ankle and foot examination part 1 Flashcards
what is the order for examination?
- history
- observation and inspection
- LQS as need (MSRs, sensation, myotome/dermatome)
- foot and ankle ROM (AROM, repeated mvmts, PROM)
- muscle performance (resisted isometrics, MMT, FTPO)
- functional testing
- special tests
- joint play/motion testing
- neurodynamic testing
- palpation
what question should you ask a patient in their history?
age
occupation (working environment, job duties FT/PT)
developmental history
living environment
medications
other medical intervention
health status (PMH/ PSH)
behavioral health risks (social habits)
what should you ask when asking about the history of their current condition?
what brought the pt to PT?
MOI?
symptoms?
what are some important things to consider when asking about MOI?
conditions preceding onset
traumatic vs non traumatic
position of body, leg or foot when injured
location and direction of external forces
pivot or twist?
what are some important questions to ask in regards to patient symptoms?
what do you feel and where?
when (duration)- helps determine chronicity
patterns: what makes it better /worse? - nature and behavior
what are some things to consider when referencing nature and behavior of symptoms?
pain
local, referred or radicular
peripheralizing or centralizing
improving, worsening, no change
time of day
what does pain at rest normally indicate?
not usually mechanical
what does pain with activity normally indicate?
structural
what does pain after activity normally indicate?
inflammatory
pain in the am may be?
plantar fasciitis
pain in the pm may be?
tarsal tunnel
what to look for with observation and inspection?
patient presentation- assistive devices, affect
willingness to bear weight/shift weight (knee and foot position)
willingness to move and use the foot
vascular- swelling (non pitting), pitting edema
what is the figure of 8 when measuring swelling?
- begin midway between the tibialis anterior tendon and lateral malleolus
- draw tape medially across instep and placed distal to navicular tubercle
- draw tape across plantar foot placing it proximal to the styloid of 5th metatarsal
- continue to draw tape across the talus towards the distal medial malleolus
- move tape posteriorly behind and aim for the other distal lateral malleolus
- return to the start of the tape to take measurement
how do you check for pitting edema?
apply pressure with thumb/index finger- behind each ankle bone, overtop mid portion of each foot, or over shins for at least 5 seconds
look to see if there is a pit?
what grade of pitting edema is this:
slight pitting, no visible change in the shape of the extremity; depth of indentations 0-1/4”; disappears rapidly
grade 1+
what grade of pitting edema is this:
no marked change in the extremity; depth of indentation 1/4-1/2’; disappears in 10-15 seconds
grade 2+
what grade of pitting edema is this:
noticeably deep pitting, swollen extremity; depth of pitting 1/2-1”; duration 1-2 minutes
grade 3+
what grade of pitting edema is this:
very swollen, distorted extremity; depth of pitting >1’; duration 2-5 minutes
grade 4+
what are some integumentary things to observe?
skin integrity- ulcers?
skin color, thickness, dryness
scars
callouses, skin creases, warts
nail condition
what are some musculoskeletal deformities to observe?
hallux valgus
tailor bunion
claw toe- flex, flex, extend
hammer toe- extend, flex, extend
what warrants a lower quarter screen?
- unsure originating factor
- suspecting radicular or referred symptoms
- numbness and tingling
- unusual patterns
- insidious onset
what are we paying attention to with AROM/PROM?
quality and quantity
stage of healing- pain and position
consider which tissues are being tensioned
AAOS values
PROM-end feel
what is the closed pack position of the ankle?
full dorsiflexion of TC joint
what is the range of the talocrural joint in gait DF and PF?
10º DF
20º PF
what is the range of the talocrural joint up stairs DF and PF?
20-25º DF
10-15º PF
what is the range of the talocrural joint in running DF and PF?
25º DF
25º PF
what is the open pack position of the ankle
20º of PF
what is the test position for resisted isometric movements?
short sitting, joints in neutral
if the patients resisted isometric movements are painless and strong what is suspected?
contractile tissues are not the source
if the patients resisted isometric movements are painless and weak what is suspected?
contractile tissue denervated, rupture or deconditioned
issue with innervation
if the patients resisted isometric movements are painful and strong what is suspected?
inflammation
if the patients resisted isometric movements are painful and weak what is suspected?
major contractile lesion, partially intact
what resisted isometric movements do we do in the foot?
hallux flexors
hallux extenders
lesser toe flexors
lesser toe extenders
what resisted isometric movements do we do in the ankle?
dorsiflexors
plantarflexors
invertors
evertors
how can we measure force to pain onset?
resisted isometric with hand held diameter
foot flat or forefoot to assess weightbearing tolerance- performed on scales, measure blind stance, FTPO
what are some functional testing of foot/ankle?
functional movements for average person
functional activities for more active person
balance tests- static and dynamic
outcome measurement tests
what are some functional movements for an average person?
standing single leg
seated foot flat
what are some functional movements for standing single leg?
lift toes (10-15 reps=functional)
lift heels
lift medial side of foot (5-6 reps=functional)
lift lateral side of foot
what are some functional movements for seated foot flat?
flex toes as to lift up an object (10-15 reps=functional)
extend toes upwards
what is the sequential progression for a more active person for functional movements?
DLS squatting
DLS standing on toes
squat and bounce at bottom
SLS standing on toes
up and down stairs
walking on toes
running straight ahead
running with twisting, cutting
jumping
jumping and going into full squat
what are some balance tests?
static/dynamic
varied surfaces
eyes open/eyes closed
how do you use outcome as a measurement tool?
obtain baseline data from a test that has shown to be reliable and valid
use tool again to track progress
compare individual scores to norms or outcomes
