Chapter 8: Foot & Toe Pathologies Flashcards
What bones make up the ankle mortise?
Talus, tibia & fibula
What is the only axial skeleton bone to not have a muscle attachment?
Talus
List the five functional articulations of the talus bone.
(1) superiorly with distal end of tibia (2) medially with medial malleolus (3) laterally with lateral malleolus (4) inferiorly with calcaneous (5) anteriorly with navicular
The navicular bone articulates anteriorly with which bone(s)?
Cuneiforms (medial, intermediate, lateral)
The navicular bone articulates laterally with which bone(s)?
Cuboid
What bones makes up the rear foot?
Talus & calcaneus
What bones makes up the mid foot?
Navicular, cuneiforms (medial, intermedius, lateral) & cuboid
What bones makes up the fore foot?
Metatarsals & phalanges (proximal, middle, distal)
What muscles make up the triceps surae muscle group?
Gastrocnemius & soleus
List all the articulations of cuboid bone.
(1) Anteriorly with 3rd & 4th metatarsal (2) medially with lateral cuneiform & navicular (3) posteriorly with calcaneus
How many sesamoid bones are in the foot?
2-3
Where are the sesamoid bones of the foot located
Two sesamoid bones are located on the flexor hallucis brevis tendon beneath the MTP & the other is often located on the plantar aspect of IP joint of first MT
Where is the subtalar joint located?
Between the inferior aspect of talus and superior aspect of calcaneus
How does a pronated foot influence the mechanics of the leg & thigh?
A pronated foot causes internal rotation of tibia, internal rotation of hip & knee flexion
How does a supinated foot influence the mechanics of the leg & thigh?
A supinated foot causes external rotation of tibia, external rotation of hip and knee extension
List the medial ligaments that go from talus to calcaneus.
Posterior talocalcaneal & medial talocalcaneal
List the ligaments that represent the junction between the rearfoot & midfoot.
Dorsal talonavicular, plantar calcaneonavicular (“spring”) & plantar calcaneocuboid
This ligament spans from the sustentaculum tali to the inferior surface of navicular.
Plantar calcaneonavicular (“spring”) ligament
What are the three primary weight-bearing points of the foot?
Head of 1st metarsal, Head of 5th metatarsal & medial tubercle of calcaneus
Where does the “spring” ligament originate and insert?
Originates on the sustentaculum tali of calcaneus & inserts on the inferior aspect of navicular
What bones form the medial longitudinal arch of foot?
1st metatarsal, medial cuneiform, navicular, calcaneus & talus
Describe the tripod theory.
It is the weight distributed between the head of 1st MT, head of 5th MT & calcaneus
What are some important things to ask during the history section of an ankle evaluation?
How did your symptoms arise?
Is this an acute onset?
Is this an insidious onset?
Have you changed the surfaces in which you have been playing on?
Have you increased the distance, duration, or intensity of your training?
Do you wear orthotics and if so why?
When was the last time you were fitted for orthotics?
During which activities do you use orthotics?
When was the last time they were fitted?
What action(s) aggravate it?
Have you had this type of injury before and if so is it similar to what you are experiencing now?
How long were you out for on the prior injury?
Who treated you?
What treatment did you receive and did it work?
Do you have a family history of rheumatoid arthritis?
List the characteristics of a pes cavus foot.
(1) Inverted rearfoot by more than 3 degrees from perpendicular (2) adducted forefoot (3) high medial longitudinal arch using Feiss Line
Explain the Feiss Line special test and its purpose.
Line is drawn from the plantar aspect of 1st MT to the medial malleolus and the navicular tubercle postion is noted relative to the line. Navicular tubercle above line is pes cavus, below line is pes planus & intersecting the line is neutral.
This special test assesses arch and foot type of an individual
Describe Morton’s Toes.
1st metatarsal is shorter than 2nd metatarsal
Describe Hammer Toes.
Affects toes 2-4. Hyperextension of MTP & DIP joints & flexion of PIP joints
Describe Claw Toes.
Affects toes 2-4. Hyperextension of MTP joint & flexion of PIP & DIP joints
What mechanical factors can lead to a pes planus foot?
Weakness of tibialis posterior, tibialis anterior, flexor hallucis longus & brevis hallucis
A pes planus causes the talus to tilt _______ and the navicular to displace _______ , making the talus more prominent and susceptible to fracturing.
Medially
Inferiorly
What is the difference between a rigid and subtle pes planus?
A rigid pes planus is marked by the absence of a medial longitudinal arch when foot is weight bearing and non-weight bearing.
A subtle pes planus is marked by the absence of a medial longitudinal arch only when weight bearing.
How can a pes planus foot affect the ACL of knee?
Pes planus causes tibia to internally rotate as navicular drops during pronation, causing the ACL to tighten as it wraps around PCL
List the phases of gait for right leg.
Initial contact Loading response Mid stance Terminal stance Pre swing Initial swing Mid swing Terminal swing
Which phases of the gait pattern are weight bearing?
Initial contact, loading response, mid stance, terminal stance & pre-swing
Which phases of the gait pattern are non-weight bearing?
Initial swing, mid swing & terminal swing
Where are heel spurs located?
On the medial tubercle of calcaneus
Define tarsal coalition.
A bony, fibrous, or cartilaginous union between two or more tarsal bones
Entrapment of the posterior tibial nerve or one of its medial or lateral branches as it passes through the tarsal tunnel can lead to which syndrome?
Tarsal tunnel syndrome
What is a Jone’s fracture?
Fracture of the 5th metarsal 1 cm distal from the proximal diaphysis
What is the Haglund’s Deformity (“pump bump”)?
Retrocalcaneal exostosis
What is antalgic gait?
A limp or unnatural walking pattern
Choose one.
The long bone compression test is used if an (acute/chronic) fracture is suspected.
Acute
List some common mechanisms of injury for Lisfranc fracture?
(1) Rotational loading with a fixed foot
(2) Axial load placed on the rearfoot while bearing weight on extended toes.
(3) Crushing force
What arteries are located in the foot to take a pulse?
Dorsal pedis
Posterior tibialis
What is the PQRST of pain?
Provocation: what causes pain? Quality: What does it feel like? Region: Where does it hurt? Severity: How bad does it hurt? Timing: When does it hurt?
What are you inspecting during palpation during an ankle evaluation?
Tenderness, swelling, deformity, crepitus, spasm, symmetry, and temperature
The lateral and inferior aspect of first cuneiform and base of the 1st MT of foot serves as the insertion for the _______ muscle.
Anterior tibialis
The Posterior Tibialis inserts on the _______ bone of the foot.
Navicular
The talus shifts _______ during plantarflexion.
Anteriorly
The talus shifts _______ during dorsiflexion.
Posteriorly
Ankle inversion is often the mechanism of a fracture to the ______ .
5th metarsal
Exostosis on the medial calcaneal tubercle is referred to as a _______ .
Heel spur
_______ is a bony, fibrous or cartilaginous union between two or more tarsal bones.
Tarsal coalition
Which special test will reproduce the symptoms of tarsal tunnel syndrome?
Dorsiflexion eversion test
Patient complains of pressure on the inferior posterior aspect of leg. Has diffused pain, burning, paresthesia and numbness that increases with activity but decreases with rest. What pathology meets these characteristics?
Tarsal Tunnel Syndrome
Define Subungual Hematoma.
Bleeding underneath the nail
Posterior tibial nerve runs under which connective tissue structure?
Flexor retinaculum
The rearfoot is compromised of which joint(s)?
Subtalar joint
The midfoot is made up of which joint(s)?
Talocalcanenavicular, talonavicular, calcaneiocuboid, cuneocuboid and intercuneiform
The forefoot is made up of which joint(s)?
Tarsometatarsal, metatarsophalageal, proximal interphalangeal, distal interphalangeal
What are the three arches of the foot?
Medial longitudinal, transverse, lateral longitudinal
The medial longitudinal arch is supported by which bones?
Talus, calcaneal, navicular, cuneiform, 1st metatarsal
The medial longitudinal arch is supported by which ligamentous structures?
Plantar calcaneonavicular (“spring”) ligament, long plantar ligament and deltoid ligament
The medial longitudinal arch is supported by which muscles?
Tibialis anterior, tibialis posterior, flexor digitorum longus, flexor hallucis longus
The transverse arch is made up by which muscles?
Tibialis anterior, tibialis posterior, peroneus longus
List the muscles of the anterior compartment of the leg.
Tibialis anterior, extensor digitorum longus, peroneus tertius, extensor hallucis longus
List the muscles of the deep posterior compartment of the leg.
Tibialis posterior, flexor digitorum longus, flexor hallucis longus
List the muscles of the superficial posterior compartment of the leg.
Gastrocnemius, soleus and plantaris
List the muscles of the lateral compartment of the leg.
Peroneus longus, peroneus brevis
List structures that you will palpate on the medial aspect of the foot during an evaluation.
1st MTP joint 1st MT 1st cuneiform Navicular Navicular tuberosity Talar head Sustentaculum tali (calcaneus) Calcaneonavicular ligament Medial talar tubercle Calcaneus Medial Calcaneal Tubercle Tibialis posterior Flexor digitorum longus Flexor hallucis longus Posterior tibial pulse
List structures that you will palpate on the lateral aspect of the foot during an evaluation.
5th MTP joint 5th MT Styloid process Cuboid Lateral calcaneal border Inferior peroneal retinacula Peroneal tubercle Peroneous Brevis Peroneus Longus
Dermatome of medial aspect of 1st metatarsal
L4
Dermatome of dorsal aspect of 3rd metatarsal
L5
Dermatome of base of 5th metatarsal
S1
Dermatome of popliteal space
S2
Afferent is to ______ as efferent is to _______.
Dermatomes : myotomes
What is the myotome of L4?
Dorsiflexion
What is the myotome of L5?
Toe extension
What is the myotome of S1?
Plantarflexion
L4 and L5 tests which reflex?
Patellar tendon reflex
S1 tests which reflex?
Achilles
Which test would you use to rule out intermetatarsal neuroma?
Mulder’s Sign
What are some signs and symptoms for a neurological pathology?
Pain, numbness, paresthesia, burning
Explain Windlass Test
Used to verify if patient has a subtle pes planus foot type. Patient will have an absence of medial longitudinal arch while weight bearing but weight bearing plantarflexion will reproduce medial longitudinal arch.
The ausculatory percussion test it used to rule out which type of fractures?
Transverse fractures
What type of fractures is an ausculatory percussion test not good in identifying?
Avulsion or buckle fractures
Where should the stethoscope and tunning fork be placed when administering an ausculatory percussion test?
Stethescope should be placed on bony landmark proximal/above to the suspected site of fracture and tunning fork should be placed on bone distal to fracture site.
Compared bilaterally what will a positive ausculatory percussion test sound like?
There will be a diminished or absent sound due to the space created by the transverse fracture.
You would use this test if you suspect a distal phalanx fracture.
Tap Test/Flick Test
Greater than _______ degrees of 1st metatarsal joint abduction is a characteristic of hallucis ______ pathology.
20 degrees : valgus
_______ are the entrapment of nerves between the metatarsal heads.
Neuromas
Morton’s neuroma is located between the ______ and _______ metatarsal heads.
3rd : 4th
The tarsal tunnel is bordered anteriorly by _______ and _______ and laterally by the _______ .
Tibia : talus : calcaneus
Retrocalcaneal exostosis is also referred to as _______ or _______ .
Haglund’s Deformity : pump bumps
Degrees of flexion and extension of great big toes.
Flexion: MTP: 35-45°, IP: 90°
Extension: MTP: 75-85°, IP: 0
Degrees of flexion and extension of rays 2-5.
Flexion: MTP - 40°, PIP - 35°, DIP - 60°
Extension: MTP - 40°, PIP - 0°, DIP - 30°
