Approach to Ankle and Foot Complaint Flashcards
When testing muscle strength, if a patient has active movement against gravity, how would you grade it?
3/5
when testing muscle strength, if a patient has a flicker or trace of contraction, how would you grade it?
1/5
when grading muscle strength, if a patient has active motion against gravity and full resistance without evidence of fatigue, how would you grade it?
5/5
when testing muscle strength, if a patient has active motion of the body part achieved with gravity eliminated, how would you grade it?
2/5
when testing muscle strength, if no contraction is detected, how would you grade it?
0/5
when testing muscle strength, if a patient has active motion against gravity and some resistance, how would you grade it?
4/5
what is the talar tilt test used for?
to test for lateral ankle sprains, calcaneofibular ligament or anterior tabofibular ligament injury
what is the anterior drawer test in the ankle/foot used for?
to test for a lateral ankle sprain
what is the eversion test used for?
medial ankle sprain or a deltoid ligament injury
what is the squeeze test used for?
to test for a high ankle sprain or a distal tibiofibular syndesmosis injury
what is Homan’s sign used for?
to test for a DVT
What are the three main types of ankle sprains?
lateral ankle sprain, medial ankle sprain, syndesmotic ankle sprain (aka high ankle sprain)
What is the most common ankle sprain?
lateral ankle sprain
what is the mechanism of injury of of a lateral ankle sprain?
foot inversion and/or plantar flexion
what is the most likely ligaments injured in a lateral ankle sprain
anterior talofibular ligament*** and calcaneofibular ligament
if there is a lateral ankle sprain, which tests are positive?
talar tilt test (aka inversion test) and anterior drawer test
what is the mechanism of injury of a medial ankle sprain?
forced eversion
what is the most likely ligament injured in a medial ankle sprain?
deltoid ligament
what test is positive if there is a medial ankle sprain?
eversion test
how are ankle sprains graded?
grading scale 1-3; 3 most severe
What is the mechanism of injury of a syndesmotic or high ankle sprain?
forced external rotation of a dorsiflexed ankle
what is the most likely ligament involved in a syndesmotic/ high ankle sprain?
tibiofibular syndesmosis
what test is positive if there is a high ankle sprain?
squeeze test
What are 3 common pathologies of the achilles tendon?
tendonitis, achilles rupture, Sever’s disease
what are the signs and symptoms of achilles tendonitis?
pain/stiffness at tendon insertion, recent increase in exercise/activity, pain is worse with activity and goes away with rest
what test is used for achilles tendonitis?
thompson test
how is achilles tendonitis diagnosed
by a NEGATIVE thompson test
symptoms of an achilles tendon rupture?
patients report a popping sensation at their heel
what test is used to diagnose an achilles tendon rupture?
thompson test
how is an achilles tendon rupture diagnosed?
a POSITIVE thompson test
an inflammation or stress injury to the areas on and around an apophysis (growth plate) near the calcaneus
Sever’s disease
who gets sever’s disease?
active children going through growth spurts
What are the signs and symptoms of sever’s disease?
chronic heel pain in growing children, pain with increased activity, pain is reproduced with direct palpation over the apophysis
a loss of the longitudinal arch of the foot
pes planus
an exaggeration of the longitudinal arch of the foot
pes cavus
What is the common sign/symptom of plantar fasciitis?
pain is worse with first few steps in the morning and then improves
inflammation and thickening of tissue that surrounds the nerve between toes
morton’s neuroma
how does morton’s neuroma present?
the patient will most likely report feeling like they are walking on a marble
what is the relevant special test used for morton’s neuroma?
Mulder’s sign
How is morton’s neuroma diagnosed?
Positive Mulder’s sign: a palpable clicking sensation between the third web space as the transverse arch is compressed
what causes steppage gait or foot drop?
fibular nerve compression
what are the common signs of fibular nerve compression?
weakness of dorsiflexion and eversion, steppage gait, sensory loss over dorsal foot/lateral shin
a consequence of chronic foot inflammation that ultimately results in mid foot deformities and a collapse of the longitudinal arch
Charcot foot
who typically gets charcot foot?
diabetic neuropathy patients
gout is an inflammatory arthropathy caused by what?
deposition of monosodium urate crystals in joints
what types of foods may lead to gout flare up?
diet high in purines (meat, shellfish, and alcohol)
joint aspirations in gout patients reveal what?
negatively birefringent needle shaped crystals
ankle injuries will frequently cause dysfunction in the knee due to what?
the linked motion at the fibular head
what causes the fibular head to glide anteriorly?
foot pronation
what causes the fibular head to glide posteriorly?
foot supination
what causes supination of the foot?
plantar flexion+inversion+adduction
what causes pronation of the foot?
dorsiflexion+eversion+abduction
What is the normal range of motion of dorsiflexion of the foot?
15-20 degrees
what is the normal plantar flexion of the foot?
55-65 degrees
what is the minor motion associated with dorsiflexion?
posterior glide
what is the minor motion associated with plantar flexion?
anterior glide
does dorsiflexion or plantar flexion make the ankle more stable?
dorsiflexion
what is the normal range of motion of eversion of the tibiotalar joint?
10-20 degrees
what is the normal range of motion of inversion of the tibiotalar joint?
20 degrees
what is the minor motion associated with eversion?
anteromedial glide of the talus
what is the minor motion associated with inversion?
posterolateral glide of the talus
What is the normal range of motion of the talocalcaneal joint eversion/anteromedial glide?
5-10 degrees
what is the normal range of motion of the talocalcaneal joint inversion/posterolateral glide?
5-10 degrees
As the calcaneus moves into eversion, the talus will glide?
anteriorly and medially
as the calcaneus moves into inversion, the talus will glide?
posteriorly and laterally
a sliding motion (along an axis) of a tarsal bone toward the plantar surface in relation to surrounding bones
plantar glide
a sliding motion (along an axis) of tarsal bones toward the dorsum of the foot in relation to the surrounding bones
dorsal glide
the plantar glide of the cuboid and navicular bones are couples with?
rotation about an AP axis
rotation of the cuboid and navicular bones creates what?
eversion of the cuboid and inversion of the navicular during plantar glide
most likely preferences of the cuboid bone
eversion glide with plantar glide
most likely preferences of the navicular bone
inversion glide with plantar glide
most likely preferences of the cuneiforms
plantar glide only
how is motion of the metatarsals named?
for the direction of the metatarsal head
what are the motions that we evaluate at the metatarsals?
dorsal glide and plantar glide
what are the motions that we evaluate at the MTPs, PIPs, and DIPs?
dorsal/plantar glide, rotatory glide, abduction/adduction
what is the name of the guidelines for when to order X-rays on a patient with an ankle injury?
Ottawa Ankle Rules
If a patient has pain in the malleolar zone, they must have at least one of?
- bone tenderness at the posterior tip of the medial or lateral malleolus or 2. Unable to bear weight immediately after injury AND unable to walk 4 steps in the doctor’s office or ER
if a patient has pain in the midfoot region, they must have at least one of?
- bone tenderness at the FIFTH metatarsal or the NAVICULAR 2. Unable to bear weight immediately after injury AND unable to walk 4 steps in the doctor’s office/ER
