Ankle, Foot Flashcards
best ankle support after injury
semi rigid bracing
taping and lace-up sleeves have some evidence to support their effectiveness, but not as sound evidence as bracing
soleus innerv
tibial nerve S1-2
tibial nerve
S1-2:
-soleus
-plantaris
L4-5:
tibialis posterior
L5-S2
FDL
FHL
plantaris innerv
tibial nerve S1-2
popliteus innerv
tibial nerve L4-S1
tibialis anterior innerv
deep peroneal L4-5
Extensor digitorum longus
lateral tibial condyle, medial surface of fibula –> mid/distal phalanges of lateral 4 digits
deep peroneal L5-S1
extensor hallucis longus
middle part of anterior fibula->dorsal aspect of base of distal phalax of great toe
deep peroneal L5-S1
deep peroneal nerve
L4-5: Tibialis anterior
L5-S1:
-EDL
-EHL
-fibularius tertius
-EDB
fibularis tertius
inferior third of anterior fibula–> base of 5th MT
deep peroneal L5-S1
peroneus longus
head and superior 2/3 of lateral fibula->base of 1st MT +medial cuneiform
superficial peroneal nerve L5-S1
peroneus brevis
inferior 2/3 of lateral fibula-> lateral side of base of 5th MT (dorsal surface of tuberosity)
superficial peroneal nerve L5-S1
tibialis posterior
posterior tibia inferior to soleal line/posterior surface of fibula–>tuberosity of navicular+cuneiform+cubois + sustenataculum tali of calcaneus
-Also bases of 2-4 MT
tibial nerve L4-5
superficial peroneal nerve
L5-S1:
-peroneus longus
peroneus brevis
flexor digitorum longus
mediaul part of posterior tibia inferior to soleal line -> bases of distal phalanges of lateral 4 digits
tibial nerve L5-S2
flexor hallucis longus
inferior 2/3 of posterior fibula–> base of distal phalanx of great toe
tibial nerve L5-S2
extensor digitorum brevis
calcaneus –> long extensor tendons of toes 2-4
deep peroneal nerve L5-S1
abductor hallucis
medial tubercle of tuberosity of calcaneus -> medial side of proximal phalanx of great toe
medial plantar nerve S1-2
medial plantar nerve
S1-2:
-abductor hallucis
-flexor hallucis brevis
flexor digitorum brevis
S1-3: 1st lumbrical
flexor hallucis brevis
plantar surface of cuboid/lateral cuneiforms–> both sides of base of proximal phalanx of great toe
medial plantar nerve S1-2
flexor digitorum brevis
medial tubercle of tuberosity of calcaneus, plantar aponeurosis –> both sides of middle phalanges of lateral 4 digits
medial plantar nerve S1-2
lumbricals
tendons of FDL –> medial aspect of expansion over lateral 4 digits
S1-3
1st: medial plantar nerve
2-4: lateral plantar nerve
lateral plantar nerve
S1-3:
lumbricals 2-4
S2-3: quadratus plantae
abd digiti minimi
flexor digiti minimi brevis
adductor hallucis
plantar interossei
quadratus plantae
plantar surface of calcaneus-> posterolateral margin of FDL
lateral plantar nerve S2-3
abd digiti minimi
med/lat tubercles of calcaneal tuberosity-> lateral side of base of prox phalanx of 5th digit
lateral plantar nerve S2-3
flxor digiti minimi brevis
base of 5th MT–> base of proximal phalanx of 5th digit
lateral plantar nerve S2-3
adductor hallucis
oblique head: base of MT 2-4
transverse head: plantar ligaments of MTP joints
–> tendons of both heads attach to lateral side of base of proximal phalanx of 1st digit
lateral plantar nerve S2-3
plantar interossei
base/medial sides of MT 3-5–> medial sides of bases of phalanges of digits 3-5
lateral plantar nerve S2-3
Ottawa Ankle Rules
Pain in malleolar or midfoot area
+ EITHER:
-unable to bear weight immediately after injury and In ED
OR:
-bone tenderness at posterior edge of tibia, fibula, or tip of medial/lateral malleolus
-bone tenderness at navicular or proximal base of 5th MT
DVT special testing
Calf swelling: SN .9, SP. 92
DVT special testing
Calf swelling: SN .9, SP. 92
dif of 15mm M, 12mm F
Homans sign
Calf tenderness SN .82
CPR for DVT: Wells Criteria
3= high prob
1-2=moderate
0=low
-active cancer +1
-paralysis, paresis, recent immobilization (cast) of LE +1
-recently bedridden for 3+ days, or major surgery within previous 12 wk requiring anesthesia +1
-localized tenderness along distribution of deep venous system +1
-entire leg swollen +1
-calf swelling at least 3cm larger than other side (measure 10cm below tibial tuberosity) +1
-pitting edema confined to symptomatic leg +1
-collateral superficial veins (Non varicos) +1
-previously documented DVT +1
-alternative dx at least as likely as DVT: -2
lateral ankle sprain special testing
-anterior drawer
-medial subtalar glide
-medial talar tilt
lateral ankle sprain CPG: outcome
LEFS, FAAM
lateral ankle sprain CPG: interventions
acute phase:
early motion- A
manual- B
ice- A
shortwave diathermy-C
electrotherapy, low level laser- D
NOT use US: A
ther ex-A
progressive loading phase:
manual- A
ther ex- C
sports related activity C
medial ankle sprain special test
lateral talar tilt
high ankle sprain (syndesmotic) special test
fibular translation test SN .82, SP .88
squeeze test SN 1
passive full DF may reproduce symptoms
achilles pathology special testing
thompson test (not indicated really for tendinopathy)
royal london hospital test SP .91
tendon palpation SP .84
royal london hospital test
Palpate achilles at tender spot
-palpate in full df, full pf
the test is considered positive for achilles tendinopathy if the pain on the tender spot initially found is absent in the maximally dorsiflexed position.
achilles CPG (interventions)
eccentric loading-A
low level laser-B
ionto-B
stretching, orthoses-C
manual, taping- F
heel lift- D
night splint-C
plantar fasciitis CPG (interventions)
manual-A
-stretching-A
-taping-A
orthoses-A
night spints-A
posterior tibialis tendinopathy
pain/limited DF, eversion
pain & possible weakness with PF, inv
may have Rf/FF varus deformities, or pes planus, –> excess pronation
anterior tib fib ligament MOI
forced df & eversion
cuboid syndrome symptoms
lateral midfoot pain
concordant with midtarsal mobility, MMT ev+inv
pain during push off phase of gait
medial plantar nerve sensation
N/T in plantar surface of 1/2nd toes
os trigonum, strieda process
- most common intra articular causes of lateral ankle pain
-bones that typically fuse with talus between 7-13
-cause compression between posterior lip of tibia & calcaneus, so if they don’t fuse, repetitive MOI like dance can cause bony block going into plantarflexion
tarsal coalition
fusion of 2 or more bones in mid foot
talocalcaneal bone is most common
associated with flat foot
severs disease
calcaneal apophysitis affecting Males often between 6-8
most commonly with growth spurt
kohlers disease
navicular - osteochondrosis of navicular bone
Jones fracture
base of 5th MT
foot anatomy
talus, navicular, cuboid, cuneiforms, MT
orthotics useful?
evidence is poor for custom
-short/long term- orthotics helpful for plantar
-achilles – weak evidence showing foot orthoses helpful
no conclusion for PFPS or LBP
Grading ankle sprains
I – no loss of function, no laxity, no tenderness, swelling 0.5 or less
II- + anterior drawer, negative talar tilt, bruising, tenderness, decreased total motion 5-10 deg, edema 0.5-2cm
III – near total loss of function, + ant drawer & talar tilt, extreme tenderness, decreased motion >10 deg; grade III further divided depending on stress xray results
ankle sprain CPG
-manual therapy- B level evidence for acute, A for post acute phase
-midfoot tenderness- see Ottawa ankle rules first
-ther ex- level A
-post acute phase- conflicting evidence level D
-acute phase
-early WB – A
-modalities – A (cryo, US); C/D (shortwave diathermy, laser)
-external support – boot, brace
LE myotomes
L2 hip flexion
L3 knee ext
L4 df
L5 toe ext
S1 pf
S2 knee flexion
baxters nerve entrapment
acute pain felt where first branch of lateral plantar nerve becomes trapped in medial heel
ROM requirements for assessment
first MTP
rearfoot
dorsiflexion
-first MTP = 65 deg extension pre swing
-rear foot/talocalcaneal ROM 4-6 eversion at loading
-tibialis posterior & fibularis longus strength to coordinate pronation
-TC df = 10 deg in terminal stance
plantar fasciitis/heel pain CPG
manual therapy 2008 level E; 2014 level A
-STM- gastric/soleus, FHL in sidelying; joint mob/manip/MWM
-stretching 2014 level A (2008 level E)
-NMR F
-Taping A
-orthotics A; night splints A
-electrotherapy 2008 B 2014 D
-low level laser, ultrasound: C
-footwear, weightloss: D
-dry needling F
maisonneuve fracture
medial malleolar + proximal fibula
ER force
lisfranc injury
fx of 2-5th MT with lateral dislocation
“stirrup” injury
medial plantar bruising can be indication
