Ankle & Foot Competency Flashcards
What 3 tests can be done to test the ligaments of the ankle/foot?
Anterior drawer test Talar tilt Eversion test
How do you perform an anterior drawer test for the ankle?
Grasp posterior calcaneus with one hand and distal tibia/fibula with the other hand, monitoring anteriorly at the anterior talus. Provide anterior force on calcaneus while stabilizing the distal tibia/fibula. Normal springing of calcaneus back to neutral
should occur.
• (+) Test: Pain, no springing, excessive motion/laxity
• Indication: ATF ligament pathology/tear (lateral ankle
sprain)
How do you perform a talar tilt test?
Grasp distal tibia/fibula with one hand and inferior calcaneus with the other, blocking motion of the calcaneus on the talus. Invert the talus to evaluate ROM.
• (+) Test: Laxity, increased ROM, or pain
• Indication: Calcaneofibular ligament pathology/tear, also
tests some ATF (lateral ankle sprain)
How do you perform an eversion test of the ankle?
Grasp distal tibia/fibula with one hand and plantar surface of the
mid-foot with the other hand. Evert the foot to evaluate ROM.
- (+) Test: Laxity, increased ROM or pair
- Indication: Deltoid ligament pathology (medial ankle sprain)
How do you perform a squeeze test of the ankle?
Wrap hands around leg proximal to the ankle, contacting distal
tibia/fibula with both thenar eminences. Squeeze for 2-3
seconds, then rapidly release.
- (+) Test: Pain at syndesmosis
- Indication: Syndesmosis pathology (high ankle sprain)
How do you perform a cross leg test?
Patient crosses affected ankle over opposite knee. Apply pressure to distal fibula of affected leg
- (+) Test: Pain at distal ankle
- Indication: Syndesmosis pathology (high ankle sprain)
How do you perform a thompson test?
Patient prone with foot off the table. Squeeze the patient’s calf.
Observe for plantarflexion.
- (+) Test: Absence of plantar flexion
- Indication: Achilles tendon rupture
How do you perform a Homan’s sign test?
Patient laying or seating with knee extended. Dorsiflex the patient’s foot. Can apply lateral compression to calf
- (+) Test: Pain with dorsiflexion
- Indication: thrombophlebitis or acute deep vein thrombosis (DVT)
Can also observe accompanying signs of edema, erythema, and warmth of lower leg. Would need to order a Venous Doppler to rule out clot
(Not always performed clinically due to potential risk of
embolus)
What in conjunction with a positive Homan’s sign increases suspicion for DVT?
Unilateral swelling and redness of calf
How do you perform a moses sign test?
Patient seated or supine with knee slightly flexed or extended. Induce an anterior compression on the gastrocnemius muscle into the posterior aspect of the tibia (compresses the calf towards the tibia).
- (+) Test: Pain with anterior compression
- Indication: Deep vein thrombosis of the posterior tibial veins
(Not always performed clinically due to potential risk of
embolus)
What type of ankle sprain accounts for 80-85% of all ankle sprains?
Ankle inversion with plantar flexion **Swelling and ecchymosis over the involved area. Both are more prevalent with increasing severity of injury**
What are the 3 major ligaments involved in an inversion ankle sprain?
- Anterior talofibular
- Calcaneofibular
- Posterior talofibular
What are the movements that cause a high ankle sprain?
Eversion and rotation (some dorsiflexion)
Where is the pain commonly in a high ankle sprain?
Medial side - Minimal swelling or ecchymosis - Pain with weight bearing **Most common in football and downhill skiing**
What ligaments are involved in a high ankle sprain?
Anterior inferior tibiofibular ligament and syndesmosis
What condition is known as inflammation of the origin of the plantar aponeurosis from stretching during walking/standing that is worse with the first steps and improves throughout the day?
Plantar fasciitis
- Point tenderness of calcaneous
- No relationship with heel spurs
What is plantar fasciitis commonly associated with?
- Tight calf muscles
- Repetitive impact activities
- High arches
- Obesity
- New/change in activities
What is Morton’s neuroma?
Inflammation and thickening of the tissue that surrounds the nerve between the toes. Most commonly between the 3rd and 4th toes
- Pt reports it feels like they are walking on a marble
- Palpable in the web space replicating pain
What is turf toe?
Inflammation and pain at the base of the 1st MTP. Presents as pain and bruising at base of great toe.
What is turf toe caused by?
Hyperextension of great toe causing damage to the joint capsule. Severe cases can damage sesamoids and flexor tendon
- Commonly due to activities performed on hard surfaces
What causes achilles tendonitis?
- Tight calf muscles
- Sudden change in activity
- Poorly fitting shoes
- Incorrect running technique
What are the components of the medial longitudinal arch of the foot?
- Navicular Cuneiforms (1-3)
- Talus
- Metatarsals (1-3)
What ligament is the primary stabilizer of the medial ankle?
Deltoid ligament
What are the components of the lateral longitudinal arch?
- Calcaneus
- Cuboid
- Metatarsals (4-5)
What ligaments are the primary stabilizers of the lateral ankle?
- Anterior talofibular ligament
- Calcaneofibular ligament
- Posterior talofibular ligament
What is the ROM for dorsiflexion?
15-20
What is the ROM for plantarflexion?
55-65
What is the ROM for ankle inversion?
20
What is the ROM for ankle eversion?
10-20
What are the motions and the ROM for ankle pronation?
Dorsiflexion, Abduction, eversion of calcaneus -> 5 degrees
What are the motions and ROM for supination?
Plantarflexion, Adduction and eversion of calcaneus -> 20 degrees
According to the ottawa ankle rules, an ankle series is only indicated for pts who have pain in the malleolar zone AND one of 2 things. What are they?
- Have bone tenderness at the posterior edge or tip of the lateral or medial malleolu OR
- Are unable to bear weight both immediately after the injury and for four steps in the ER or Dr office
According to the ottawa ankle rules, a foot series is only indicated for pts who have pain in the midfoot AND 1 of 2 things. What are they?
- Have bone tenderness at the base of the 5th metatarsal or at the navicular OR
- Are unable to bear weight both immediately after the injury and for four steps in the ER or Dr office
According to the use fo the ottawa ankle rules, when is a pt considered able to bear weight even if they are limping?
If the pt can transfer weight twice to each foot (4 steps), he or she is considered able to bear weight even if he or she limps
According to the ottawa ankle rules, where do you palpate when assessing for bone tenderness?
Palpate the distal 6cm of the posterior edge of the fibula when assessing for bone tenderness
