Exam 2: Foot & Ankle Evaluation Flashcards
What are 4 management options when looking at foot and ankle dysfunctions
Exercise
Mobilization/Manipulation
Shoes
Orthotics
What are 6 hindfoot conditions
Ankle sprains Heel/arch pain syndromes Sever's Disease Subtalar/ankle pain Tendon injuries Retrocalcaneal exostosis
What is the most common injury of the ankle and foot in the US
ankle sprains
__% of ankle sprains are athletic related
50
50% of ankle sprains are _____ related
athletic
Put the following conditions in order from most occurrent to least occurrent:
Foot fractures, ankle fractures, foot sprain, and ankle sprains
- ankle sprains (2 million a year)
- Foot fractures (590,000)
- Ankle fractures (436,000)
- Foot sprains (265,000)
If an ankle sprain didn’t occur due to an athletic injury, what is the next likely cause
a fall from stairs
Walking puts up to ____ times your body weight on your foot
1.5
Your feet log ____ miles a year
1000
As shock absorbers, feet cushion up to __ ____ pounds of pressure during one hour of strenuous exercise
1 million
(lateral/medial) ankle sprains are more common
lateral
What position are lateral ligaments least stable in
The loose pack position of PF and inversion
Why are medial ankle sprains less common
The medial side is protected due to bony architecture and has decreased eversion
True or False:
Proximal/syndesmotic ankle sprains are usually caught early on and have quicker recoveries
False, they are usually unrecognized and prolong rehab
____% of ankle sprains can potentially progress to chronic problems
40
According to the Ottawa Ankle Rules, when is an ankle x-ray required
If there is bone tenderness in the malleolar zone, bone tenderness over the navicular or base of the 5th metatarsal, or the inability to weight bear
When are percussion and compression tests used
when a fracture is suspected
A (percussion/compression) test is a blow to the tibia, fibular, or heel to create vibratory force that resonates in fracture causing pain
percussion
A (percussion/compression) test involves compression of tibia and fibula either above or below the site of concern
compression
Which ligaments are usually involved in a syndesmotic ankle sprain
ATFL and PTFL
List the ligaments and their sequence of injury with increasing stress of an ankle injury
- Anterior talofibular (ATFL)
- Calcaneofibular (CFL_
- Posterior talofibular (PTFL)
What is a common MOI for an inversion ankle sprain injuring the ATFL followed by the CFL
Coming down after rebound (the foot in PF) and landing on another players foot (foot is inverted)
What is a common MIO for an inversion ankle sprain injuring the CFL by itself
When the foot is planted with inversion like cutting in soccer and field sports
Use the ____ principle for immediate care of an ankle sprain
RICE
There are 5 lateral ankle sprain sequela (injuries that occur after an initial injury). List what they are
- Impingement of the medial joint capsule
- Peroneal tendon strain/rupture
- Avulsion fracture of 5th metatarsal or lateral malleolus
- Talus/ankle mortise chondral lesions
- Superficial branch of the fibular nerve injury
How many grades are there to describe lateral ligament injuries
3
Grade (1/2/3) describes a minor tear with pain and only the ATFL involved
1
Grade (1/2/3) describes some degree of laxity with a firm end point
2
Grade (1/2/3) describes gross laxity without an endpoint
3
If a patient has a grade 1 sprain and anterior drawer and talar tilt test are both negative, how long until they can return to sport
1-10 days
If a patient has a grade 2 sprain, anterior drawer reports with increased laxity, and a negative talar tilt test - How long until they can return to sport
2-4 weeks
If a patient has a grade 3 sprain, a positive anterior drawer, and a positive talar tilt test - How long until they can return to sport
5-8 weeks with rehab
Which ligament controls anterior shift of the talus on the tib/fib or a posterior shift of the tib/fib on the talus
ATFL
Which ligament blocks IR of the talus on the tib/fiv or ER of the tib/fib on the talus
ATFL
The ATFL prevents (IR/ER) of the (talus/tib-fib) on the (talus/tib-fib)
- IR of the talus on tib/fib
2. ER of the tib/fib on talus
Which special test is used to test the integrity of the ATFL
anterior drawer test
What is the anterior drawer test testing
ATFL integrity
What is a positive sign of the anterior drawer test
If the foot slides forward and/or makes a clunking sound as it reaches the end point
Out of these three ligaments, which one is the strongest:
ATFL, PTFL, CFL
PTFL
What is a common MOI for the PTFL
deceleration with a quick stop
Which special tests is used to test the integrity of the PTFL
posterior drawer test or ER test
What is the posterior drawer test testing
PTFL integrity
What position of the foot makes the CFL tight and what position makes the CFL slack
Tight in DF
Slack in PF
The CFL checks (inversion/eversion) in (DF/PF)
inversion in PF
A tear of the CFL will allow movement of the ____ on the ____
talus on calcaneus
Which special test is used to test the integrity of the CFL
Talar tilt test
How is the talar tilt test performed and what is it testing
It tests the integrity of the CFL by inverting the calcaneus with the ankle in neutral
What are the signs and symptoms of a 1st degree sprain
acute ankle pain, maybe a pop
Little loss of function or ROM, no laxity
mild tenderness
little or no bruising/swelling
What are the types of management for a 1st degree sprain
RICE for 1-2 days
limit weight bearing initially then hard rehab
Taping may help
Return to play in 7-10 days
What are signs and symptoms of a second degree sprain
severe ankle pain/tenderness popping loss of function/painful ROM Increased laxity but has an end point general swelling/bruising limited WB
What are the types of management for a 2nd degree sprain
RICE for 72 hours
boot/crutches for 5-10 days
Taping will help early stages
Retrain proprioception to prevent re-injury
What are signs and symptoms of a 3rd degree sprain
Severe or no ankle pain popping/joint dislocation severe tenderness loss of function immediate swelling/bruising Positive anterior drawer and talar tilt tests
Ankle sprains are an example of what type of pain
nociceptive
What are the types of management for a 3rd degree sprain
RICE X-RAY per ottawa rules isometrics ROM, PRE, and balance exercises Maybe surgery
What sport is medial/eversion ankle sprains commonly seen in
wrestling
Which ligament is at risk during a medial ankle sprain
deltoid
75% of ankle fractures occur on the (medial/lateral) side
medial
What are the 3 types of fractures that are seen on the medial side
- Avulsion fracture of medial malleolus
- Pott’s - a Bimalleolar fracture
- Ankle mortise chondral lesions
What special test is done to test the integrity of the deltoid ligament
Lateral talar tilt test done in neutral, PF, and DF
A foot that is (supinated/pronated), (hypermobile/hypomobile) and has a depressed medial longitudinal arch is more predisposed to eversion sprains
pronated and hypermobile
If a patient has localized point tenderness and swelling over the the deltoid ligament, what would you expect
a medial ankle sprain
A positive talar tilt test eludes to what condition
medial ankle sprain
What are the signs and symptoms of a syndesmotic sprain
Pain with passive ER and DF
loss of function
severe anterolateral pain
What is a typical MOI of a syndesmotic sprain
A torsion force - The foot is planted and the leg moves on the foot
A syndesmotic sprain is (easy/difficult) to treat and may take _____ of treatment
difficult; months
If a patient has a syndesmotic ankle sprain, what would your course of treatment look like
The same as other ankle sprains, but immobilization and total rehab will be longer
Which ligaments are affected during a syndesmotic ankle sprain
anterior and posterior tibiofibular ligaments
What are the four structures that can be affected with a syndesmotic sprain
Posterior tibiofibular ligament
Anterior tibiofibular ligament
Interosseous membrane
Posterior talofibular ligament
A taped ankle starts losing stability after ___ minutes of activity
30
Ankle distraction is good for stiff _____ and ___ joints after being immobilized
TCJ and STJ
A posterior glide of the tibia on the talus will increase (DF/PF)
PF
A posterior glide of the talus on the tibia will increase (DF/PF)
DF
During a stance stretch to the gastroc increase DF, make sure the individual does not (supinate/pronate) during the stretching
pronate
What are 5 risk factors for developing a lateral ankle sprain
- History of ankle sprains
- No external support
- No warm up
- Limited DF
- No balance/proprioception exercises after old ankle sprain
To evaluate activity and participation limitations, what are activities you can do post acute stage
single limb hop for lateral and diagonal movements
If a patient has an acute ankle sprain, what types of manual therapy can be done
lymphatic drainage
joint mobs
AP talar mobs
For an acute ankle sprain, what in one modality you should definitely use and one modality you definitely should not use
use ice
do not use ultrasound
What are three MOI of nerve injuries
compression
tension
inflammation
