Exam 2: Foot & Ankle Intro Lecture Flashcards
What are the two outcome measures that we can use during an examination of the ankle
Timed 6 minute walk test
Lower Extremity Functional Scale (LEFS)
Which outcome measure times a patient for six minutes to determine how far they walk
Timed-6 minute walk test
How do we evaluate if a patient is improving with a timed 6 minute walk test
Make a comparison to a baseline that is taken another day during a re-evaluation
Is the 6 minute walk test functional or nonfunctional
functional
Is the LEFS outcome measure reliable or unreliable
reliable
The LEFS has good (sensitivity/specificity) and is (easy/hard) to administer and score
sensitivity; easy
True or False:
The LEFS outcome measure is not useful for research and clinical decision making
False, it is useful
An examination of the ankle involves collecting data via patient history, observation, palpation, and ROM/Position testing. State what we are looking for during the observation component.
During observation we are looking at measuring joint swelling of the ankle
An examination of the ankle involves collecting data via patient history, observation, palpation, and ROM/Position testing. State what we are looking for during the ROM/Position testing component. (Hint: There’s 9 positional tests)
- Calcaneal relaxed in stance
- Ankle DF
- Ankle PF
- Subtalar Neutral
- Subtalar Inversion
- Subtalar Eversion
- First Ray DF
- Navicular Drop
- Forefoot Varus/Valgus
In regards to the ankle, the term “subtalar” often refers to which bone of the foot
The calcaneus
During strength testing of the ankle, PT’s should perform isometric and functional testing. List the 5 isometric tests that should be performed.
- Ankle DF
- Ankle PF
- Eversion
- Inversion
- Great Toe Extension
Which muscle is firing the most during ankle DF isometric strength testing
Tibialis anterior
Which muscles are firing the most during ankle PF isometric strength testing
Gastroc and Soleus
Which muscle is firing the most during ankle inversion isometric strength testing
Tibialis posterior
Which muscle is firing the most during ankle eversion isometric strength testing
Peroneals/fibular
Which muscle is firing the most during great toe extension isometric strength testing
EHL and EHB
During strength testing of the ankle, PT’s should perform isometric and functional testing. List some examples of functional tests that could be performed
Squatting, up/down stairs, sit to stand, or walking
During an examination of the ankle, PT’s should perform ligamentous/instability testing. What are the two general injuries that would be checked for stability
Tibiofibular syndesmosis (high ankle sprain) and a lateral ankle sprain
What is another name for a high ankle sprain
syndesmotic sprain
A (medial/lateral) ankle sprain is the most common
lateral
During an examination of the ankle, PT’s should perform special tests. What are the three general injuries that would be checked during special testing
Anterolateral ankle impingement
Achilles Tendon tears
Plantar fasciitis
(yellow/red) flags are considered psychosocial problems
yellow flags
List a few examples of a yellow flag
Someone going through a divorce, depression, stress
If a patient reports a traumatic incident resulting in forced inversion or eversion, what would be your initial hypothesis
possible ankle sprain, possible fracture, possible fibular nerve
If a patient reports trauma to the ankle that included tibial rotation on a planted foot, what would be your initial hypothesis
Possible syndesmotic sprain
If a patient notes tenderness of anterior shin and exhibits excessive pronation while complaining that symptoms exacerbate during weight bearing activities, what would be your initial hypothesis
Possible medial tibial stress syndrome
If a patient reports atraumatic event resulting in an inability to plantarflex the ankle, what would be your initial hypothesis
possible achilles tendon rupture
If a patient reports pain with stretch of calf muscles and during gait/push off, what would be your initial hypothesis
possible achilles tendonitis or Sever’s disease
If a patient reports pain at the heel with a few steps out of bed after prolonged periods of walking, what would be your initial hypothesis
possible plantar fasciitis
If a patient reports pain or paresthesia in the plantar surface of the foot, what would be your initial hypothesis
Possible tarsal tunnel syndrome, possible sciatica or lumber radiculopathy
If a patient reports pain on the plantar surface of the foot between the 3rd and 4th metatarsals and that the pain is worse when with shoes versus barefoot, what would be your initial hypothesis
possible morton’s neuroma, possible metatarsalgia
If swelling of the ankle is present, then we need to measure and observe what we see. List the three ways we measure and observe a swollen ankle
- Water displacement
- Tape measurement - figure 8
- Observe color, ecchymosis, location of swelling, and temperature.
Does water displacement or figure 8 tape measurement have greater reliability in regards to measuring a swollen ankle
water displacement, but it isn’t practical in most clinics so we resort to tape measurements
What are three general structures that should be palpated during an ankle evaluation
bony prominences
ligaments
soft tissues
Which nerves should we be aware of during palpation of the ankle.
tibial nerve, sural nerve, superficial and deep fibular nerve
True or False:
The overall reliability of measuring PF and DF with a goniometer ranges from poor to fair for both inter and intra examiner
False: it is fair to very good
The ____ _____ ____ was developed as a clinical prediction rule to determine the need for radiographs after an acute ankle injury
Ottawa Ankle Rules
According to the Ottawa Ankle Rules, when should a referral for a radiograph of the ankle be made
If a patient cannot bear weight immediately after the injury or if there is tenderness at the posterior edge of lateral malleolus, the base of the 5th metatarsal, the posterior edge of the medial malleolus, or the navicular
What type of physician was the Ottawa Ankle Rules originally designed for
ER physicians that would X-Ray everything
A pooled sensitivity of 27 studies investigated the rule was 97.6% and the CI range was 96.6-98.9. Explain the significance of these findings
The sensitivity of 97% means that the study was able to rule out 97% of cases that did not need an xray. The range is tight or close together, which is a good thing.
