Ankle/Foot Mobility Deficits Flashcards
With these patients, what may you find in the history?
- Insidious onset or prior trauma
-Rotational injury - Limited motion, stiffness, and pain
- Gradually worsening
With these patients, what will you find during the Physical Examination?
- Limited A/PROM
- Hypomobility
- Abnormal pronation/supination foot posture
- Muscle performance (Strength/endurance/power)
What are some areas that a person can get OA in the Foot/Ankle?
- Ankle
- Midfoot
-2nd Cuneform-Metatarsal
-Talo-navicular
-Naviculo-cuneiform
-1st cuneiform-metatarsal - Forefoot
-1 MTP
When considering Ankle/Foot OA, what should we rule out?
- Red Flags
- Sx from neighboring body regions
-Lumbar P! with radiating p!
-Hip and knee
-Neurologic (SLR/Slump Test)
What are significant Exam findings we will see with Ankle/Foot OA?
- Transient Morning stiffness
- Pain worse at beginning and end of physical activity
- AROM = PROM
- Hypomobility w/ crepitus/grinding with joint mobility test
-Hard End-feel - (+) Grind Test
What is Tarsal Coalition?
An Autosomal Dominant trait disorder, that results in the congenital fusion of 2 or more bones in the hind or mid foot
- Most Common
-Calcaneonavicular and Talocalcaneal Coalition
What are the Risk Factors of Tarsal Coalition?
- Male
- Age
-8-12 Calcaneonavicular coalition
-12-16 talocalaneal coalition
Those patient with tarsal coalition, what may we hear in the history?
- Vague pain
-Mid/Hind foot - Hx of Ankle sprains
- Activities of Athletic training
Those patient with tarsal coalition, what may we find in ROM Testing?
- A/PROM limited (especially to the affected articulations)
Those patient with tarsal coalition, what may we find in Joint Integrity Testing?
Hypomobility or Fusion (Hard end-feel)
What is Hallux Limitus/Rigidus? What is the difference between them?
A degenerative disorder resulting in loss of sagittal plane ROM, in particular DF
- Hallux Limitus = Chronic Hypomobility
- Hallus Rigidus = Auto-fusion of 1st MTP
@ least 45-60° extension needed for gait
What are the Risk Factors for Hallux Limitus/Rigidus?
- Abnormal pronated foot posture
- 1st ray hypomobility
- Family hx
- Obesity
- Improper footwear
With those patients with Hallux Limitus/Rigidus what are may we find during the exam?
- Decreased P! motion of 1st MTP
-Decreased tolderance to wearing constrictive footwear and performing heel raises - Reports of swelling, pain with walking/running uphill, climbing stairs, during gait push off
With those patients with Hallux Limitus/Rigidus what are some Key Findings during the Examination?
- Limited and painful 1st MTP ROM
- Decreased accessory mobility of 1 ray
- Painful palpation of osteophytes on dorsal aspect of 1st MTP
For Special Test
- Axial Grind test for articular cartilage involvement
What is Hallux Valgus?
This is a deformity of the 1st Metatarsophalangeal joint
- This results in medial deviation of the 1st metatarsal, with simultaneou lateral deviation of the proximal phalanx
What are the Prevalence/Risk factors for Hallux Valgus?
Prevalence
- Women > Men
- Women ages 18 - < 65
Risk Factors
- Obesity
- Tight foot wear/high heels
Individuals with Hallus Valgus tend to develop what?
A Bunion on the medial side of the first MTP jont
Those patient with Hallux Valgus, what are common findings during the examination?
Posture
- Abnormal pronated foot posture
- Great toe valgus deformity
- bunion
ROM
- Limited 1st MTP
- Limited ankle DF
Joint integrity/mobility test
- 1st MTP hypomobile
- Midfoot and rearfoot limitations
What is Hammer Toe?
When there is Mild Extension of the MTP and Hyperflexion of the PIP
What is Mallet Toe?
When there is Normal MTP and PIP; Hyperflexion of DIP
What is Claw Toe?
When there is Hyperextension of MTP; Hyperflexion of PIP and DIP
With Mobility Deficity, what are Intervention Strategies?
Manual Therapy:
- Joint mobs
Theraeutic Exercise
- Stretching, strength, endurance, power
- Address abnormal foot posture
Adaptive and assistive technology
- Taping/orthotics/bracing
-Promote normal foot posture
-Reduce stress to affected area
