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Musculo 2 > Ankle and Foot Examination > Flashcards

Ankle and Foot Examination Flashcards

1
Q

What are more common total ankle arthroplasty or ankle fusions

A

Ankle fusion

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2
Q

What is the order of the examination process (12)

A
  1. History
  2. Observation
  3. LQS prn
  4. AROM
  5. Repeated movements
  6. PROM
  7. Muscle performance
  8. Anthropometrics
  9. Special tests
  10. Joint play/passive accessory motion testing
  11. Functional testing
  12. Palpation
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3
Q

What can giving way be indicative of (2)

A
  1. Ligament

2. Pain

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4
Q

What can an ache be indicative of (2)

A
  1. Muscle

2. Arthritis

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5
Q

What can a sharp pain be indicative of (2)

A
  1. Nerve

2. Bone

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6
Q

What can stiffness be indicative of (2)

A
  1. Ligament

2. Muscle

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7
Q

What can numbness and tingling be indicative of (2)

A
  1. Nerve

2. Swelling

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8
Q

What can burning be indicative of (1)

A
  1. Nerve
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9
Q

What can sensitivity be indicative of (2)

A
  1. Pain

2. Infection

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10
Q

What can tearing be indicative of (2)

A
  1. Ligament

2. Muscle

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11
Q

Diagnose:

Painful WB with first steps in the morning and after sitting for a while (2)

A
  1. Arthritis

2. Plantarfasciitis

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12
Q

Diagnose:

Parathesias over lateral and ventral aspects of foot belowe ankle to digits 4-5 (2)

A
  1. Nerve

2. Radiculopathy

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13
Q

Diagnose:

Symptoms in calf worsen with activity, gripping, and sharp pain (1)

A
  1. Compartment syndrome
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14
Q

Diagnose:

Unable to perform single limb heel raise (3)

A
  1. Weakness,
  2. Strain
  3. Rupture
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15
Q

Diagnose:

Diffuse burning in foot that is worse in the pm (3)

A
  1. Tarsal tunnel
  2. Neuropathy
  3. Venous insufficiency
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16
Q

What is pain at rest indicative of

A

Not usually mechanical

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17
Q

What is pain with activity indicative of

A

Structural

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18
Q

What is pain after activity indicative of

A

Inflammatory

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19
Q

When is plantar fasciitis worse pm or am

A

am

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20
Q

When is tarsal tunnel worse

A

pm

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21
Q

Which arch change is most evident from NWB to WB

A

Medial longitudinal arch

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22
Q

What can cause a too many toes sign (2)

A
  1. Pes cavus

2. Pes planus

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23
Q

Why do pes cavus and pes planus cause a too many toes sign

A

Calcaneus is not in line with the tibia

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24
Q

What is normal dorsiflexion of the ankle

A

20

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25
Q

What is normal dorsiflexion of the ankle with the knee flexed

A

Look up

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26
Q

What is normal plantarflexion of the ankle

A

50

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27
Q

What is normal inversion of the tarsal joints

A

Look up

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28
Q

What is normal eversion of the tarsal joints

A

Look up

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29
Q

What is normal inversion of the subtalar joint

A

35

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30
Q

What is normal eversion of the subtalar joint

A

15

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31
Q

What is normal inversion of the transverse tarsal joint

A

Look up

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32
Q

What is normal eversion of the transverse tarsal joint

A

Look up

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33
Q

What is normal flexion of the MTP joints

A

45

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34
Q

What is normal extension of the MTP joints

A

70

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35
Q

What is normal abduction of the MTP joints

A

Look up

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36
Q

What is normal adduction of the MTP joints

A

Look up

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37
Q

What is normal flexion of the IP joints

A

Look up

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38
Q

What is normal extension of the IP joints

A

Look up

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39
Q

How many of the motions need to be limited for a capsular pattern to be present

A

All motions but they don’t all need to be equally limited

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40
Q

What is the capsular pattern of the talocrural joint

A

PF greater than DF

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41
Q

What is the capsular pattern of the subtalar joint

A

Limited varus/valgus PROM translation

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42
Q

What is the capsular pattern of the transverse tarsal joint

A

DF then PF then ADD then IR

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43
Q

What is the capsular pattern of the 1st MTP joint

A

Extension greater than flexion

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44
Q

What are the functional requirements at the talocrural joint during gait

A

DF: 10
PF: 20

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45
Q

What are the functional requirements at the talocrural joint to ascend stairs

A

DF: 20-25
PF: 10-15

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46
Q

What are the functional requirements a the talocrural joint while running

A

DF: 25
PF: 25

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47
Q

What is the closed pack position of the talocrural joint

A

Full DF

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48
Q

What are common sites for foot fractures (3)

A
  1. 5th metatarsal
  2. Stress fracture of metatarsals
  3. Calcaneous
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49
Q

What is an other name for a 5th metatarsal fracture

A

Marching fracture

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50
Q

What are the special tests for a stress fracture (2)

A
  1. Metatarsal compression test

2. Tuning fork

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51
Q

What are the Ottawa Ankle Rules for ankle x-rays (4)

A
  1. Pain in anterior aspect of medial or lateral malleoli and anterior talar dome area
  2. Bone tenderness at posterior medial malleous
  3. Bone tenderness at lateral malleous
  4. Inability to bear weight on limb immediately after the injury and in the emergency room (ER)
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52
Q

What are the Ottawa Ankle Rules for foot x-rays (4)

A
  1. Pain in dorsal medial and lateral aspect of midfoot
  2. Bone tenderness at the base of the 5th metatarsal
  3. Bone tenderness at navicular
  4. Inability to bear weight on limb immediately after the injury and in the emergency room (ER)
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53
Q

What is the metatarsal compression test (Morton’s test)

A

Compress the forefoot to aggravate any potential fractures

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54
Q

What is the tuning fork test

A

Place stethescope on fibular head and hit tuning fork on lateral malleous

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55
Q

What is a positive tuning fork test

A

Different tuning fork sound heard by stethescope

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56
Q

True or False:

The metatarsal compression test gives a lot of false positives in patient

A

True

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57
Q

What causes an achilles tendon rupture

A

Trauma, jumping or landing, prolonged steroid use

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58
Q

What are the special tests for achilles tendon rupture (2)

A
  1. Thompson test

2. Bilateral toe raise

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59
Q

What is the Thompson test

A

Squeeze calf and see if there is any plantarflexion present if not it is positive

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60
Q

What is the bilateral toe raise

A

Have the patient go up onto toes and see if they can complete the task and compare legs

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61
Q

What causes a deep vein thrombosis (2)

A
  1. After recent surgery

2. Immobilization

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62
Q

What are signs and symptoms of DVT (4)

A
  1. Calf pain
  2. Ankle swelling
  3. Redness
  4. Antalgic gait
63
Q

What are the special tests for DVT (3)

A
  1. Homan sign
  2. Calf swelling
  3. Well’s clinical prediction rule for DVT
64
Q

What is Homan sign

A

Pain in the popliteal and/or calf pain

65
Q

Does the Homan sign give few or a lot of false positives

A

A lot

66
Q

For calf swelling how much of a difference does there need to be between calves for men and women

A

Men: 15 mm
Women: 12 mm

67
Q

What is the Well’s clinical prediction rule for DVT

A

Online test that 2 positives put you at high risk for DVT

68
Q

You should always squeeze a person’s calf who you suspect to have DVT

A

NOOOOOOOOOOOO that can cause a stroke, MI, or PE

69
Q

What ligaments are injured with an inversion/supination sprain (3)

A
  1. Anterior talofibular ligament
  2. Calcaneofibular ligament
  3. Posterior talofibular ligament
70
Q

What ligament is injured with an eversion/pronation sprain (1)

A
  1. Deltoid ligament
71
Q

What causes a syndesmosis injury (2)

A
  1. Hyperdorsiflexion

2. Leg rotation with immobile foot

72
Q

What is a kissing lesion

A

Bone bruise

73
Q

What are the grades of a lateral ankle sprain (3)

A
  1. Grade I (mild)
  2. Grade II (moderate)
  3. Grade III (severe)
74
Q

What is a grade I lateral ankle sprain (4)

A
  1. Mild effusion without hemorrhage
  2. Negative anterior drawer and varus laxity
  3. Pain with inversion and PF
  4. Little to no limp but trouble hopping
75
Q

What is a grade II lateral ankle sprain (4)

A
  1. More swelling and hemorrhage
  2. Positive anterior drawer
  3. Negative varus laxity at neutral
  4. Limping, unable to raise onto toes, hop, or run
76
Q

What is a grade III lateral ankle sprain (4)

A
  1. Diffuse swelling and hemorrhage
  2. Significant instability
  3. complete tear of ATFL and CFL
  4. Unable to BW completely
77
Q

What is the most commonly sprained ankle ligament

A

ATFL

78
Q

When is surgery required for chronic ankle sprains

A

When the fibularis longus is stretched too much and can’t properly evert the ankle

79
Q

What are the special test for a lateral ankle sprain (3)

A
  1. Anterior drawer
  2. Talar tilt
  3. Posterior drawer
80
Q

What is the anterior drawer test

A

Stabilize patients foot in 20 degrees PF and examiner moves distal tibia and fibula posteriorly

81
Q

What is a positive anterior drawer test

A

Pain is reproduced laterally or excessive gaping between distal lateral malleolus and calcaneous

82
Q

What is the talar tilt test

A

Stabilize distal tibia/fibula and provide a varus stress to foot test in PF, neutral, and DF

83
Q

What is a positive talar tilt test

A

Pain is reproduced or excessive gaping between lateral malleolus and calcaneus

84
Q

What is the posterior drawer test

A

Stabilize patient’s foot in 20 degrees PF and pull distal tibia and fibula anterior

85
Q

What is a positive posterior drawer test

A

Pain is reproduced or excessive gaping between distal lateral malleolus and calcaneus

86
Q

What is the special test for medial ankle sprain (1)

A
  1. Eversion stress test
87
Q

What is the eversion stress test

A

Patient side lying foot in 20 degrees PF and examiner grabs calcaneus and stabilizes tibia then glide calcaneus superiorly

88
Q

What are the signs and symptoms for syndesmosis injuries (3)

A
  1. Pain in anterior distal shin
  2. Difficulty with ambulation
  3. Decreased ROM
89
Q

What are the tests for syndesmosis injuries (3)

A
  1. Fibular translation test
  2. Crossed leg test
  3. Kleiger test (ER stress test)
90
Q

What is the crossed leg test

A

Patient sits with legs crossed and patient applies gradual pressure to knee

91
Q

What is a positive crossed leg test

A

Pain produced is chief complaint

92
Q

What is the Kleiger test

A

Patient seated with leg dangling at 90/90 and therapist stabilizes leg and grabs arch of foot a passively ER with eversion and DF of the foot

93
Q

What is a positive Kleiger test

A

Pain produced is the chief complaint

94
Q

What are 3 differential diagnoses for giving way symptoms at the ankle

A
  1. Longitudinal fibularis tendonitis/subluxation
  2. Loose bodies within joint (OCD)
  3. Anteriorlateral synovitis (hypertrophic synovium)
95
Q

What is the special test for anteriorlateral synovitis

A

Forced DF test

96
Q

What is a positive forced DF test

A

Reproduction of chief complain and anterolateral aspect of ankle

97
Q

What are common causes of musculotendinous injury at the ankle (4)

A
  1. Poor footwear
  2. Tight musculature
  3. Overuse
  4. Muscle imbalance
98
Q

What are the signs/symptoms of musculotendinous injury

A

Pain with active contraction of muscle and passive lengthening of the muscle

99
Q

What are 3 musculotendinous injuries that occur at the posterior heel

A
  1. Achilles tendonitis
  2. Acute rupture
  3. Chronic rupture
100
Q

What is a musculotendinous injury that occurs at the medial foot (1)

A
  1. Posterior tibialis tendon insufficiency (PTTI)
101
Q

Where does non insertional achilles tendinitis most commonly occur

A

6 cm proximal to insertion

102
Q

What are the MOI of non insertional achilles tendinitis (3)

A
  1. Overuse
  2. Increased running frequency/distance
  3. Change in footwear
103
Q

What are the types of non insertional achilles tendinitis (1)

A
  1. Paratendonitis
  2. Tendonosis
  3. Paratendonitis with tendonosis
104
Q

What is paratendonitis

A

Inflammation of the lining around the tendon

105
Q

What is tendonosis

A

Non inflammatory, age related degeneration of the tendon itself

106
Q

What is paratendonitis with tendonosis

A

Paratendon inflammation with intratendinous degeneration

107
Q

What are the 3 types of insertional achilles tendonitis

A
  1. Haglund’s deformity
  2. Pretendon bursitis (pump bump)
  3. Retrocalcaneal bursitis
108
Q

Typical age for achilles tendon rupture

A

30-40

109
Q

What is the risk of re-rupture with nonsurgical repair of achilles rupture

A

8-10%

110
Q

What is the risk of re-rupture with surgical repair of achilles rupture

A

2%

111
Q

What is the protocol for nonsurgical achilles rupture repair

A

Immobilized in 20 PF at least 4 weeks and progressive WBAT

112
Q

What is the standard protocol for surgical achilles rupture repair

A

NWB in cast for 4-6 weeks then controlled ankle motion boot (CAM) to go from DF to neutral at 6 weeks

113
Q

What is the accelerated protocol for surgical achilles rupture repair

A

May progress to DF ROM to neutral 2 weeks earlier and allow earlier WB

114
Q

What is the MOI of posterior tibialis tendon dysfunction/insufficiency (PTTD/PTTI)

A

Inflammation and degeneration of the tendon progresses to lengthening and mechanical insufficiency of the tendon

115
Q

What are the signs and symptoms of posterior tibialis tendon dysfunction (6)

A
  1. Acquired flat foot
  2. Pain in medial longitudinal arch
  3. Secondary pain lateral hindfoot
  4. Pain and weak MMT
  5. Hindfoot valgus while WB
  6. Medial talar bulge
116
Q

What are the special tests for posterior tibialis tendon dysfunction (2)

A
  1. No inversion of calcaneus during heel raise

2. Too many toes sign

117
Q

What are the stages of PTTI (3)

A
  1. Stage I
  2. Stage II
  3. Stage III
118
Q

What is stage I PTTI

A

Pain with ankle inversion

119
Q

What is stage II PTTI

A

History of pain for 2-3 years no rearfoot inversion during single limb heel raise

120
Q

What is stage III PTTI

A

Fixed hindfoot valgus with compensated forefoot varus and arthrosis of STJ

121
Q

What is the treatment for stage I PTTI

A

Tendon rest, modalities, and walking brace

122
Q

What is the treatment for stage II PTTI

A

Walking brace for 4 weeks and orthotics for 6 months

123
Q

What is the treatment for stage III PTTI

A

Triple arthrodesis and heel cord lengthening

124
Q

What is the MOI for plantar fasciitis (5)

A
  1. Direct repetitive microtrauma
  2. Pes planus or cavus
  3. Increased BMI
  4. Prolonged standing
  5. Decreased DF ROM
125
Q

Signs and symptoms of plantar fasciitis (3)

A
  1. Pain/stiffness in the morning and after prolonged sitting
  2. Worsen when walking in bare feet
  3. Point tenderness over medial calcaneal tubercle
126
Q

2 differential diagnoses for plantar fasciitis

A
  1. Achillies tendonitis

2. Peripheral nerve entrapment

127
Q

In acute cases of plantar fasciitis what percent of people get better withing 10 months

A

85%

128
Q

When does plantar fasciitis become chronic

A

After 10 months

129
Q

How do you stretch the gastrocnemius

A

Knee extended

130
Q

How do you stretch the soleus

A

Knee flexed

131
Q

What is the MOI of osteochondral injuries (2)

A
  1. OCD (joint mouse)

2. Traumatic ankle sprain

132
Q

What are the signs and symptoms of osteochondral injuries (3)

A
  1. Pain during terminal stance
  2. Decreased standing tolerance
  3. Aching during rest
133
Q

What is the non surgical intervention for osteochondral injuries

A

Period of immobilization and NWB to allow for the cartilage to heal

134
Q

What are the surgical interventions for osteochondral injuries (4)

A
  1. Debridement
  2. Fixation of injured fragment
  3. Microfracture or drilling of the lesion
  4. Transfer or grafting of bone and cartilage
135
Q

What does RA often effect in the foot

A

Metatarsals and digits

136
Q

What s gout

A

Excessive uric acid cyrstals

137
Q

What does gout mostly effect

A

1st digit

138
Q

What are the criteria for diagnosis of osteoarthritis (6)

A
  1. Older than 50
  2. Stiffness for more than 30 minutes
  3. Crepitus
  4. Bony tenderness
  5. Bony enlargement
  6. No palpable warmthe
139
Q

What are the causes of tarsal tunnel (2)

A
  1. Insidious onset

2. RA

140
Q

What are the signs and symptoms of tarsal tunnel (3)

A
  1. Difficulty localizing pain
  2. Diffuse burning
  3. Worse pain at night or when restign at the end of the day
141
Q

What is the special test for tarsal tunnel syndrome

A

Tinel’s test

142
Q

What nerve is effected in distal tarsal tunnel syndrome

A

Baxter’s nerve (lateral plantar nerve)

143
Q

What is the most common age range for distal tarsal tunnel syndrome

A

40-50

144
Q

What is the MOI of distal tarsal tunnel syndrome (3)

A
  1. More than 9 months of plantar fascia pain non responsive to PT
  2. Long distance runners
  3. Hypertrophied abductor hallucis muscle
145
Q

What are the signs and symptoms of distal tarsal tunnel syndrome (3)

A
  1. Pain at medial calcaneal tubercle
  2. Decreased sensation at lateral heel
  3. Unable to abduct 5th digit
146
Q

What are 2 major foot problems that can arise with diabetes

A
  1. Diabetic peripheral neuropathy

2. Diabetic charcot neuropathy

147
Q

What causes diabetic peripheral neuropathy (1)

A
  1. Neuropathic ulcers
148
Q

What causes diabetic charcot neuropathy (2)

A
  1. Osteomyelitis

2. Charcot neuropathic fractures/dislocations

149
Q

What is the treatment for diabetic peripheral neuropathy and diabetic charcot neuropathy (2)

A
  1. Amputation

2. Foot salvage

150
Q

What are 3 ways to educate a patient with diabetes to prevent diabetic foot problems

A
  1. Daily foot inspections
  2. Appropriate footwear
  3. Custom diabetic inserts
151
Q

How do you bias the tibial nerve during the straight leg raise test

A

DF and eversion

152
Q

How do you bias the peroneal nerve during the straight leg raise test

A

PF and inversion

153
Q

How do you bias the sural nerve during the straight leg raise test

A

DF and inversion

Musculo 2 (3 decks)

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