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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
What is normal dorsiflexion of the ankle with the knee flexed
Look up
26
What is normal plantarflexion of the ankle
50
27
What is normal inversion of the tarsal joints
Look up
28
What is normal eversion of the tarsal joints
Look up
29
What is normal inversion of the subtalar joint
35
30
What is normal eversion of the subtalar joint
15
31
What is normal inversion of the transverse tarsal joint
Look up
32
What is normal eversion of the transverse tarsal joint
Look up
33
What is normal flexion of the MTP joints
45
34
What is normal extension of the MTP joints
70
35
What is normal abduction of the MTP joints
Look up
36
What is normal adduction of the MTP joints
Look up
37
What is normal flexion of the IP joints
Look up
38
What is normal extension of the IP joints
Look up
39
How many of the motions need to be limited for a capsular pattern to be present
All motions but they don't all need to be equally limited
40
What is the capsular pattern of the talocrural joint
PF greater than DF
41
What is the capsular pattern of the subtalar joint
Limited varus/valgus PROM translation
42
What is the capsular pattern of the transverse tarsal joint
DF then PF then ADD then IR
43
What is the capsular pattern of the 1st MTP joint
Extension greater than flexion
44
What are the functional requirements at the talocrural joint during gait
DF: 10 PF: 20
45
What are the functional requirements at the talocrural joint to ascend stairs
DF: 20-25 PF: 10-15
46
What are the functional requirements a the talocrural joint while running
DF: 25 PF: 25
47
What is the closed pack position of the talocrural joint
Full DF
48
What are common sites for foot fractures (3)
1. 5th metatarsal 2. Stress fracture of metatarsals 3. Calcaneous
49
What is an other name for a 5th metatarsal fracture
Marching fracture
50
What are the special tests for a stress fracture (2)
1. Metatarsal compression test | 2. Tuning fork
51
What are the Ottawa Ankle Rules for ankle x-rays (4)
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)
52
What are the Ottawa Ankle Rules for foot x-rays (4)
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)
53
What is the metatarsal compression test (Morton's test)
Compress the forefoot to aggravate any potential fractures
54
What is the tuning fork test
Place stethescope on fibular head and hit tuning fork on lateral malleous
55
What is a positive tuning fork test
Different tuning fork sound heard by stethescope
56
True or False: | The metatarsal compression test gives a lot of false positives in patient
True
57
What causes an achilles tendon rupture
Trauma, jumping or landing, prolonged steroid use
58
What are the special tests for achilles tendon rupture (2)
1. Thompson test | 2. Bilateral toe raise
59
What is the Thompson test
Squeeze calf and see if there is any plantarflexion present if not it is positive
60
What is the bilateral toe raise
Have the patient go up onto toes and see if they can complete the task and compare legs
61
What causes a deep vein thrombosis (2)
1. After recent surgery | 2. Immobilization
62
What are signs and symptoms of DVT (4)
1. Calf pain 2. Ankle swelling 3. Redness 4. Antalgic gait
63
What are the special tests for DVT (3)
1. Homan sign 2. Calf swelling 3. Well's clinical prediction rule for DVT
64
What is Homan sign
Pain in the popliteal and/or calf pain
65
Does the Homan sign give few or a lot of false positives
A lot
66
For calf swelling how much of a difference does there need to be between calves for men and women
Men: 15 mm Women: 12 mm
67
What is the Well's clinical prediction rule for DVT
Online test that 2 positives put you at high risk for DVT
68
You should always squeeze a person's calf who you suspect to have DVT
NOOOOOOOOOOOO that can cause a stroke, MI, or PE
69
What ligaments are injured with an inversion/supination sprain (3)
1. Anterior talofibular ligament 2. Calcaneofibular ligament 3. Posterior talofibular ligament
70
What ligament is injured with an eversion/pronation sprain (1)
1. Deltoid ligament
71
What causes a syndesmosis injury (2)
1. Hyperdorsiflexion | 2. Leg rotation with immobile foot
72
What is a kissing lesion
Bone bruise
73
What are the grades of a lateral ankle sprain (3)
1. Grade I (mild) 2. Grade II (moderate) 3. Grade III (severe)
74
What is a grade I lateral ankle sprain (4)
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
What is a grade II lateral ankle sprain (4)
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
What is a grade III lateral ankle sprain (4)
1. Diffuse swelling and hemorrhage 2. Significant instability 3. complete tear of ATFL and CFL 4. Unable to BW completely
77
What is the most commonly sprained ankle ligament
ATFL
78
When is surgery required for chronic ankle sprains
When the fibularis longus is stretched too much and can't properly evert the ankle
79
What are the special test for a lateral ankle sprain (3)
1. Anterior drawer 2. Talar tilt 3. Posterior drawer
80
What is the anterior drawer test
Stabilize patients foot in 20 degrees PF and examiner moves distal tibia and fibula posteriorly
81
What is a positive anterior drawer test
Pain is reproduced laterally or excessive gaping between distal lateral malleolus and calcaneous
82
What is the talar tilt test
Stabilize distal tibia/fibula and provide a varus stress to foot test in PF, neutral, and DF
83
What is a positive talar tilt test
Pain is reproduced or excessive gaping between lateral malleolus and calcaneus
84
What is the posterior drawer test
Stabilize patient's foot in 20 degrees PF and pull distal tibia and fibula anterior
85
What is a positive posterior drawer test
Pain is reproduced or excessive gaping between distal lateral malleolus and calcaneus
86
What is the special test for medial ankle sprain (1)
1. Eversion stress test
87
What is the eversion stress test
Patient side lying foot in 20 degrees PF and examiner grabs calcaneus and stabilizes tibia then glide calcaneus superiorly
88
What are the signs and symptoms for syndesmosis injuries (3)
1. Pain in anterior distal shin 2. Difficulty with ambulation 3. Decreased ROM
89
What are the tests for syndesmosis injuries (3)
1. Fibular translation test 2. Crossed leg test 3. Kleiger test (ER stress test)
90
What is the crossed leg test
Patient sits with legs crossed and patient applies gradual pressure to knee
91
What is a positive crossed leg test
Pain produced is chief complaint
92
What is the Kleiger test
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
What is a positive Kleiger test
Pain produced is the chief complaint
94
What are 3 differential diagnoses for giving way symptoms at the ankle
1. Longitudinal fibularis tendonitis/subluxation 2. Loose bodies within joint (OCD) 3. Anteriorlateral synovitis (hypertrophic synovium)
95
What is the special test for anteriorlateral synovitis
Forced DF test
96
What is a positive forced DF test
Reproduction of chief complain and anterolateral aspect of ankle
97
What are common causes of musculotendinous injury at the ankle (4)
1. Poor footwear 2. Tight musculature 3. Overuse 4. Muscle imbalance
98
What are the signs/symptoms of musculotendinous injury
Pain with active contraction of muscle and passive lengthening of the muscle
99
What are 3 musculotendinous injuries that occur at the posterior heel
1. Achilles tendonitis 2. Acute rupture 3. Chronic rupture
100
What is a musculotendinous injury that occurs at the medial foot (1)
1. Posterior tibialis tendon insufficiency (PTTI)
101
Where does non insertional achilles tendinitis most commonly occur
6 cm proximal to insertion
102
What are the MOI of non insertional achilles tendinitis (3)
1. Overuse 2. Increased running frequency/distance 3. Change in footwear
103
What are the types of non insertional achilles tendinitis (1)
1. Paratendonitis 2. Tendonosis 3. Paratendonitis with tendonosis
104
What is paratendonitis
Inflammation of the lining around the tendon
105
What is tendonosis
Non inflammatory, age related degeneration of the tendon itself
106
What is paratendonitis with tendonosis
Paratendon inflammation with intratendinous degeneration
107
What are the 3 types of insertional achilles tendonitis
1. Haglund's deformity 2. Pretendon bursitis (pump bump) 3. Retrocalcaneal bursitis
108
Typical age for achilles tendon rupture
30-40
109
What is the risk of re-rupture with nonsurgical repair of achilles rupture
8-10%
110
What is the risk of re-rupture with surgical repair of achilles rupture
2%
111
What is the protocol for nonsurgical achilles rupture repair
Immobilized in 20 PF at least 4 weeks and progressive WBAT
112
What is the standard protocol for surgical achilles rupture repair
NWB in cast for 4-6 weeks then controlled ankle motion boot (CAM) to go from DF to neutral at 6 weeks
113
What is the accelerated protocol for surgical achilles rupture repair
May progress to DF ROM to neutral 2 weeks earlier and allow earlier WB
114
What is the MOI of posterior tibialis tendon dysfunction/insufficiency (PTTD/PTTI)
Inflammation and degeneration of the tendon progresses to lengthening and mechanical insufficiency of the tendon
115
What are the signs and symptoms of posterior tibialis tendon dysfunction (6)
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
What are the special tests for posterior tibialis tendon dysfunction (2)
1. No inversion of calcaneus during heel raise | 2. Too many toes sign
117
What are the stages of PTTI (3)
1. Stage I 2. Stage II 3. Stage III
118
What is stage I PTTI
Pain with ankle inversion
119
What is stage II PTTI
History of pain for 2-3 years no rearfoot inversion during single limb heel raise
120
What is stage III PTTI
Fixed hindfoot valgus with compensated forefoot varus and arthrosis of STJ
121
What is the treatment for stage I PTTI
Tendon rest, modalities, and walking brace
122
What is the treatment for stage II PTTI
Walking brace for 4 weeks and orthotics for 6 months
123
What is the treatment for stage III PTTI
Triple arthrodesis and heel cord lengthening
124
What is the MOI for plantar fasciitis (5)
1. Direct repetitive microtrauma 2. Pes planus or cavus 3. Increased BMI 4. Prolonged standing 5. Decreased DF ROM
125
Signs and symptoms of plantar fasciitis (3)
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
2 differential diagnoses for plantar fasciitis
1. Achillies tendonitis | 2. Peripheral nerve entrapment
127
In acute cases of plantar fasciitis what percent of people get better withing 10 months
85%
128
When does plantar fasciitis become chronic
After 10 months
129
How do you stretch the gastrocnemius
Knee extended
130
How do you stretch the soleus
Knee flexed
131
What is the MOI of osteochondral injuries (2)
1. OCD (joint mouse) | 2. Traumatic ankle sprain
132
What are the signs and symptoms of osteochondral injuries (3)
1. Pain during terminal stance 2. Decreased standing tolerance 3. Aching during rest
133
What is the non surgical intervention for osteochondral injuries
Period of immobilization and NWB to allow for the cartilage to heal
134
What are the surgical interventions for osteochondral injuries (4)
1. Debridement 2. Fixation of injured fragment 3. Microfracture or drilling of the lesion 4. Transfer or grafting of bone and cartilage
135
What does RA often effect in the foot
Metatarsals and digits
136
What s gout
Excessive uric acid cyrstals
137
What does gout mostly effect
1st digit
138
What are the criteria for diagnosis of osteoarthritis (6)
1. Older than 50 2. Stiffness for more than 30 minutes 3. Crepitus 4. Bony tenderness 5. Bony enlargement 6. No palpable warmthe
139
What are the causes of tarsal tunnel (2)
1. Insidious onset | 2. RA
140
What are the signs and symptoms of tarsal tunnel (3)
1. Difficulty localizing pain 2. Diffuse burning 3. Worse pain at night or when restign at the end of the day
141
What is the special test for tarsal tunnel syndrome
Tinel's test
142
What nerve is effected in distal tarsal tunnel syndrome
Baxter's nerve (lateral plantar nerve)
143
What is the most common age range for distal tarsal tunnel syndrome
40-50
144
What is the MOI of distal tarsal tunnel syndrome (3)
1. More than 9 months of plantar fascia pain non responsive to PT 2. Long distance runners 3. Hypertrophied abductor hallucis muscle
145
What are the signs and symptoms of distal tarsal tunnel syndrome (3)
1. Pain at medial calcaneal tubercle 2. Decreased sensation at lateral heel 3. Unable to abduct 5th digit
146
What are 2 major foot problems that can arise with diabetes
1. Diabetic peripheral neuropathy | 2. Diabetic charcot neuropathy
147
What causes diabetic peripheral neuropathy (1)
1. Neuropathic ulcers
148
What causes diabetic charcot neuropathy (2)
1. Osteomyelitis | 2. Charcot neuropathic fractures/dislocations
149
What is the treatment for diabetic peripheral neuropathy and diabetic charcot neuropathy (2)
1. Amputation | 2. Foot salvage
150
What are 3 ways to educate a patient with diabetes to prevent diabetic foot problems
1. Daily foot inspections 2. Appropriate footwear 3. Custom diabetic inserts
151
How do you bias the tibial nerve during the straight leg raise test
DF and eversion
152
How do you bias the peroneal nerve during the straight leg raise test
PF and inversion
153
How do you bias the sural nerve during the straight leg raise test
DF and inversion

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