Ankle And Foot Complaint Flashcards
What should be palpated on the foot?
Anterior ankle joint, medial and lateral malleolus, Achilles’ tendon, MP joint and heads, heel
What is normal muscle strength?
5/5
Active motion against gravity and full resistance without evidence of fatigue
What is the talar tilt test?
Lateral ankle sprain
Calcaneofibular ligament or anterior talofibular ligament injury
What is the eversion test?
Medial ankle sprain
Deltoid ligament injury
Anterior drawer test can also test for what injury?
Lateral ankle sprain
What is the squeeze test?
High ankle sprain
Distal tibiofibular syndesmosis injury
What does Homan’s sign test for?
DVT
What are the three main types of ankle sprains?
Lateral ankle sprain, medial ankle sprain and syndesmosis ankle sprain (aka high ankle sprain)
What is the most common ankle sprain?
Lateral ankle sprain
Describe lateral ankle sprains
Mechanism of injury is foot inversion and/or plantar flexion
Most likely ligaments injured include anterior talofibular ligament* and calcaneofibular ligament
What positive special tests are associated with lateral ankle sprains?
Talar tilt test (inversion test) and anterior drawer
Describe medial ankle sprains
Mechanism of injury is forced eversion
Most likely ligament involved is the deltoid ligament
Associated positive special test is eversion test
What is a grade 1 ankle sprain?
No laxity in the joint = minimal ligament damage
Manage conservatively with NSAIDs, RICE, PT
What is a grade 2 ankle sprain?
Mild to moderate laxity in the joint
Manage conservatively
What is a grade 3 ankle sprain?
Complete disruption of the ligament
Conservative management with immobilization x3 weeks (if unstable surgery is likely needed)
What is a syndesmodic/high ankle sprain?
Mechanism of injury is forced external rotation of a dorsiflexed ankle
Most likely ligament involved tibiofibular syndesmosis
Associated positive test: squeeze test
What are the most common Achilles diagnoses?
Tendinitis, Achilles rupture and Sever’s disease (calcaneal apophysitis)
What is Achilles tendonitis?
Inflammation of the Achilles tendon
Repetitive motions create micro tears in the tendon resulting in inflammation
Most commonly associated with competitive/recreational activites
What are signs and sx for Achilles tendonitis?
Pain/stiffness at tendon insertion
Recent increase in exercise/activity level
Pain is worse with activity and goes away with rest
NEGATIVE Thompson test
What is Achilles’ tendon rupture?
A tear of the Achilles’ tendon
Most commonly associated with competitive/recreational athletes
What are the signs and sx for Achilles’ tendon rupture?
80% occur during high impact recreational sports
Pts report a popping sensation at their heel
+/- pain
Associated special test: positive Thompson test
What is Sever’s disease (calcaneal apophysitis)?
An inflammation or stress injury to the areas on and around an apophysis (growth plate)
Active children going through growth spurts are affected
What are sings and sx for Sever’s disease?
Chronic heel pain in growing children
Pain is related to increased activity
Pain is reproduced with direct palpation over the apophysis
What is tibiotalar effusion?
An abnormal accumulation of fluid in or around a joint
Can be caused by a number of things including injury, arthritis, infection or hemearthrosis
What is pes planus?
A loss of the longitudinal arch of the foot
Flat feet
What is pes cavus?
An exaggeration of the longitudinal arch of the foot
What is hallux valgus (aka a bunion)?
Very common foot malformation
Defined by the lateral deviation of the big toe
Progressively leads to the development of a prominence on the medial aspect of the MP joint (a bunion)
Presence of hallux valgus can lead to inflammation and irritation at the first MTP joint
What is plantar fasciitis?
Inflammation of plantar fascia
The result of repetitive biomechanical use resulting in micro tears of the fascia
What are the signs and sx of plantar fasciitis?
Sharp stabbing plantar/heel pain
Pain is worse with first few steps in the morning and improves as the day goes on
Pain is made worse by prolonged standing
Pain reproduced with forced dorsiflexion
What is Morton’s neuroma?
Inflammation and thickening of tissue that surrounds the nerve between the toes
Pt will report feeling like they are walking on a marble*
Palpable in web space which will replicate burning pain
Can have radiation of pain and numbness of toes
What is the relevant special test of Morton’s neuroma?
Mulder’s sign - a palpable clicking sensation between the third web space as the transverse arch is compressed
What is fibular nerve compression?
When the fibular nerve gets compressed leading to dysfunction of the distal nerve
Most commonly compressed at the point it wraps around the lateral aspect of the fibular head (prolonged lying, crossing legs, ankle sprains, prolonged immobilization in a cast)
What is Charcot foot?
A consequence of chronic foot inflammation that ultimately results in mid foot deformities and a collapse of the longitudinal arch
Always associated with neuropathy of the foot (diabetic neuropathy)
What are the signs and symptoms of Charcot foot?
Visible collapse of the longitudinal arch
Warmth, redness and edema over the joint
History of minor trauma
Long term history of peripheral neuropathy
What is diabetic neuropathy?
A common complication of uncontrolled diabetes
When the pts blood sugar remains elevated peripheral nerves are damaged which no longer function well and pts will lose sensation
As a result pts frequently develop injures in their feet
What is gout?
An inflammatory arthropathy caused by the deposition of monosodium urate crystals in the joints
What are the signs and sx of gout?
Most commonly occurs in the first MTP joint
Diet high in purines
Pts frequently have past exacerbation
Joint aspiration reveals negatively birefringement needle shaped crystals
Because the distal fibula is attached to the talus and calcaneus, motion of the ankle will cause what?
Motion of the fibula
Injures at the ankle will frequently cause dysfunction in what?
The knee due to the linked motion at the fibular head
What is supination of the foot?
Plantar flexion + inversion + adduction
Pronation is opposite
Motion at the foot/ankle can both be what?
A modality to create and treat SD at the fibular head
What is dorsiflexion of the tibiotalar joint?
Posterior glide of the talus is the minor motion with dorsiflexion
Makes the ankle stable
What occurs with plantar flexion of the tibiotalar joint?
Anterior glide of the talus is the minor motion
Makes ankle less stable
What is the minor motion with eversion of the tibiotalar joint?
Anteromedial glide of the talus
What is the minor motion with inversion?
Posterolateral glide of the talus
As the calcaneus moves into eversion the talus will do what?
Glide anteriorly and medially 5-10 degrees
As the calcaneus moves into inversion, the talus will do what?
Glide posteriorly and laterally 5-10 degrees
What is plantar glide?
A sliding motion (along an axis) of a tarsal bone toward the plantar surface in relation to surrounding bones
What is dorsal glide?
A sliding motion along an axis of tarsal bones toward the dorsum of the foot in relation to surrounding bones
The plantar glide of the cuboid and navicular bones are coupled with what?
Rotation about an AP axis which creates an eversion of the cuboid and an inversion of the navicular during plantar glide
What motion does the cuboid prefer?
Eversion glide with plantar glide
What motion does the navicular prefer?
Inversion glide with plantar glide
What motion do the cuneiforms prefer?
Plantar glide only
Describe metatarsal motions
The metatarsals will glide toward the plantar and dorsal surface as they articulate with their respective tarsal bones
Motion is named for the direction of the metatarsal head
Thus the motions that we evaluate at the metatarsals are dorsal and plantar glide
What are the three motions of the MTP, PIPs and DIPs?
Dorsal/plantar glide (flexion/extension)
Rotatory glide (internal/external rotation)
Abduction/adduction (medial/lateral glide)
What are the Ottawa ankle rules?
The guidelines for when to order X rays on a pt with an ankle injury
What do the Ottawa ankle rules when a pt has pain in the malleolar zone?
Must have at least one of the following:
Bone tenderness at the posterior tip of the medial and lateral malleolus
Unable to bear weight immediately after injury and unable to walk 4 steps in the office
What do Ottawa ankle rules state when a pt has pain in the mid foot region?
Must have at least one of the following:
Bone tear depress at 5th metatarsal or the navicular
Unable to bear weight immediately after injury and unable to walk 4 steps in the office
What are the two types of pain that should make you consider an X-ray?
Pain in the malleolar zone or pain in mid foot region
