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PTA Ortho > ANKLE > Flashcards

ANKLE Flashcards

1
Q

Motions

A

DF/PF

Inversion/Eversion

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2
Q

Tibia and Fibula bound together by

A

interossous membrane

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3
Q

Hind foot

A

talus and calcaneus

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4
Q

mid foot

A

navicular
cuboid
3 cuniforms

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5
Q

forefoot

A

5 metatarsals

14 phalanges

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6
Q

Distal tibiofibular Joint

A

CONVEX fibular head with CONCAVE fibular notch on TIBIA

fibrous joint

small amount of gliding occurs with ankle motions

**W/ full ankle DF there is gliding with this joint

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7
Q

Talcrural Joint-Ankle Mortise

A

Distal tibia, distal fibula and talus

Hinge Joint

DF/PF motion

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8
Q

Open/Closed pack of Talocural joint

A

Open: 10 degrees of PF
Closed=full DF

End feels: FIRM

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9
Q

Open and Closed Chain movement of Talocrural Joint

A

CONVEX talus on CONCAVE tibia/fibula

OPEN: Talus on Tib/Fib
PF: anterior
DF-posterior

CLOSED: Tib/Fib on Talus
DF:anteriorly
PF: Posteriorly

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10
Q

Deltoid ligament

A

Talocrural joint ligament
medial malleolus to navicular, talus and calcaneus

Mantains medial stability and prevents eversion injuries

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11
Q

Lateral ligaments of Talocrural joint

A

-Mantains lateral stabiliity, prevents inversion injuries

  1. anterior talofibular lig=from tibia to fibula
    - ant. side
    - lateral malleolus to ant. talus
  2. posterior talofibular lig.= tibia to fibula
    - post. side
    - lateral malleolus to pos. talus

3.calcaneofibular lig.= from lateral malleolus to calcaneus

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12
Q

subtalar joint

A

supination/pronation=standing position= CK
eversion/inversion=open chain

  • planar joint
  • calcaneus articulates with Talus
  • pronation/supination
  • eversion/inversion

OPEN/CLOSED PACK

O: Neutral
C: Full Supination

**CONVEX calcaneus on CONCAVE talus

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13
Q

Transverse Tarsal Joint

A

Planar Joint

Between talus and: Navicular, calacneous and cuboid

Transverse Arch= Cuboid-> cuneiform 3-> cuneiform 2 -> cuneiform 1

Position:
Pronation/supination

P: transverse arch flattens
S: transverse arch raises

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14
Q

MTP JOINTS

A

condyloid joint
CONVEX distal metatarsal head on CONCAVE proximal portion of proximal phalanx

Flex/ext
Abd/add

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15
Q

IP PIP DIP joints

A

Hinge joint

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16
Q

Medial Longitudinal arch

A

longer and higher arch

RUNS FROM:
medial metatarsals to:
-cuneiforms
-navicular
- talus
-calcaneus

Supported by spring lig., plantar aponeurosis and long/short plantar lig.

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17
Q

Lateral Longitudinal arch

A

Lateral Metatarsals to:
cuboid
calcaneus

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18
Q

Transverse longitudinal arch

A

cuboid to cunieform 3
to Cunieform 2—-which is HIGHEST
to cuneiform 1

Lateral to medial

supported by spring ligament

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19
Q

windlass effect

A

during heel off in gait::
MTPs extend

  • increases tension on plantar aponeurosis
  • helps increase the arch
  • provides more rigid foot during push-off as foot Plantarflexes and supinates
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20
Q

Prontation

A

foot/heel ABDUCTED
Foot EVERSION

flexible foot to accommodate to ground surfaces during foot flat-> midstance

overpronation effect:
internally rotates leg with flexion
SHORTENS LIMB
-everything drops down and in

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21
Q

Supination

A

Foot/hee ADDUCTIONs
Foot INVERSION

rigid foot to develop force for push-off

Oversupination effect:
Externally rotates leg with extension
everything goes up and out

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22
Q

Gait: SWING PHASE

A

when foot is not in contact with the ground “swing through”

3 stages:
acceleration, midswing and deceleration-> opp. muscles are working to slow everything down

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23
Q

Gait: Stance phase

A

when foot is in contact with the ground

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24
Q

heel strike

A

when heel contacts the ground and foot is slowly lowered to the ground

eccentric control

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25
Q

foot flat

A

when entire foot is in contact with the ground

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26
Q

midstance

A

body passes over WB foot

27
Q

heel off

A

heel raises off the ground

28
Q

toe off

A

period just before and after toes leave the ground

29
Q

DF muscles

A

anterior tibialis
extensor digitorum longus and brevis needed for pure DF

Gait Function:
-controls food as it lowers to the ground after heel strike–eccentric

-keeps foot from dragging during swing phase–concentric

30
Q

Plantarflexor muscles

A

attach to calcaneus by way of achilles tendon

Gastrocnemeus-2 joint muscle
soleus-1 joint muscle

GAIT FUNCTION:

  • Heel-off : raise heel before push off—concentric
  • powerful concentric contraction for PUSH OFF-concentric
31
Q

Evertors

A

evert the foot and support the arches

peroneus longus-EV//PF
Peoneus bevis-EV

32
Q

Invertors

A

anterior tibialis
posterior tibialis-slows down foot so when we heel strike the foot doesnt roll into eversion

GAIT FUNCTION
heel strike to midstance
controls movement of foot into pronation-eccentric

33
Q

Anterior Drawer sign

A

identifies tear in anterior talofibular ligament

pt. supine with leg relazed and ankle in 10-20 degrees plantarflexion

therapist stabilizes distal tib& fib and draws the talus anterior on the mortise

+= anterior translation is greater than univolved side

34
Q

Talar tilt test

A

identifies tear in calcanofibular ligament

pt. supine w/ leg relazed and ankle in neutral
therapist tilts the talus medially while palpating the calcanofibular lig.

+= excessive inversion compared to uninvolved side

35
Q

Thompson test

A

identifies rupture of achilles tendon

pt. prone with knee extended and feet over the edge of plinth
therapist squeezes the middle 1/3 of gastroc muscle belly

+= normal plantar flexion response is not elicited

36
Q

Homan’s sign

A

identifies DVT

signes of DVT= calf swelling, erythema, warmth
therapist passively DF ankle while squeezing pts. calf

+= pt. c/o sudden increase in pain

37
Q

Lateral ankle complex

A

anterior talofibular lig
calcaneal fibular lig
posterior talofibular lig

most common ankle sprain

38
Q

Lateral ankle complex causes

A

inversion with PF-stepping off curb, stepping on another persons foot

medial malleolus is not able to stop inversion because it does not extend distally

39
Q

Clinical signs of lateral ankle complex injury

A

tenderness over ligaments
swelling of lateral ankle/bruising
painful gait
weakness

40
Q

tests for lateral ankle complex injury

A

anterior drawer

talar tilt

41
Q

Phase 1 : inversion sprain rehab

A 
Max protextion
RICE
modalities
joint protextion-bracing
AROM
isometrics
general fitness
42
Q

Phase 2: inversion sprain rehab

A 
Moderate Protection
RICE
PREs
bands, weights
joint protection
achilles/calf stretching
proprioception exercises
general fitness/cycling
avoid inversion/PF

**Need to reteach muscles how to properly fire in correct sequence

43
Q

Phase 3: inversion rehab

A

minimal protection

joint protection during activities
advanced proprioception exercsies
functional progression
running, jumping
plyometrics
44
Q

Medial Ankle Complex

A

Deltoid ligament injury
less common

CAUSE:
eversion with DF

**deltoid ligament can avulse-tearing off a piece of tibia due to the strength of tendon
distal fibula may fracture from eversion force

45
Q

achilles tendonITIS

A

inflammation of tendon

CAUSE:
oceruse-increase in training/running
changes in running surfaces
decreased flexibility of gastrocnemius/soleus–>possibly hamstrings too

**acute and located where achilles inserts

46
Q

Achilles tendinOSIS

A

fibrotic changes of tendon–>pain and issue more along muscle portion of achilles

CAUSES:
impairment of blood supply to tendon with resultant tendon degeneration

achilles tendon does not normally have good circulation

47
Q

Clinical signs of achilles tendinopathy

A

pain with resisted PF
pain with stretch of gastrocnemues, soleus
tendon site tender to palpation
antalgic gait with poor heel rise/push-off

48
Q

achilles tendon rupture

A

occurs as sudden DF injury
*often due to recreational sport
tear typically occurs 2 inches above instertion
most common in men from 20-50 y.o

49
Q

clinical signs of achilles rupture

A

audible pop when rupture occurs
severe pain when rupture occurs
gait changes-no heel up or push off

TEST:
Thompson test

50
Q

surgical management of achilles rupture

A

open surgical repair by non essential muscle-plantaris

s/p surgery ankle will be casted or put in boot
different MDs and procedures will determine exercise progression

cast will be in PF to keep plantarflexors on slack
slow return to DF and PF ROM
start with isometrics

51
Q

Plantar fasciiitis

A

longitudinal arch flattens, pulling and inflaming on the plantar fascia

chronic inflammation of the plantar fascia/aponeurosis results

52
Q

causes of plantar fasciitis

A

repetitive microtrauma to plantar fascia-jumping, running etc

can include heel spur
obesity
age-40-60
occupational-standing long periods of time
poor arch support
53
Q

clinical signs of plantar fasciitis

A

pain at heel
pain along longitudinal arch

antalgic gait:
pain with push off
pain with WB
pain worse in morning, especially first few steps
heel spur-point tenderness
54
Q

Hallux Valgus and Bunion deformity

A

transverse arch has flattened
distal portion of metatarsals have moved away from each other

proximal phalanx of great tos is held in place by adductor hallucis

can be exacerbated by improper footware
surgical management: Bunionectomy=surgical relocation of phalanx with pin/screws

more common in women

55
Q

Shin Splints

A

inflammation and micro damage to the periosteum of the tibia near origin of posterior or anterior tibialis muscle
caused by muscles trying to slow down the foot at heel strike*

Outside of leg pain= ant. tib
inside of leg pain= post. tib

56
Q

Clinical signs of shin spints

A 
pain along medial or lateral lower leg
pain with acitivity/ running
pain with resisted :
DF= ant. tib
Inversion=post. tib
57
Q

Overprontation issue with shin splints

A

tight PF and weak Ant. tib

58
Q

Stress fracture

A

overuse and unrelenting stress to tibia, fibula and metatarsals

usually due to running
*can be caused by shin splints

59
Q

Pylon fracture

A

distal tibia compression fracture when forced into talus
usually fibula breaks too

CAUSES:

  • auto accident
  • fall from a height
  • skiing accident

**Extensive surgical management

60
Q

Malleolar fractures

A

Lateral Malleolar-distal fib fracture
medial malleolar-distal tib fracture
bimalleolar-both distal tib/fib fracture
trimalleolar-distal fib/tib and posterior margin of distal tibia fractured

61
Q

protection phase rehab

A 
follw MD protocol
alter activity to protect motion
braces/splinting/taping
decrease stress on area with altering WB -AD if needed
well joint mobility strength&flexibility
pain free ROM
multi-angle isometrics
supportive modalities
62
Q

Controlled motion phase rehab

A

CRITERIA

  • decreased edema
  • full pain-free WB
Maximize ROM
Maximie strength-OKC,CKC
resolve gait deviations
maximize flexibility of entire chain
balance
return to functional acitiivities
63
Q

Return to function phase

A

Criteria:

  • full pain free ROM
  • good strength&balance
  • no gait deviations

Functional training
adapt return to function to prevent reinjury

If appropriate:
-plyometrics
speed drills

PTA Ortho (5 decks)

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