Foot And Ankle

Question 1

Bony landmarks and additional structures of tibial/fibula

Answer 1

• lateral malleolus
• medial malleolus

Question 2

Bony landmarks and additional structures of the foot

Answer 2

• 7 tarsal bones
• hindfoot
• midfoot

Question 3

Hindfoot

Answer 3

• talus
• calcaneus

Question 4

Talus

Answer 4

• creates surface for ankle joint

Question 5

Calcaneus

Answer 5

• heel of the foot

Question 6

Midfoot

Answer 6

• navicular
• cuboid
• cuneiforms (medial, intermediate, lateral)
• stabilized by plantar ligaments and plantar aponeurosis
• stabilize and support weight

Question 7

Joints of the foot and ankle

Answer 7

• proximal and distal tibiofibular joints
• talocrural joint
• subtalar joint
• MTP
• IP

Question 8

Proximal and distal tibiofibular joints

Answer 8

• contribute to stability of ankle
• interosseus membrane binds tibia and fibula together

Question 9

Talocrural joint

Answer 9

• hinge joint
• dorsiflexion and plantar flexion
• talus held between distal tibia and fibula

Question 10

Subtalar joint

Answer 10

• formed by calcaneus and inferior aspect of talus
• provides inversion and eversion

Question 11

MTP

Answer 11

• metatarsal phalanges
• flexion and extension
• some adduction and abduction

Question 12

IP

Answer 12

• interphalanges
• flexion and extension

Question 13

ROM of plantar flexion

Answer 13

• prime movers = gastrocnemius, soleus, tibialis posterior
• patient position = siting or supine with ankle in neutral (90 degrees)
• goniometer axis = lateral malleolus
• stationary arm = midline of lateral fibula
• moving arm = parallel to calcaneus (heel)
• compensatory movement = knee flexion and toe flexion

have shoes off

Question 14

Typical ROM of plantar flexion

Answer 14

50 degrees

Question 15

Prime movers of plantar flexion

Answer 15

• gastrocnemius
• soleus
• tibialis posterior

Question 16

Compensatory movement of plantar flexion

Answer 16

• knee flexion
• toe flexion

Question 17

ROM of dorsiflexion

Answer 17

• prime movers = tibialis anterior, extensor hallucis longus, extensor digitorum longus
• patient position = sitting or supine with ankle in neutral (90 degrees)
• goniometer axis = lateral malleolus
• stationary arm = midline of lateral fibula
• moving arm = parallel to calcaneus (heel)
• compensatory movement = knee extension and toe extension

have shoes off

Question 18

Typical ROM of dorsiflexion

Answer 18

20 degrees

Question 19

Prime movers of dorsiflexion

Answer 19

• tibialis anterior
• extensor hallucis longus
• extensor digitorum longus

Question 20

Compensatory movements of dorsiflexion

Answer 20

• knee extension
• toe extension

Question 21

Typical ROM of inversion

Answer 21

35 degrees

Question 22

Typical ROM of eversion

Answer 22

15 degrees

Question 23

MMT of plantar flexion

Answer 23

• against gravity position = prone
• stabilizing hand = posterior tibia
• resistive hand = plantar surface of foot
• force application = against plantar flexion
• gravity eliminated = side lying, leg extended
• stabilization = lower leg proximal to ankle
• palpation = gastrocnemius at proximal posterior tibia

Question 24

Palpation of plantar flexion

Answer 24

• gastrocnemius at proximal posterior tibia

Question 25

MMT of dorsiflexion

Answer 25

- against gravity position = sitting or supine - stabilizing hand = dorsal surface of foot over metatarsals - force application = against dorsiflexion - gravity eliminated = side lying, knee flexed - stabilization = lower leg proximal to ankle - palpation = tibialis anterior at distal anterior tibia

Question 26

Palpation of dorsiflexion

Answer 26

- tibialis anterior at distal anterior tibia

Question 27

Clinical implications

Answer 27

- neurological impairment of lower extremity - foot drop - plantar fasciitis

Question 28

Neurological impairment of lower extremity

Answer 28

- joints and skin of foot are highly innervated - constantly sending information to the brain - assist in stabilizing on uneven surfaces - consider how numbness and weakness may affect gait/mobility = those that cannot feel their feet, ankles, or legs very well

Question 29

Foot drop

Answer 29

- common with hemiparesis - inability to actively dorsiflex foot - foot may drag against ground during mobility - intervention = AFO (holds foot in passive neutral position to restore a modified gait pattern) **when in hospital bed, the patient is dorsiflexing a lot which stretches out the muscles, leading to the foot drop**

Question 30

Interventions of foot drop

Answer 30

- AFO (holds foot in passive neutral position to restore a modified gait pattern

Question 31

Plantar fasciitis

Answer 31

- inflammation of plantar aponeurosis - pain when bearing weight on foot - causes = repetitive use, running, and obesity - features scarring, micro tears, and collagen breakdown - intervention = rest, orthotics, modalities, and stretching

Question 32

Interventions of plantar fasciitis

Answer 32

- rest - orthotics - modalities - stretching