Ankle_Foot

Question 1

Plantar flexion

Answer 1

50 deg
tibiotalar joint
performed by gastroc, soleus and other minor players
side to side glide, rotation, abduction, adduction

Question 2

Dorsiflexion

Answer 2

20 deg
TA is major player
ankle is more stable in dorsiflexion
talus glides posterior

Question 3

Abduction and Adduction

Answer 3

subtalar joint: talus on calcaneus 
adduction=varus=20 deg
abduction=valgus=10 deg
heel deviates out 
calcaneus articulates with cuboid 
talus on navicular

Question 4

Inversion

Answer 4

calc adduction+navicular rotation + glide on talus
* plantar flexion
TA and TP
inc height of medial arch

Question 5

Eversion

Answer 5

calc abduction+navicular rotation+glide on talus
*dorsiflexion
Fibularis longus and brevis
decreases height of medial arch

Question 6

pronation

Answer 6

eversion+dorsiflexion+abduction (calc and foot)

**Walking

Question 7

supination

Answer 7

inversion+plantar flexion+adduction

*Walking

Question 8

Lateral arches

Answer 8

weight bearing and elastic 
firm osseous 
calc, cuboid, 4th, 5th MTs
limited mobility
transmits weight and thrust to the ground

Question 9

Medial arch

Answer 9

more mobile and higher
calc, talus, navicular, cuneiform, 1-3MTs
supported by plantar lig, plantar fascia etc
no firm osseous support
change to adapt to terrain
**Controls gait

Question 10

high medial arch

Answer 10

caused by adduction of foot and a varus calcaneus

Question 11

dropped medial arch

Answer 11

caused by abduction of foot and valgus calcaneus and dorsiflexion of ankle (extreme pronation)

Question 12

ant transverse arch

Answer 12

made of MT heads, transmits weight to ground, flattens during weight bearing

Question 13

posterior transverse arch

Answer 13

make of MT bases

Question 14

tarsal arch

Answer 14

made of navic, cuboid, cuneiforms
assists in flexibility of foot
**loss of this arch causes pes planus

Question 15

Hammer toes

Answer 15

flexion deformity of the PIP

Extension deformity of DIP

Question 16

Claw toes

Answer 16

flexion of PIP and DIP

Question 17

bunion

Answer 17

problem with the second MTP causing medial deviation of 1st MTP with lateral deviation of proximal phalanx of great toe

Question 18

5th MT motion testing

Answer 18

lock the cuboid
wiggle 5th MT and note degrees of movement
also think avulsion fx from fibularis brevis

Question 19

1st MT motion testing

Answer 19

lock 1st cuneiform
rotate to check for freedom of motion
flex=45deg
extension 70-90deg

Question 20

foot strike progression

Answer 20

1) heel strike
2) foot rolls to lateral edge
3) weight should roll back to ant transverse arch
4) great toe pushes off
5) swing phase

Question 21

inversion ankle sprain

Answer 21

ligament: ATF, calcaneofibular, posterior talofib

inversion and plantar flexion:

Question 22

grade 1 sprain

Answer 22

grade 1= microtear with ligament

swelling and disability but no instability (no laxity)

Question 23

grade 2

Answer 23

partial tear of the ligament
severe swelling over the ankle, mild instability, antalgic gait, mild laxity with endpoint, decreased ROM
+talar tilt

Question 24

Grade3

Answer 24

complete tear
marked loss of function and complete instability with no endpoint, noted on provocative weightbearing
+ talar tilt

Question 25

X ray determination for ankle sprain

Answer 25

+ant drawer test
+Talar tilt (only in 2nd and 3rd deg)
*Follow ottawa ankle rules

Question 26

unilateral acute flat arches

Answer 26

may indicate tear of TP after inversion sprain

**Order MRI, must be surgically corrected ASAP

Question 27

Ottawa ankle rules: ankle x ray:

Answer 27

tenderness at posterior later malleolus, posterior edge of medial malleolus
inability to bear weight

Question 28

Ottawa ankle rules: foot x ray

Answer 28

tenderness at base of 5th MT or navicular

Question 29

effects of inversion sprain on the body

Answer 29

ankle inverts 
lateral malleolus moves anterior 
fib head moves posterior (think of foot drop)
tibia ER
femur IR
ipsilateral anterior innominate
anterior torsion of sacrum: Right on Right 
L5 rotates opposite of the sacrum

Question 30

tx for grade 1 and 2

Answer 30

conservative, PRICE, NSAIDs, OMT, maybe crutches

Question 31

Grade 3 tear

Answer 31

PRICES (s stands for surgery)

Question 32

Return to play criteria

Answer 32

full painless ROM
strength 90% compared to uninjured side
able to tolerate specific activity w/o increasing pain