Foot and Ankle Flashcards

Question

Windlass Mechanism

Answer 1

coordinated action of the layers of muscle, tendon, ligament, and bony architecture to maintain arch height and foot rigidity. -w/o this being correct=not efficient lever/no effective push off power

Answer 2

65 degrees= this tightens the fascia and lifts the arch.

Answer 3

cuboids dislocate or fracture (long healing time); tarsals can sublux on each other

Answer 4

too much friction b/w these can pinch the nerve b/w them (neuromas)

Answer 5

second metatarsal has most fractures

Answer 6

ATF (85%) | MCL=5-7%

Answer 7

Grade I=week off Grade II=2-6 weeks Grade III=might require surgery

Answer 8

forceful inversion, plantarflexion, adduction of foot and ankle; swelling in sinus tarsi, pain with palpation and (+) anterior drawer & talar tilt test

Answer 9

pain with mild disability, minimal loss of weight bearing, ATFL tender with palpation, some swelling none to mild laxity with ant. drawer test

Answer 10

athlete hears a pop or snap at time of injury, moderate pain, and disability, moderate swelling (hemarthrosis), echhymosis present. (+) ant. drawer and talar tilt. CF ligament outstretched

Answer 11

involves tearing of ATFL; CF and possibly PTF ligaments. Severe pain and swelling, can't weight bear (+) ant. drawer and talar tilt test.

Answer 12

OPP=10-20 PF | CPP= full DF

Answer 13

lots of inversion; should be ~25 degrees, you would see more

Answer 14

hypereversion force; Post. Capsule would be stretched—you would look for posterior instability (landing in a lot of DF) would show a (+) posterior drawer test that could have to do with medial ankle sprain

Answer 15

``` painful with palpation over deltoid ligament (+) Kleiger's test may have (+) anterior drawer ```

Answer 16

excessive DF force and or foot ER force-in CC (foot on ground)

Answer 17

Severe DEEP pain, DEEP anterolateral pain-esp. about their tib fib ligament (+) Mortice Spring test/Fibular translation (+) squeeze test (+) Kleiger's

Answer 18

challenging rehab; may take months to heal

Answer 19

repeated stress, obesity, traumatic landing on foot from a height

Answer 20

pain along spring ligament and plantar fascia, decreased weight bearing fxn

Answer 21

(+) Feiss line or navicular drop test, (+) palpation over spring ligament or fascia

Answer 22

1) low-energy loading observed in sports related injuries | 2) high-energy loading observed in motor vehicle and industrial accidents

Answer 23

5 TMT jts=lisfranc jt | serves as dividing line b/w rigid midfoot and more flexible weightbearing forefoot

Answer 24

plantar midfoot ecchymosis pain along the TMT joints w/ palpation, motion, and/or weight bearing midfoot instability

Answer 25

rigid immobilization in a non-weightbearing posture at least 8 weeks screws are left in place for 5-6 months post-surgery

Answer 26

forceful hyperflexion or hyperextension of 1st MTP jt

Answer 27

EHL stretched-hyperextension FHL painful-overstretched in hyperflexion Broken toe-squeeze test, tapping test on toes

Answer 28

No special test, palpate, listen to history, do passive ROM (curl toe under will hurt) MMT to EHL will hurt….send if you think possible fracture rest from weight bearing and treat with modalities if you R/O fracture

Answer 29

Talar Dome Fx (talar cyst, osteochondritis dissecans) | hyperinversion or other force that could cause a sprain, compression injury-landing from a jump or fall

Answer 30

athlete presents like they have a sprain slow improvement during ankle rehab or ankle getting worse during normal healing process post sprain ---first thought would be high ankle sprain, if all those tests are (-) and hurts at night you need to screen for talar dome

Answer 31

casting up to 3 months; possible osteotomy

Answer 32

medical management: closed reduction ORIF MOI: classic is on tibia-but could have it on the fibula; could happen with inversion sprain--talus could give an impacting force on the tibia and break it

Answer 33

Medical management: closed reduction ORIF: open reduction internal fixation MOI: break on both sides typically tibia & fibula also known as Pott's fx

Answer 34

Medical Management: closed reduction ORIF The tri comes from tibia, fibula, and posterior aspect of medial malleolus coming off the fib and tib

Answer 35

tibial shaft; fibular shaft closed reduction, ORIF, external fixation

Answer 36

Entrapment of the posterior tibial nerve or one of its branches within the tarsal tunnel Tunnel= posterior to medial malleolus, has osseous floor covered by flexor retinaculum

Answer 37

burning on plantar aspect of foot particularly at night FWB increases symptoms (+) Tinel's Not tender to touch on plantar aspect of foot Rx: orthotics or surgery

Answer 38

chronic tendinosis resulting in fibrosis, excessive pronation, RA, myxedema (swelling from thyroid deficiency)

Answer 39

``` RICE Heel lift Shoe fit US, phono, ionto Ice massage, WPL Stretching ```

Answer 40

``` Pump bump-exostosis Tx: RICE Heel lift Shoe fit US, phono, ionto Ice massage, WPL Stretching ```

Answer 41

Most common b/w 30-50 yrs old Forefoot pushoff while knee is extending "pop" heard at time of injury

Answer 42

visible defect in tendon, inability to PF | CC: swelling;bruising around malleoli, excessive passive DF, (+) Thompson test

Answer 43

acute-compression wrap, ice, immobilization splint, get pt to orthopedist surgery or non-surgical healing 6 month progression to full ROM and strength

Answer 44

MOI: over stretching it, running, not having good length in the calf

Answer 45

Tearing the lateral retinaculum--snapping peroneals it will snap in front of the malleolus. Peroneus Longus is important for stabilizing the first toe.

Answer 46

Mechanism Injury-sports requiring sudden turning and sharp cutting (wrestling, football, ice skating) Also direct blow to lateral malleolus or hyerinversion force Watch them walk, and palpate

Answer 47

During running or jumping the athlete hears and feels the tendon snapping and coming out of its groove. May have lateral pain, ecchymosis, and swelling

Answer 48

Conservative approach: horseshoe pad laterally around the malleolus with splinting 4-6 weeks followed by rehab program. Operative-if conservative approach fails.

Answer 49

Unstable cuboid Too much motion around OMJA Painful Cuboid palpation Painful PF in Weight bearing

Answer 50

Cuboid whip RE-check palpation Try PF and see if pain is reduced Give arch strengthening exs

Answer 51

Osgood Schlatter’s of the ankle. “Calcaneal Apophysitis” Age: 10-15 Cause: repetitive jumping or direct trauma.

Answer 52

heel pain, PM

Answer 53

NSAIDS, rest, heel lift, walking cast or splint.

Answer 54

Direct trauma such as by being kicked

Answer 55

possible loss of ankle DF and toe extension, pain at end range PF, swelling, discoloration Severe pain, Tingling-burning pain (nerve compression), inability to DF, lower foot will feel cold and blue Can result in dropped foot b/c they have lost nerve supply to anterior compartment muscles

Answer 56

fascial release, deep massage to break up myofascial tightness before surgery, live with it if they feel that they can do without what caused it hence running 10 miles

Answer 57

MMT, sensory testing, Dorsal pedal pulse

Answer 58

involve either the anterior tib, EHL, EDL

Answer 59

overexertion of the muscle, too hard of heel, hard surface, tight gastroc/soleus; overuse of anterior tib

Answer 60

heat, redness, swelling, tenderness at site of lesion

Answer 61

Rest them, address tightness to gastroc/soleus, strengthen the DF and calf more lengthened then reintroduce running if you don't stress fx can result Rest, ice, proper shoe fit, restore normal gastroc/soleus length, improve pretibial muscle strength, change running surface. Gradual return to running

Answer 62

Involves mechanical inflammation of posterior tib, FHL or FDL.

Answer 63

overexertion of muscles during loading response. High correlation with excessive pronation.

Answer 64

heat, redness, swelling, tenderness at site of lesion

Answer 65

Rest, ice, proper shoe fit, restore normal gastroc/soleus length, orthotics to control pronation, gradual running return. Invertor controls pronation PRONATORS PROBLEM: especially posterior tibialis Correct for extra pronation, get appropriate running shoe, tape arch, get orthotic to block pronation, stretch gastroc out

Answer 66

> 3 degrees RF varus when in STJN

Answer 67

Mobilize Stretching Soft orthotic Curved last shoe

Answer 68

Determine where the compensation is coming from Rearfoot Midfoot Forefoot

Answer 69

Forefoot is inverted when RF is in STJN. Determine amount Post forefoot medial up to 50% or the problem, never more than a 6 degree post.

Answer 70

Forefoot is everted when in STJN. | Post laterally up to 50% of the deformity, not more than 6 degrees.

Answer 71

Abnormally high arch that remains in open and closed chain.

Answer 72

person can’t achieve normal pronation during the gait cycle and increased pressure on metatarsal heads.

Answer 73

In STJN ankle cannot come to a neutral DF position. Contracture of Gastrocnemius Congenital malalignment, post-trauma, Neurological disorder. Common with cerebral palsy

Answer 74

Foot with an abnormally low medial-longitudinal arch in open and closed chain.

Answer 75

Congenital vertical talus with a dislocated navicular. DF occurs as a result of this at the midtarsals. This deformity is often surgically corrected with foot fusion.

Answer 76

Gradual loss of 1st MTP DF ROM due to joint inflammation, scarring, cartilage degeneration, osteophytes

Answer 77

Severe loss of DF ROM 1st MTP due to arthritis

Answer 78

reduce Windlass mechanism may result in plantar fasciitis or stress fractures

Answer 79

joint mobilization, toe wedge, surgery

Answer 80

``` Disrupted Windlass mechanism from Hallux limitus/rigidus Excessive pronation Repetitive loads on foot Training error Weight gain Pes Cavus/supinated foot ```

Answer 81

very painful first step in AM. Diminishes in 5-10 minutes, slowly worsens throughout day. Point tenderness over medial tubercle. May lead to onset of heel spurs.

Answer 82

``` Correct the biomechanical dysfunction Orthotic Joint mobilizations Stretching Weight loss NSAIDs, ice, friction massage, ultrasound, phonophoresis, iontophoresis, heel lift ```