Ankle and Foot reference guide Flashcards
which's and why's
Which: lateral ankle sprain
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- ↓ ankle DF ROM
- talocrural joint restriction (segmental mobility)
- ↓ hip abduction/ER strength
clinical exam:
- gait
- (+) anterior drawer
- (+) talar tilt - latera
- TTP
- ankle and foot segmental mobility
- figure 8 test
possible interventions:
GOAL: restore function, mobility strength
- progressive weight bearing (crutches as needed) mobility - TCJ: distal tibiofibular joint; proximal tibiofibular joint, progressive strengthening
other info: see also - ankle stability and movement coordination impairments: lateral ankle ligament sprains CPG
Which: Chronic ankle instability
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- ↓ sagittal plane motion during gait
- ↓ ankle DF ROM
- ↓ hip abduction/ER strength
- ↓ fibularii strenth
- decreased proprioception
clinical exam:
(+) anterior drawer
(+) reverse anterior drawer
(+) talar tilt - lateral
ankle & foot segmental mobility
hip and ankle strength
balance
possible interventions (goal):
GOAL: mobility/stability and proprioception
- mobility (talocrural joint)
- proprioception
- presseive strengthening
- motor control
which: Fibularis longus/brevis tendinopathy
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- ↓ fibularii strength
- ↓ ankle PF ROM
clinical exam:
ankle eversion MMT
soleus MMT
segemntal mobility :
- TCJ; distal
- tibiofibular joint; proximal
- tibiofibular joint; cuboid
possible interventions (goal):↓
GOAL: Increased strength and loading mechanics
Reactive: activity moidifaction progressive strengthening
degenerative: progressive strengthing
also see: cook (2016)
which: Fibularis longus/brevis subluxation
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- previous lateral ankle sprain
clinical exam:
- fibularis subluxation test
- soleus MMT
possible interventions (goal):
GOAL: limit subluxation
- strengthening in pain free range without subluxation
- mobility - TCJ proprioception
- referral to orthopedic specialist - surgery may be needed (time sensitive)
which: osteochondral defect
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- previous traumatic ankle injury
clinical exam:
- weight bearing assessment (e.g. single leg squat, etc.)
- palpation
possible interventions (goal):
- referral to orthopedic specialist - surgery may be needed (time sensitive)
see also: international cartilage research society classification system
which: osteoarthritis
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- previous traumatic ankle injury
- ↓ ankle strength
- decreased ankle ROM & joint mobility
clinical exam:
- gait
- squat
- ROM- all planes
- segmental mobility - talocural
possible interventions (goal):
GOAL: mobility
- mob - talocrural joint
- progressive strengthening cyclic, repetitive loading
- referral to orthopedic specialist - surgery may be needed (routine)
which: anterior ankle impingement
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- traumatic injury or repetitive loading
- TCJ restriction (segmental mobility)
clinical exam:
- forced DF sign
- segmental mobility: TCJ
possible interventions (goal):
- mobility posterior talar glides
- progressive strengtheing
- proprioception
see also: anterior ankle impingement clinical prediction rule
which: posterior ankle impingement
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- previous lateral ankle sprain
- TCJ restriction (segmental mobility)
clinical exam:
- heel thurst test
- flexor hallucis longus MMT
possible interventions (goal):
- mobility: anterior talar glides
- prgressive strengthening
- proprioception
which: achilles tendinopathy
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- underloading
- sudden increase in loading
- rearfoot valgus or varus
- long term corticosteroid use
clinical exam:
- single leg heelraise test
- ryoga london hospital test
- arc sign
- palpation
- MMT; gastroc; soleus; tib posterior; FHL; FDL
- segmental mobility - TCJ, rearfoot alignment
possible interventions (goal):
- mobility; anterior or posterior talar glides; subtalar joint glides
- reactive: activity modificatioin progressive strengthening
- degenerative: progressive strengtheing
see also cook (2016)
achillies pain, stiffness and muscle power deficits: midportion achilles tendinopathy CPG
which: achilles rupture
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- ankle DF injury
- traumatici njury
- may have history of achilles tendon pain
clinical exam:
- palpation (sulcus sign)
- thompson test
- matles test
possible interventions (goal):
- referral to orthopedic specialist - surgery may be needed (time sensitive)
which: severs disease
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- active children ages 7-14
- growth spurts
- males > females
clinical exam:
- single leg heel raise test
- palpation
- MMT- gastroc; soleus
- radiographs
possible interventions (goal):
- activity modification
- shoe orthoses
- referral to orthopedic specialist (routine)
which: medial ankle sprain
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- traumatic injury
clinical exam:
- talar tilt test; medial
- figure- 8 test
possible interventions (goal):
- referral to orthopedic specialist (time sensitive)
- grade I: immobilization, limited ankle DF ROM
which: high ankle sprain
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- traumatic injury
clinical exam:
- dorsiflexioin- Er rotation test
- squeeze test
- fibular translation test
- cotton test
- palpation segmental mobility- TCJ, figure 8 test
possible interventions (goal):
- referral to orthopedic specialist (time sensitive)
- Grade I: immobiliation, limited ankle DF ROM
- grade II & III: surgery
which: posterior tibialis tendon dysfunction
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- ↓sagittal plane motion during gait
- ↓ TCJ mobility
- ↓ strength of tibialist posterior; tibialist anterior; gastroc-soleus complex; fibularis longus/brevis, abnormal windlass mechanis m
clinical exam:
- SL heel raise test
- segmental mobility; TCJ, subtalar joint. midfoot joints; 1 MTP joint
- rearfoot and forefoot alignment
- MMT - gastroc; soleus; tib post.; FHL; FDL
possible interventions (goal):
GOAL: limit movement into frontal plane
- mobility -1st MTP joint
- mobilization; TCJ glides, subtalar joint glides; 1st MTP abduction strength
see wee 3 chart review
which: hallux valgus/hallux rigidus
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- decreased ankle ROM & joint mobility
clinical exam:
- segmental mobilty -1st ray
- MMT - FHL; tib post; FDH; toe flexors
- gastroc muscle length test
- rearefoot and forefoot alignment
possible interventions (goal):
GOAL: limit movement into frontal plane
mobility -1st MTP joint mob
TCJ glies
subtalar joint glides
1st MTP abduction strength
see week 3 chart review
which: lisfranc injury
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- traumatic foot injury (axial laoding w/ ER on plantarflexed foot)
clinical exam:
- ankle and forefoot ROM
- segmental mobility - 1st and 2nd rays
- palpation
possible interventions (goal):
- immobilization
- referral to orthopedic specialist (time sensitive)
which: plantar heel pain
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- prolong underloading
- sudden increased in loading
- overpronation
- underpronation
clinical exam:
- windlass test
- palpation
- TCJ and 1st MTP ROM
- rearfoot and forefoot alignment
possible interventions (goal):
- TCJ ROM/joint mobility
- 1st MTP joint ROM/mobility
- strengthening - tibialis post; tib anterior, hip abduction/ER
see also: heel pain- plantar fasciitis/faschiopathy: CPG
which cuboid dysfunction
possible why’s (contributing impairments):
clinical exam:
possible interventions (goal):
possible why’s (contributing impairments):
- excessive pronation
- previous lateral ankle sprain
- ↓ ankle DF ROM
- ↓ sagittal plane motion during gait
clinical exam:
- gait
- segmental mobilty - calcaneocuboid joint; talocrural joint
- MMT- FHL/brevis; tib post
possible interventions (goal):
- joint mobility- calcaneocuboid joint; TCJ; 1st MTP joint
- ROM- TCJ; 1st MTP joint
- strengthening - fibularis longus/brevis; tib post; hip abduction/ER
