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Foot and Ankle Flashcards

1
Q

What is Turf Toe?

A
  • Sprain to First MTP joint

- Usually involves hyperextension on artifical turf while pushing off

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2
Q

What are the Major Anatomic Divisions of the Foot?

A
  • Rear Foot- Talus and Calcaneus
  • Mid Foot- Navicular, Cuboid, and Cuneiforms
  • Fore Foot- Metatarsals and Phalanges
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3
Q

How much ROM is required for normal gait?

A
  • 6-10 deg Dorsiflexion
  • 20-30 degrees of Plantar Flexion
  • 4-6 degrees of inversion/eversion
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4
Q

What is the Windlass Mechanism?

A
  • Supination and creation of a medial longitudinal arch due to extension of the toes, specifically the Hallux
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5
Q

What are the common arches of the foot?

A
  • Medial Longitudinal Arch
  • Lateral Longitudinal Arch
  • Proximal Transverse Arch
  • Distal Transverse Arch
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6
Q

What is the ideal position for ankle arthrodesis?

A
  • Neutral Dorsiflexion
  • Slight Valgus
  • External Rotation of approx 5-10 deg
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7
Q

What is Lisfrancs Ligament?

A
  • Ligament spanning the Medial Cuneiform and the base of the 2nd Metatarsal
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8
Q

What is the role of the spring ligament?

A
  • Primary Static Stabilizer of the Medial Longitudinal Arch
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9
Q

What is the difference between Choparts and Lisfranc Joints

A
  • Choparts- Mid Tarsal- Talonavicular and Calcaneocuboid

- Lisfranc- TarsoMetatarsal

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10
Q

What is the most common way of treating Clubfoot?

A
  • Ponseti Method of serial manipulation and casting
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11
Q

What is Kohlers Disease?

A
  • Avascular necrosis of the navicular bone
  • Occurs in young children typically age 4-7
  • Midfoot Pain, TTP Navicular, Limp
  • Immobilization with short leg walking cast
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12
Q

What is Iselins Disease?

A
  • Traction apophysitis of the tuberosity of the fifth metatarsal
  • Seen in Physically active children aged 8-13
  • Pain on Lateral Foot, TTP base 5th Met
  • RICE, Activity Modification
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13
Q

What is Severs Disease?

A
  • Calcaneal Apophysitis in the skeletally immature athlete
  • TTP Calcaneal Apophysis
  • RICE, NSAIDs and Activity Modification
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14
Q

What is Metatarsus Adductus?

A
  • Common Pediatric Foot Disorder
  • Forefoot Varus and Adduction, In Toeing in Gait
  • Most resolve with shoe modification and serial casting, few need surgery (Midfoot Osteotomy)
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15
Q

What is the function of the Dorsal and Palmar Interossei of the foot?

A
  • DAB, PAD
  • Dorsal are ABductors
  • Palmar are ADductors
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16
Q

What conditions might be indicated by palpation of the Achilles?

A
  • Pain in different parts with palpation indicative of different pathology
  • Musculotendinous Junction- Muscle strain
  • Mid Substance of Tendon- Tendonosis
  • Calcaneal Insertion- Retrocalcaneal bursitis
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17
Q

What is the Thompson Test?

A
  • Calf Squeeze test to check for Achilles Tendon Rupture
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18
Q

What is typical protocol after Achilles Rupture Repair?

A
  • Immobilization in cast in slight PF x 6-8 weeks
  • WB at discretion of Surgeon
  • Progress to Heel Lift in shoe
  • DF Stretching avoided x 4 months
  • Progressive Strengthening of PF and return to run x 7-9 months
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19
Q

Describe the Accelerated plan for Achilles Tendon Repair

A
  • Performed when patient receives surgery with stronger sutures
  • Patient Immobilized x 72 hours, early AROM begun, Post Splint x 2 weeks
  • Return to pre injury level at 4 months
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20
Q

What is Tarsal Tunnel Syndrome?

A
  • Entrapment of the Posterior Tibial Nerve as it passes under the retinaculum
  • Pain and parasthesias in plantar foot are common symptoms
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21
Q

Describe the Clinical Presentation of Posterior Tibial Tendon Dysfunction?

A
  • Pain and swelling of medial ankle and onset of flatfoot deformity
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22
Q

What is common cause of Peroneal Tendon Subluxation?

A
  • Sudden, Forceful passive dorsiflexion of the everted foot with sudden, strong reflex contraction of the peroneal muscles
  • Skiing Injury, Soccer
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23
Q

What are the Ottawa Ankle Rules?

A

Radiographs warranted if:

  • Bone Tenderness to Post 6 cm of distal lateral or medial malleoli
  • Unable to walk 4 steps immediately after injury
  • TTP Navicular or Base of 5th Metatarsal
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24
Q

What is a Syndesmotic Ankle Sprain?

A
  • High Ankle Sprain
  • MOI is External Rotation of Tibia on Planted Foot
  • Squeeze Test for diagnosis
  • Rule out fracture of the Proximal Fibula
  • Possible Referral to Ortho
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25
Q

What is the Sinus Tarsi?

A
  • Funnel Shaped opening in rear foot between the talus and calcaneus
  • Wider AnteroLaterally and narrow PosteroMedially
  • Main Blood Supply to Talus and TaloCalcaneal Ligament pass through it as well as nerve endings and fatty tissue
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26
Q

What is Sinus Tarsi Syndrome?

A
  • Tenderness over Sinus Tarsi (Lateral Hindfoot)
  • Often Associated with recurrent lateral ankle sprains. Sprain of Talocalcaneal ligament and inflammation of Tarsal Sinus
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27
Q

What is Tarsal Coalition?

A
  • A fibrous or Osseous bar that spans two or more of the tarsal bones
  • Usually in early teens
  • Pain and Loss of Rearfoot motion and rigid pes planus
  • Treat with Rest, Mobilization and in extreme cases, surgical release or fusion
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28
Q

What are Hallux Limitus and Hallux Rigidus?

A
  • Decreased Extension of the First MTP of varying degrees.
  • Limitus then Rigidus
  • Treatment focuses on Joint Mobilization
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29
Q

What is a Hammertoe?

A
  • MTP Extension and PIP Flexion
  • Callous on dorsum of PIP
  • Treatment focuses on Joint Mobiliation, Flexibility and wearing of a deeper shoe
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30
Q

What is Claw Toe?

A
  • MTP Extension, PIP And DIP Flexion
  • Extrinsics Stronger than Intrinsics
  • Stretching is main treatment
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31
Q

What is Sesamoiditis?

A
  • Inflammation and pain in sesamoids of Foot

- Pain under First MTP, Pain in ambulation, Pain with Extension of great toe, swelling at head of first Metatarsal Head

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32
Q

What is typical treatment for Forefoot Pain?

A
  • Metatarsal Pad
  • Shoewear Changes
  • Improve MTP Flexion and IP Extension with Intrinsic Strengthening
  • Strengthening of Arch
33
Q

What is most common site of neuroma in the foot?

A
  • In the Web Space between the third and fourth metatarsals
34
Q

What fractures of the foot are at risk for AVN?

A
  • Talus and Calcaneus
35
Q

What is a Jones Fracture?

A
  • Fracture of Fifth Metatarsal Base
  • Non Union Common
  • 4-6 weeks NWB Cast and Protected WB in boot until full union
36
Q

Describe the Zones of the Proximal 5th Metatarsal and the types of fractures that occur there

A
  • Zone 1- Peroneus Brevis Insertion, Proximal, Site of Avulsion Fracture, WBAT in Hard Sole Shoe
  • Zone 2- Site of Jones Fracture, less proximal, NWB x 4-8 weeks
  • Zone 3- Site of Stress Fracture, most distal of the three zones, NWB x 4-8 weeks
37
Q

What is Friebergs Disease?

A
  • anterior metatarsalgia, involves head of second metatarsal;
  • occurs during the growth spurt at puberty - most are female
  • caused by avascular necrosis of the metatarsal head;
  • from repetitive stress with microfractures at the junction of the metaphysis and the growth plate
38
Q

What are the Rear Foot Postures typically associated with Pes Planus and Cavus?

A
  • Pes Planus- Rear Foot Valgus

- Pes Cavus- Rear Foot Varus

39
Q

A Spring Ligament Injury is typically associated with what type of foot deformity?

40
Q

Where is the Majority of the Distal attachment of the Tibialis Posterior?

A
  • Navicular and Medial Cuneiform

- Supports the Medial Longitudinal Arch

41
Q

What is the Functional Importance of Hind Foot Inversion/ Rear Foot Varus?

A
  • To allow the foot to act as a rigid lever

- With Flexible Flat Foot (Midfoot Instability), becomes a “Flexible” lever

42
Q

Describe the Amounts of Plantar Flexion and Dorsiflexion during phases of Gait

A
  • Initial Contact- Slight Dorsiflexion
  • Early and Mid Stance- Moderate Dorsiflexion
  • Late Stance- Rapid Transition into PlantarFlexion for Toe Off (Pre Swing)
43
Q

What are Some Special Tests for Pes Cavus?

A
  • Coleman Block Test (Flexible Flat Foot)

- The “Peek a Boo” Sign

44
Q

What is a low arch foot type in one foot but not the other associated with?

A
  • Acquired Flat Foot Deformity

- Usually a result of Posterior Tibial Tendon Dysfunction

45
Q

What do the Anterior Drawer of the Ankle and the Talar Tilt Test for?

A
  • Ant Drawer- ATFL Injury

- Talar Tilt- ATFL and/or CFL

46
Q

What are Some Special Tests for Syndesmotic Injury?

A
  • External Rotation Test
  • Squeeze Test
  • Cotton Test
  • Fibula Transition test
47
Q

What are Some Special Tests for Achilles Tendon Rupture?

A
  • Thompson Test
  • Achilles Palpation
  • London Royal Hospital Test
  • Arc Sign
48
Q

What is a common special test for Plantar Fasciitis?

A
  • Windlass Test
49
Q

What is a common special test for Mortons Neuroma?

A
  • Mulder Click Test
50
Q

What is a common special test for Posterior Tarsal Tunnel Syndrome?

A
  • Tinel Sign
51
Q

What is a common special test for DVT?

A
  • Homan Sign
52
Q

Describe the progression of arch height/ foot posture during development?

A
  • Infants born with flat foot

- Develops to a normal foot print around age 12-13

53
Q

Give a Description and Diagnostic Criteria for Hammer Toe

A
  • IP Flexion Deformity
  • Only one or Two toes involved
  • Typically does not include MTP joint Extension
54
Q

Give a Description and Diagnostic Criteria for Claw Toe

A
  • Flexion of IP Joints
  • Extension of MTP
  • Caused by Neuromuscular Disorder
  • Typically involves all toes
55
Q

What are the 3 sites of painful corns associated with Claw Toe?

A
  • Dorsum of PIP
  • Dorsum of MTP
  • Plantar to Nail Bed
56
Q

Give a Description and Diagnostic Criteria for Mallet Toe

A
  • Abnormal Flexion of DIP
  • Can occur in isolation or secondary to Hammer Toe
  • Most common at Second Toe
  • Often Develops a painful corn plantar to nail bed
  • Can be Fixed or Flexible
57
Q

Give a Description and Diagnostic Criteria for High Ankle Sprain

A
  • MOI is Dorsiflexion of ankle and ER of the Tibia on Planted Foot
  • Pain at Distal Tib Fib Joint
  • Return to play is longer than lateral ankle sprains
  • Usually a few weeks to 2 months
  • Can result is Proximal Fibula Fractures (maisonneuve fracture)
58
Q

Give a Description and Diagnostic Criteria for Functional Ankle Instability

A
  • Chronic Instability with absence of Objective Joint Instability
  • Muscle Weakness, Poor Muscle Recruitment Patterns
  • Poor Single Leg Stance and Dynamic Balance
59
Q

Give a Description and Diagnostic Criteria for Mechanical Ankle Instability

A
  • Evidence of Ankle Laxity
  • Treatment same as Functional Ankle Instability (balance, strength, etc)
  • If rehab fails, Surgery indicated
60
Q

Give a Description and Diagnostic Criteria for Anterior Impingement Syndrome

A
  • Repeated Microtrauma at anterolateral ankle result in scar tissue formation
  • Impingment of this scar tissue
  • Anterior Joint pain with Forced Dorsiflexion, Squatting, Stair Climbing, and increased stride length
  • Progression of treatment: Manual Therapy, Heel LIft, Surgery
61
Q

Give a Description and Diagnostic Criteria for Loose Bodies and Osteochondral Lesions

A
  • Vague Nonspecific nature of clinical presentation
  • Low Grade Persistent pain after sprain
  • Deep Ache with Weight Bearing
  • Swelling, Clicking, Catching, Locking, Giving Way
62
Q

Give a Description and Diagnostic Criteria for Ankle Osteoarthritis

A
  • Fairly Rare

- History of Ankle Fracture as Predisposing factor

63
Q

Give a Description and Diagnostic Criteria for Plantar Fasciitis

A
  • Most commonly affected are overweight, bilateral limitations in Dorsiflexion, have and occupation that requires prolonged standing
64
Q

Give a Description and Diagnostic Criteria for Tarsal Coalition

A
  • Congenital Fibrous, Cartilaginous, or osseous fusion of two or more bones in midfoot or hindfoot
  • Most common at Calcaneonavicular (CNC) and Talocalcaneal (TCC)
  • Occurs in Adolescents 12-16
  • Family History, Repeated Ankle Sprains, rear foot pain worse with activity and relieved with rest
  • TTP over Sinus Tarsi
  • Diagnosed with X Ray and Surgery Common
65
Q

Give a Description and Diagnostic Criteria for Lisfranc Injuries

A
  • Longitudinal Force applied to Plantar Flexed ankle
  • Low Energy (sports) or High Energy (MVA)
  • Deformity, Swelling, Pain on Medial Foot
  • Instability Diagnosed with Radiographs
  • If Instability, Surgery
  • If Stable, Casting or Immobilization
66
Q

Give a Description and Diagnostic Criteria for Sever Disease

A
  • Calcaneal Apophysitis
  • Occurs mostly in boys during growth spurt between the ages of 6-8 when they start higher impact sports like soccer and running
  • Resolves in 2 weeks to 2 months with activity modification, heel lift, shoe inserts, stretching
67
Q

Give a Description and Diagnostic Criteria for Kohler Disease

A
  • Uncommon Pathology that results in Osteochondrosis of the Navicular
  • Caused by Disturbance in Dorsalis Pedis or Medial Plantar Arteries
  • Presents in children ages 2-10
  • Resolves in approx 8 months with conservative treatment
68
Q

Give a Description and Diagnostic Criteria for Hallux Rigidus

A
  • Caused by Degenerative Arthritis and impingement of Osteophytes
  • Limited First MTP Extension
  • Treatments include Joint Mobs, In Shoe Orthotics that limit joint motion or Cheilectomy (removal of bone spurs and osteophytes)
69
Q

Give a Description and Diagnostic Criteria for Metatarsalgia

A
  • Pain in Forefoot with stress over the Metatarsal Head
  • Key Indicators are location of pain and skin integrity (keratosis and calluses)
  • Metatarsal Pads
70
Q

Give a Description and Diagnostic Criteria for Morton Neuroma

A
  • Perineural Fibrosis and Nerve Degeneration of Common Digital Nerve
  • Most common between 3rd and 4th Metatarsals
  • Pain is sharp and burning and complaints of parasthesias common
  • Painful Click with Mulder Sign
  • Unloading of Area, Soft Soled Shoes, Injection
71
Q

Give a Description and Diagnostic Criteria for Sesamoiditis

A
  • Pain, Tenderness, Swelling under affected Sesamoid Bones
  • Aggravated with movement of Great Toe
  • Increased with Weight Bearing
  • Treat with Decreased Weight Bearing, Non Weight Bearing in Tow Spica Cast depending on severity
  • Surgery is Sesamoidectomy
72
Q

What are some variables thought to contribute to increased stress on sesamoids?

A
  • Pes Cavus Foot
  • Plantar Flexed First Ray
  • Ankle Equines
73
Q

Give a Description and Diagnostic Criteria for Achilles Tendon Rupture

A
  • Sudden Pain, Inability to Bear Weight, Weakness
  • Palpable Gap and Increased Passive Dorsfilexion on exam
  • (+) Thompson test
74
Q

Give a Description and Diagnostic Criteria for Posterior Tibial Tendon Dysfunction

A
  • Hallmark is weakness of Subtalar Inversion and Forefoot Adduction
  • Typically associated with flat foot, overweight females
  • Treat with custom brace that controls hindfoot eversion supports medial longitudinal arch or orthotics
75
Q

Give a Description and Diagnostic Criteria for Fibulars Tendon Dysfunction or Subluxation

A
  • Pain along Posterior lateral foot
  • Swelling, Clicking, Visual Subluxation
  • Special Test is Resisted Ankle Dorsiflexion and Subtalar Eversion
  • Surgery
76
Q

What is the Time frame for immobilization for typical ankle and foot fractures?

77
Q

Describe the Weber Classification Scheme for Ankle Fractures

A
  • Type A- Lateral Malleolar Injury Distal to Tibial Plafond
  • Type B- Level of Tibial Plafond
  • Type C- Proximal to Tibial Plafond
78
Q

What is the Typical MOI for Calcaneal Fractures?

A
  • Fall from Significant Height or MVA

- Should check Lumbar Spine for Compression Fractures if Calcanear Fracture found

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