Foot and Ankle Flashcards
3 Needs at the foot and ankle
- 30 deg DF (fxnl), 30 deg 1st MTP extension
- Wall lunge = 4-6 cm from wall
- Arthrokinematics (MTP, tib-fib, CMC, etc.)
Ottawa Ankle Rules
4 Items total
- Pain in malleolar or midfoot area AND EITHER
- Inability to bear weight immediateley after injury (4 steps)
OR
- Bone tenderness at the posterior edge of tibia or fibula or tip of medial or lateral meniscus.
- Bone tenderness at the navicular or proximal base of the 5th metatarsal.
West Point Ankle Sprain Grade 1 by location
Anterior talofibular ligament
West Point Ankle Sprain Grade 2 by location
Anterior talofibular ligament and calcaneofibular ligament
West Point Ankle Sprain Grade 3 by location
Anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament
West Point Ankle Sprain Grade 1 by edema and ecchymosis
Slight and local
West Point Ankle Sprain Grade 2 by edema and ecchymosis
Moderate and local
West Point Ankle Sprain Grade 3 by edema and ecchymosis
Significant and diffuse
West Point Ankle Sprain Grade 1 by weight-bearing ability
Full or partial
West Point Ankle Sprain Grade 2 by weight-bearing ability
Difficult without crutches
West Point Ankle Sprain Grade 3 by weight-bearing ability
Impossible without significant pain
West Point Ankle Sprain Grade 1 by ligament damage
Stretched
West Point Ankle Sprain Grade 2 by ligament damage
Partial tear
West Point Ankle Sprain Grade 3 by ligament damage
Complete tear
West Point Ankle Sprain Grade 1 by instability
None
West Point Ankle Sprain Grade 2 by instability
None or slight
West Point Ankle Sprain Grade 3 by instability
Definite
How many toes is abnormal for the “too many toes sign”?
3-5
Identify the joint associated with the phase of stance:
Loading response
Subtalar joint
Identify the joint associated with the phase of stance:
Mid stance
Lateral midtarsal joint axis
Identify the joint associated with the phase of stance:
Terminal stance
Oblique midtarsal joint axis
When the foot makes full contact with the ground, the foot begins PRONATING/SUPINATING and the entire LE EXTERNALLY/INTERNALLY rotates.
Pronating; internally rotating
During mid stance the foot is at max PRONATION/SUPINATION, it begins PRONATING/SUPINATING, and the LE begins INTERNALLY/EXTERNALLY rotating.
Pronation; supinating; externally
5 functional measures for Foot and ankle:
- FAAM
- LEFS
- FAI
- Star excursion or Y-balance test
- Lateral hop for distance
Y-Balance test criteria
4cm difference is ~2.5x more likely to sustain an injury.
Lateral hop for distance criteria
20% difference side-to-side is suggestive of a longer recovery and slower return to function.
Normal range for Fick angle
5-18 degrees
Plantar flexion normal ROM
50 deg
Dorsiflexion normal ROM
20 deg??
Most people 10-12ish
Supination normal ROM
45-60 deg
Pronation normal ROM
15-30 deg
Hindfoot inversion normal ROM
20 degrees
Hindfoot eversion normal ROM
10 deg
For normal gait, how much foot eversion is required?
4-6 deg
For normal gait, how much inversion is required?
8-12 deg
Identify
The angle at which the ratio of calcaneal inversion vs eversion is 2:1
STJ neutral
Identify the special test:
Identifies laxity at the ankle, also look for tibia rotation
Anterior Drawer
Identify the special test:
Tests the calcaneofibular ligament and deltoid legament depending on position.
Talar tilt test
Identify the special test:
Tests for syndesmosis sprain (high ankle sprain) by assessing for pain/laxity
Kleiger Test
Identify the special test:
Tests for pain at the end range of MTP extension
Windlass Test
Identify the special test:
Examines integrity of achilles tendon by squeezing the calf
Thompson Test
What results in a positive Thompson test?
No apparent plantar flexion when calf is squeezed.
Identify the special test:
Assesses for tibial stress fracture
Heel thump test
Two possible positive results with a heel thump test and their interpretations:
- Pain along tibial shaft - stress fracture indication
- Pain in ankle indicates syndesmosis injury
Identify the special test:
Tap posterior tibial nerve on medial side
Tinel’s test
Identify the special test:
Compress foot at medial and lateral aspects at MTP joints.
Morton’s test
Identify the special test:
Forcefully dorsiflexes heel while knee is in extended position. Pain elicited in popliteal region and calf is a positive test.
Homan’s test
Identify the special test:
BP cuff is wrapped around thigh and inflated to 40 mmHg. Pressure maintained for 2 minutes. Increase in pain and inability to tolerate sustained pressure is a positive test.
Ramirez’s test
When measuring for edema using figure 8, what finding is minimally clinically significant?
2-2.5 cm difference between uninvolved and involved side.
Identify all 9 components of Well’s criteria
- Active cancer
- Bedridden recently >3 days, OR major surgery within 4 weeks
- Calf swelling >3cm
- Entire leg swollen
- Localized tenderness along deep venous system
- Pitting, edema, greater in symptomatic leg
- Paralysis, paresis, or recent plaster immobilization of lower leg
- Previous DVT
- Alternative diagnosis more likely (-2)
Identify:
MAY be associated with pes planus, rearfoot valgus, forefoot varus, and ankle joint equinus
Overpronation
A less rigid lever for push off is associated with UNDERPRONATION/OVERPRONATION.
Overpronation
Two PT management options for overpronation:
- Improve dynamic support
- Provide external support
PT management for ankle equinus:
Mobilize and/or stretch
Identify:
Foot is in plantarflexed position with ankle dorsiflexion limited to <10 degrees.
Ankle Equinus
