Ankle/Foot Eval & Treat Flashcards
Tibialis Posterior Action
- Plantarflexes
- Invert foot
- Supports medial longitudinal arch
Fibularis Brevis Action
- Eversion of subtalar joint
- Weakly plantarflexes
Fibularis Longus Action
- Eversion of subtalar joint
- Weakly plantarflexes
Tibialis Anterior Action
- Dorsiflexes ankle
- Weakly plantarflexes Subtalar joint
Talocrual Joint
-Talus and lower leg
-Narrow posterior surface
-Wide anterior Surface
Subtalar Joint
-Under talus
-Inversion and eversion
-hindfoot
Deltoid Lig
-medial rolled ankle ligaments
-limit eversion
-very stable
Lateral Ankle
-more commonly injured
-resist inversion
-Anterior Talofibular lig (most common)
-calcaneofibular lig
-Posterior talofibular lig
Tarsal Tunnel
-TDAVNH
-medial ankle
-under deltoid lig and flexor retinaculum
Ottawa Ankle and foot Fracture rules
Midfoot zone Rules:
-Inability to bear weight
-tenderness to base of 5th MT
-Tenderness to navivular
Malleolar zone rules:
-inability to bear weight
-tenderness to lateral malleolus
-tenderness to medial malleolus
High Ankle Sprain
- at Tibiofibular syndesmosis
-interosseous membrane
-anterior talofibular lig
-during ER and DF
Rearfoot (hindfoot)
-talus
-calcaneus
Midfoot
-navicular
-cuboid
-cuneiform (mayb)
Forefoot
-metatarsals
-phalanges
maybe cuneiforms
Foot Motions
Talocrual: DF/PF
Subtalar: INV/EV and ABD/ADD
Toes: flx/ext
Pronation: DF/EV/abd
Supination: PF/IV/add
Hindfoot: Calcaneovalgus/Calcaneovarus
Proximal Tibiofibular Joint
-head of fib and posterolateal tib
-convex tiba and concave fibula
-functionally ankle, anatomically knee
-DF: pushes fib up and ER
Distal Tibiofibular Joint
-syndesmosis union
-ligaments only, no capsule
-injury at syndesmosis can lead to widening of mortise and instability at talocrual
-fibula more distal and posterior
-DF: spread ligs and mortise forced into ligs
Mortise
-talus in socket of distal tibiofibular joint
Talocrural Joint
-synovial hinge joint
Convex talus on Convave mortise (open chain)
Dorsiflexion at Talocrural J
Open Chain: talus rolls anteriorly and glides posteriorly
Closed Chain: mortise rolls and glides anteriorly
-Closed packed position full DF
Plantarflexion at Talocrural J
Open Chain: talus rolls posteriorly and glides anteriorly
Closed Chain: mortise rolls and glides posteriorly
-Loose packed position 5-10deg
Talus Shape
-wider anteriorly (convex) than distally (concave)
Subtalar Joint
-Talus and calcaneus
-alternating convex/concave improves stability
Posterior: concave talus on convex calcaneus
Anterior: convex talus on concave calcaneus
Subtalar Motion
Open Chain:
-Supination: calcaneal INV, ADD/PF
-Pronation: calcaneal EV, ABD/DF
Closed Chain:****
-Supination: calcaneal INV, talar ABD/DF, tib/fib LR (closed packed)
-Pronation: calcaneal EV, talar ADD/PF
Resting: btwn pronation and supination
Closed Packed: supination
Capsular Pattern: Sup/in» pron/ev
Subtalar Joint in Gait
Loose Adaptor (swing): sup/pro/sup
Initial contact to loading response: sup to pro
Shock Absorber (weight acceptance): pronation
Midstance: pro to sup
Rigid Level (midstance to toe off): supination
Preswing to initial: sup to pro
Midtarsal Joints
-talocalcaneonavicular, calcaneocuboid, cuboideonavicular
Resting Position: midway btwn pronation and sup
Closed Packed: Supination
Capsular Pattern: DF>PF>add>inversion
Plantar Flexion Muscles
-Tibialis Post: sup, inv
-FDL and FHL: weak PF and sup and inv
-Plantaris
Anterior Compartment Muscles
-DF
-Tib ant: DF, supination, inversion
-EHL: weak sup
-EDL: hindfoot pronator
-FIbularis tertius
Pes Cavus
-high arch
-supinated
-decreased shock absortion
-ankle sprains common
Pes Planus
-low arch
-decreaed rigid lever
-pronated
-hallux valgus
Talocrual Capsular Pattern
-PF»_space; DF
-DF more important functionally
First Ray
-med cuneiform and 1st metatarsal
Pronation: PF, ABD, EV
Supination: DF, ADD< IN
Fifth Ray
-5th metatarsal and cuboid
Pronation: DF, ABD, EV
Supination: PF, ADD< INV
MTP Joints
-convex metatarsal head and concave proximal phalanx (same in open chain)
-need 65-70 in big toe for walking
IP Joints
-convex proximal phalanx and concave distal
Plantar Fascia
-non contracile
lateral: lat calcaneus to pinky
Medial: medial calcaneus to big toe
Central band: medial calcaneus to toe fat pads
Tarsal Tunnel
-tibial nerve > medial and lateral plantar nerves
Anterior Ankle Nerves
-deep peroneal/fibular nerve
-goes to between big and 2nd toe
-common site for retinaculum compression
Lateral Ankle Nerves
-superficial peroneal/fibular
-can be stretched by ankle sprain
Medial Longitudinal Arch
-calcaneus, talus, navicular, med cuniforms, metatarsals
-supported by tibialis posterior, flexor hallucis longus, flexor digitorum and plantar fascia
Lateral Longitudinal Arch
-cuboid and metatarsals
-supported by fib longus/brevis tendon
Transverse Arch
-metatarsal heads
-cuboid, cuneiforms, metatarsals
-Supported by plantar fascia, fib previs, tibialis ant and post
Common MSK Disorders of Ankle/Foot
-Articular (OA, arthritis, subluxation, loose body)
-Ligamentous
-Muscular (strains, tendonitis, tenosynovitis)
-Soft tissue (compartment syndrome, fascitis)
-Nerve (impingement, neuroma)
Pronatory Foot Type Injuries
-plantar fascitis
-sesamoiditis
-interdigital neuroma
-shin-splints
-tarsal tunnel
Supinatoy Foot Type Injuries
-plantar fascitis
-sesamoiditis
-stress fracture
-IT band friction
-lateral ankle sprain
-Fibularis tendinitis
Ankle Sprain Research
-support manual therapy and manipulation
-exercise to reduce risk of recurrent
-functional treatment over immobilization
-Immobilize for <10 day
-RK: overweight
-Balance training
-PT better than home exercises
-Myofascial release not helpful
-Chronic ankle sprains have decreased postural control
-NO ULTRSOUND
-Measure: swelling, ROM, Talar, SL Balance
-Outcome Measures: Self-reports, pain, physical performance
CPR of Response to Thrust after Inv Ankle Sprain
- S/s worse when standing
- S/s worse in evening
- Navicular drop >5mm
- Distal tibiofibular joint hypo
3/5= 95%
Risk Factors Acute Lateral Ankle Sprain
-Pt age
-BMI
-pain coping strategies
-instability
-Hx of ankle sprain
-balance
-Ankle DF ROM
Risk Factors Chronic Ankle Instability
-Previous Hx
-pain level
-balance systems
-previous ankle sprains
-dynamic postural control
Ankle Fractures
-Ottawa ankle/foot rules
-(+) immobilization and clearance by MD
Compartment Syndrome
-tissue pressure increased by trauma
-muscle and nerve ischemia
S/s:
-swelling
-Pain
-no pulses
Tx:
-fasciotomy
-rest (for developing)
Achilles Tendinopathy
S/s:
-pain at junction, tendon, at bony insertion
Tx:
-eccentric loading
-heavy load, low speed
-stretching
-patient education
Posterior Tibialis Tendon Dysfunction
-degenerative and progressive condition
S/s:
Observation: loss of arch height, abduction
Mobility: limited and/or painful PF
Functional: abnormal gait, decreased push off, pain with WB or single leg balance
Strength: weak and painful SL heel raise, weakness with inversion and PF
Cuboid Subluxation
-almost always plantar subluxation
-lateral ankle sprain
-COG in front of midtarsals
-“i feel like there’s a rock in my shoe”
Tx:
-Cuboid Whip
-Cuboid Squeeze
Plantar Fascitis Common Interventions
Modalities: iontophoresis, CFM
Orthotics
Shoewear: cushioning for supinator, support for pronator
-night splints
-taping
-relative rest
-corticosteroids
-NO orthoses
PT Tx:
-Manual therapy
-Stretching
-Taping
-Night splints
-Exercise
-Dry needling
Hallux Rigidus
-trauma
-degenerative
Tx:
-mobilization
-rigid insert
-arthroplasty
