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Musculoskeletal > Ankle Complex > Flashcards

Ankle Complex Flashcards

1
Q

What is the 2nd longest bone in the body?

A

Tibia

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2
Q

Where is the attachment site for muscles that provide stability to the talus in the talocrural joint?

A

fibula

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3
Q

What motions can occur at the distal tibiofibular joint?

A

slight ROT and elevation

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4
Q

What is the open packed position for the distal tibiofibular joint?

A

full PF

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5
Q

What is the closed pack position of the distal tibiofibular joint?

A

full DF

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6
Q

What is the capsular pattern of the distal tibiofibular joint?

A

There is no capsular pattern for this joint

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7
Q

Ligaments and the interosseous membrane of the distal tibiofibular joint are stressed with what motions?

A

combined DF and Eversion

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8
Q

What is the primary stabilizer at the distal tibiofibular joint?

A

interosseous membrane

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9
Q

The talus is wider (anteriorly/posteriorly)

A

anteriorly

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10
Q

What is the function of the talocrural joint?

A

distributes body weight posteriorly to the heel and anteriorly to the midfoot

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11
Q

What is the most stable position of the talocrural joint?

A

full DF

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12
Q

What motion occurs with ankle DF/PF at the talocrural joint? Why?

A

Conjunct ROT due to angulation of bony surfaces

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13
Q

Describe the arthrokinematics of the talocrural joint during DF.

A

Talus glides posteriorly and slightly everts

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14
Q

Describe the arthrokinematics of the talocrural joint during PF.

A

The talus glides anteriorly and slightly inverts

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15
Q

What is the OPP of the talocrural joint?

A

10 degrees of PF and midway between EV and INV

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16
Q

What is the CPP of the talocrural joint?

A

full DF

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17
Q

What is the capsular pattern of the talocrural joint?

A

PF = DF

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18
Q

What is the function of the ATFL?

A

Resists anterior displacement of the talus relative to the ankle mortise

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19
Q

What position is the ATFL stressed in?

A

combined PF and inversion

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20
Q

What is the most common lateral ligament to be strained in the ankle?

A

ATFL

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21
Q

What is the function of the calcaneofibular ligament (CFL)?

A

Resists excessive ankle inversion and calcaneal adduction through full ankle ROM.

Most effective at resisting these motions from neutral ankle through ankle DF

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22
Q

What is the strongest ligament of the lateral ankle?

A

PTFL

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23
Q

What is the function of the PTFL?

A

Resists excessive talar movements during extremes of combined ankle DF and eversion (High ankle sprain)

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24
Q

How are the deltoid ligaments damaged?

A

Damaged by hyper-eversion of calcaneus

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25
Q

Describe the arthrokinematics of anterior subtalar joint calcaneal inversion.

A

calcaneus rolls AND glides medially on the facet of the talus

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26
Q

Describe the arthrokinematics of anterior subtalar joint calcaneal Eversion.

A

Calcaneus rolls AND glides laterally on the facet of the talus.

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27
Q

Describe the arthrokinematics of posterior subtalar joint calcaneal inversion.

A

Facet on the superior calcaneus rolls medially and glides laterally on the inferior aspect of the talus

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28
Q

Describe the arthrokinematics of posterior subtalar joint calcaneal eversion.

A

Facet of the superior calcaneus rolls laterally and glides medially on the inferior aspect of the talus.

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29
Q

What is the normal composite motion at the subtalar joint?

A

20 degrees of inversion, 10 degrees of eversion

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30
Q

What is the OPP of the subtalar joint?

A

midway between inversion and eversion

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31
Q

What is the CPP of the subtalar joint?

A

supination/calcaneal inversion

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32
Q

What is the capsular pattern of the subtalar joint?

A

limited calcaneal inversion/supination

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33
Q

What are the functions of the interosseous ligaments of the subtalar joint?

A

anterior band: holds the anterior joint surface together

posterior band: holds the anterior and posterior joint surfaces together

34
Q

What does the medial collateral ligament of the subtalar joint do?

A

Resists excessive valgus forces

35
Q

What does the lateral collateral ligament of the subtalar joint do?

A

resists excessive varus forces

36
Q

What happens with pronation of the ankle during WB?

A
  • the medial longitudinal arch of the foor lowers
  • calcaneal eversion
  • talar ADD and PF
  • tibial IR
37
Q

What happens with supination of the ankle during WB?

A
  • medial longitudinal arch of the foot is elevated
  • calcaneal inversion
  • talar ABD and DF
  • tibial ER
38
Q

What is the acute MOI leading to acute achilles tendonitis?

A

Sudden or extreme ankle DF.
Rapid/forceful contraction of gastroc/soleus muscles in WB position

39
Q

What is the common population that presents with acute achilles tendonitis?

A

males, 30-55 y/o

40
Q

What is commonly seen with acute achilles tendonitis?

A
  • abrupt onset of pain at insertion of achillies
  • swellling
  • aggs: stairs, wearing shoes that rub against achilles
  • pain at beginning of activity followed by decreased pain and then increased pain at the end of the activity
  • TTP over distal 1/3 of achilles tendon
41
Q

What is the typical MOI of chronic achilles tendonitis?

A

repetitive microtrauma (often with running), hypovascularity in central portion of tendon, collagen degeneration (Chronic)

42
Q

What is the most common population to present to the clinic with chronic achilles tendonitis?

A

males, > 35 y/o

43
Q

What is commonly seen with chronic achilles tendonitis?

A
  • gradual onset at the insertion of the achilles tendon
  • minimal to no swelling
  • aggs: stairs and shoes that rub against achilles
  • TTP over distal 1/3 of achilles tendon
  • painful ankle DF PROM
  • TTP over distal 1/3 achilles tendon
44
Q

What are the MOIs for achilles rupture?

A
  1. Pushing off with WB on forefoot with knee extended (running, sprinting, jumping)
  2. Sudden DF with full WB which occurs with a slip, fall, sudden deceleration
  3. Violent DF when jumping from a height and landing on a plantar-flexed foot
45
Q

What population commonly presents with achilles rupture?

A

Males, 30-40 y/o

46
Q

What is the typical PMH of achilles rupture?

A
  • Report hearing a “pop” and describe the feeling as “being shot in the back of the ankle”
  • PMH of achilles tendinopathy or corticosteroid injections
  • fluoroquinolone antibiotic use
47
Q

What is the typical clinical presentation of achilles rupture?

A
  • limited ROM due to edema
  • weak/pain-free contractile testing for PF
  • unable to perform unilateral heel raises
  • swelling over the distal LE w/o ability to palpate tendon
    (+) thompson test
48
Q

___% of PCPs miss the diagnosis of an achilles rupture

49
Q

What is the most frequent injury during physical activity?

A

lateral ankle sprains (70-80% of active individuals)

50
Q

Almost ___% of ankle sprains involve the lateral ligaments

51
Q

What is the typical MOI of lateral ankle sprains?

A

Unanticipated ankle plantarflexion/inversion due to a miss-step (“rolling the ankle”)

52
Q

What ligament is the most injured with lateral ankle sprains?

53
Q

What is the common presentation of lateral ankle sprains?

A
  • Patients report “rolling their ankle”
  • Pain with walking, stairs, navigating uneven terrain
  • Sensation of instability
  • Swelling/bruising observed
  • Limited/painful ankle ROM-all directions
  • Contractile Findings: Painful/weak with ankle resistance testing
  • Impaired balance (especially SLS)
    (+) TTP over ATFL (most common)
    (+) Stress testing of lateral ligaments/Anterior Drawer Test
54
Q

What is the population that is most likely to present with lateral ankle sprains?

A

females, 15-19 y/o

55
Q

Patients with rearfoot (pronation/supination) are more at risk for ankle sprains.

A

supination

56
Q

(true/false) HVLAT techniques have been shown to be extremely effective immediately following lateral ankle sprains

57
Q

What is the CPR for Manual therapy and exercise after an Inversion Ankle sprain?

A
  1. symptoms worse with standing
  2. symptoms worse in the evening
  3. navicular drop >5 mm
  4. distal tibiofibular joint hypomobility
58
Q

What is the typical MOI for high ankle sprains?

A
  1. forceful ER
  2. forceful EV of the talus
  3. forceful DF
59
Q

What is the common patient presentation for high ankle sprains?

A
  • Pain/swelling reported over distal, anterior lower leg
  • Increased pain with ER of foot, WB, passive ankle DF/EV
  • Limited ankle ROM/strength
  • Sensation of instability & difficulty walking
60
Q

What are risk factors for posterior tibialis tendinopathy?

A
  • rearfoot PRON
  • HTN
  • DM type II
  • obesity
  • shortening of triceps surae
61
Q

What is the presentation of posterior tibialis tendinopathy?

A
  • posteromedial ankle pain and/or swelling
  • aggs: prolonged walking, stairs, running
  • pain with resisted ankle PF/INV (heel raise test)
  • TTP along PT tendon
  • collapse of medial longitudinal arch
  • limited subtalar mobility with INV
62
Q

What are the s/s of medial tibial stress syndrome (Shin splints)?

A
  • Vague, diffuse pain located in the middle, distal tibia which occurs with exertion
  • Patient reports pain is worse in the beginning of exercise and subsides after a few minutes of exercise. As the injury progresses, pain can occur at rest
  • TTP over anteromedial shin
63
Q

definition: Swelling within the anterior compartment of the lower leg which can lead to compression of neurovascular structures

A

anterior compartment syndrome

64
Q

What are the s/s of anterior compartment syndrome?

A

5 P’s:
- Pain
- Pallor
- Paresthesia
- pulselessness
- paralysis

  • bulbus calves
65
Q

What is the gold standard for Dx compartment syndromes?

A

Compartment pressure measurement

66
Q

What population most commonly presents with plantar fasciitis?

A

Females, 40-70 y/o

67
Q

What are the s/s of plantar fasciitis?

A
  • Report of medial, plantar heel pain
  • Pain with initial WB after prolonged inactivity (sleeping, sitting, driving, etc.)
  • Decreased pain with non-WB and as patient continues to walk
  • TTP
  • limited DF
  • intrinsic foot muscle weakness
68
Q

Night splints to treat plantar fasciitis focus on maintaining ___.

69
Q

definition: Fracture that occurs 1.5 cm distal to the styloid of the fifth metatarsal.

A

jones fracture

70
Q

What population commonly presents with a jones fracture?

A

Males = Females, Non-athletes over age 21

71
Q

What is the s/s of a jones Fx?

A

Pain with running and WB

72
Q

What is the treatment for a jones Fx?

A

3 months in a non-WB cast
Surgical fixation

73
Q

definition: Fracture of the medial cuneiform and/or bases of 2nd/3rd metatarsals and injury to ligamentous structures

A

lisfranc Fx

74
Q

What is the MOI of a lisfranc Fx?

A

crush injury

75
Q

What is the MOI of jones Fx?

A

repetitive WB and pivoting on the involved foot

76
Q

What are the s/s of lisfranc Fx?

A

Inability to WB
swelling over midfoot

77
Q

What is the treatment for a lisfranc Fx?

A

non-WB cast for 6 weeks
surgical fixation

78
Q

When can an avulsion Fracture of 5th Metatarsal from Peroneus Brevis attachment occur?

A

With severe PF/INV ankle sprains

79
Q

When can a bi-malleolar Fx occur?

A

with trauma involving sudden, forceful Eversion of foot

80
Q

When can navicular Stress Fx occur?

A

Repetitive running in runners with excessive pronation and unsupportive footwear

Musculoskeletal (23 decks)

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