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OCS Studying > Foot And Ankle > Flashcards

Foot And Ankle Flashcards

1
Q

Trochlea you with an influence on stability

A

Wider anteriorly. Therefore increased stability in Dorsey flexion decreased ability in plantar flexion

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2
Q

Primary ligamentous support of lateral ankle and function

A

ATFL and CFL

ATFL prevents anterior displacement of talus relative to ankle
CFL taut with inversion and adduction of calcaneous relative to fibula

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2
Q

Ligamentous supportive subtalar joint

A

CFL, cervical ligaments, parts of the deltoid ligament, interosseous talocalcaneal

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3
Q

Primary ligamentous support to posterior lateral ankle and function

A

Posterior talofibular ligament

Taut in external rotation of talus relative to ankle mortise
Rarely injured except in severe ankle sprains

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4
Q

Consequences of severing interosseous ligament

A

1: increased range of motion of subtalar joint especially toward supination
2: instability of subtalar joint
3: disconnect between the calcaneous in the talus resulting in market motion between the tibia and calcaneus

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5
Q

Four bands of the deltoid ligament

A

Tibionavicular, anterior tibiotalar , tibiotalar, posterior tibiotalar

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6
Q

Lateral compartment muscles and function

A

Fibularis longus and fibularis brevis

Pronate subtalar joint
Fibularis longus may have a strong role in supporting the transverse arch

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7
Q

Deep posterior compartment muscles and function

A

FHL, FDL, tibialis posterior

Supinating at the subtalar joint

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8
Q

Functions of tibialis posterior muscle in order of strength

A

One: subtalar supination
Two: first metatarsal abduction
Three: arch rising

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9
Q

Anterior compartment muscles and

A

Tibialis anterior, fibularis tertius, extensior digitorum longus, extensor hallucis longus

Primarily dorsiflexors of ankle joint

Tibialis anterior may supinate at subtalar joint based on attachment point at plantar surface of medial cuneiform and first metatarsal

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10
Q

Intrinsic muscles of foot, compartments, and strongest muscles.

A

Medial compartment: abductor hallucis, flexor hallucis brevis

Central compartment: quadratic plantae, flexor digitorum brevis, adductor hallucis, lumbricales

Lateral compartment: abductor digiti mini, flexor digiti mini brevis

Deep compartment: dorsal and plantar interossei

Strongest: abductor hallucis and oblique head of adductor hallucis

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11
Q

Oblique axis of subtalar joint orientation and explanation of motion of supination and pronation

A

Extremely variable from person-to-person, but average orientation is: superiorly 42° in the sagittal plane relative to the horizontal, and medially 16°

Supination: calcaneus into inversion (frontal), talus into abduction (transverse) and Dorsiflexion (Sagittal)

Pronation: calcaneous into eversion, talus into adduction and plantarflexion

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12
Q

Transverse tarsal joints, ligamentous support, function, midfoot locking

A

Talonavicular and calcaneocuboid joint

Calcaneocuboid joint supported by long planter ligament therefore very little motion

Talonavicular joint highly mobile, Talar dorsiflexion limited by plantar calcaneonavicular ligament a.k.a. spring ligament

Midfoot locking mechanism: when axes of midfoot are parallel increased forefoot motion, when calcaneous is inverted decreased forefoot motion

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13
Q

Influence of release of plantar fascia on ligamentous support in foot

A

52% increase load on long plantar ligament,

94% increase load on spring ligament

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14
Q

MTP dorsiflexion and windlass mechanism

A

Directly related to tension in the planter fascia and Achilles tendon

See figure 7 in monograph

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15
Q

Muscle control of the medial longitudinal arch

A

Limited force generating abilities of intrinsic and extrinsic muscles may be able to counter the deforming force of triceps surae and body weight because of the bony architecture and ligamentous support in addition to muscles forces

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16
Q

Relationship between proximal and distal lower extremity biomechanics and medial longitudinal

A

Tibial position influences medial longitudinal arch orientation

Proximal Control mechanisms ( hip mm) are likely contributor to femoral and tibial rotation which in turn may influence medial longitudinal arch

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17
Q

Action of triceps surae muscle during gait

A

80% of the energy required for forward progression

Soleus- responsible for decelerating the tibia after foot flat during gait

Combined activation of the triceps surae muscles for push off

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18
Q

Great toe flexor rehabilitation focus – three areas

A

One: ensuring functional range of motion
Two: hi loads that may be transferred to the hallux
Three: that the muscles function isometrically when prescribing exercise

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19
Q

Ligaments involved in adult acquired flatfoot deformity

A 
Plantar calcaneonavicular ligament 87%
Interossouse talocalcaneal ligament 74%
Deltoid ligament 32%
Plantar metatarsal cuneiform 20% 
Plantar fascia
Long and short plantar
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20
Q

Neuromuscular disease and pes cavus foot deformity

A

Often associated with overactivity of tibialis posterior and or tibialis anterior

21
Q

Identification of pes cavus foot deformity

A

One: a high medial arch during weight-bearing
Two: an inverted calcaneous
Three: foot motion testing considered rigid and nonreducible

Positive peekaboo sign

22
Q

Coleman block test

A

After observation of inverted calcaneous place fifth metatarsal head on 2 inch block

If calcaneous remains inverted then subtalar joint is not mobile

If calcaneous inverts then subtalar joint is mobile and there is a pronation deformity in the forefoot

23
Q

Pes cavus foot and orthotic/shoe support

A

The goal is to improve shock absorption or distribute the pressures under the foot even

a systematic review that suggests that custom foot orthotics showed some success in patients with pes cavus foot type

24
Q

Arch height index description and importance

A

Dorsum height measured (50% of foot length) divided by the truncated foot length (measured from posterior aspect of the foot to center of the first MTP joint)

Foot type classification:
High arch = less than 0.21
Normal arch = 0.21–0.26
Lower arch = greater than 0.26

change from the nonweightbearing to weight-bearing was 10 mm or 13.4% of our tight

This is important because recent studies show an association with foot posture and injury pattern and an association of static foot posture and foot mobility

25
Q

Navicular drop test and injury considerations

A

Difference in navicular height is greater than 10 mm is a positive test

is not associated with MTSS or ACL injuries

Is associated with the Patellafemmoral problems and was running injuries

26
Q

Timed top tests used in screening patients with foot and ankle conditions and MDC

A

Figure of eight: MDC 4.59 seconds
Side-HOP: MDC 5.82 seconds
6 m crossover: MDC 1.03 seconds
Square up: MDC 3.88 seconds

table 15 monograph

27
Q

Foot kinematic observations during heel raise test

A

1: heel height
2: knee and trunk position
3: subtalar joint in version and Eversion
4: 1st metatarsal plantarflexion orders you function
5: pressure distribution under the forefoot

28
Q

Hallux limitus definition and consequences

A

Passive hallux dorsiflexion during quiet stance less than 40°

Decreasing range of motion of first metatarsal may result in lateral shift of center of pressure during walking

29
Q

Age of Development of normal foot posture

A

12-13 years

30
Q

Definition of hallux Valgus toe

A

Observed deviation of the hallux from that of the first metatarsal by greater than 15°

31
Q

Hammer toe versus claw toe versus mallet toe

A

Hammertoe: flexion deformity of IP went only one or two toes are involved

Claw toe: includes extension of MTP and flexion of IP. caused by neuromuscular disorder often present in all toes

Mallet toe: flexion of the DIP and can occur in isolation or secondary to hammertoe deformity

32
Q

Recovery phases of high ankle sprain and indications for progression

A

Phase 1: protection
Progress when pain in the DMR controlled and patient walks with minimal gate problems
Phase 2: subacute
Progress when able to jog and hop repetitively without difficulty
Phase 3: sport specific training

33
Q

Risk factors for lateral ankle sprains

A 
One – fatigue
Two – static and dynamic balance
Three – ankle strength
Four – coordination
Five – range of motion
34
Q

Ottawa ankle rules

A

1- bone tenderness at the milleolar zone – along the medial and lateral malleoli, Talar neck/head
2- bone tenderness specifically at:
– Posterior edge or tip of lateral malleolus
– Posterior and your tip of medial malleolus
– Base of the fifth metatarsal a
– Navicular
3- inability to bear weight immediately following the injury in during examination

35
Q

Grading of lateral ankle sprain

A

Grade 1: no loss of function, no ligamentous instability (anterior drawer and Talar tilt test), little or no ecchymosis, and point tenderness

Grade 2: some loss of function, decreased motion, a positive anterior drawer, negative Talar to test, Ecchymosis , swelling, point tenderness

Grade 3: nearly total ass of function, a positive anterior drawer and Talar tilt test, diffuse swelling and he Ecchymosis , and extreme point tenderness

36
Q

Clinical prediction rule for joint mobilization and lateral ankle sprain

A

1: symptoms worse with standing
2: symptoms worse in the evening
3: navicular drop of greater than or equal to 5 mm
4: distal tibiofibular hypomobility

Three out of four of the above increased likelihood of six excess to 95%

38
Q

Definition of chronic ankle instability

A

When symptoms and giving way persist for greater than six months

39
Q

Rearfoot varus

A

Heel angled inward; associated with pes cavus

40
Q

Rearfoot valgus

A

heel angled outward; rearfoot eversion; associated with pes planus

41
Q

Forefoot varus:

A

forefoot angled inward; may result in compensatory rearfoot eversion or 1st ray PF to bring 1st MT to floor

42
Q

Forefoot valgus

A

forefoot angled outward

43
Q

Subtalar supination:

A

Inversion (frontal plane) adduction (transverse plane) and PF (sagittal plane)

44
Q

Subtalar pronation:

A

Eversion (frontal plane) abduction (transverse plane) and DF (sagittal plane)

45
Q

History and physical examination findings that indicate plantar fasciitis

A

– Plantar medial heel pain most noticeable after periods of inactivity
-Heel pain precipitated by recent increase in weight very activity
– Pain with palpation proximal insertion of plantar fascia
– Positive windlass test
– Negative tarsal tunnel test
– Limited active and passive talocrural joint Dorsiflexion
– Abnormal FBI score
– Hi body mass index and nonathletic individuals

46
Q

Foot type associated with planter fasciitis in runners

A

Pes cavus and hindfoot Varus

47
Q

Differential diagnosis of fat pad atrophy versus plantar fasciitis

A

Fat pad atrophy – aggravated by prolonged standing, neck pain, bilateral pain, no pain with first step

48
Q

Established risk factors for lateral ankle sprain (5) and level of evidence.

A

One – history of previous ankle sprain
Two – do not use external support
Three – not properly warm up
Four – do not have normal ankle dorsiflexion range motion
Five – do to participTe in balancing /proprioceptive prevention program with hx of injury

Level B

49
Q

Risk factors for developing ankle instability

A

1 – increased Talar curvature
2 – not using external support
3 – not perform bouncer proprioception activities following acute lateral ankle sprain

50
Q

Ankle swelling minimal detectable change

A

6.8 mm

51
Q

Specificity and sensitivity of the anterior drawer and talar tilt tests

A

Anterior drawer – sensitivity .80, specificity .74

Taylor two – sensitivity .50, specificity .88

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