaneal) joint
2- Mid-tarsal (transverse tarsal) joints:

2a- Calcaneocuboid joint
2b- Talocalcaneonavicular joint

3- TMJ and MTP
4- IP

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16
Q

What are the functional movements in the subtalar joint?

A

Pronation and Supination

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17
Q

What ligaments support the calcaneocuboid joint? (3)

A

1- Dorsal calcaneocuboid ligament (most often injured with inversion injuries)
2- Short plantar ligament
3- Long plantar ligament

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18
Q

Which ligament supports the talocalcaneonavicular joint?

A

Spring ligament (sustentaculum tali –> navicular under the talar head)

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19
Q

What type of joint is the talocalcanealnavicular joint?

A

Ball and socket

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20
Q

What are the accessory movements of the mid-tarsal joint?

A 
Plantarflexion
Dorsiflexion
Abduction
Adduction
Inversion
Eversion
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21
Q

What is the medial arch of the foot made out of?

A

Posteriorly- calcaneus
Anteriorly - metatarsal heads
Top - talus

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22
Q

What is the role of the medial arch of the foot?

A

Dynamic role for gait: absorbs and transmits weight while providing elasticity for propulsion

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23
Q

What is the role of the lateral arch of the foot?

A

Static role for weight bearing: touches the ground to support load in standing and is supported by the plantar fascia (prevents arches from collapsing)

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24
Q

What is the role of the transverse arch of the foot?

A

Supports and transmits body weight - as body weight is applied the metatarsal bones separate and flatten slightly

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25
Q

What are the main ligaments supporting the arches of the feet? (4)

A

1- Short plantar ligament (lateral)
2- Long plantar ligament (lateral)
3- Spring ligament (medial)
4- Plantar aponeurosis

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26
Q

What are the muscular supports to the foot’s arches? (2)

A

1- Tibialis anterior (medial)

2- Peroneus longus (lateral)

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27
Q

What is the innervation of the anterior muscles of the lower leg?

What are their actions?

A
  • Deep peroneal nerve
  • Dorsiflexion of the ankle and extension of the toes
  • Support to the medial arch
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28
Q

What is the primary action of the lateral muscles of the lower leg?

A
  • Evert the foot
  • Controlling side to side movement in standing
  • Support to the lateral arch
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29
Q

What are the actions of the superficial posterior muscles of the lower leg?

A

Plantarflexion

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30
Q

What are the actions of the deep posterior muscles of the lower leg?

A

Flexion of the toes

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31
Q

What is the innervation for the posterior muscles of the lower leg?

A

Tibial nerve

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32
Q

How long is the Achilles tendon?

A

15 cm

33
Q

What are the two bursae of the Achilles tendon?

A

1- Retrocalcaneal bursa

2- Subcutaneous achilles bursa

34
Q

What lies underneath the flexor retinaculum?
“Tom Dick And Very Naughty Harry” (medial to lateral)

Behind the medial malleolus

A 
Tibialis posterior
flexor Digitorum longus
tibial Artery
tibial Vein
tibial Nerve
flexor Hallucis
35
Q

What lies beneath the extensor retinaculum?

“Tom Harry And Very Naughty Dick” (medial to lateral)

A 
Tibialis anterior
extensor Hallucis longus
dorsalis pedis Artery
dorsalis pedis Vein
deep peroneal Nerve
extensor Digitorum longus
36
Q

What are the two types of flat foot?

A

1- Pes planus (structural flat foot)

2- Functional flat foot (only on weight bearing)

37
Q

What is Haglund’s deformity?

A

A bony enlargement of the posterior calcaneus that can be observed at the back of the heel. This can be associated with bursitis and soft tissue swellings called ‘pump bumps’

38
Q

What are the end feels of the ankle?

A

Dorsiflexion - hard

Plantarflexion - soft

39
Q

What are the end feels of the subtalar joint?

A

Supination and Pronation - hard

40
Q

What does the talar tilt test?

A

Integrity of the calcaneofibular ligament - it would be positive if there is laxity with a varus force

41
Q

Does the calcaneofibular ligament get injured alone?

A

No, it is often injured with the ATFL

42
Q

How to test the dorsal calcaneocuboid ligament?

A

Place the foot into passive adduction and inversion to reproduce pain if the test is positive.

43
Q

How common is OA in the ankle?

A

Not common unless:

  • Previous fracture
  • Repetitive postural overuse
  • Instability caused by recurrent sprain
44
Q

What is the treatment for OA and RA?

A

Injection

45
Q

Can you inject all capsular lesions of the foot and ankle?

A

Yes

46
Q

How common is a lateral collateral ligament sprain?

A

85-90% of ankle sprains

The ATFL is the weakest and is involved in nearly all of them
The Calcaneofibular ligament is involved in 50-70%
The Posterior talofibular ligament in less than 10%

47
Q

What are the findings and treatments for a Grade 1 ATFL sprain?

A
  • Mild stretching of the ligament
  • Mild swelling and tenderness over the ligament
  • Some limitation to movement
  • Some difficulty weight-bearing
  • No instability

Usually take 8-10 days to resolve with early mobilisation

48
Q

What are the findings and treatments for a Grade 2 ATFL sprain?

A
  • Partial rupture
  • Mild instability
  • Moderate to severe swelling, bruising, pain and local tenderness
  • Limited range -> capsular pattern

Takes approx 15-21 days to resolve with early mobilisation

49
Q

What are the findings for a Grade 3 ATFL sprain?

A
  • Complete rupture of ATFL and Calcaneofibular ligaments and lateral capsule
  • Gross instability of the joint
  • Diffuse swelling and marked evidence of haemorrhaging
  • Severe pain
  • Loss of movement
  • Great difficulty weight-bearing
50
Q

What is the treatment for a Grade 3 ATFL sprain?

A
  • Surgery is only considered for elite athletes, otherwise conservative management.
  • Early mobilisation
  • NSAIDs, ice
51
Q

What is the treatment for an acute lateral collateral ligament sprain?

A
  • POLICE
  • Ice during the first 3 days
  • Gentle friction then Grade A mobilisation as able 3-5 days post injury
  • Should be pain free and walking normally within 8-21 days
  • Functional rehab: proprioceptive work, strengthen the peroneals, balance, coordination
  • Gait correction
52
Q

What are the findings for a chronic lateral collateral ligament sprain in the ankle?

A

Hx:

  • Past sprains
  • Pain and swelling on activity on the lateral side
  • Mechanical instability
  • Functional instability (sensation of giving way due to neuromuscular and proprioceptive deficits)

Objective:

  • Postitive talar tilt or drawer test
  • Pain in full passive inversion
53
Q

What is the treatment for chronic lateral collateral ligament sprains?

A
  • Mechanical correction and functional rehab with an emphasis on: proprioception, balance, postural control, taping
  • Grade C manipualtion following deep transverse friction
  • Vigorous mobilisation
54
Q

What are some differential diagnosis with chronic lateral collateral ligament sprains?

A

1- Osteochondral fracture
2- Ruptured peroneal tendon
3- Synovitis
4- Ligamentous impingement of the anterior aspect of the ankle (very uncommon)

55
Q

How do you strain the dorsal calcaneocuboid ligament?

A

Adduction and inversion of the mid-tarsal joints

56
Q

What is the treatment for a medial collateral ankle sprain?

A
  • NOT a Grade C due to the multidirectional nature of its fibres
  • Friction
  • Biomechanical assessment of the foot
  • Orthotics
57
Q

Can you differentiate between a retrocalcaneal bursa and an achilles tendinopathy?

A

Only with Xray

58
Q

What is the treatment for subcutaneous Achilles bursa?

A
  • Advice on footwear

- Rest

59
Q

What is a typical Hx for plantar fasciitis?

A
  • Gradual onset
  • Pain over the medial plantar aspect of the heel
  • Pain under heel when the foot is first put on the floor in the morning
  • Worse after prolonged periods of standing and on initial exercise –> easing as the foot warms up
60
Q

What is the differential diagnosis for plantar fasciitis?

A

Fat pad syndrome (occurs acutely following a fall onto the heel or chronically through poor heel cushioning)

61
Q

What is the treatment for plantar fasciitis?

A

90-95% of cases get better under a year without surgery

  • Friction
  • Injection
  • Rest from overuse activities
  • Full rehab programme (intrinsic foot muscle exs, correct foot posture, orthotics
62
Q

What causes peroneal tendinopathy?

A
  • Chronic overuse

- Acute onset as tenosynovitis if the tendons are involved in an inversion sprain of the ankle

63
Q

What is found on examination for peroneal tendinopathy?

A
  • Pain felt on the lateral side of the ankle on resisted eversion
  • Acute tenosynovitis may also produce pain on passive inversion
  • Site of lesion based on palpation
64
Q

What are the five possible sites of a lesion in peroneal tendinopathy?

A 
1- Musculotendinous junction
2- Tendons above the lateral malleolus
3- Tendons behind the lateral malleolus
4- Tendons below the lateral malleolus
5- Insertion of peroneus brevis into the base of the fifth metatasal
65
Q

How to test for subluxation of the retinacula of the peroneus tendons?

A

The ankle needs to be actively dorsiflexed and everted against resistance

66
Q

What is the treatment for peroneal tendinopathy?

A
  • Injection if the injury is below the malleolus

- Friction

67
Q

How many fingers are required to friction the peroneal tendons above the malleolus?

A

3

68
Q

Do you put the peroneal tendons on stretch for friction if you are frictioning behind the malleolus?

A

Yes - in plantarflexion and inversion

69
Q

How many fingers are required to friction the peroneal tendons below the malleolus?

Does it need to be on stretch?

A

2

Yes

70
Q

Is the Achilles tendon in a synovial sheath?

A

No, it is not in a true synovial sheath but a paratenon (thin gliding membrane)

71
Q

What are typical symptoms of Achilles tendinopathy?

A
  • Posterior heel pain with stiffness before, during and after exercise
72
Q

Where do most Achilles lesions occur on the tendon?

A

2-6cm proximal to its insertion –> poor vascularity

73
Q

What differential diagnosis is there for Achilles tendinopathy? (3)

A

1- Retrocalcaneal or superficial bursitis
2- Haglund’s deformity (impingement between calcaneus and Achilles)
3- Calcification or avulsion fracture

74
Q

How do you clinically diagnose Achilles tendinopathy?

A

A combination of:

  • Pain in the Achilles tendon
  • Swelling and impaired performance
  • Pain on resisted plantarflexion
75
Q

What are the most common sites of Achilles tendinopathy?

A

1- Anterior aspect (medial and/or lateral)
2- Sides of the tendon
3- Insertion of the tendon into the calcaneus

76
Q

What are two common mechanisms of injury to the gastrocnemius muscle belly?

A

1- Sudden sprinting action with the ankle in dorsiflexion

2- Sudden eccentric overstretching of the muscle (missing your step on the curb)

77
Q

What is the Hx for gastrocnemius muscle belly lesions?

A
  • Sudden acute pain
  • Swelling and bruising
  • Weight bearing is difficult
78
Q

What is the treatment for an acute gastrocnemius muscle belly lesion?

A
  • POLICE

- Gentle friction (with the muscle belly relaxed) followed by Grade A mobilisations

OMS Peripheral (8 decks)

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