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MSK > Ankle/Foot Eval & Treat > Flashcards

Ankle/Foot Eval & Treat Flashcards

1
Q

Tibialis Posterior Action

A
  1. Plantarflexes
  2. Invert foot
  3. Supports medial longitudinal arch
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2
Q

Fibularis Brevis Action

A
  1. Eversion of subtalar joint
  2. Weakly plantarflexes
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3
Q

Fibularis Longus Action

A
  1. Eversion of subtalar joint
  2. Weakly plantarflexes
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4
Q

Tibialis Anterior Action

A
  1. Dorsiflexes ankle
  2. Weakly plantarflexes Subtalar joint
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5
Q

Talocrual Joint

A

-Talus and lower leg
-Narrow posterior surface
-Wide anterior Surface

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6
Q

Subtalar Joint

A

-Under talus
-Inversion and eversion
-hindfoot

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7
Q

Deltoid Lig

A

-medial rolled ankle ligaments
-limit eversion
-very stable

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8
Q

Lateral Ankle

A

-more commonly injured
-resist inversion

-Anterior Talofibular lig (most common)
-calcaneofibular lig
-Posterior talofibular lig

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9
Q

Tarsal Tunnel

A

-TDAVNH
-medial ankle
-under deltoid lig and flexor retinaculum

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10
Q

Ottawa Ankle and foot Fracture rules

A

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

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11
Q

High Ankle Sprain

A
  • at Tibiofibular syndesmosis
    -interosseous membrane
    -anterior talofibular lig

-during ER and DF

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12
Q

Rearfoot (hindfoot)

A

-talus
-calcaneus

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13
Q

Midfoot

A

-navicular
-cuboid
-cuneiform (mayb)

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14
Q

Forefoot

A

-metatarsals
-phalanges
maybe cuneiforms

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15
Q

Foot Motions

A

Talocrual: DF/PF
Subtalar: INV/EV and ABD/ADD
Toes: flx/ext

Pronation: DF/EV/abd
Supination: PF/IV/add

Hindfoot: Calcaneovalgus/Calcaneovarus

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16
Q

Proximal Tibiofibular Joint

A

-head of fib and posterolateal tib
-convex tiba and concave fibula
-functionally ankle, anatomically knee

-DF: pushes fib up and ER

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17
Q

Distal Tibiofibular Joint

A

-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

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18
Q

Mortise

A

-talus in socket of distal tibiofibular joint

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19
Q

Talocrural Joint

A

-synovial hinge joint
Convex talus on Convave mortise (open chain)

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20
Q

Dorsiflexion at Talocrural J

A

Open Chain: talus rolls anteriorly and glides posteriorly
Closed Chain: mortise rolls and glides anteriorly

-Closed packed position full DF

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21
Q

Plantarflexion at Talocrural J

A

Open Chain: talus rolls posteriorly and glides anteriorly
Closed Chain: mortise rolls and glides posteriorly

-Loose packed position 5-10deg

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22
Q

Talus Shape

A

-wider anteriorly (convex) than distally (concave)

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23
Q

Subtalar Joint

A

-Talus and calcaneus
-alternating convex/concave improves stability

Posterior: concave talus on convex calcaneus

Anterior: convex talus on concave calcaneus

24
Q

Subtalar Motion

A

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

25
Q

Subtalar Joint in Gait

A

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

26
Q

Midtarsal Joints

A

-talocalcaneonavicular, calcaneocuboid, cuboideonavicular

Resting Position: midway btwn pronation and sup
Closed Packed: Supination
Capsular Pattern: DF>PF>add>inversion

27
Q

Plantar Flexion Muscles

A

-Tibialis Post: sup, inv
-FDL and FHL: weak PF and sup and inv
-Plantaris

28
Q

Anterior Compartment Muscles

A

-DF
-Tib ant: DF, supination, inversion
-EHL: weak sup
-EDL: hindfoot pronator
-FIbularis tertius

29
Q

Pes Cavus

A

-high arch
-supinated
-decreased shock absortion
-ankle sprains common

30
Q

Pes Planus

A

-low arch
-decreaed rigid lever
-pronated
-hallux valgus

31
Q

Talocrual Capsular Pattern

A

-PF&raquo_space; DF
-DF more important functionally

32
Q

First Ray

A

-med cuneiform and 1st metatarsal

Pronation: PF, ABD, EV
Supination: DF, ADD< IN

33
Q

Fifth Ray

A

-5th metatarsal and cuboid

Pronation: DF, ABD, EV
Supination: PF, ADD< INV

34
Q

MTP Joints

A

-convex metatarsal head and concave proximal phalanx (same in open chain)
-need 65-70 in big toe for walking

35
Q

IP Joints

A

-convex proximal phalanx and concave distal

36
Q

Plantar Fascia

A

-non contracile

lateral: lat calcaneus to pinky
Medial: medial calcaneus to big toe
Central band: medial calcaneus to toe fat pads

37
Q

Tarsal Tunnel

A

-tibial nerve > medial and lateral plantar nerves

38
Q

Anterior Ankle Nerves

A

-deep peroneal/fibular nerve
-goes to between big and 2nd toe
-common site for retinaculum compression

39
Q

Lateral Ankle Nerves

A

-superficial peroneal/fibular
-can be stretched by ankle sprain

40
Q

Medial Longitudinal Arch

A

-calcaneus, talus, navicular, med cuniforms, metatarsals
-supported by tibialis posterior, flexor hallucis longus, flexor digitorum and plantar fascia

41
Q

Lateral Longitudinal Arch

A

-cuboid and metatarsals
-supported by fib longus/brevis tendon

42
Q

Transverse Arch

A

-metatarsal heads
-cuboid, cuneiforms, metatarsals
-Supported by plantar fascia, fib previs, tibialis ant and post

43
Q

Common MSK Disorders of Ankle/Foot

A

-Articular (OA, arthritis, subluxation, loose body)
-Ligamentous
-Muscular (strains, tendonitis, tenosynovitis)
-Soft tissue (compartment syndrome, fascitis)
-Nerve (impingement, neuroma)

44
Q

Pronatory Foot Type Injuries

A

-plantar fascitis
-sesamoiditis
-interdigital neuroma
-shin-splints
-tarsal tunnel

45
Q

Supinatoy Foot Type Injuries

A

-plantar fascitis
-sesamoiditis
-stress fracture
-IT band friction
-lateral ankle sprain
-Fibularis tendinitis

46
Q

Ankle Sprain Research

A

-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

47
Q

CPR of Response to Thrust after Inv Ankle Sprain

A
  1. S/s worse when standing
  2. S/s worse in evening
  3. Navicular drop >5mm
  4. Distal tibiofibular joint hypo

3/5= 95%

48
Q

Risk Factors Acute Lateral Ankle Sprain

A

-Pt age
-BMI
-pain coping strategies
-instability
-Hx of ankle sprain
-balance
-Ankle DF ROM

49
Q

Risk Factors Chronic Ankle Instability

A

-Previous Hx
-pain level
-balance systems
-previous ankle sprains
-dynamic postural control

50
Q

Ankle Fractures

A

-Ottawa ankle/foot rules
-(+) immobilization and clearance by MD

51
Q

Compartment Syndrome

A

-tissue pressure increased by trauma
-muscle and nerve ischemia

S/s:
-swelling
-Pain
-no pulses

Tx:
-fasciotomy
-rest (for developing)

52
Q

Achilles Tendinopathy

A

S/s:
-pain at junction, tendon, at bony insertion

Tx:
-eccentric loading
-heavy load, low speed
-stretching
-patient education

53
Q

Posterior Tibialis Tendon Dysfunction

A

-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

54
Q

Cuboid Subluxation

A

-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

55
Q

Plantar Fascitis Common Interventions

A

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

56
Q

Hallux Rigidus

A

-trauma
-degenerative

Tx:
-mobilization
-rigid insert
-arthroplasty

MSK (34 decks)

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