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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
What is the Sinus Tarsi?
- 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
26
What is Sinus Tarsi Syndrome?
- Tenderness over Sinus Tarsi (Lateral Hindfoot) - Often Associated with recurrent lateral ankle sprains. Sprain of Talocalcaneal ligament and inflammation of Tarsal Sinus
27
What is Tarsal Coalition?
- 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
28
What are Hallux Limitus and Hallux Rigidus?
- Decreased Extension of the First MTP of varying degrees. - Limitus then Rigidus - Treatment focuses on Joint Mobilization
29
What is a Hammertoe?
- MTP Extension and PIP Flexion - Callous on dorsum of PIP - Treatment focuses on Joint Mobiliation, Flexibility and wearing of a deeper shoe
30
What is Claw Toe?
- MTP Extension, PIP And DIP Flexion - Extrinsics Stronger than Intrinsics - Stretching is main treatment
31
What is Sesamoiditis?
- 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
32
What is typical treatment for Forefoot Pain?
- Metatarsal Pad - Shoewear Changes - Improve MTP Flexion and IP Extension with Intrinsic Strengthening - Strengthening of Arch
33
What is most common site of neuroma in the foot?
- In the Web Space between the third and fourth metatarsals
34
What fractures of the foot are at risk for AVN?
- Talus and Calcaneus
35
What is a Jones Fracture?
- Fracture of Fifth Metatarsal Base - Non Union Common - 4-6 weeks NWB Cast and Protected WB in boot until full union
36
Describe the Zones of the Proximal 5th Metatarsal and the types of fractures that occur there
- 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
What is Friebergs Disease?
- 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
What are the Rear Foot Postures typically associated with Pes Planus and Cavus?
- Pes Planus- Rear Foot Valgus | - Pes Cavus- Rear Foot Varus
39
A Spring Ligament Injury is typically associated with what type of foot deformity?
- Flat Foot
40
Where is the Majority of the Distal attachment of the Tibialis Posterior?
- Navicular and Medial Cuneiform | - Supports the Medial Longitudinal Arch
41
What is the Functional Importance of Hind Foot Inversion/ Rear Foot Varus?
- To allow the foot to act as a rigid lever | - With Flexible Flat Foot (Midfoot Instability), becomes a "Flexible" lever
42
Describe the Amounts of Plantar Flexion and Dorsiflexion during phases of Gait
- Initial Contact- Slight Dorsiflexion - Early and Mid Stance- Moderate Dorsiflexion - Late Stance- Rapid Transition into PlantarFlexion for Toe Off (Pre Swing)
43
What are Some Special Tests for Pes Cavus?
- Coleman Block Test (Flexible Flat Foot) | - The "Peek a Boo" Sign
44
What is a low arch foot type in one foot but not the other associated with?
- Acquired Flat Foot Deformity | - Usually a result of Posterior Tibial Tendon Dysfunction
45
What do the Anterior Drawer of the Ankle and the Talar Tilt Test for?
- Ant Drawer- ATFL Injury | - Talar Tilt- ATFL and/or CFL
46
What are Some Special Tests for Syndesmotic Injury?
- External Rotation Test - Squeeze Test - Cotton Test - Fibula Transition test
47
What are Some Special Tests for Achilles Tendon Rupture?
- Thompson Test - Achilles Palpation - London Royal Hospital Test - Arc Sign
48
What is a common special test for Plantar Fasciitis?
- Windlass Test
49
What is a common special test for Mortons Neuroma?
- Mulder Click Test
50
What is a common special test for Posterior Tarsal Tunnel Syndrome?
- Tinel Sign
51
What is a common special test for DVT?
- Homan Sign
52
Describe the progression of arch height/ foot posture during development?
- Infants born with flat foot | - Develops to a normal foot print around age 12-13
53
Give a Description and Diagnostic Criteria for Hammer Toe
- IP Flexion Deformity - Only one or Two toes involved - Typically does not include MTP joint Extension
54
Give a Description and Diagnostic Criteria for Claw Toe
- Flexion of IP Joints - Extension of MTP - Caused by Neuromuscular Disorder - Typically involves all toes
55
What are the 3 sites of painful corns associated with Claw Toe?
- Dorsum of PIP - Dorsum of MTP - Plantar to Nail Bed
56
Give a Description and Diagnostic Criteria for Mallet Toe
- 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
Give a Description and Diagnostic Criteria for High Ankle Sprain
- 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
Give a Description and Diagnostic Criteria for Functional Ankle Instability
- Chronic Instability with absence of Objective Joint Instability - Muscle Weakness, Poor Muscle Recruitment Patterns - Poor Single Leg Stance and Dynamic Balance
59
Give a Description and Diagnostic Criteria for Mechanical Ankle Instability
- Evidence of Ankle Laxity - Treatment same as Functional Ankle Instability (balance, strength, etc) - If rehab fails, Surgery indicated
60
Give a Description and Diagnostic Criteria for Anterior Impingement Syndrome
- 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
Give a Description and Diagnostic Criteria for Loose Bodies and Osteochondral Lesions
- Vague Nonspecific nature of clinical presentation - Low Grade Persistent pain after sprain - Deep Ache with Weight Bearing - Swelling, Clicking, Catching, Locking, Giving Way
62
Give a Description and Diagnostic Criteria for Ankle Osteoarthritis
- Fairly Rare | - History of Ankle Fracture as Predisposing factor
63
Give a Description and Diagnostic Criteria for Plantar Fasciitis
- Most commonly affected are overweight, bilateral limitations in Dorsiflexion, have and occupation that requires prolonged standing
64
Give a Description and Diagnostic Criteria for Tarsal Coalition
- 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
Give a Description and Diagnostic Criteria for Lisfranc Injuries
- 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
Give a Description and Diagnostic Criteria for Sever Disease
- 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
Give a Description and Diagnostic Criteria for Kohler Disease
- 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
Give a Description and Diagnostic Criteria for Hallux Rigidus
- 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
Give a Description and Diagnostic Criteria for Metatarsalgia
- Pain in Forefoot with stress over the Metatarsal Head - Key Indicators are location of pain and skin integrity (keratosis and calluses) - Metatarsal Pads
70
Give a Description and Diagnostic Criteria for Morton Neuroma
- 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
Give a Description and Diagnostic Criteria for Sesamoiditis
- 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
What are some variables thought to contribute to increased stress on sesamoids?
- Pes Cavus Foot - Plantar Flexed First Ray - Ankle Equines
73
Give a Description and Diagnostic Criteria for Achilles Tendon Rupture
- Sudden Pain, Inability to Bear Weight, Weakness - Palpable Gap and Increased Passive Dorsfilexion on exam - (+) Thompson test
74
Give a Description and Diagnostic Criteria for Posterior Tibial Tendon Dysfunction
- 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
Give a Description and Diagnostic Criteria for Fibulars Tendon Dysfunction or Subluxation
- Pain along Posterior lateral foot - Swelling, Clicking, Visual Subluxation - Special Test is Resisted Ankle Dorsiflexion and Subtalar Eversion - Surgery
76
What is the Time frame for immobilization for typical ankle and foot fractures?
- 6-8 weeks
77
Describe the Weber Classification Scheme for Ankle Fractures
- Type A- Lateral Malleolar Injury Distal to Tibial Plafond - Type B- Level of Tibial Plafond - Type C- Proximal to Tibial Plafond
78
What is the Typical MOI for Calcaneal Fractures?
- Fall from Significant Height or MVA | - Should check Lumbar Spine for Compression Fractures if Calcanear Fracture found

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