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OS Final. 100 or bust! > Ankle/Foot -OSCE 10 > Flashcards

Ankle/Foot -OSCE 10 Flashcards

1
Q

Point out these bones on your foot

A
  1. Talus
  2. Calcaneus
  3. Navicular
  4. Cuboid
  5. Cuneiforms (1-3)
  6. Metatarsophalangeal joints
  7. Base of the 5th metatarsal
  8. Phalanges
  9. Medial Malleolus (Tibia)
  10. Lateral Malleolus (fibula)
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2
Q

Bones of Medial Longitudinal Arch?

A
  1. Calcaneus
  2. Talus
  3. Navicular
  4. Cuneiforms 1-3
  5. Metatarsal 1-3 (higher arch)
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3
Q

Bones of Lateral Longitudinal Arch?

A
  1. Calcaneus
  2. Talus
  3. Cuboid
  4. 4th and 5th metatarsal bones (lower arch)
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4
Q

Bones of Transverse tarsal arch?

A
  1. Navicular
  2. Cuboid
  3. Cuneiforms 1-3
  4. Proximal Metatarsals
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5
Q

Bones of Metatarsal Arch

A
  1. Metatarsal Heads
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6
Q

Ligaments: High ankle sprain

A
  1. Interosseous membrane
  2. Ant. Inf. tibiofibular ligament
  3. Test = Squeeze Test
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7
Q

Ligaments: Ankle Sprain

A
  1. Anterior talofibular L.

Dat shit allllllwayz tears first #weak

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8
Q

Ligaments: Involved in inversion

A
  1. Calcaneofibular Ligament

2. Talar Tilt Test

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9
Q

Ligaments: Eversion

A
  1. Deltoid L.

2. Talar tilt test

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10
Q

Ligaments: Achilles Tendon Evaluation

A
  1. Thompson test
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11
Q

Ankle Dysfunction: Anterior Tibia on Talus: Motions?

A

Freedom: Ankle prefers dorsiflexion and anterior glide

Restriction: Tibia restricted to post glide on talus

Due to distal tibia mechanics

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12
Q

Ankle Dysfunction: Post tibia on talus

Motions?

A

Freedom: ankle prefers plantar flexion and post glide

Restriction: Tibia restricted in gliding anteriorly on talus

Due to distal tibia mechanics changes

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13
Q

Ankle Dysfunction: Ant. Lateral Malleolus

Motions

A

Freedom: Lateral malleolus has free ant. glide relative to distal tibia

Restriction: Lat Malleolus restricted to post glide

Distal Medial border of talus is more prominent

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14
Q

Ankle Dysfunction: Post lat malleolus

A

Freedom: Lat mall moves post relative to distal tibia

Restriction: Lat can’t move ant.

-Ant portion of Lat mall displaced laterally

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15
Q

Foot Dysfunction: Dorsiflexed Talus dysfunction

Dorsi ROM? Motions?

A
  1. ROM = 15-20
  2. Freedom: Talus likes dorsiflex
    Restriction: Plantarflex
    Talus mechanics to blame
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16
Q

Foot Dysfunction: Plantarflexed talus dysfunction

Plantar ROM? Motions?

A
  1. ROM = 50-65
  2. Freedom = plantar
    Restriction = Dorsi
    Talus mechanics problem
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17
Q

Foot Dysfunction: Inversion calcaneus dysfunction

Expected Inversion ROM? Motions/Test?

A
  1. 5 deg
  2. Test: Grasp calcaneus in 1 hand, lock out talus motion w/other. Note deg of moteion
  3. Freedom: Inversion
    Restriction Eversion

Subtalar Problem

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18
Q

Foot Dysfunction: Eversion calcaneus dysfuntion

Expected Eversion ROM? Motions/Tests?

A
  1. 5 deg
  2. Freedom: Eversion
    restriction: Inversion

Subtalar problem

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19
Q

Foot Dysfunction: Plantar Navicular dysfunction

What happens to navicular bone?

A
  1. Most common dysfunction (plantar) of Navicular bone

2. Lateral Navicular drops plantar

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20
Q

Foot Dysfunction: Plantar Navicular dysfunction

How to test? Motions?

A
  1. Lock out calcaneus w/one hand
  2. Grasp Navicular btw thumb and forefinger (glide dorsally and ventrally)
  3. Freedom: Plantar
    Restriction: Dorsal
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21
Q

Foot Dysfunction: Plantar Cuboid dysfunction

What happens to Cuboid

A
  1. Medial Cuboid drops plantar

2. Most common dysfunction (plantar) of cuboid

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22
Q

Foot Dysfunction: Plantar Cuboid dysfunction

Test? Motion?

A
  1. Lockout calcaneous
  2. Grasp Cuboid and move up and down
  3. Freedom: Plantar
    Restriction Dorsi
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23
Q

Foot Dysfunction: Plantar Cuboid dysfunction

Often associated with…?

A

Posterior Fibular head dysfunction

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24
Q

Foot Dysfunction: Plantar Cuneiform dysfunction

A
  1. Most common Cuneiform problem
  2. Grasp and lockout at navicular then move cuneiforms up and down noting restrictions
  3. Freedom: plantar glide
    Restriction to Dorsi glide
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25
Foot Dysfunction: Metatarsal dysfunction | What causes problem?
Change in Metatarsal Head mechanics
26
Foot Dysfunction: Metatarsal dysfunction | Test?
Grasp adjacent metatarsal heads and glide plantar and dorsal relative to one another noting ease/restriction
27
ROM: Dorsiflexion
15-20
28
ROM: Plantarflexion
50-60
29
ROM: Ankle inversion (no lock)
35
30
ROM: Ankle eversion (no lock)
20
31
ROM: Subtalar inversion (talus lock)
5
32
ROM: Subtalar eversion (talus lock)
5
33
ROM: Forefoot ADduction
20
34
ROM: Forefoot ABduction
10
35
ROM: 1st Metatarsophalangeal flexion
45
36
ROM: 1st Metatarsophalangeal extension
70-90
37
ME Dorsiflexed Talus: | Patient position?
Supine
38
ME Dorsiflexed Talus: | How doe doc set uPPPPP?
1. Grab ankle at level of Malleoli 2. Other hand over dorsum of foot 3. Plantar flex that shit
39
ME Dorsiflexed Talus: | Patient force?
Dorsiflexion force (15-20 deg)
40
ME provides what type of resistance?
ISOmetric (like a lonely european)
41
ME when do we stop??
When no new barriers are met. (there are always barriers in live mannn never quit)
42
ME Plantarflexed Talus: | Patient position
Supine so fine
43
ME Plantarflexed Talus: what that doc doin?
1. grab ankle at malleoli level 2. other hand on plantar survace 3. dorsiflex that shit
44
ME Plantarflexed Talus: | Patient force
PUT the mEtAL to DA flooooooooor! -Isometric resistance 3-5 sec then isometric relaxation
45
Myofascial Release- Ankle or foot: What is Direct vs indirect
1. Direct MFR: Force into barrier until tissue creep. Associated with da viscoelastic properties (like a flexible disco) 2. Indirect MFR: Force away. Dr. needs the ultimate concentration to accomplish this proprioceptive task that ends in tissue relaxation
46
HVLA Post Tibia on Talus: | Restriction?
1. Restricted to Ant. Glide | 2. Ankle prefers plantarflexion
47
HVLA Post Tibia on Talus: | Pt position?
Supine all mine
48
HVLA Post Tibia on Talus: | Doc setup?
1. Wrap hands around foot w/fingers interlaced on dorsum 2. Thumbs over ball of foot (choke the ball of foot) 3. Dorsiflex at the ankle
49
HVLA Post Tibia on Talus: | Movement?
1. Apply traction and increase dorsiflexion of foot | 2. Apply hvla AXIAL tug
50
HVLA Ant. Tibia on Talus: | Motions?
1. Restricted to post glide | 2. Ankle likes dorsiflextion
51
HVLA Ant. Tibia on Talus: | Doc Setup?
1. Doc cups calcaneus 2. Other hand over distal tibia 3. Distract caudally
52
HVLA Ant. Tibia on Talus: | hvla force?
1. Thrust posterior on distal tib/fib | 2. Axial tug on calcaneus
53
HVLA Post Lat Malleolus: | Patient Position?
Prone
54
HVLA Post Lat Malleolus: | Doc position?
At the foot of the table
55
HVLA Post Lat Malleolus: | Doc Set up?
1. ipsilateral hand of dysfunctional foot wraps dorsal foot 2. Plantar flex dat shit 3. Thumb of lateral hand contact the posterior aspect of distal fibula with thumb of opposite hand on top
56
HVLA Post Lat Malleolus: | Force?
Anterior force with thumbs
57
HVLA Ant Lat Malleolus: | Pt position?
Supine
58
HVLA Ant Lat Malleolus: | Doc position?
At foot of table
59
HVLA Ant Lat Malleolus: | Doc set up?
1. wraps fingers around calcaneus 2. Dorsiflex dat shiiiiiiit do it 3. Thumbs of lateral hand contact anterior aspect of distal fib. Thumb of other hand on top.
60
HVLA Ant Lat Malleolus: | Force?
Force is posterior
61
HVLA Plantar flexed Talus: | Pt position?
Supine
62
HVLA Plantar flexed Talus: | Doc Setup?
1. Interlock fingers and grasp dorsum of foot (4th or 5th digit of both hands should contact talus) 2. Thumbs on ball of foot 3. Dorsiflex at the ankle yo
63
HVLA Plantar flexed Talus: | Force?
1. Apply traction (may add slight eversion) | 2. HVLA tug to re-seat talus in the mortise of the ankle
64
HVLA Plantar flexed Talus: | Where does the Talus reset to?
The mortise (aka the tortise) of the ankle.
65
HVLA Dorsiflexed Talus: | Patient position?
Supine`
66
HVLA Dorsiflexed Talus: | Doc Setup?
1. Interlock fingers over dorsum of foot 2. Thumbs on ball of foot 3. Plantar flex at ankle
67
HVLA Dorsiflexed Talus: | Force?
1. Apply traction (slight INVERSION) | 2. HVLA tug to re-seat in mortise of ankle
68
HVLA Eversion-Inversion Calcaneus "Ankle Tug": | Pt position?
Supine
69
HVLA Eversion-Inversion Calcaneus "Ankle Tug": Doctor Position?
Foot of table
70
HVLA Eversion-Inversion Calcaneus "Ankle Tug": | Doc setup?
1. Contact calcaneus w/one hand | 2. Other hand contacts dorsum of foot in mid-tarsal region
71
HVLA Eversion-Inversion Calcaneus "Ankle Tug": | Force?
Distract and thrust in linear direction
72
Plantar Metatarsal: | Pt position?
Supine
73
Plantar Metatarsal: | Doc setup?
1. Grasp both sides of metatarsal phalangeal joint | 2. Engage restrictive barrier and distract
74
Plantar Metatarsal: | Force?
Apply hyperflexion HVLA thrust
75
Transtarsal thrust of navicular-cuboid: | Pt position?
1. supine 2. Ipsilateral extremity slightly flexed, externally rotated and ABducted 3. Lateral aspect of foot is flat on table
76
Transtarsal thrust of navicular-cuboid: | Doc setup?
1. Contact calcaneus w/one hand (hind-foot) 2. Contact Talus and 1st metatarsal/first cuneiform/navicular (mid-foot/fore-foot) w/other hand 3. For cuboid: INVERT the fore-foot/mid-foot into barrier 4. For Navicular: EVERT the fore-foot/mid-foot into barrier
77
Transtarsal thrust of navicular-cuboid: | Force?
Thrust cuboid (Inversion) Thrust navicular (Eversion)
78
Hiss-Whip: | When to apply technique?
Any of the plantar tarsal dysfunctions
79
Hiss-Whip: | Pt position?
Prone
80
Hiss-Whip: | Doc setup?
1. Flex hip and knee slightly and drop patient's leg off side of table 2. Grasp foot with both hands and place thumbs in "V" shape over plantar surface of affected tarsal 3. Plantar-flex ankle and induce dorsal force on dysfunctional tarsal
81
Hiss-Whip: | Force?
Thrust dorsally w/thumbs in a whip-like manner
82
Ankle Dorsiflexion Test: | What does it do?
Helps determine which muscle may be cause of restriction to dorsiflexion
83
Ankle Dorsiflexion Test: | What are the two muscles involved?
Soleus and Gastrocnemius`
84
Ankle Dorsiflexion Test: | Test
1. Have patient sit w/knee flexed 90 | 2. Have Pt dorsiflex ankle
85
Ankle Dorsiflexion Test: | If they can dorsiflex
Gastrocnemius problem
86
Ankle Dorsiflexion Test: | If they can't Dorsiflex
Soleus Problem
87
Ankle Dorsiflexion Test: | Which muscle crosses 2 joints?
Gastrocnemius
88
Ankle Drawer sign: | What is the purpose?
Determine integrity of ATF | first to tear inversion sprain
89
Ankle Drawer sign: | Doc setup?
1. Doc grasps distal tib/fib w/one hand 2. Doc uses other hand to cup posterior aspect of calcaneus 3. Anterior force on post. calcaneus
90
Ankle Drawer sign: | Results?
Normal: talus moves ant. w/slight medial rotation followed by spring-back Abnormal is NO spring-back
91
Homan's sign: | What is the point?
Indicates thrombophlebitis or acute venous thrombosis
92
Homan's sign: | Doc setup and test?
1. Doc grasps calf of affected leg and squeezes while dorsiflexing ankle
93
Homan's sign: | Results?
+ = pain Indicative of venous thrombosis
94
Homan's sign: | Additional concerns
1. Venous doppler needed to rule out a clot | 2. Pt at risk for other stuff`
95
Moses Sign: | What is the point?
Indicate DVT of posterior tibial veins
96
Moses Sign: | Pt position?
seated or supine
97
Moses Sign: | Test
1. Doc induces anterior compression on gastrocnemius M.
98
Moses Sign: | Results.
+ = Pain on ant. compression
99
Squeeze Test: | What is the point?
Looking for high ankle sprain/interosseous membrane tear
100
Squeeze Test: | + test?
Pain on lateral ankle
101
Squeeze Test: | What causes this injury?
Dorsiflexion and eversion of the foot
102
Talar Tilt Test: | What is the point?
Determines integrity of the calcaneofibular ligament
103
Talar Tilt Test: | + test
If when inverting the talus gaps and rocks in the ankle mortice, then ligament is damaged
104
Talar Tilt Test: | + test in eversion checks?
Checks the deltoid ligament
105
Thompson Test: | What is the point?
Tests integrity of Achilles tendon
106
Thompson Test: | Pt position?
Prone, ankle off table
107
Thompson Test: | + Test?
No plantar flexion on gastroc squeeze = complete tear of Achilles

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