Exam 2: Foot & Ankle Intro Lecture

Question 1

What are the two outcome measures that we can use during an examination of the ankle

Answer 1

Timed 6 minute walk test

Lower Extremity Functional Scale (LEFS)

Question 2

Which outcome measure times a patient for six minutes to determine how far they walk

Answer 2

Timed-6 minute walk test

Question 3

How do we evaluate if a patient is improving with a timed 6 minute walk test

Answer 3

Make a comparison to a baseline that is taken another day during a re-evaluation

Question 4

Is the 6 minute walk test functional or nonfunctional

Answer 4

functional

Question 5

Is the LEFS outcome measure reliable or unreliable

Answer 5

reliable

Question 6

The LEFS has good (sensitivity/specificity) and is (easy/hard) to administer and score

Answer 6

sensitivity; easy

Question 7

True or False:

The LEFS outcome measure is not useful for research and clinical decision making

Answer 7

False, it is useful

Question 8

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.

Answer 8

During observation we are looking at measuring joint swelling of the ankle

Question 9

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)

Answer 9

1. Calcaneal relaxed in stance
2. Ankle DF
3. Ankle PF
4. Subtalar Neutral
5. Subtalar Inversion
6. Subtalar Eversion
7. First Ray DF
8. Navicular Drop
9. Forefoot Varus/Valgus

Question 10

In regards to the ankle, the term “subtalar” often refers to which bone of the foot

Answer 10

The calcaneus

Question 11

During strength testing of the ankle, PT’s should perform isometric and functional testing. List the 5 isometric tests that should be performed.

Answer 11

1. Ankle DF
2. Ankle PF
3. Eversion
4. Inversion
5. Great Toe Extension

Question 12

Which muscle is firing the most during ankle DF isometric strength testing

Answer 12

Tibialis anterior

Question 13

Which muscles are firing the most during ankle PF isometric strength testing

Answer 13

Gastroc and Soleus

Question 14

Which muscle is firing the most during ankle inversion isometric strength testing

Answer 14

Tibialis posterior

Question 15

Which muscle is firing the most during ankle eversion isometric strength testing

Answer 15

Peroneals/fibular

Question 16

Which muscle is firing the most during great toe extension isometric strength testing

Answer 16

EHL and EHB

Question 17

During strength testing of the ankle, PT’s should perform isometric and functional testing. List some examples of functional tests that could be performed

Answer 17

Squatting, up/down stairs, sit to stand, or walking

Question 18

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

Answer 18

Tibiofibular syndesmosis (high ankle sprain) and a lateral ankle sprain

Question 19

What is another name for a high ankle sprain

Answer 19

syndesmotic sprain

Question 20

A (medial/lateral) ankle sprain is the most common

Answer 20

lateral

Question 21

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

Answer 21

Anterolateral ankle impingement
Achilles Tendon tears
Plantar fasciitis

Question 22

(yellow/red) flags are considered psychosocial problems

Answer 22

yellow flags

Question 23

List a few examples of a yellow flag

Answer 23

Someone going through a divorce, depression, stress

Question 24

If a patient reports a traumatic incident resulting in forced inversion or eversion, what would be your initial hypothesis

Answer 24

possible ankle sprain, possible fracture, possible fibular nerve

Question 25

If a patient reports trauma to the ankle that included tibial rotation on a planted foot, what would be your initial hypothesis

Answer 25

Possible syndesmotic sprain

Question 26

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

Answer 26

Possible medial tibial stress syndrome

Question 27

If a patient reports atraumatic event resulting in an inability to plantarflex the ankle, what would be your initial hypothesis

Answer 27

possible achilles tendon rupture

Question 28

If a patient reports pain with stretch of calf muscles and during gait/push off, what would be your initial hypothesis

Answer 28

possible achilles tendonitis or Sever’s disease

Question 29

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

Answer 29

possible plantar fasciitis

Question 30

If a patient reports pain or paresthesia in the plantar surface of the foot, what would be your initial hypothesis

Answer 30

Possible tarsal tunnel syndrome, possible sciatica or lumber radiculopathy

Question 31

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

Answer 31

possible morton’s neuroma, possible metatarsalgia

Question 32

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

Answer 32

1. Water displacement
2. Tape measurement - figure 8
3. Observe color, ecchymosis, location of swelling, and temperature.

Question 33

Does water displacement or figure 8 tape measurement have greater reliability in regards to measuring a swollen ankle

Answer 33

water displacement, but it isn’t practical in most clinics so we resort to tape measurements

Question 34

What are three general structures that should be palpated during an ankle evaluation

Answer 34

bony prominences
ligaments
soft tissues

Question 35

Which nerves should we be aware of during palpation of the ankle.

Answer 35

tibial nerve, sural nerve, superficial and deep fibular nerve

Question 36

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

Answer 36

False: it is fair to very good

Question 37

The ____ _____ ____ was developed as a clinical prediction rule to determine the need for radiographs after an acute ankle injury

Answer 37

Ottawa Ankle Rules

Question 38

According to the Ottawa Ankle Rules, when should a referral for a radiograph of the ankle be made

Answer 38

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

Question 39

What type of physician was the Ottawa Ankle Rules originally designed for

Answer 39

ER physicians that would X-Ray everything

Question 40

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

Answer 40

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.