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Test and Measures > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

Distal Tibiofibular Joint

A

-Fibrous/syndesmosis type of joint
-Movement:
Small amount of spread with (1-2mm) at the ankle to allow full DF [talus wedging]
DF causes fibula to move superiorly which can also stress the proximal tibiofibular joint
Lose stability of joint -> lose stability of entire ankle

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2
Q

Distal Tibiofibular Joint Ligamentous Support

A
  • Anterior tibiofibular
  • Posterior tibiofibular
  • Inferior transverse
  • Interosseous ligament / syndesmosis
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3
Q

Talocrural (Ankle) Joint

A

-Modified hinge, synovial joint:
Talus - Wider anteriorly (more mobile in PF, less in DF)
Lateral malleolus of fibula - Extends down to almost subtalar level
Medial malleolus of tibia - Extends down to mid talus
Responsible for DF & PF

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4
Q

Subtalar Joint

A
  • Synovial joint w/ 3 DOF
  • Inversion & eversion are responsible for the alignment of the transverse tarsal joint axes
  • -Locking & unlocking the mid-foot
  • Pronated hind foot = parallel axes = increased movement
  • Supinated hind foot = axes not parallel = decreased movement
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5
Q

Subtalar Joint Articular Facets

A
  • Posterior: Talus concave, calcaneus convex

- Two Anterior: Talus is convex, calcaneus is concave

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6
Q

Subtalar Joint Positions

A
  • Resting: Midway between extremes of ROM
  • Closed: Supination
  • Capsular Pattern: Varus, valgus
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7
Q

Talocrural (Ankle) Joint Positions

A
  • Resting: 10 deg plantar flexion, midway between inversion/eversion
  • Closed: Maximum DF
  • Capsular Pattern: PF, DF
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8
Q

Distal Tibiofibular Joint Positions

A
  • Resting Position: PF
  • Closed: Maximum DF
  • Capsular Pattern: Pain when joint is stressed
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9
Q

Midfoot (Mid Tarsal Joints)

A
  • Talonavicular and Calcaneocuboid
  • In isolation, minimal movement
  • Together, significant movement allowing the foot to adapt to many positions
  • Chopart Joint = mid tarsal joints between talus-calcaneous and navicular-cuboid [separates medial from lateral side]
  • Don’t measure range of midfoot
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10
Q

Midfoot (Mid Tarsal Joints) Positions

A
  • Resting Position: Midway between extremes of ROM
  • Closed: Supination-most rigid/close together
  • Capsular Pattern: DF, PF, adduction, medial rotation
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11
Q

Forefoot Joints

A
  • Tarsometatarsal Joint
  • Metatarsophalangeal Joints
  • Interphalangeal Joints
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12
Q

Tarsometatarsal Joint Postions

A
  • Resting Position: Midway between extremes of ROM
  • Closed Packed Position: Supination
  • Capsular Pattern: None
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13
Q

Metatarsophalangeal Joints Positions

A
  • Resting: 10 deg extension
  • Closed: Full extension
  • Capsular Pattern
  • -Big Toe = extension, flexion (make sure to check the big toe for gait, make sure there’s about 70dg of extension)
  • -Second to fifth toe = variable
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14
Q

Interphalangeal Joints Positions

A
  • Resting: Slight flexion
  • Closed: Full extension
  • Capsular Pattern: Flexion, extension
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15
Q

Movements at Each Region of the Ankle/Foot

A
  • Talocrural joint: PF and DF
  • Subtalar joint: Inversion and eversion
  • Midtarsal joints: Adduction and abduction
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16
Q

Lateral Malleolus

A
  • Distal aspect of the fibula
  • Three main ligaments attach here:
  • -Anterior talofibular ligament
  • -Calcaneofibular ligmaent
  • -Posterior talofibular ligment
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17
Q

Medial Malleolus

A
  • Distal aspect of tibia
  • Higher than lateral
  • Main ligament: Deltoid
  • -Tibionavicular
  • -Tibocalcaneal
  • -Tibiotalar
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18
Q

Talus (Talar Dome)

A
  • Moves out in PF
  • Wider anteriorly
  • Palpate in the depressions anterior to the lateral and medial malleolus
  • -Invert to feel lateral dome “pop out”
  • -Evert to feel medial dome “pop out”
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19
Q

Sinus Tarsi

A
  • Small canal under the talus on the outer lateral aspect
  • Soft tissue depression just anterior to lateral malleolus
  • Swelling and pain can occur here
  • Filled by extensor digitorum brevis
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20
Q

Calcaneus / Peroneal Tubercle

A
  • Bump on the lateral aspect of the calcaneus distal to the lateral malleolus
  • Separates peroneus brevis and longus. (fibularis brevis and longus)
  • Can be sensitive area
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21
Q

Cuboid

A
  • Between the 5th metatarsal and calcaneus
  • Can be felt as an indentation between these structures
  • Articulates with 4th & 5th metatarsals
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22
Q

5th Metatarsal

A
  • Large palpable styloid process at the flared base.

- Peroneus brevis inserts here

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23
Q

Medial Tubercle of Talus

A
  • Posterior to the distal end of the medial malleolus

- Posterior portion of the deltoid ligament attaches here

24
Q

Sustentaculum Tali

A
  • Bony shelf approximately 1 finger width distal to the medial malleolus
  • Attachment site for the spring ligament
25
Q

Navicular Tubercle

A
  • Most medial prominence distal the the sustentaculum tali

- See how close it is to the floor

26
Q

1st Cuneiform

A

Between navicular and the base of 1st metatarsal.

27
Q

Medial Calcaneal Tubercle

A
  • Medial plantar aspect of the calcaneus
  • Broad and large, may be sharp if patient has “heel spurs”
  • 3 main things attach here
  • -Medially: Abductor Hallucis
  • -Anteriorly: Flexor digitorum brevis & Plantar aponeurosis / fascia
28
Q

1st MTP

A
  • Restriction here can lead to hallucis rigidis/limitis

- Site of gout

29
Q

Sesmoids

A
  • Small bone located at the distal end of the 1st metatarsal

- Embedded within flexor hallucis brevis

30
Q

Deltoid Ligament

A
  • Anterior to navicular
  • Inferior to calcaneus
  • Posterior to talus
  • “Fan-like”
31
Q

Tibialis Posterior Tendon

A
  • Most anterior of the Tom, Dick, an Harry group

- Invert and plantar flex

32
Q

Flexor Digitorum Longus Tendon

A
  • Just behind tibialis posterior

- Flex toes

33
Q

Posterior Tibial Artery

A
  • Posterior to FDL

- Easier to palpate in non-weight-bearing

34
Q

Tibial Nerve

A
  • Posterior and lateral to posterior tibial artery

- Difficult to palpate in isolation

35
Q

Flexor Hallucis Longus Tendon

A
  • Posterior aspect of the TC joint

- Flex great toe though difficult to palpate due to Achilles

36
Q

ATFL

A
  • Anterior lateral malleolus to anterolateral talar neck
  • Resists excessive inversion
  • 1st one “to go”
  • Plantar flex and invert to tension
  • Usually the weakest with more mobility
37
Q

CFL

A
  • Inferior lateral malleolus to calcaneus
  • Resists maximum inversion
  • Posterior to peroneal tubercle
  • Invert with foot in neutral to tension
38
Q

PTFL

A
  • Posterior lateral malleolus to posterior talus

- Resists ankle DF, adduction (tilt), medial rotation, and medial translation of talus

39
Q

Peroneus Longus

A
  • Tendon is the inferior division at peroneal tubercle
  • Inserts onto the 1st cuneiform and base of the 1st metatarsal
  • Evert to contract
40
Q

Peroneus Brevis

A
  • Superior tendon
  • Inserts onto the styloid process of the 5th metatarsal
  • Evert to contract
41
Q

Extensor Digitorum Brevis

A

Palpate within the sinus tarsi while patient extends toes

42
Q

Tibialis Anterior

A
  • Most medial and prominent tendon on dorsum of ankle joint

- Dorsiflex and invert to feel

43
Q

Extensor Hallucis Longus

A
  • Lateral to tibialis anterior

- Extend the great toe to feel

44
Q

Extensor Digitorum Longus

A
  • Lateral to extensor halluces longus

- Extend the toes to feel

45
Q

Dorsal Pedal Artery

A

Between EHL and EDL on dorsum of the foot.

46
Q

Plantar Fascia

A
  • Medial tubercle of the calcaneus to MTP
  • Will feel rough
  • Look at in DF and PF
  • Helps with Windlass Effect
47
Q

Abductor Hallucis

A
  • Most medial aspect of the plantar aspect of the foot

- If unable to abduct great toe, shorten foot in standing

48
Q

Dorsiflexion ROM

A
  • Normal: 20 dg
  • End Feel: Firm
  • F=lat. aspect of lateral malleolus
  • S=lat. midline of the fibula
  • M= // to lat. aspect of 5th metatarsal
49
Q

Plantarflexion ROM

A
  • Normal: 50 dg
  • End Feel: Firm
  • F=lat. aspect of lateral malleolus
  • S=lat. midline of the fibula
  • M= // to lat. aspect of 5th metatarsal
50
Q

Inversion ROM

A
  • Normal: 35 dg
  • End Feel: Firm
  • F= anterior aspect of the ankle mid-way between the malleoli
  • S=anterior midline of the lower leg [tibial tuberosity]
  • M= anterior midline of the second metatarsal
51
Q

Eversion ROM

A
  • Normal: 15 dg
  • End Feel: Hard
  • F= anterior aspect of the ankle mid-way between the malleoli
  • S=anterior midline of the lower leg [tibial tuberosity]
  • M= anterior midline of the second metatarsal
52
Q

1st MTP Flexion

A
  • Normal: 45 dg
  • End Feel: Firm
  • F=dorsal aspect of 1st MTP
  • S=dorsal midline of the metatarsal
  • M=dorsal midline of the proximal phalanx
53
Q

1st MTP Extension

A
  • Normal: 70 dg
  • End Feel: Firm
  • F=dorsal aspect of 1st MTP
  • S=dorsal midline of the metatarsal
  • M=dorsal midline of the proximal phalanx
54
Q

Non-Weight-Bearing ML Testing-Gastrocnemius

A
  • Patient supine with knee fully extended and foot in neutral inversion/eversion
  • Passively DF the ankle
  • Look for compensation at knee joint [Knee flexion]
55
Q

Weight-Bearing ML Testing-Gastrocnemius

A
  • Pt standing with knee fully extended and foot/heel in contact with floor
  • Pt leans body forward keeping heel down

-To quantify the muscle length measure the amount of ankle dorsiflexion

56
Q

Ankle Figure 8 Measurement

A
  • Pt in long sitting with ankle off edge of table foot in neutral
  • Can put something under the patient’s knee if needed for comfort
Landmarks:
Midway between tibialis anterior and the lateral malleolus.
Navicular tuberosity
Base of the 5th metatarsal
Distal medial and lateral malleolus
57
Q

Circumferential Malleoli Measurement

A

Standard circumferential measurements at the inferior aspect of the ankle.

Test and Measures (8 decks)

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