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DPT 616 : MSK > Ankle Lecture > Flashcards

Ankle Lecture Flashcards

1
Q

when is the foot a mobile adapter?

A

at heel strike

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2
Q

when is the foot a rigid lever?

A

at push off

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3
Q

what makes up the rearfoot?

A

the talus and calcaneous

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4
Q

what makes up the midfoot?

A

navicular, cuneiforms, cuboid

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5
Q

what makes up the forefoot?

A

metatarsals and phalanges

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6
Q

what are the axes of the talocrural jt?

A

14 deg inferior to the transverse plane

23 deg posterior to the frontal plane

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7
Q

what is the “true ankle jt”?

A

talocrural jt

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8
Q

what are the actions of the talocrural jt?

A

DF and PF

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9
Q

how much DF is available at the talocrural jt?

A

26 deg

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10
Q

how much PF is available at the talocrural jt?

A

48 deg

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11
Q

what are the 3 articulations of the subtalar jt?

A

anterior, middle, and posterior talocalcaneal articulations

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12
Q

what structures divides the subtalar jt?

A

tarsal tunnel

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13
Q

what are the main motions of the subtalar jt?

A

inversion and eversion?

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14
Q

what are the axes of the subtalar jt?

A

42 deg superior to the transverse plane

16 deg medial to the sagittal plane

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15
Q

what is the mitered hinge of the ankle?

A

when the tibia moves in the transverse plane, the foot moves in the frontal plane

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16
Q

when the tibia moves into IR, what does the foot and femur do?

A

the foot goes into pronation

the femur goes into IR

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17
Q

when the tibia moves into ER, what does the foot and femur do?

A

the foot goes into supination

the femur goes into ER

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18
Q

what is the main motion of the talonavicular jt of the midtarsal jt?

A

PF/DF

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19
Q

what are the two articulations of the midtarsal jt?

A

the talonavicular jt

the calcaneocuboid jt

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20
Q

when the axes of the midtarsal jt are crossed, is it more stiff or more loose?

A

stiffer

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21
Q

when the axes of the midtarsal jt are parallel, is it more stiff or more loose?

A

looser

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22
Q

t/f: the midtarsal jt can contribute to DF/PF

A

true

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23
Q

what is the position of the foot at heel strike?

A

inverted heel that immediately everts from ground reaction forces

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24
Q

what is the triplanar motion of pronation?

A

DF

eversion

abd

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25
Q

what is the triplanar motion of supination?

A

PF

inversion

add

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26
Q

what does the interosseous ligament do?

A

holds the tibia and fibula together

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27
Q

what happens to the interosseous lig with PF?

A

it naturally stretches some as the tibia and fibula separate some

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28
Q

when the ankle rotates and goes into PF, what is there risk for?

A

high ankle sprain

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29
Q

what is the LEFS?

A

20 item self assessment of functional activities

items rated 0-4 on difficulty

score is a sum of the responses with a max score of 80

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30
Q

what is the MDC and MCID for the LEFS?

A

9 points

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31
Q

what item are a part of the historical interview?

A

past medical hx, occupation and activities, meds, diagnostic tests, pain level/pattern/duration

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32
Q

what are the various MOIs for ankle injuries?

A

macrotrauma
microtrauma (instrinsic, extrinsic, combo)

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33
Q

what is the MOI of lateral ankle sprains?

A

inversion and PF

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34
Q

t/f: plantar fasciitis is usually a cumulative trauma

A

true

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35
Q

when there is increased valgus, is there increased pronation or supination?

A

protation

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36
Q

what is the most injured ligament in the body?

A

anterior tibiofibular ligament (ATF lig)

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37
Q

what should we observe for in an ankle exam?

A

foot type

callus pattern

nails

skin (capillary refill and pulse)

swelling

scars

deformities

footwear

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38
Q

what is pes cavus?

A

a high arched foot with a high navicular in the Feis line

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39
Q

what is pes planus?

A

a flat foot with a drop in the navicular in the Feis line

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40
Q

what is normal inversion of the rearfoot?

A

6-8 deg

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41
Q

when there is increased inversion of the rearfoot, what is this called?

A

rearfoot varus

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42
Q

what foot abnormality makes it take longer for the rearfoot to get into the correct position in gait due to increased inversion?

A

rearfoot varus

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43
Q

t/f: normally the metatarsal heads should be in the same plane as the calcaneal condyles

A

true

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44
Q

what is rearfoot varus?

A

increased rearfoot inversion that causes the foot to stay pronated longer and gives less supination

increased rearfoot inversion in NWB and looks everted in WB

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45
Q

what is forefoot varus?

A

when the metatarsal head are further up on the medial side (inverted metatarsals) and the foot stays pronated for too long

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46
Q

forefoot varus puts stress on what structures?

A

post tib

plantar fascia

peroneus longus

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47
Q

what happens at the knee with forefoot varus?

A

knee valgus

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48
Q

how does the talus move in relation to the tibia?

A

they move together

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49
Q

when the talus pronates (moves down and in) what does the tibia do?

A

the tibia rotates in and down a little

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50
Q

when the talus pronates (moves down and in) what does the knee do?

A

likely to go into valgus

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51
Q

when the talus supinates (moves up and out) what does the tibia do?

A

the tibia rotates out and up a little

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52
Q

when the talus supinates (moves up and out) what does the knee do?

A

likely to go into varus

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53
Q

t/f: forefoot valgus is common

A

false

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54
Q

what is forefoot valgus?

A

when the lateral aspect of the foot is up and the medial aspect is down

foot has increased supination and decreased time in pronation

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55
Q

what foot abnormality causes the medial foot to hit the ground sooner than it should when pronating?

A

forefoot valgus

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56
Q

what is the risk with forefoot valgus?

A

ankle sprain

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57
Q

t/f: forefoot valgus causes an unstable ankle bc the foot isn’t becoming a mobile adapter

A

true

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58
Q

t/f: the foot is more inverted with forefoot valgus

A

true

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59
Q

what other foot abnormality may mimic forefoot valgus?

A

PF of the 1st ray

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60
Q

with PF of the 1st ray, what is the risk to the ankle?

A

lateral ankle sprains bc the medial side of the foot is hitting soon than it should and puts stress on the lateral ankle

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61
Q

what is forefoot valgus?

A

an overly supinated foot

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62
Q

why is a pronated foot looser?

A

bc it causes the axes of the midtarsal jt to line up

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63
Q

what causes calluses?

A

friction bw the bone and the skin that increases keratinization

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64
Q

what is a claw toe?

A

DF MTP

PF IPs

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65
Q

where are the calluses with a claw toe?

A

on the top of the PIP and the bottom of the MTP

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66
Q

when does claw toe often occur?

A

when the foot in unstable from overpronation

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67
Q

what is a hammer toe?

A

hyperext MTP

flex IPs

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68
Q

what is a mallet toe?

A

flexed DIP

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69
Q

what is the too many toes sign a sign of?

A

post tib tendinitis

70
Q

why do we check callus patterns on the feet?

A

they give reliable clues of the biomechanical response of the foot in fxn

71
Q

when someone has calluses on the medial and lateral ball of their foot, what does this tell us?

A

they may have a valgus foot and PFed 1st ray

the foot is hitting the medial side early and throwing the foot out laterally

72
Q

what is a callus of the medial great toe?

A

pinch callus

73
Q

if someone has a rearfoot varus, what might the callus patterns look like?

A

increased thickness across the 2nd >3rd met head w/little to no shear over the 1st and 5th met head

74
Q

why is there increased thickness across the 2nd >3rd met head w/little to no shear over the 1st and 5th met head in rearfoot varus?

A

bc the amount of pronation produces instability late in midstance as the foot remains partially pronated. this hypermobility prevents the 1st ray from being stabilized

75
Q

t/f: athletic tape on the arch may help with overpronation

A

true

76
Q

what is the low-dye taping technique?

A

taping the arch of the foot for overpronation, or plantar fasciitis

77
Q

how do insoles work?

A

they seem like arch support, but really are trying to control the foot by making the thickness of the sole higher or lower to prevent pronation/supination

78
Q

how do we measure the density of foam in insoles?

A

durometers

79
Q

what is a straight last often for?

A

medial support

80
Q

who often uses very curved lasts?

A

sprinters

81
Q

what are the types of lasts?

A

straight, semi-curved, very curved

82
Q

what is the last of a shoe?

A

the shape of the sole of the shoe

83
Q

what are the benefits of zero drop heels?

A

they allow increased splaying of the foot for better balance

strengthens the intrinsic muscles of the foot

84
Q

what are the items involved in the neuromuscular screen for the foot and ankle?

A

dermatome testing for sensation

DTRs (Achilles reflex)

circulation (capillary refill)

girth (figure 8)

85
Q

how much DF is there at the ankle?

A

10-20 deg

86
Q

how much PF is there at the ankle?

A

45-50 deg

87
Q

how much inversion is there at the ankle?

A

30 deg

88
Q

how much eversion is there at the ankle?

A

20 deg

89
Q

how can you take out the gastroc to measure DF?

A

by flexing the knee

90
Q

what is the concave surface of the distal tibiofibular joint?

A

tibia

91
Q

what is the convex surface of the distal tibfib jt?

A

fibula

92
Q

what is the arthrokinematics of the distal tibfib jt in DF?

A

tib and fib separate as the talus enters the jt

fib glides sup

93
Q

what is the arthrokinematics of the distal tibfib jt in PF?

A

tib and fib return to neutral

94
Q

what is the concave surface of the talocrural jt?

A

distal tib/fib

95
Q

what is the convex surface of the talocrural jt?

A

talus

96
Q

what is the arthrokinematics of the talocrural jt in OKC DF?

A

talus rolls ant, glides post

97
Q

what is the arthrokinematics of the talocrural jt in CKC DF?

A

tibia rolls and glides ant

98
Q

what are the arthrokinematics of the talocrural jt in OKC PF?

A

talus rolls post, glide ant

99
Q

what are the arthrokinematics of the talocrural jt in CKC PF?

A

talus rolls and glides post

100
Q

what is the concave surface of the subtalar jt?

A

ant calcaneal facet and post talus

101
Q

what is the convex surface of the subtalar jt?

A

post calcaneal facet and ant talus

102
Q

what are the arthrokinematics of the subtalar jt in OKC inversion?

A

ant calcaneal facet rolls and glides med

post calcaneal facet rolls and glides lat

103
Q

what are the arthrokinematics of the subtalar jt in CKC inversion?

A

talus rolls med, glides lat on ant calcaneal facet while the talus rolls and glides med on post calcaneal facet

104
Q

what are the arthrokinematics of the subtalar jt in OKC eversion?

A

ant calcaneal facet rolls and glides lat while the post calcaneal facet rolls and glides med

105
Q

what are the arthrokinematics of the subtalar jt in CKC eversion?

A

talus rolls lat and glides med on ant calcaneal facet while talus rolls and glides lat on post calcaneal facet

106
Q

what are the 2 midtarsal jts?

A

talonavicular and calcaneocuboid jts

107
Q

what is the concave surface of the talonavicular jt?

A

navicular

108
Q

what is the convec surface of the talonavicular jt?

A

talus

109
Q

what type of jt is the calcaneocuboid jt?

A

saddle jt

110
Q

what are the arthrokinematics of the midtarsal jt in DF and inversion?

A

navicular and cuboid glide dorsally on the talus and calcaneous respectively

111
Q

what are the arthrokinematics of the midtarsal jt in PF and eversion?

A

navicular and cuboid glide plantarly on talus and calcaneous respectively

112
Q

what is the concave surface of the MTPs?

A

phalynx

113
Q

what is the convex surface of the MTPs?

A

metatarsal

114
Q

what are the arthrokinematics of MTP flexion?

A

phalynx rolls and glides plantarlly on the proximal phalynx

115
Q

what are the arthrokinematics of MTP extension?

A

phalynx rolls and glides dorsally on the proximal phalynx

116
Q

the foot should have ____ mobility when innverted/supinated?

A

decreased

117
Q

the foot should have ____ mobility when everted/pronated?

A

increased

118
Q

is a foot that DF and everts when asked to point foot up normal or abnormal?

A

abnormal

119
Q

what is the anterior drawer test sensitivity and specificity?

A

sn=78%
sp=75%

120
Q

what is the anterior drawer test a test for?

A

lateral ankle sprain (ATF lig)

121
Q

what a (+) anterior drawer test of the ankle?

A

pain/hypermobility

122
Q

what is the technique for the anterior drawer test of the ankle?

A

hold the tib/fib and pull up on the calcaneous with a bit of PF

123
Q

if we want to test for hypermobility, what do we have to do?

A

do the special tests bilaterally to get a sense for the person’s normal

124
Q

what grade ankle sprain would likely produce very little pain and lots of extra motion?

A

grade 3 sprain

125
Q

what grade ankle sprain would likely produce lots of pain and lots of extra motion?

A

grade 1-2 sprains

126
Q

what is the sensitivity and specificity of the talar tilt test?

A

sn=67%
sp=75%

127
Q

what is the talar tilt test a test for?

A

lateral ankle sprain (ATF, some calcaneofib, and maybe some talofib lig)

128
Q

what is a positive talar tilt test?

A

pain/laxity

129
Q

what is the technique for the talar tilt test?

A

grab the calcaneous and shift the grip anteriorly to move the calcaneous, cuboid, and 5th metatarsal medially

130
Q

what is the sensitivity and specificity of the squeeze test?

A

NA

131
Q

what is the squeeze test a test for?

A

syndesmotic sprain, high ankle sprain, ATF sprain

132
Q

what is a (+) squeeze test?

A

pain

133
Q

what is the technique for the squeeze test?

A

at the mid to distal calf, squeeze the tib and fib together

134
Q

what is the sensitivity and specificity of the ER test?

A

sensitivity=NA

specificity=95%

135
Q

what is the ER test a test for?

A

high ankle sprain?

136
Q

what is a (+) ER test?

A

pain and laxity

137
Q

what is the technique for the ER test?

A

take the calcaneous and talus into ER in the mortis to separate the mortis

138
Q

what is the Thompson test a test for?

A

a full Achilles tear

139
Q

what is the sensitivity and specificity for the Thompson test?

A

sn=40-96%

sp=NA

140
Q

what is the technique for the Thompson test?

A

in prone, w/the foot off the edge of the table, squeeze the calf and the foot should PF

141
Q

what is a (+) Thompson test?

A

if the foot doesn’t move when you squeeze the calf

142
Q

if there is a partial Achilles tear, will the Thompson test be positive?

A

probably not

143
Q

what is the sensitivity and specificity for the impingement sign?

A

sn=95%

sp=88%

144
Q

what is the impingement sign a test for?

A

lateral ankle sprain

145
Q

what is the technique for the impingement sign?

A

in sitting/supine, block the talus with the thumb of one hand and evert the foot w/a little DF with the other hand

146
Q

what is a (+) impingement sign?

A

pain

147
Q

what is the sensitivity and specificity of the Windlass test?

A

sn=13.6-31.8%

sp=100%

148
Q

what is the Windlass test a test for?

A

plantar fasciitis, hallux limitus, flexor hallicus longus tendinopathy

149
Q

what is normal DF of the great toe?

A

65 deg (more in runners)

150
Q

what is the technique for the Windlass test?

A

stabilize the first ray from the medial side of the foot with one hand and DF the great toe with the other hand in neutral and DF with some inversion to lock up the midtarsal jt

OR can also do in standing

151
Q

what is a (+) Windlass test?

A

pain and tightness

152
Q

what is the sensitivity and specificity for the Morton test?

A

sn=NA

sp=NA

153
Q

what is the Morton test a test for?

A

Morton’s neuroma (a balled up nerve that becomes sensitive bw the metatarsals)

154
Q

what is the technique for Morton’s test?

A

squeeze the metatarsals together

155
Q

what is a (+) Morton test?

A

plantar pain in the foot and numbness midfoot distal

156
Q

what is the sensitivity and specificity of the Tinel test?

A

sn=58%

sp=NA

157
Q

what is the Tinel test a test for?

A

nerve irritation or damage of the nerve in the tarsal tunnel bw the medial malleolus and calcaneous

158
Q

what is the technique for the Tinel test?

A

tap on the nerve outside the medial malleolus

159
Q

what is a (+) Tinel test?

A

numbness and tingling along the nerves distribution

160
Q

what is the sensitivity and specificity of the calcaneal bump test?

A

sn=NA
sp=NA

161
Q

what is the calcaneal bump test a test for?

A

fx or high ankle sprain

162
Q

what is the technique of the calcaneal bump test?

A

push up on the calcaneus to compress it into the tibfib

163
Q

what is a (+) calcaneal bump test?

A

pain in the calcaneous (fx)

pain in the high ankle (sprain)

164
Q

what is the purpose of the Ottowa ankle and foot rules?

A

to decide whether or not a radiograph is indicated

165
Q

what are the Ottowa ankle rules?

A

tender at the posterior edge of the distal 6cm of medial malleolus

tender at the posterior edge of 6cm of the lateral malleolus

unable to WB for 4 steps

166
Q

what is the sn and sp of the Ottowa ankle rules?

A

sn=95-100%

sp=16%

167
Q

t/f: if any one of the Ottowa ankle and foot rules are positive, a radiograph is indicated

A

true

168
Q

if all 3 Ottowa ankle or foot rules are negative, is a radiograph indicated?

A

nope

169
Q

t/f: a stress fx may not immediately show up on imaging, so if the pt still can’t WB after a few days, send for another image

A

true

170
Q

what are the Ottowa foot rules?

A

tender at the navicular

tender at the base of the 5th metatarsal

unable to WB for 4 steps

171
Q

what is the sn and sp of the Ottowa foot rules?

A

sn=93-100%

sp=12-21%

DPT 616 : MSK (15 decks)

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