Ankle Foot Flashcards
What toe is considered the reference for the middle of the foot
2nd toe
How far from the wall should your toes be for a dorsiflexion mobility test
3-4 inches
To improve toe ext, which way do we mobilize the toe
Up (dorsally) because the toes are concave on convex joints
Which way should you orient the foot (inversion or eversion) to stretch the calf without stretching the plantar fascia
Inversion
Eversion will increase the stretch of the plantar fascia
Supination is used in what part of gait
Push off
Pronation is used in what part of gait
Absorbing force
What is the progression of rehab for tendinopathies
Eccentric
Isotonic
Energy storage
Return to sport
Heel raises while squeezing a tennis ball between your malleoli is targeting what muscle
Posterior tibialis
Side stepping with band around your feet is targeting what muscles?
Peroneals
What body part does the steamboat exercise focus on
Foot
Which way should a band pull the leg in order to mobilize into dorsiflexion in a kneeling lunge?
Pull the lower leg forward and creates normal arthrokinematics of the joint
4 layers of plantar intrinsics
1: Abductor hallicus, FDB, Abductor DM
2: Quadratus Plantae, Lumbricals
Layer 3: FHB, adductor hallucis, FDMB
Layer 4: Interossei
ER of the tibia happens with ankle _______
IR happens with ___________
supination
pronation
Claw toe
MTP Hyperext, IP flexion
Hammertoe
MTP hyperext, PIP flex, DIP hyperext
Grade 1 lateral ankle sprain vs grade 2 and 3
1: Microscopic damage to typically the ATFL (5-14 days)
2: Partial tear of ATFL, some damage to calcaneofibular (2-3 weeks)
3: Complete tear of all 3 lateral ligaments (3-12 weeks)
What ligament is most commonly torn first
Anterior talofibular ligament
What is the mechanism of a syndesmotic ankle sprain
Dorsiflexion + Eversion
How should we measure dorsiflexion for ankle sprains?
How should we measure dynamic balance?
Weight bearing lunge test
Star excursion balance test
What should we measure in patients w/ ankle sprain
Swelling, ROM< Talar translation, inversion, single leg balance
Prophylactic bracing or external supports for people with ankle sprain risk factors has what level evidence
Level A evidence
What is the most important thing to work on for ankle stability
proprioception
Should we use ultrasound on lateral ankle sprains?
No
should we use an external support for patients with ankle sprains
Yes but not as the only intervention
How do we progress patients with ankle sprain
isometric
eccentric
energy storage
return to sport
Is it normal for achilles tendinopathy patients to have some pain when you progress them to eccentric drills? Is this acceptable?
Yes it can be expected they will have some pain
What outcome measures are best for Achilles tendinopathy and lateral ankle sprain
FAAM, LEFS
What should we advise regarding rest for patients with achilles tendinopathy
that complete rest is not indicated
What should we use to decrease pain in patients with acute midportion achilles tendinopathy
iontophoresis with dexamethasone
What treatment should we give plantar fasciitis
Manual therapy to address LE joint mobility
Plantar fascia and gastroc/soleus stretching
antipronation taping for up to 3 weeks
foot orthoses
perscribe a 1 to 3 month program of night splints
How can we diagnose plantar fasciitis
Medial heel pain noticable with initial steps after period of inactivity or prolonged weight bearing
positive windlass test
abnormal foot posture index score
limited dorsiflexion and tight hamstrings
pain radiating up to calf, reporting sharp shooting foot pain and numbness
vague pain over medial ankle/plantarfoot
may be worse at night
Tarsel Tunnel Syndrome
Lis Franc injury happens where?
What is the MOI?
Medial and cuneiform and second metatarsal are separated
MVA, or someone steps on your foot
Dorsum of the foot is swollen
Bruising on dorsum or plantar surface
pain w/ WBing
Abnormal widening of the foot
Lis Franc Injury
What muscles support the medial arch?
Tibialis anterior and posterior
peroneal longus
flexor digitorum longus
flexor hallucis longus
the intrinsic foot muscles
What is Baxter’s nerve entrapment
Compression of the inferior calcaneal nerve
tibial nerve -> lateral plantar nerve -> inferior calcaneal nerve
Norman inversion and eversion?
30 inversion
20 eversion
What muscle passes deep to the abductor hallicus and can become compressed during repetitive eversion
medial plantar nerve
s/s : aching numbness and paraesthesia on medial side of foot
How much IR and ER of the tibia is normal?
20-30
How is the distal tib-fib joint oriented?
30 degrees off of anterior/posterior
How to test for lis franc injury
Pronation-abduction test or squeeze test
Ankle operation WB precautions:
Plates:
Intermedullary nail:
Plates: NWB
Intermedullary nail: WBAT
Should patients Weightbear with external fixators?
yes
What is the first exercise to give someone for NM control of their foot?
short foot exercises/arch raises
