Ankle: Examination Flashcards
What is the difference between inversion/eversion of the ankle and varus/valgus?
Inversion/eversion are normal, triplanar movements of the ankle, where varus/valgus describe pathological foot conditions, usually observed in NWB. Varus = decrease in medial angle, valgus is increase.
Where is Chopart’s joint?
Between the calcaneus and cuboid. Also known as the midtarsal joint on the lateral foot.
Where is the Lisfranc joint?
Transverse tarsal joint between tarsals and metatarsals. Used in history as an incision site to easily amputate frostbite damage toes.
Lisfranc fx is common with devices where the forefoot is locked to an object (e.g. horse stirrup or snowboard).
What motions of the foot happen in the transverse plane?
Adduction, abduction
What motions occur in the frontal plane?
Eversion, inversion
Varus and valgus in the foot are pathological and refer to the medial angle and how it changes. Which correspond to an increase and decrease in the medial angle?
Varus = decrease Valgus = increase
In the sagittal plane, there are two malignments of the foot. What are they?
Equinus = plantarflexed forefoot. Ankle is above rest of foot.
Calcaneous = dorsiflexed.
In KC WB, what’s the relationship between neighboring segments?
They are interdependent (depend on each other).
What are equinovarus and calcaneovalgus foot deformities?
Equinovarus = club foot; inversion and adduction with a lot of varus
- most go away on their own or with bracing
- could be due to ligament or soft tissue length issues
Calcaneovalgus =
-can be due to ligament tightening
What would you call a deformity that has an increase in the medial angle when in subtalar neutral? How do you reference the medial angle?
Valgus.
Bisection between calcaneous and lower leg angle.
How do you position the leg when assessing tibial torsion?
Placing the femoral condyles on flat on the table.
How do you assess foot posture versus foot and leg alignment?
Posture = bipedal WB Alignment = NWB
What is the purpose, and what are the parameters of the Foot Posture Index?
Characterize degree of foot supination and pronation. -2 to +2 where negative is more supinated.
In the FPI, what does talar head palpation tell you?
Prominence compared medially and laterally to indicate pronation or supination.
In the FPI, what does lateral malleolar curvature tell you, and which condition has the flattest distal curve?
Neutral foot has equal curves; supinated foot has flattest distal curve.
In calcaneal frontal plane position, the 3rd metric, what would an estimated rearfoot varus of <5* get you?
+1 supination.
Is a bulging talonavicular joint more prominent in a pronated or supinated foot?
Pronated. Talus adducts with pronation.
In the 5th metric, the medial longitudinal arch is assessed. Is arch height or congruence more important?
Congruence.
What does “too much toe” refer to in the 6th metric and what does it signify?
Excessive forefoot abduction, indicative of excessive pronation.
What FPI score was indicative of significant increase in the risk of overuse injury?
FPI less than 2 (supinated).
How do you calculate the Staheli Arch Index (SAI), and what is its importance?
Foot is divided into 3 sections, A, B, C where C is forefoot and A is calcaneous. narrowist width of B / greatest width of trisection A = SAI.
Important because it provide quantification of WB foot posture clinically.
Not good for associate risks.
What are the risks associated with a pes planus foot posture?
Increased prevalence of ipsilateral knee pain and medial cartilage damage in older adults.
T/F: forefoot vaus is associate with hip pain and THR in older adults?
True. More forefoot varus = 1.9x hip pain and 5.1x THR.
T/F: static barefoot alignment is unlikely to be strictly determinative of emergent movement patterns?
True. Avoid Chiropractic thinking that alignment dictates function.
In the sagittal plane form a posterior view, what direction does the axis of the talocrural joint slope? What about from a superior view?
Superomedial to inferolateral.
Posterolateral to anteromedial.
For midtarsal motion there are two axes that contribute to triplanar motion. What are they?
OMJA = oblique midtarsal joint axis
-motion at the talonavicular joint
LMJA = longitudinal midtarsal joint axis
-motion at the calcaneocuboid joint
What are the 3 movement components of pronation in WB?
- Dorsiflexion
- Eversion
- Abduction (too much toe laterally)
Useful in early stance.
- midfoot unlocked
- supple and adaptive
- shock absorption
What are the 3 movement components of supination in WB?
- Plantarflexion
- Inversion
- Adduction (can see big toe).
Useful in late stance.
- Midfoot locked
- Foot rigid
- Lever for push-off
What are the criteria for applying the Ottawa Ankle Rules?
Xrays are required only if:
- bone tenderness on distal 6cm of posterolateral malleolus.
- bone tenderness at base of 5th metatarsal
- inability to bear weight both immediately and in ER
- bone tenderness at distal posteromedial malleolus
- bone tenderness at the navicular
- inability to bear weight both immediately and in ER
Can a tuning fork identify fracture?
Yes, with stethoscope. Sens, Spec = .8
What are the 6 P’s of compartment syndrome?
- Pain
- Paresthesia
- Pallor
- Paralysis
- Pulselessness
- Pressure
What are components of the circulatory system review?
-Distal pulses
-Edema (venous insufficiency)
>presents with aching, heaviness, itching, tingling and cramps
What nerve in the foot is entirely sensory?
Superficial peroneal nerve (L4-S1). Lateral distal half of leg and dorsum of foot, minus deep peroneal (L5) at interspace between hallux and digit 2.
What are the common foot positions for ATF, CF, PTF and syndesmosis ligament sprains?
ATF
- PF and inversion
- heel off ground
CF
- Inversion
- heel on ground
PTF
- Eversion
- heel off ground
Syndesmosis
-Eversion + rotation of fixed foot
