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PCM exam 1 > Ankle & Foot Exam > Flashcards

Ankle & Foot Exam Flashcards

1
Q

What are some things to look for in terms of general observation?

A
  • standing vs. seated vs. ambulating
  • asymmetry, varus/valgus
  • hyperpronation
    hypersupination
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2
Q

What are some key landmarks of the ankle/foot?

A
  • medial and lateral malleoli
  • navicular
  • cuneiforms (1-3)
  • deltoid ligament (primary stabilizer of medial ankle)
  • medial longitudinal arch (talus, navicular, cuneiforms 1-3, metatarsals 1-3)
  • posterior tibial artery pulse
  • calcaneus
  • cuboid
  • lateral longitudinal arch (calcaneus, cuboid, metatarsals 4-5)
  • anterior talofibular ligament
  • calcaneofibular ligament
  • posterior talofibular ligament
  • metatarsals/MTP joints
  • phalanges
  • transverse distal tarsal arch
  • dorsalis pedis pulse
  • plantar fascia
  • achilles tendon
  • posterior tibialis tendon, flexor digitorum longus, flexor hallucis longus - all pass thru tarsal tunnel
  • extensor hallucis longus tendon
  • extensor tendons
  • peroneus (fibularis) tendon
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3
Q

Capillary refill testing

A
  • compress digits between index and thumb to cause blanching - then release pressure and note time to regain color
  • normal is 3 seconds or less
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4
Q

Monofilament test

A
  • test is performed on the plantar aspect of foot
  • doctor asks patient to close their eyes
  • monofilament is placed on first and fourth pad of toes and at base of 1st, 3rd and 5th plantar MTP joints with enough pressure to cause slight bend of monofilament
  • if (+): if patient cannot feel monofilament
  • imp component of diabetic foot exam
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5
Q

ROM of ankle: dorsiflexion

A

15-20 deg

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6
Q

ROM of ankle: plantarflexion

A

50-65

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7
Q

ROM of ankle: subtalar inversion

A

20-30

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8
Q

ROM of ankle: subtalar eversion

A

10-20

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9
Q

ROM of ankle: metatarsophalangeal flexion and extension

A

N/A

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10
Q

ROM of ankle: forefoot adduction and abduction

A

N/A

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11
Q

ROM of ankle: pronation

A

dorsiflexion, abduction and eversion of calcaneus

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12
Q

ROM of ankle: supination

A
  • plantarflexion, adduction, inversion of calcaneus
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13
Q

What are the dorsiflexors and their innervation?

A 
tibialis anterior (primary) - deep peroneal n (L4/5) 
extensor hallucis longus - deep peroneal n (L5) 
extensor digitorum longus - deep peroneal n (L5)
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14
Q

What are the plantar flexors and their innervation?

A

gastrocnemius/soleus (primary) - tibial n (S1/2)
peroneus longus/brevis - superficial peroneal n (L5)
Flexor digitorum longus - tibial n (L5)
Tibialis posterior - tibial n (L5)

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15
Q

What is the reflex at the ankle?

A

Achilles tendon - S1

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16
Q

What are the spinal contributions to the dermatomes of the ankle/foot?

A

L4,5,S1

17
Q

Anterior drawer test

A
  • Doc grasps posterior calcaneus with one hand and cups 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
  • if (+): pain, no springing, excessive motion
  • indicates anterior/laxity - ATF ligament pathology/tear
18
Q

Talar tilt test

A
  • doc grasps distal tibia/fibula with one hand and the inferior calcaneus with the other, blocking motion of the calcaneus on the talus
  • invert the talus to evaluate ROM
  • if (+): laxity, increased ROM or pain
  • indicates calcaneofibular ligament pathology/tear and some ATFL
19
Q

Eversion test

A
  • Doc grasps distal tibia/fibula with one hand and grasps the
    midfoot from the plantar surface of the foot with the other hand.
  • Doc everts the foot to evaluate ROM.
  • if (+): laxity, increased ROM or pain
  • indicates deltoid ligament pathology
20
Q

Squeeze test

A
  • for high ankle sprain
  • Doc wraps hands around leg proximal to the ankle, contacting the distal tibia/fibula with both thenar eminences.
  • Squeeze for 2-3 seconds then rapidly release.
  • if (+): pain at syndesmosis
  • indicates syndesmosis pathology
21
Q

Cross leg test

A
  • for evaluation of high ankle sprain
  • patient seated
  • patient crosses affected leg over opp knee
  • patient then applies pressure to proximal fibula of affected leg
  • if (+): pain at distal ankle
  • indicates syndesmosis injury
22
Q

Thompson test

A
  • patient prone with foot off the table
  • doc squeezes calf
  • if (+): absence of plantar flexion
  • indicates achilles tendon rupture
23
Q

Homan’s sign

A
  • Indicates thrombophlebitis or acute venous thrombosis
  • pt laying or seated with knee extended
  • doc dorsiflexes foot (sometimes add lateral compression of calf as well)
  • if (+): pain with dorsiflexion
  • indicates venous thrombosis in presence of edema, erythema, and increased warmth of skin of lower leg
  • need to get a venous doppler to rule out clot
24
Q

Moses sign

A
  • indicates deep vein thrombosis of posterior tibial veins
  • pt seated or supine
  • physician induces an anterior compression on the gastrocnemius mm into the posterior aspect of the tibia (compresses the calf towards the tibia)
  • if (+): pain with anterior compression (NOT lateral compression)
25
Q

Inversion ankle sprain (lateral sprains)

A
  • Accounts for 80-85% of all ankle sprains
  • Ankle inversion with plantar flexion
  • Ligaments Involved:
  • Anterior talofibular (ATF=always tears first)
  • Calaneofibular
  • Posterior talofibular
  • Swelling and ecchymosis over involved area
26
Q

High ankle sprain

A
  • Accounts for 10% of all ankle sprains
  • Ankle Eversion and rotation (some dorsiflexion)
  • Ligaments Involved:
  • Anterior Inferior tibiofibular
  • Syndesmosis
  • Pain more common on medial aspect with minimal swelling
  • Pain worse with weight bearing
27
Q

Plantar fasciitis

A
  • Inflammation of origin of plantar aponeurosis
  • Worse with first steps, improves through day
  • Pt will complain pain is worst when they get out of bed in morning
  • Point tenderness of calcaneous
  • Causes: tight calves, repetitive impact activities, high arches, obesity,
    new/changes in activities
  • You already know a way to treat this!!
28
Q

Morton’s neuroma

A
  • Inflammation and thickening of tissue that surrounds the nerve
    between toes.
  • Most commonly between 3rd and 4th toes.
  • Patient reports feeling like they are walking on a marble
  • Palpable in web space, which will replicate pain
29
Q

Turf toe

A
  • Inflammation and Pain at base of 1st MTP
  • Presents as pain and bruising at base of great toe
  • Caused by hyperextension of great toe causing damage to the joint
    capsule.
  • Severe cases can damage sesamoids and flexor tendon
  • Common due to activities performed on hard surface
30
Q

Achilles tendonitis

A
  • Inflammation at Achilles tendon
  • Presents as sharp heel pain and stiffness at mid-achilles tendon to
    insertion
  • Worse with strenuous exercising, better with walking
  • Micro tears in tendon causes swelling and thickening
  • Causes: tight calf muscles, sudden change in activity, poorly fitting
    shoes, incorrect running technique

PCM exam 1 (7 decks)

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