Foot and Ankle Flashcards
the podiatric model focuses on…
alignment and biomechanics
functions of the foot
1 - absorb rotation
2 - loose adaptor
3 - base of support
4 - rigid lever
which muscles attach to the talus
none of them
what muscle controls foot pronation
posterior tib
how much DF do you need for normal walking
10
20 for running
for stress fractures, how do you decide if they should be non-weight bearing
if they have pain with normal everyday activities they should probably be NWB for a period of time
what is chronic compartment syndrome usually due to
overuse of a muscle in that compartment
can we treat chronic compartment syndrome
sometimes but it often still becomes a surgical issue
the talocrural joint is approx __ degrees varus and about ______ degrees externally rotated
2-3
23
talocrural DF range of motion
10-25
DF arthrokinematics
anterior roll
posterior glide
what could limit DF ROM
1 - posterior capsule
2 - gastroc/soleus
3 - deltoid ligament
4 - posterior tib-tib ligament
PF range of motion
40-65 degrees
what could limit PF
anterior capsule
anterior tib-fib ligament
PF arthrokinematics
posterior roll
anterior glide
ligamnets of the ankle mortise
interosseous membrane
ant tibio-fibular
post tibio-fibular
how long does it typically take for a high ankle sprain to heal
6-8 weeks
typical MOI for high ankle sprain
ER
is immobilization common with a high ankle sprain
yes
what are the ligs of the medial ankle
ant tibio-talar
ant tibio-navicular
calcaneo-tibio
post tibio-talar
what are the ligs of the lateral ankle
ant talo-fibular
calcaneo-fibular
post talo-fibular
most commonly sprained ligament
anterior talofibular ligament
is ultrasound affective for acute ankle sprains
no
are bracing and manual therapy supported for acute ankle sprains
yes
is manual therapy supported for chronic sprains
yes
should pts with chronic ankle sprains wear an ankle sprains
not usually, b/c they need to work on strength instead of relying on the support of the brace
ottawa ankle rules
- tenderness at lateral/medial malleoli, base of 5th metatarsal or navicular
- inability to walk 4 steps at site of injury or in ER
3 parts of the foot
rearfoot
midfoot
forefoot
there is 1 posterior ___ facet and 2 anterior _____ facets on the superior surface of the calcaneus. this is where the talus articulates
convex
concave
T or F: fractures of the calcaneus are often complex and long-term dysfuction is common
T
supination calcaneal motion and arthrokinematics in the OCK
inversion
PF
adduction
medial roll, lateral glide
what happens in the entire LE w/ supination in the CKC
calcaneus inverts
talus DF
talus abducts
tibia ER
kee ext/varus
femur ER
hip ext
posterior pelvic tilt
ankle inversion ROM is OKC? CKC?
20
10
pronation calcaneal motion and arthrokinematics in the OCK
calcaneus everts
talus PF
talus adductus
tibia IR
knee flex/valgus
femur IR
hip flex
anterior pelvic tilt
ankle eversion ROM in OCK? CKC?
10
8
ligs of subtalar joint
interosseus talo-calcaneal
cervical
two parts of the midtarsal joint
calcaneus-cuboid
talus-navicular
at the talo-navicular joint, the talus is _____ and the navicular is _______
convex
concave
supination creates a _____ foot while pronation creates a ______ foot
rigid
supple
during pronation the oblique and longitudinal axes become more ____ while during supination they become more ______
parallel
perpendicular
3 joints of the midfoot
navicular-cuneiforms
cuneiforms-met
cuboid - met
at the navicular-cuneiform articulation, the cuneiforms are _______ and the navicular is _______
concave
convex
at the cuneiform-met articulation and cuboid-met articulation the arthrokinematics are ______ on ________
convex on concave
lisfranc joint
1st cuneiform and 1st metatarsal
what is usually the MOI for a lisfranc injury
plantarflexion
what happens to the midfoot with a lisfranc injury
it becomes hypermobile
should you get imaging with a possible lisfranc injury
yes, immobilization and/or surgery is needed
what muscle helps control the medial longitudinal arch
posterior tib
what muscles help support the transverse arch
intrinsic foot muscles
what do patient’s often complain of feeling with a cuboid sublux? what does a cuboid sublux often come from
- it feels like they are walking on a rock
- comes from chronic ankle sprains
what can you do for a cuboid sublux
- manipulations
- intrinsic foot and peroneal strength for stability
the metatarsophalangeal joints are _______ on _______
convex on concave
what can you do for hallux valgus
offload pain and prevent further valgus by controlling abnormal motion
metatarsalgia often comes from a lack of _____ or over____
dorsiflexion
pronation
plantar fascia tightens during ankle/toe
dorsiflexion
people with plantar fascitis usually have the most pain when
they first stand up in the mornings
is dry needling recommended for plantar fascitis
no
what is recommended for plantar fascitis
manual therapy, stretching, taping, orthotics, night splints, ther-ex, footwear, patient ed
how long should you try night splints for plantar fascitis
1-3 months
T or F: some achilles tendon ruptures are now treated non-surgically
T
is early mobilization beneficial for achilees tendon ruptures
yes
too much _____ stresses the post tib while too much _____ stresses the achilles tendon
pronation
dorsiflexion
treatment approach for tendinopathies
- protect healing tendon (soft tissue treatment)
- restore ROM
- strengthen (esp eccentrics)
should you wear night splints for tendinopathies
no
Orthoses, heel lifts, and laser therapy have __________ evidence when it comes to treating tendinopathies.
conflicting
most common LE tendinopathies
Achilles tendon
posterior tib
peroneals
anterior tib OIA innervation
O: upper 2/3 lateral tibia
I: 1st cuneiform/1st metatarsal
A: DF/inversion
N: deep fibular
extensor hallicus longus OIA innervation
O: middle of fibula
I: distal 1st ray
A: great toe ext/DF
N: deep fib
gastrocnemius OIA innervation
O: femoral condyles
I: calcaneal tuberosity
A: plantar flexion, knee flexion
N: tibial
posterior tibialis OIA innervation
O: posterior lateral tibia
I: navicular, cuneiforms, cuboid, base of 2,3,4
A: inversion, PF
N: tibial
fibularis longus/brevis OIA innervation
O: lateral tibia, proximal 2/3 fibula
I: base of 5th, 1st metatarsal, 1st cuneiform
A: eversion, PF
N: superficial fibular
three phase approach for foot/ankle rehab
1) protection (acute)
2) ROM (subacute)
3) return to activity (advanced training/maintenance)
What kind of strength training is appropriate (if any) during protection phase?
sub-max isometrics
By the end of the ROM phase the goal is to have full ROM and be fully…
weightbearing
*also want to return to full ADLs
What kind of strength training during ROM phase?
endurance and balance
The goal is for _____% of strength to be regained by the end of ROM phase.
80
During the return to activity the tissue is able to withstand full stress and the goal by the end of this phase is to return to…
athletics or occupation/daily activity
What kind of strength training during return to activity phase?
strength, balance, and agility
The goal is for _____% of strength to be regained by the end of return to activity phase.
90
What do foot orthotics do?
control abnormal motion or change abnormal position
Are soft orthotics used for rigid or hypermobile feet? What is the goal of soft orthotics?
rigid
goal is to rest/off load
What population are soft orthotics often seen in?
older adults
those with wounds
post-operative/trauma
Are semi-rigid orthotics for rigid or hypermobile feet? What is the goal?
hypermobile
forefoot control
What population are semi-rigid orthotics often seen in?
overpronators
heavier or more active individuals
T or F: orthotics have shown to be very useful for treating back pain
F: they have the most impact where you put them (foot/ankle)
T or F: orthotics can improve balance in older adults
T
Best position to measure PF and DF
prone
*for DF measure in both knee extension and flexion
How to control pronation during standing gastroc stretch
put a towel under medial arch and first two toes
How to stretch plantar fascia during gastroc stretch
towel under big toe
posterior glides improve…
dorsiflexion
What can cause the fibula to move forward? What can you do for this?
ankle sprains (the ATFL gets stretched out and pulls on it)
posterior glide
How many single leg calf raises should you be about to do for running?
30
