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DPT 691 - MSK II > Ankle & Foot - Evaluation > Flashcards

Ankle & Foot - Evaluation Flashcards

1
Q

Four ankle red flags = ?

Ankle & Foot Evaluation

A

a) Fractures

  • Ankle fractures, midfoot, fifth metatarsal, stress fractures of the foot, fibular fractures show variability in symptoms that may mimic sprains or other milder pathologies
    Was their trauma.

b) Compartmental Syndrome:

  • Increased pressure in muscles that can lead to loss of blood flow to nerves and muscles seen in runners.

c) DVT:

  • Well’s criteria

d) Infections:

  • Cellulitis, septic arthritis, wound/puncture to the foot
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2
Q

Ottawa Ankle Rules

X ray required IF = ?

Ankle & Foot Evaluation

A

Ottawa Ankle Rules - Rule out a fracture:

- Lateral Ankle - X ray required IF:

  • Pain anterior aspect of medial or lateral malleolus.
  • Bone tenderness at posterior aspect of medial malleolus.
  • Inability to bear weight after injury or in ER (take 4 steps)
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3
Q

Ottawa Ankle Rules

A foot series is indicated IF = ?

Ankle & Foot Evaluation

A

Ottawa Ankle Rules - Rule out a fracture:

- A foot series is indicated IF:

  • Any pain at dorsal medial and lateral aspect of the mid-foot.
  • Bone tenderness at the base of the 5th metatarsal.
  • Bone tenderness at navicular.
  • Inability to bear weight after injury or in ER (take 4 steps)
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4
Q

ROM

DF = ?

Ankle & Foot Evaluation

A

ROM:

  • DF = 0-20d
  • PF = 0-50d
  • Inversion = 0-35d
  • Eversion = 0-20d
  • Great Toe Ext = 70d
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5
Q

ROM

PF = ?

Ankle & Foot Evaluation

A

ROM:

  • DF = 0-20d
  • PF = 0-50d
  • Inversion = 0-35d
  • Eversion = 0-20d
  • Great Toe Ext = 70d
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6
Q

ROM

Inversion = ?

Ankle & Foot Evaluation

A

ROM:

  • DF = 0-20d
  • PF = 0-50d
  • Inversion = 0-35d
  • Eversion = 0-20d
  • Great Toe Ext = 70d
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7
Q

ROM

Eversion = ?

Ankle & Foot Evaluation

A

ROM:

  • DF = 0-20d
  • PF = 0-50d
  • Inversion = 0-35d
  • Eversion = 0-20d
  • Great Toe Ext = 70d
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8
Q

ROM

Great Toe Ext = ?

Ankle & Foot Evaluation

A

ROM:

  • DF = 0-20d
  • PF = 0-50d
  • Inversion = 0-35d
  • Eversion = 0-20d
  • Great Toe Ext = 70d
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9
Q

Measuring Closed Chain Dorsiflexion

Normative value = ?

degrees

Ankle & Foot Evaluation

A

Measuring Closed Chain Dorsiflexion:

  • Normative number = 35-40d
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10
Q

Functional Closed Chain DF assessment…

Toes in tandem stance… the back knee should clear the lead leg malleous if the ankle has _ ? _ DF.

Ankle & Foot Evaluation

A

Functional Closed Chain DF assessment (Two options):

1) Normative value is patient should be able to touch the wall with the knee with the foot 1 hand width away from the wall.

2) Toes in tandem stance with lead foot toes against the wall. Elbows flexed to 90d with fist against the wall. Bend back knee as far as possible without the heel lifting off.

  • Back knee should clear the lead leg malleous if the ankle has 40d DF.

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11
Q

What are the indicators of fractures that are red flags in ankle and foot evaluations?

Ankle & Foot Evaluation

A
  • Presence of trauma
  • Inability to bear weight
  • Significant pain on boney structures
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12
Q

What is compartment syndrome and why is it a red flag?

Ankle & Foot Evaluation

A

Increased pressure in muscle compartments leading to potential loss of blood flow to nerves and muscles, indicating serious pathology.

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13
Q

What symptoms indicate DVT in the ankle and foot evaluation?

Ankle & Foot Evaluation

A

Use Well’s criteria to screen for DVT, looking for pain and swelling as key indicators.

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14
Q

Red Flag

Cellulitis, septic arthritis, or presence of wound/puncture suggest = ?

Ankle & Foot Evaluation

A

Infection

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15
Q

What are the general considerations for red flags in foot and ankle therapy suitability ?

Ankle & Foot Evaluation

A

Check for …. before proceeding with therapy

  • Fractures
  • Compartment syndrome
  • DVT
  • Infections
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16
Q

What are the Ottawa Ankle Rules for determining the need for an X-ray of the ankle?

Ankle & Foot Evaluation

A
  • Pain near malleoli
  • Inability to bear weight immediately post-injury or in ER
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17
Q

What are the Ottawa Ankle Rules for determining the need for a foot X-ray?

Ankle & Foot Evaluation

A
  • Pain at dorsal medial and lateral aspects of the mid-foot
  • Bone tenderness at the base of 5th metatarsal or navicular
  • Inability to bear weight
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18
Q

What is the normal range for dorsiflexion in ankle evaluation?

Ankle & Foot Evaluation

A

0-20 degrees

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19
Q

What is the normal range for plantarflexion in ankle evaluation?

Ankle & Foot Evaluation

A

0-50 degrees

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20
Q

What is the normal range for inversion in ankle evaluation?

Ankle & Foot Evaluation

A

0-35 degrees

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21
Q

What is the normal range for eversion in ankle evaluation?

Ankle & Foot Evaluation

A

0-20 degrees

22
Q

How is closed chain dorsiflexion measured and what are the normative values?

Ankle & Foot Evaluation

A
  • Measured with tape measure or inclinometer during a weight-bearing lunge
  • 35-40 degrees is normative.
23
Q

Describe the proprioception screening technique for ankle evaluation.

Ankle & Foot Evaluation

A

Eyes open for 10 seconds, then eyes closed for 10 seconds.

24
Q

What does neuromuscular screening involve in ankle evaluations?

Ankle & Foot Evaluation

A
  • MMT
  • Reflexes
  • Sensory testing
  • Neuro-tension exams (Slump & STLR)
25
Q

What does the Tuning Fork test check for in ankle evaluations?

Ankle & Foot Evaluation

A

Used to test for stress fractures, particularly fibular stress fractures.

26
Q

What does the Anterior Drawer Test assess in ankle evaluations?

Ankle & Foot Evaluation

A

Assesses the integrity of the anterior talofibular ligament.

27
Q

What is the Talar Tilt Test used for in ankle evaluations?

Ankle & Foot Evaluation

A

Used to assess calcaneofibular ligament integrity by tilting the talus in the ankle joint.

28
Q

Describe a special test used for diagnosing syndesmotic ankle sprains.

Ankle & Foot Evaluation

A

Syndesmotic stabilization (Taping test), positive if pain or instability is relieved with taping.

29
Q

How is swelling observed and measured in ankle evaluations?

Ankle & Foot Evaluation

A

Girth measurement using the Figure 8 method around the medial and lateral malleolus.

30
Q

What basic observations should be made regarding foot structure in an ankle evaluation?

Ankle & Foot Evaluation

A

Observe for swelling, loss of foot arches, and overall alignment of the foot.

31
Q

How is the Girth Measurement performed for assessing ankle swelling?

Ankle & Foot Evaluation

A

Use tape to measure around both the medial and lateral malleoli, under the foot, starting and ending at the midpoint of the anterior aspect of the ankle.

32
Q

How is the arch assessment performed using Navicular Height and Feiss Line?

Ankle & Foot Evaluation

A
  • Draw a line from the first metatarsal head to a point on the Achilles at the same height as the center of the medial malleolus.
  • A line intersecting the navicular tubercle indicates normal arch; above indicates pes cavus, below indicates pes planus.
33
Q

What are the special tests used for diagnosing Achilles tendinopathy?

Ankle & Foot Evaluation

A

Royal London Hospital Special Test, and Heel Raise Special Test.

34
Q

How is the Windlass Mechanism Test performed for diagnosing Plantar Fasciitis?

Ankle & Foot Evaluation

A

Patient extends the big toe while standing with toe over the edge of a table; positive if pain is reproduced at the plantar fascia insertion.

35
Q

How is Tinel’s Sign used to diagnose Tarsal Tunnel Syndrome?

Ankle & Foot Evaluation

A

Tapping over the posterior tibial nerve to elicit pain or tingling along the nerve’s distribution, indicating nerve compression.

36
Q

Describe the Functional Hallux Limitus Test.

Ankle & Foot Evaluation

A

Non-weight bearing test where the examiner DF’s the proximal phalanx of the great toe and observes for limited movement or immediate PF of the first ray.

37
Q

What general strategies are suggested for clinical intervention post ankle and foot evaluation?

Ankle & Foot Evaluation

A

Based on specific diagnosis, interventions might include exercises, taping, manual therapy, and modalities to manage symptoms and improve function.

38
Q

What diagnostic tools are highlighted for use in ankle and foot evaluation?

Ankle & Foot Evaluation

A

Goniometer, tape measure, and inclinometer are noted for their high reliability in measuring ROM and swelling.

39
Q

Describe the special test used for diagnosing an Achilles rupture.

Ankle & Foot Evaluation

A

The test involves observing for the absence of plantar flexion when squeezing the calf muscles, commonly known as the Thompson Test.

40
Q

What tests are used to diagnose Morton’s Neuroma?

Ankle & Foot Evaluation

A

Foot squeeze test and web space tenderness examination to detect irritation or enlargement of the nerves between the toes.

41
Q

When measuring closed chain dorsiflexion with a tape measure or inclinometer, which had a high reliability?

  • A ) Goniometer
  • B ) Tape measure
  • C ) Inclinometer
  • D ) All the above

Ankle & Foot Evaluation

A

When measuring closed chain dorsiflexion with a tape measure or inclinometer, which had a high reliability?

  • A ) Goniometer
  • B ) Tape measure
  • C ) Inclinometer
  • D ) All the above
42
Q

Functional Hallux Limitus Test

  • Grade 0 = Dorsiflexion _ ? _ degrees
  • Grade I = _ ? _ degrees of dorsiflexion
  • Grade II: _ ? _ degrees of dorsiflexion
  • Grade III: Dorsiflexion _ ? _ degrees

Ankle & Foot Evaluation

A

Functional Hallux Limitus Test & Test for Turf Toe:

  • Grade 0: Dorsiflexion 40-60 degrees
  • Grade I: 30-40 degrees of dorsiflexion
  • Grade II: 10-30 degrees of dorsiflexion
  • Grade III: Dorsiflexion 0-10 degrees
43
Q

Triple compression special test is used to diagnose = ?

BONUS: This stress what nerve?

Ankle & Foot Evaluation

A

The triple compression stress test (TCST) is a test that puts stress on the posterior tibial nerve and its branches to diagnose tarsal tunnel syndrome (TTS).

44
Q

Dorsiflexion eversion test is used to assess = ?

Ankle & Foot Evaluation

A

Tarsal Tunnel Syndrome Special Test - Posterior Tibial Nerve:

  • Pain seems to be more sensitive than numbness as a positive test
45
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DPT 691 - MSK II (20 decks)

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