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Lower Extremity Evaluation Lecture > Ankle & Lower Leg > Flashcards

Ankle & Lower Leg Flashcards

1
Q

What two bones make up the Ankle Mortise?

A

Tibia (medial) & Fibula (lateral)

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2
Q

The Ankle Mortise is comprised of what joint?

A
  • The Talocrural Joint
    ~ Articulation between Talus & Ankle
    Mortise
    ~ Talus relative to Ankle Mortise
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3
Q

Tibia

A
  • Primary weight bearing bone of lower leg
  • Forms roof & medial portions of Ankle
    Mortise
  • Distal portion known as Medial Malleolus
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4
Q

Fibula

A
  • Forms lateral portion of Ankle Mortise
  • Distal portion known as Lateral Malleolus
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5
Q

What are the classic movements for the Talocrural Joint?

A

Dorsiflexion & Plantarflexion

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6
Q

Which classic movement of the Talocrural Joint would offer the most stability & why?

A

Dorsiflexion is more stable because it causes the Talus to jam into the Ankle Mortise, leaving no space for movement. Movement at the Talocrural Joint causes injuries.

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7
Q

Functional Loading/Pronation: Planes of Motion at the TCJ

A

Sagittal: Dorsiflexion

Frontal: Eversion (very minimal due to lateral Malleolus)

Transverse: Adduction

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8
Q

Functional Unloading/Supination: Planes of Motion at the TCJ

A

Sagittal: Plantarflexion

Frontal: Inversion (very minimal)

Transverse: Abduction (very minimal)

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9
Q

Articulations: Proximal Tibiofibular

A

Articulation between Lateral Tibial Condyle & Head of Fibula

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10
Q

Movements: Proximal Tibiofibular

A

Anterior/Posterior & Superior/Inferior gliding

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11
Q

Articulations: Distal Tibiofibular

A

Articulation between Lateral Malleolus of the Fibula & Distal, Lateral portion of Tibia

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12
Q

Movements: Distal Tibiofibular

A

Anterior/Posterior & Superior/Inferior gliding

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13
Q

What muscles move the ankle?

A
  • Tibialis Posterior
  • Peroneus Longus
  • Gastrocnemius
  • Soleus
  • Plantaris
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14
Q

Tibialis Posterior Function during Functional Loading at the MTJ, STJ, & TCJ

A
  • MTJ
    ~ Decelerates Abduction & Dorsiflexion
  • STJ
    ~ Decelerates Eversion
  • TCJ
    ~ Decelerates Dorsiflexion
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15
Q

Peroneus Longus Function during Functional Loading at the MTJ and TCJ

A
  • MTJ
    ~ Decelerates Inversion & Dorsiflexion
  • TCJ
    ~ Decelerates Dorsiflexion
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16
Q

Gastrocnemius Function during Functional Loading at the STJ & TCJ

A
  • STJ
    ~ Decelerates Eversion
  • TCJ
    ~ Decelerates Dorsiflexion

Unhappy during Rearfoot Varus

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17
Q

Soleus Function during Functional Loading at the STJ & TCJ

A
  • STJ
    ~ Decelerates Eversion
  • TCJ
    ~ Decelerates Dorsiflexion

Unhappy during Rearfoot Varus

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18
Q

Gastrocnemius

A

Origin: Posterior Femur Proximal to Femoral Condyles

Insertion: Calcaneus

Nerve: Tibial

Action: Plantarflexion & Knee Flexion

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19
Q

Plantaris

A

Origin: Lateral Epicondyle of Femur

Insertion: Calcaneus

Nerve: Tibial

Action: Plantarflexion & Knee Flexion

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20
Q

Soleus

A

Origin: Posterior & Medial Border of Middle 1/3 of Tibia, Proximal 1/3 of Posterior Fibula

Insertion: Calcaneus

Nerve: Tibial

Action: Plantarflexion

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21
Q

Tibialis Posterior

A

Origin: Proximal 2/3 of Posterior Tibia, Fibula, & Interosseous Membrane

Insertion: Navicular, Cuneiforms, Cuboid, & Bases of 2-4 Metatarsals

Nerve: Tibial

Action: Inversion & Plantar Flexion & Supports Arch

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22
Q

Peroneus Longus

A

Origin: Proximal 2/3 of Lateral Fibula

Insertion: Base of 1st metatarsal & Medial Cuneiform

Nerve: Superficial Fibular

Action: Eversion & Plantar Flexion & Supports Arch

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23
Q

Things to notice during Anterior Inspection

A
  • Hip & Trunk Position
    ~ Fick’s Angle: 12-18 degrees of toe out
  • Foot Type
    ~ Pronated
    ~ Supinated
  • Swelling
    ~ Caveman Foot: foot looks obviously
    enlarged
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24
Q

Things to notice during Posterior Inspection

A
  • Gastrocnemius-Soleus Complex
  • Achilles
  • Calcaneus
  • Swelling (Caveman Foot)
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25
Q

Things to notice during Lateral Inspection

A
  • Peroneal Muscle Group
  • Distal Fibula
  • Swelling (Caveman Foot)
26
Q

Things to notice during Medial Inspection

A
  • Distal Tibia
  • Medial Longitudinal Arch
  • Swelling (Caveman Foot)
27
Q

Where do most ankle sprains take place and why?

A
  • Lateral ankle
  • The lateral ligaments are small and weak
    because they don’t have to deal with
    much stress
28
Q

AROM Talocrural Joint Test

A
  • Dorsiflexion & Plantarflexion measured with goniometer
  • Normal Dorsiflexion: 20 degrees
  • Normal Plantarflexion: 50 degrees
29
Q

AROM Subtalar Joint Test

A
  • Inversion & Eversion measured with goniometer
  • Normal Inversion: 20 degrees
  • Normal Eversion: 5 degrees
30
Q

ROM Testing

A
  • Passive
  • Resistive
31
Q

Neurological Assessment

A

Lower Quarter Screen

32
Q

What ligaments support the TCJ?

A
  • Laterally:
    ~ Anterior Talofibular Ligament (ATF)
    ~ Calcaneofibular Ligament (CF)
    ~ Posterior Talofibular Ligament (PTF)
  • Medially:
    ~ Deltoid Ligaments
    > Anterior Tibiotalar
    > Tibiocalcaneal
    > Posterior Tibiotalar
    > Tibionavicular
33
Q

Anterior Talofibular Ligament (ATF)

A

Origin: Anterolateral Surface of Lateral Malleolus

Inserts: Talus near Sinus Tarsi

Resists: Plantarflexion & Inversion

34
Q

Calcaneofibular Ligament (CF)

A

Origin: Posterolateral portion of Lateral Malleolus

Inserts: Calcaneus

Resists: Inversion

35
Q

Posterior Talofibular Ligament (PTF)

A

Origin: Posterior portion of Lateral Malleolus

Inserts: Talus & Calcaneus

Resists: Posterior translation of talus on Tibia or Ankle Mortise

36
Q

ATF Ligament Test

A
  • Anterior Drawer
    ~ Positive test indicated by Talus sliding
    anteriorly with excess laxity
37
Q

CF Ligament Test

A
  • Inversion Talar Tilt
    ~ Lengthens lateral ligaments
    ~ Positive test indicated by excessive
    Talar Tilt
38
Q

Deltoid Ligaments

A
  • Anterior Tibiotalar
  • Tibiocalcaneal
  • Posterior Tibiotalar
  • Tibionavicular
  • Used more and therefore, harder to
    rehab due their importance to daily life
  • Thicker and more supportive
39
Q

Ankle sprain vs Deltoid ligaments?

A
  • Listen to where pain is
  • Pt. will point to exactly where pain is
40
Q

What ligaments & structure support the Distal Tibiofibular Joint?

A
  • Anterior & Posterior Tibiofibular
    Ligaments
  • Interosseous Membrane
    ~ Keeps Tibia & Fibula from separating
    ~ Crural Interosseous Ligament
    > Extension of Interosseous
    Membrane
41
Q

Distal Tibiofibular Joint Tests

A
  • Kleiger’s Test (External Rotation):
    Ligaments
    ~ Positive test indicated by pain in
    anterolateral ankle at the site of the
    Distal Tibiofibular Joint
  • Squeeze Test: Fractures
    ~ Positive test indicated by pain at the
    site of the Distal Tibiofibular Joint
42
Q

Ankle Sprains

A
  • Usually caused by forceful inversion
    (lateral ankle sprain) or eversion (medial
    ankle sprain)
  • Signs & Symptoms:
    ~ Tenderness over ligament site
    ~ Swelling on side of sprain
    > High Ankle Sprain: all over
    ~ Discoloration
    ~ Increased laxity: grade 2 & 3
    ~ Instability
43
Q

Ankle/Lower Leg Fracture Test

A
  • Stress or Gross
  • Squeeze Test
    ~ Positive test indicated by pain away
    from point of compression
    ~ Not needed if displaying typical signs
    for fracture
  • Bump/Thump Test
    ~ Positive test indicated by pain away
    from area being bumped
44
Q

Other than fractures, what else could the Bump/Thump Test be used for?

A

High Ankle Sprains
~ Causes Fibula & Tibia to separate

45
Q

Achilles Tendinitis

A
  • Chronic inflammation due to limited
    blood supply especially in the Distal
    Portion 2-6 cm from insertion
46
Q

Achilles Tendon Rupture

A
  • Long term breakdown (inflammation or disuse) of tendon or one forceful event
  • Also occurs at 2-6 cm from insertion, therefore it’s common to have a Rupture & Tendonitis simultaneously
  • Very loud
  • Feels like you’ve been kicked
  • No obvious deformity, but obvious
    swelling: looks like ankle sprain
47
Q

Achilles Tendon Rupture Test

A
  • Thompson Test
    ~ Artificially making the Achilles contract
    ~ Positive test indicated by a lack of
    Plantarflexion when calf is squeezed
    > May still Plantarflex due to muscles
48
Q

Compartment Syndrome

A
  • VERY IMPORTANT TO NOT MISS!
  • Injury to a structure within a
    compartment in the leg that causes a
    build up of fluids (swelling) & compresses
    nerves, arteries, & veins
    ~ No blood flow = tissue death
  • Most common in the Anterior & Deep
    Posterior compartments
49
Q

Anterior Compartment Contents

A
  • Muscles
    ~ Tibialis Anterior
    ~ Extensor Hallucis Longus
    ~ Extensor Digitorum Longus
    ~ Peroneus Tertius
  • Nerve
    ~ Deep Peroneal (1st web space of foot)
  • If limited/dysfunction with Dorsiflexors &
    nerves along with calf pain: refer
    immediately
50
Q

Deep Posterior Compartment Contents

A
  • Muscles
    ~ Popliteus
    ~ Flexor Hallicus Longus
    ~ Flexor Digitorum Longus
    ~ Tibialis Posterior
  • Nerve
    ~ Tibial (bottom of foot & toes)
  • If limited/dysfunction with Plantarflexors
    along with calf pain: refer immediately
51
Q

Signs, Symptoms, & Management for Compartment Syndrome

A
  • Signs & Symptoms:
    ~ Complaints of pain and PRESSURE in
    affected compartment
    ~ Paresthesia/Anesthesia
    ~ Loss of function
    ~ Will be able to see and feel difference
    between unaffected leg
  • Management
    ~ Early diagnosis
    ~ Surgery
    > Cuts connective tissue, but causes
    scar tissue, ultimately bringing pt.
    back to square one
    ~ Not sure? Refer!
52
Q

Exertional Compartment Syndrome

A
  • Compartment syndrome only with activity
    ~ Causes blood to enter muscles & cause
    pressure
    ~ Goes away after some time
53
Q

Deep Vein Thrombosis (DVT)

A
  • VERY IMPORTANT TO NOT MISS!
  • Blood clot, usually post surgery or
    following trauma to lower leg
  • Causes:
    ~ Abnormalities in vessel wall
    ~ Abnormal Blood: increased
    coagulation factors
    ~ Decreased Plasma Volume:
    dehydration
    ~ Major Surgery or Trauma: cutting
    vessels
    ~ Slowing down blood flow: causes
    clotting
54
Q

DVT Signs, Symptoms, & Management

A
  • Signs & Symptoms
    ~ Calf tenderness
    ~ Swelling of leg
    ~ Increased warmth in leg
    ~ Discoloration of leg
    ~ Pain with Dorsiflexion
  • Management
    ~ Booties/compression sleeve: squeezes
    blood vessels & allows for blood to
    flow
55
Q

DVT Test

A
  • Homan’s Signs
    ~ Forced Dorsiflexion with calf squeeze
    ~ Positive test indicated by pain in calf
56
Q

Subluxating Peroneal (Longus & Brevis) Tendons

A
  • Tendons don’t stay behind Lateral
    Malleolus
    ~ Peroneals can’t Evert or Plantarflex
  • Cause
    ~ Forceful Dorsiflexion & Inversion
    causing tearing of Peroneal
    Retinaculum
57
Q

Subluxating Peroneal (Longus & Brevis) Signs, Symptoms, & Management

A
  • Signs & symptoms
    ~ Pain in lower leg/foot
    ~ Pain on site & popping of tendons
    ~ Dysfunction due to altered
    biomechanics
  • Management
    ~ Surgery
    ~ Deal with pain
    ~ Retire
58
Q

Medial Tibial Stress Syndrome (“Shin Splints”)

A
  • Soft tissue pain around medial aspect of
    Tibia
    ~ Tibialis Posterior or Soleus
  • Cause
    ~ New activity/changes in activity
    > Muscles need to build up edurance
59
Q

Medial Tibial Stress Syndrome (“Shin Splints”) Signs, Symptoms, & Management

A
  • Signs & symptoms
    ~ Stress fracture
    ~ Pain
  • Management
    ~ Compression sleeve can bring muscles
    closer to bone & relieve pain/tension
60
Q

Talar/Tibial Osteochondral Lesions

A
  • Bone & Cartilage defects
    ~ Piece gets knocked off
  • Cause
    ~ Excess inversion/eversion/rotation
61
Q

Talar/Tibial Osteochondral Lesions Signs, Symptoms, & Management

A
  • Signs & symptoms
    ~ Listen to complaints
    ~ Self limiting
    ~ Difficult to see on X-Ray
  • Management
    ~ May need surgery if serious
62
Q

Deltoid Ligament Tests

A
  • Eversion Talar Tilt
    ~ Lengthens the medial ligaments
    ~ Positive test indicated by excessive
    Talar tilt
  • Kleiger’s Test (External Rotation)
    ~ Positive test indicated by medial joint
    pain

Lower Extremity Evaluation Lecture (8 decks)

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