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Boards Prep - MSK > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

1
Q

Overuse/degenerative injuries are typically due to

A
  • poor footwear
  • training errors
  • biomechanical faults
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2
Q

excessive supination

A
  • hypomobility
  • poor shock absorber
  • poor at absorbing limb rotation
  • may lead to stress up the chain
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3
Q

treatment for excessive supination

A
  • joint mobs
  • stretching
  • cushioned shoes/inserts for shock absorption
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4
Q

excessive pronation

A
  • hypermobile foot
  • increased stress to soft tissues due to stretching and flattening arch
  • absorbed limb rotation too quickly can lead to stresses up the chain
  • decreased ability to become a rigid lever during push off
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5
Q

treatment for excessive pronation

A
  • strengthening
  • arch taping/orthotics
  • motion controlling shoes
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6
Q

What is tarsal tunnel syndrome

A
  • entrapment of tibial n as it passes under flexor retinaculum in the posterior tarsal tunnel (contains Tom, Dick, and Harry)
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7
Q

signs and symptoms of tarsal tunnel syndrome

A
  • pain, burning, throbbing, paresthesias on plantar aspect of foot
  • increased symptoms with WB (excessive pronation)
    • tinel’s sign at post tarsal tunnel
  • weakness of foot intrinsics
  • sensory deficits possible
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8
Q

etiology of tarsal tunnel syndrome

A
  • tenosynovitis/teninopathies of PT, FDL, FHL
  • ankle sprain
  • excessive/uncontrolled pronation
  • previous fractures
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9
Q

interventions for tarsal tunnel syndrome

A
  • based on etiology
  • stretch gastric and soleus
  • arch supports
  • strengthen intrinsics, PT, AT
  • neural mobilizations
  • address tendinopathies
  • surgical release
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10
Q

What is Morton’s neuroma?

A
  • plantar digital nerve comes entrapped between metatarsal heads
  • typically 3rd and 4th
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11
Q

etiology of Mortons neuroma

A
  • F>M
  • 25-50 yo
  • overuse or biomechanical abnormalities
  • poor shoe fit/style (high heels, small toe box)
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12
Q

Signs and symptoms of Morton’s Neuroma

A
  • burning and/or throbbing sensation at MT heads that usually shoots into toes
  • may have dorsal pain or pain radiating proximally into foot
  • worse with walking/running
    • Mortons test (squeeze MT heads together)
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13
Q

Interventions for Morton’s Neuroma

A
  • neural mobs
  • joint jobs of MT heads and MT joints
  • forefoot strengthening into flexion
  • footwear adjustments/changes –> wide toe box
  • nerve block, injections, surgery
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14
Q

signs and symptoms of common fibular nerve compression/injury

A
  • DF, EV, toe ext weakness
  • foot drop and/or foot slap
  • decreased sensation of ant leg and dorsal of foot/sides of toes
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15
Q

Interventiosn for common fibular n compression/injury

A
  • nerve mobs
  • joint mobilizations of superior tib-fib joint
  • soft tissue mobs of fibularis mm
  • support if needed (AFO)
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16
Q

Charcot Marie Tooth diagnosis

A
  • first noticed due to foot deformities
  • fatigue, pain, loss of balance
  • nerve conduction tests/genetic testing
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17
Q

Charcot Marie Tooth treatment

A
  • no definitive treatment
  • usually, progression steadies on its own
  • stretching, strengthening, endurance
  • contracture management, bracing, AD
  • pain reduction/ management
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18
Q

What is hallux valgus

A
  • medial deviation of MT head; lateral deviation of proximal phalanx
  • normal angle: 15 degrees
  • pathological: >20
    “bunion”
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19
Q

hallux valgus etiology

A
  • excessive pronation
  • limited MTP extension during heel-toe off
  • lax ligamentous structures
  • weak musculature
  • shoe wear
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20
Q

hallux valgus conservative management

A
  • joint mobs/stretching/strengthening
  • correct biomechanics/arch supports
  • shoe wear
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21
Q

hallux valgus surgical management

A
  • bunionectomy
  • osteotomy
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22
Q

Hammer toes

A
  • MTP extension
  • PIP flexion
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23
Q

claw toes

A
  • MTP hyperextension
  • DIP and PIP flexion
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24
Q

mallet toes

A
  • flexion deformity of distal IP
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25
Q

interventions for toe deformities - conservative

A
  • joint mobs/ stretching
  • intrinsic strengthening
  • orthotics/ shoe alteration
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26
Q

interventions for toe deformities - surgical

A
  • bony corrections
  • osteotomy
  • bunionectomy
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27
Q

fibular fracture

A
  • may cause injury to inferior tibiofibular joint
  • may require surgical fixation if syndesmosis widening is more than 5 mm
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28
Q

malleolar fractures

A
  • 85% involved isolated malleolus without displacement
  • evidence supports god to excellent results with non surgical approach
  • immobilization 6-7 weeks
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29
Q

bimalleolar fractures

A
  • lateral malleolus fracture with either medial Mal fracture or rupture of deltoid ligament
  • ORIF
  • NWB/PWB 4-6 weeks
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30
Q

trimalleolar fractures

A
  • bimalleolar fracture plus fracture of posterior lip of tibia
  • ORIF with posterior fixation if large posterior fragments are present
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31
Q

extra-articular calcaneal fracture

A
  • avulsion of achilles
  • anterior process
    (hyperdosiflexion injury)
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32
Q

intra-articular calcaneal fractures

A
  • usually due to large compressive force
  • fall from height
  • requires surgical intervention
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33
Q

Talus fractures

A
  • most are considered intra-articular bc most of talus is covered by articular cartilage
  • most common: talar neck due to hyper-dorsiflexion at TC joint
  • poor blood supply –> avascular necrosis common in talus
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34
Q

navicular tuberosity fracture

A
  • PF/INV injury
  • immobilize in supinated position
  • possible surgery
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35
Q

navicular body fracture

A
  • direct trauma
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36
Q

stress fracture of navicular

A

dorsomedial pain

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37
Q

cuboid fractures

A
  • avulsion fractures commonly associated with PF/INV injuries
  • frequently occur with lateral MT fractures
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38
Q

Cuneiform fractures

A

typically due to direct trauma

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39
Q

what is a Lisfranc Fracture

A
  • disruption of 2nd TMT joint usually due to sudden twisting
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40
Q

presentation of LisFranc Fracture

A
  • significant pain; inability to WB
  • bruising (top or bottom of foot), swelling
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41
Q

treatment of LisFranc fracture

A
  • NWB in cast/boot for 6 weeks
  • RICE
  • surgery
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42
Q

MT fractures

A
  • displaced: need reduction
  • non-displaced: #2-5 treated with tape immobilization; #1 NWB for 2 weeks then progressive WB
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43
Q

Phalangeal fractures

A
  • primary cause is direct trauma - stubbing toe
  • “nightwalker fractures”
  • Rx: tape immobilization and protected weight bearing
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44
Q

general PT interventions for fracture

A
  • in subacute phase
  • progressive, protected WBing/gait training as instructed by MD
  • ROM
  • strengthening
  • balance/proprioception
  • joint mobs as cleared by MD
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45
Q

Intervention for shin splints

A
  • relative rest
  • address cause –> educate, training adjustments, biomechanical faults
  • cushioned inserts/shoes
  • gradual return to activity
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46
Q

Risk factors for shin spints/anterior medial tibial stress syndrome

A
  • F>M
  • increased body weight
  • increased mm stiffness
  • greater rear foot eversion during during running
  • increased hip ER in flex
  • previous running injury
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47
Q

Heel spur signs and symptoms

A
  • local heel pain/plantar pain
  • pain after activity, better with rest, worsens with in creased WBing
  • may have excessive supination or pronation
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48
Q

PT intervention for heel spurs

A
  • joint mobs and stretching if hypo mobility is present
  • orthotics and footwear changes to reduce stress on plantar fascia
  • heel insert/cushion
  • strengthening if hyper mobility is present
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49
Q

Grade I ankle sprain - pathology

A
  • mild stretch
  • no instability
  • single ligament (usually ATFL)
50
Q

Grade I ankle sprain - signs and symptoms

A
  • no hemorrhage
  • minimal swelling
  • point tenderness
  • (-) ant drawer
  • no varus laxity
51
Q

Grade I ankle sprain - disability/ participation restrictions

A
  • little/no limp
  • minimal to no functional loss
  • difficulty hopping
  • recovery 2-10 days
52
Q

Grade II ankle sprain - pathology

A
  • large spectrum of injury
  • mild-mod instability
  • complete tear of ATFL OR partial tear of ATFL and CFL
53
Q

Grade II ankle sprain - signs and symptoms

A
  • localized swelling
  • (+) anterior drawer
  • no varus laxity
54
Q

Grade II ankle sprain - disability/participation restrictions

A
  • limp with walking
  • unable to toe raise
  • unable to hop
  • unable to run
  • Recovery: 10-30 days
55
Q

Grade III ankle sprain - pathology

A
  • significant instability
  • complete tear: ATFL, CFL, anterior capsule
56
Q

Grade III ankle sprain - signs and symptoms

A
  • diffuse swelling
  • early hemorrhage
  • (+) ant drawer
  • (+) varus laxity
57
Q

Grade III ankle sprain - disability/participation restrictions

A
  • unable to FWB
  • significant pain inhibition
  • initial loss of ROM (almost complete)
  • recovery: 30-60 days
58
Q

Management of Grade I and II ankle sprains

A
  • depends on severity
  • RICE 2-3 days for swelling
  • strengthening and balance training
  • proprioception
  • external trading or taping may be required for high level activities
59
Q

Management of Grade III sprains

A
  • early mobilization and activity vs immobilization
  • if immobilized, place in neutral or slight DF
  • used for approx 3 weeks
  • should allow WBing
60
Q

Plantar fasciitis etiology

A
  • Traumatic: sudden excessive pronation or direct pressure/contusion of plantar longitudinal arch surface
  • mechanical/overuse
61
Q

plantar fasciitis history/exam findings

A
  • plantar (medial) heel pain –> most noticeable w/ initial steps after period of inability; worse following prolonged WBing
  • recent change in activity (increased WBing)
  • tenderness with palpation over medial plantar heel
  • excessive pronation or supination
    • Windlass
  • (-) Tarsal tunnel
  • limited DF A/PROM
  • possible heel spur
62
Q

plantar fasciitis CPG - outcome measures

A
  • use outcome measures such as Foot and Ankle Ability Measure, Foot Function Index, and others (LEFS, Foot health status questionnaire)
    (I)
63
Q

plantar fasciitis CPG - Interventions

A
  • Manual Therapy (joint and tissue mobilization)
  • Stretching - should use fascia specific and gastroc-soleus stretching
  • Taping - should use taping (1-3 weeks); use foot orthoses to support medial longitudinal arch and cushion the heel (2 weeks to 1 yr); should prescribe night splints (1-3 mo)
64
Q

Achilles tendonopathy etiology

A
  • most prevalent in 40-59 age group
  • risk factors: increased body weight, other systemic diseases, previous injury, decreased mm strength and flexility, family history
65
Q

Ankle ligament sprains CPG - outcome measure

A
  • use valid/reliable measures: PROMIS physical function and pain interference, Food and Ankle ability measure, lower extremity functional scale
  • utilize at baseline and at least 1 follow up
    (I)
66
Q

Ankle ligament sprains CPG - physical impairment measures

A
  • include objective measures of ankle swelling, ROM, talar transition and inversion, and single leg balance
  • specifically include: WBing lunge test, static SLB on firm surface with eyes closed, dynamic balance (Star balance extrusion test)
    (I)
67
Q

Ankle ligament sprains CPG - Acute lateral ankle sprain intervention

A
  • for primary prevention, should prescribe prophylactic bracing, particularly with risk factors
  • for secondary prevention, should prescribe prophylactic bracing and use proprioception/balance training
  • should advise patient on external support and progressive WBing
  • for severe injustices, may immobilize for up to 10 days post
  • should implement structures Therex program that includes protective AROM, stretching, neuromuscular training, post re-ed and balance training, both in the clinic and at home
  • should use manual therapy in conjunction with exercise to reduce swelling, improve mobility, and normalize gait
  • should NOT use ultrasound
68
Q

Ankle ligament sprain CPG - chronic ankle instability interventions

A
  • should prescribe proprioceptive and neuromuscular therapeutic exercise to improve dynamic postural stability and patient perceived stability
  • should use manual therapy (mobs, manips, mobs with movement) to improve WBing DF and dynamic balance in short term
69
Q

Achilles tendonopathy CPG - outcome and physical performance measure

A
  • use the Victorian Institute of Sport Assessment-Achilles (VISA-A) t assess pain and stiffness (I)
  • Use the foot and ankle ability measure or LEFS to assess activity and participation (I)
  • include hope tests and heel raise endurance tests (II)
70
Q

Achilles tendonopathy CPG - interventions

A
  • use mechanical loading (eccentric or heavy-load, slow velocity) exercise to decrease pain and increased function (I)
  • educate relative rest is not indicated (II)
  • dexamethasone iontophoresis to decrease pain and improve function (II)
71
Q

signs and symptoms of Achilles tendonopathy

A
  • located pain (2-6 cm from insertion) and perceived stiffness following inactivity
  • “warm up” phenomenon –> lessens with acute activity; may increase with prolonged activity
  • selective tissue testing confirms pain with resisted testing, pain with stretching
  • tender to palpation
  • (+) London royal hospital test; arc sign
  • excessive pronation
72
Q

achilles tendon rupture signs and symptoms

A
  • described as like being “kicked” or “shot” in the calf
  • pain and swelling
  • severe weakness and gait deviations due to limited/absent push off
  • (+) thompson test
73
Q

Achilles tendon rupture conservation management w/ early mobilization

A
  • typically < 2 weeks immobilization at 20 degrees PF
  • typically WBAT w/ hinged CAM boot
  • progress to 0 degrees DF w/ in CAM boot
  • may use 1-1.5 cm heel lift (B) after D/C from boot
  • 6-8 weeks pain free ambulation w/o AD
74
Q

achilles tendon rupture surgical repair

A
  • immobilized 2 weeks
  • Not > 10 deg DF by 8 weeks
  • Symmetrical DF by 12 week
  • limited and protected WB for 4 weeks then WBAT
75
Q

flexor hallucis tendonopathy is commonly seen in

A

ballet performers

76
Q

Pes Cavus (hollow foot) etiology

A
  • numerous etiologies to include genetic predisposition, neurological disorders resulting in muscle imbalances, and contracture of soft tissue
77
Q

deformity observed in pes cavus

A
  • increased height of longitudinal arches, dropping of anterior arch, MT heads lower than hindfood, plantar flexion, and splaying of forefoot, and claw toes
78
Q

PT goals, outcomes, and interventions for pes cavus

A

pt education emphasizing limitation of high impact sports, use of proper footwear, and fitting for orthoses

79
Q

equinus etiology

A
  • can include congenital bone deformity, neurological disorders such as CP, contracture of gastroc and/or soleus mm, trauma, or inflammatory disease
80
Q

deformity observed in equinus

A

plantar flexed foot

81
Q

compensation from equinus deformity

A
  • limited dorsiflexion results in compensation of subtalar joint pronation and mid tarsal joint pronation
82
Q

equinus deformity PT goals, outcomes, intervention

A
  • flexility exercises of shortened structures within foot, joint mobilization to joint restrictions identified in examination, strengthening to intrinsic and extrinsic foot muscles, and orthotic management
83
Q

etiologies of metatarsaliga

A
  • mechanical: tight triceps sure group and/or achilles tendon, collapse of transverse arch, short first ray, pronation of forefoot
  • structural changes in transverse arch, possible leading to vascular and/or neural compromise in tissues in forefoot
  • changes in footwear
84
Q

complaints frequently heard in matatarsalgia

A
  • pain at first and second metatarsal heads after long periods of weight bearing
85
Q

PT interventions, goals, outcomes for metatarsalgia

A
  • correction of biomechanical abnormality (improving flexility of triceps surae), and modalities to decreased pain
  • prescription and/or creation of orthoses
  • pt education on foot wear
86
Q

etiology of rear foot valgus

A
  • abnormal mechanical alignment of the knee (genu valgum) or tibial valgus
87
Q

deformity observed in rear foot valgus

A
  • eversion of calcaneus with a neutral subtalar joint
88
Q

do more muscular skeletal problems develop with rear foot valgus or varus?

A
  • rearfoot varus
  • due to increased mobility of hindfoot
89
Q

PT goals for rear foot valgus

A
  • regaining proper mechanical alignment
  • improving flexibility of shortened soft tissues
  • orthotic fitting and patient ed regarding foot wear selection
90
Q

etiology of rear foot varus

A
  • congenital abnormal deviation of head and neck of talus
91
Q

deformity observed in rear foot varus

A

inversion of forefoot when subtalar joint is in neutral

92
Q

PT goals, interventions, outcomes for rear foot varus

A
  • regaining proper mechanical alignment
  • improving flexibility of shortened soft tissues
  • orthotic fitting and patient ed regarding foot wear selection
93
Q

what is forefoot varus

A
  • forefoot is in inverted position relative to the calcanea bisection due to lack of derotation of the talus
94
Q

compensated forefoot varus

A

STJ and mid foot pronation

95
Q

uncompensated forefoot varus

A
  • anterior midfoot
  • excessive forces and ankle or knee
96
Q

what is forefoot valgus

A

forefoot is in an everted position relative to the calcaneal bisection due to excessive rotation of the talus

97
Q

where will compensation occur for forefoot valgus deformity

A

compensation will occur through rearfoot
- will be supinated during mid stance

98
Q

toes concave/convex rule

A

concave moving on convex

99
Q

MTP joint abd/add concave/convex rule

A

concave on convex

100
Q

subtalar concave/convex

A

concave on convex

101
Q

talocrural concave/convex rule

A

convex on concave

102
Q

TC joint OPP/CPP

A

OPP: mid inv/eversion and 10 degrees PF
CPP: full DF

103
Q

subtalar joint OPP/CPP

A

OPP: midway between extremes
CPP: full inversion

104
Q

mid tarsal joint OPP/CPP

A

OPP: Midway between extremes
CPP: full supination

105
Q

TMT joint OPP/CPP

A

OPP: midway between supination and pronation
CPP: full supination

106
Q

MTP OPP/CPP

A

OPP: neural (10 degrees ext)
CPP: full ext

107
Q

IP joint OPP/CPP

A

OPP: flight flexion
CPP: full extension

108
Q

talocrural joint capsular pattern

A

PF > DF

109
Q

mid tarsal joint capsular pattern

A

supination > pronation

110
Q

1st MTP capsular pattern

A

ext > flex

111
Q

MTP II-V capsular pattern

A

variable –> tends toward flexion restrictions

112
Q

IP capsular pattern

A

tends towards extension restrictions

113
Q

ankle normal supination/pronation

A

sup: 45-60
pro: 15-30

114
Q

ankle normal PF/DF

A

PF: 50
DF: 20

115
Q

2nd -5th MTP normal flex/ext

A

flex: 40
ext: 40

116
Q

1st MTP normal flex/ext

A

flex: 45
ext: 70

117
Q

1st IP normal flex/ext

A

flex: 90
ext: 0

118
Q

2nd-5th PIP normal flex/ext

A

flex: 35
ext: 0

119
Q

2nd - 5th DIP normal flex/ext

A

flex: 60
ext: 30

120
Q
A

Boards Prep - MSK (29 decks)

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