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Physical Exam > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

What are the four main joints of the foot?

A
  1. ankle (tibotalar)
  2. subtalar (talocalcaneal)
  3. mid tarsal (chopart)
  4. mid foot (lisfranc)
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2
Q

Why don’t we see amputations at the chopart or lisfranc joint?

A

equinovarus foot–> cannot put an artificial foot on

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3
Q

Which ligament tears first?

A

ATF: anterior talofibular

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4
Q

When do we see the too many toes sign?

A

pes planus

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5
Q

Whats the difference between claw toes and hammer toes?

A
  • claw toes- result of neuropathy

- hammer toes- result of neuropathy

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6
Q

What is Hallus Valgus?

A

the toes angle laterally

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7
Q

Why can you get knee pain with pes planus?

A
  • Because the tibia rotates internally

* may cause lateral OA

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8
Q

What’s another sign of pet planus?

A

-look at the achilles tendon–> If it curves out, signifies yes plants

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9
Q

What is the bony landmark to palpate in plantar fasciitis?

A

-anteromedial calcaneus–> bottom of heel on medial side

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10
Q

What are the Tom, Dick, and Harry tendons?

A
  • Posterior tibial
  • Flexor digitorum longus
  • Flexor hallucis longus
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11
Q

What is “pump bump” refer to?

A

-retrocalcaneal bursa

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12
Q

What is the functional ROM?

A
  • walking 10 DF, 20 PF

- running 20 DF, 25 PF

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13
Q

How can you evaluate the ATF ligament (MC ligament injured in inversion ankle sprains)?

A

Anterior drawer test

  • grab heel with one hand, stabilize tibia with other hand, pull heel anterior
  • compare to opposite side
  • positive test is 3-5mm increased translation
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14
Q

What does the taller tilt test evaluate?

A

-ATFL and CFL (calcaneofibular ligament)

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15
Q

How to perform talar tilt test?

A
  • grab hell with one hand, stabilize the tibia with other hand
  • inversion of foot with ankle plantar flexed evaluates ATFL
  • inversion of foot dorsiflexed evaluates CFL
  • positive test is 10-15 degrees increase in inversion compared to opposite side
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16
Q

What test do you do to evaluate for morton’s neuroma?

A
  • metatarsal squeeze test
  • positive test is reproduction of pain and paresthesias

*remember, rarely, does a lumbar radic cause symptoms in 3rd and 4th toes

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17
Q

What test do you do to evaluate achilles tendon?

A
  • Thompson test
  • patient lies prone
  • examiner squeezes gastro muscle
  • positive test is absence of ankle plantar flexion; indicated ruptured achilles tendon
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18
Q

What is the peroneal subluxation test?

A
  • evaluates for subluxation of peroneal tendons over lateral malleolus; may be a/w recurrent inversion ankle sprains
  • have patient DF foot and evert the foot against resistance while palpating the peroneal tendons posterior to lateral malleolus
  • positive test is pain, clicking, or feeling of instability
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19
Q

How do you attempt to distinguish between MTSS (shin splints) and tibial stress fracture?

A

Hop test

  • have patient single leg hop on affected leg ten times
  • If negative, patient can return to activity (i.e. running)
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20
Q

What type of ankle sprain is MC?

A
  • inversion ankle sprain (70-85%) with injury to the lateral ligamentous complex
  • ATFL is the MC, followed by CFL, then PTFL
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21
Q

Deltoid ligament injury- common or rare?

A
  • Isolated injury is rare

- high suspicion for associated injuries

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22
Q

Exam of ankle sprain?

A

-swelling, anterior drawer test (ATFL), talar tilt test (ATFL, CFL)

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23
Q

What do you ALWAYS need to palpate with inversion/eversion ankle sprains?

A
  • Base of the 5th metatarsal with inversion sprains (tuberosity avulsion or Jone’s fracture)
  • Proximal fibula with eversion sprains (Maisonneuve fracture)
24
Q

Jones fracture

A
  • a/w inversion ankle sprain
  • always palpate base of the 5th MT
  • serious issue!
  • can be acute or chronic
25
Q

Which tendon can cause avulsion fracture with inversion ankle sprain?

A

-peroneous braves tendon can cause avulsion fracture at the base of the 5th MT

26
Q

Ottawa Ankle Rules

A
  • Used to determine if x-ray if indicated
  • Sensitive, not specific
  • X-ray indicated if:
  • unable to take 4 steps after injury
  • tenderness over distal 6cm of tibia and fibula
  • tenderness over navicular (post tibias inserts) or base of the 5th MT
27
Q

What is a Maisonneuve fracture?

A
  • Medial malleolus fracture a/w fracture of the proximal fibular
  • Occurs with eversion ankle sprain but with greater force
  • eversion force is transmitted through syndesmosis to proximal fibula
28
Q

What type of training can help prevent ankle sprains?

A

-proprioception training

29
Q

What is a high ankle sprain?

A
  • injury to the interosseous ligament complex between the tibia and fibula
  • usual mechanism is hyperdorsiflexion and/or eversion
  • long recovery (2-8 weeks)
30
Q

What do you do on exam for high ankle sprain?

A
  • tenderness over distal tibia/fibula syndesmosis
  • squeeze test: pain with compression of proximal calf
  • external rotation test: pain with passive DF and external rotation of foot
  • fibular drawer test: patient laying on side, anterior and posterior forces applied to fibula; positive test with increased translation and/or pain
31
Q

What 3 ligaments are injured in a high ankle sprain?

A
  • posterior inferior tibiofibular
  • anterior inferior tibiofibular
  • interosseous membrane
32
Q

What is tarsal tunnel syndrome?

A

-Compression syndrome of tibial nerve as it passes through tarsal tunnel

33
Q

What symptoms do patient’s report with tarsal tunnel syndrome?

A
  • burning/electrical like pain on base of foot/heel and paresthesias radiating to toes
  • symptoms exacerbated by activity, relieved by rest
  • exam: +tinel’s sung over tarsal tunnel
34
Q

What is hallux rigidus?

A
  • OA of the 1st MTP joint
  • a/w pronated feet, unstable arches, and hyper mobile 1st MT
  • interferes with push off phase of gait
35
Q

What is the exam finding of hallux rigidus?

A

-tenderness over 1st MTP joint with LOSS of passive MTP extension/great toe DF

36
Q

What is turf toe?

A
  • HyperDF injury to 1st MTP joint leads to stretching or tearing of soft tissue restraints on plantar aspect
  • a/w soft shoe wear and hard playing surfaces
  • may eventually lead to hallux rigidus
37
Q

Exam of turf toe?

A

-swelling, ecchymosis, and tenderness over 1st MTP joint, limited ROM of 1st MTP

38
Q

What is Lisfranc injury?

A
  • midfoot sprain/fracture/dislocation
  • usually traumatic etiology (MVC, fall, sports)
  • exam: swelling/tenderness over tarsal/MT area, inability to bear weight or stand on toes, pain with passive abduction and pronation while hind foot is stabilized
39
Q

What is the Lisfranc joint?

A

tarsal-metatarsal joint

40
Q

What is plantar fasciitis?

A
  • overuse/inflammatory condition of plantar fascia
  • MCC of heel pain
  • hx: pain with first few steps in the morning
41
Q

What to do have on exam with plantar fasciitis?

A

-tenderness on plantar aspect over anterior medial calcaneus

42
Q

What is Freiberg’s infraction?

A
  • AVN of metaphysics of 2nd/3rd MT heads
  • more common in younger women who wear heels
  • present with forefoot pain
43
Q

Tendonitis

A
  • Multiple area of tendonitis possible in foot/ankle
  • posterior heel pain: achilles tendonitis
  • medial ankle pain- Tom, Dick, and Harry
  • lateral ankle pain: peroneus braves/longus

Exam: pain with resisted contraction of involved muscle, pain with passive stretching of the muscle

44
Q

What is retrocalcaneal bursitis?

A
  • 2 bursa near achilles tendons insertion
  • due to repetitive trauma/overuse, may be related to poorly fitted shoes
  • may be a/w with inflammatory arthritis, gout, spondyloarthropathy, etc.
  • hx: posterior heel pain worse with pressure or wearing tight shoes
45
Q

What is Haglund’s deformity?

A
  • prominence of posterior superior aspect of calcaneus

- causes mechanical irritation of retrocalcaneal bursa with DF

46
Q

Exam for retrocalcaneal bursitis?

A

-warmth/swelling over posterior heel, pain with passive DF and active PF

47
Q

What is a stress fracture?

A
  • failure of wolf’s law that bone will adapt to loads to which it is subjected to due to remodeling
  • hx of increase in training
48
Q

MC sites for stress fracture?

A

-tibia (49%) followed by metatarsals

49
Q

Exam for stress fracture?

A

-point tenderness over bone, + hop test, pain with vibratory stimulus, focal edema sometimes

50
Q

Treatment of stress fractures?

A

-Low and high risk –> conservative rest vs. surgery

51
Q

What is a march fracture?

A
  • 5th metatarsal fracture
  • high risk of nonunion and considered a “high risk” site
  • exam: point tenderness over proximal 5th MT, positive hop test, may have focal area of edema
  • treatment is surgical
52
Q

Tarsal navicular stress fractures (pointy bone on inside of foot)

A
  • common in track and field athletes
  • point tenderness over posterior navicular, + hop test, pain with toes raises
  • conservative tx: NWB 4-6 weeks
53
Q

MTSS (medial tibial stress syndrome)

A
  • “shin splints”
  • overuse injury
  • hx: pain at start of activity, improves over time
  • exam: tenderness on medial border of tibia
54
Q

Bone scan in MTSS vs. stress fracture

A
  • diffuse uptake= shin splints

- treaded black line= final stress fracture

55
Q

Exertion compartment syndrome

A
  • exercise induced pain, often a/w paresthesias and weakness, localized to a neuromuscular compartment
  • pathophys not well understood
  • hx: symptoms occur in a predictable time after onset of activity (i.e. 10-20 minutes), diminished with rest
56
Q

Exam and dx of exertion compartment syndrome?

A
  • Exam: pain with active contraction/passive stretching of muscles in compartment during episode; muscle herniation in 20-60% of patients
  • lack of boney tenderness
  • usually with normal pulses and neurological exam
  • dx: compartment pressures; test at rest and exercise until symptomatic

Physical Exam (7 decks)

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