Foot and Ankle

Question 1

What are the components of the ICF Model?

Answer 1

Health Condition
Body Structure and Function
Activity
Participation
Contextual Factors

Question 2

For self-reported outcomes, what 3 questionnaires are patients given for Region Specific information?

Answer 2

LEFS: Lower Extremity Functional Scale
DASH: Disabilities of the Arm, Shoulder, and Hand
NDI: Neck Disability Index

Question 3

For Self-reported Outcomes, what 2 questionnaires are patients given for Joint Specific information?

Answer 3

HOS: Hip Outcome Sores
FAAM: Foot and Ankle Measurements

Question 4

For Self-reported outcomes, what 2 questionnaires are patients given for Tissue Specific information?

Answer 4

VISA-A: Index of severity of Achilles Tendinopathy

VISA-P Index of severity of Patellar Tendinopathy

Question 5

What are the common Red Flags therapists should ask patients in their subjective examination?

Answer 5

Have you been experiencing any of the following

1. Fever
2. Chills
3. Night Sweats
4. Malaise/Fatigue
5. Unexplained Nausea/Vomiting
6. Paresthesia: Tingling associated with nerve pathology
7. Shortness of Breath
8. Dizziness

Question 6

During a subjective examination, clinicians should categorize a patients sources of pain and movement dysfunction in regards to what 3 factors?

Answer 6

1. Local Neuro and/or Musculoskeletal
   - Intra Articular
   - Extra Articular
2. Remote and/or Referred Neuro/Musculoskeletal
3. Systemic Sources

Question 7

When analyzing a patients movements, a therapist should analyze why it is they move the way they do. What are the 6 common symptoms for such movements?

Answer 7

1. Pain: Trauma, overuse, abnormalities
2. Neuromuscular: Strength or control issue
3. Range of Motion: Bony Deformity, Joint Pathology, Shortened, Musculature
4. Habit (work, Sport, Leisure)
5. Structural Deformity (mild to Extreme)
6. The life history of the patient

Question 8

What is the specific questionnaire designed to rule in/out if a patient has a fracture?

Answer 8

Ottawa Ankle Rules

Question 9

For someone who suffered a Grade 3 ankle sprain, underwent surgery, and is now referred to physical therapy, what will your differential diagnosis include? (8 things)

Answer 9

1. Fracture: (Ottawa Ankle Rules)
2. Subtalar Sprain: Other Ligament Sprains
3. Peroneal Tendon Injury: Tendon vs. Retinaculum
4. Achilles Rupture: Palpation, Thompson
5. Osteochondral Lesion: shows up later
   6: Fifth Meta-Tarsal Fracture: Avulsion vs. Jones Fracture
6. Midfoot Sprain: Cuboid Positional Fault
7. Fracture Anterior Calcaneal Process

Question 10

List the Ligaments of the Ankle and their relative position. (Lateral, Medial)

Answer 10

Posterior Tibiofibular Ligament (Lateral)
Calcaneofibular Ligament: (Lateral)
Anterior Tibiofibular Ligament (Lateral)
Anterior Talofibular Ligament (Lateral)

Deltoid Ligament (Medial)
Posterior Talocalcaneal Ligament (Medial)

Question 11

What are the different levels to the stress/strain curve and their definitions?

Answer 11

Grade 1: Fibers are tightened to the point of microscopic failure (Minor Tear)
Grade 2: Macroscopic failure (Incomplete Tear)
Grade 3: Rupture of the structure (Disruption of the Ligament with Instability)

Question 12

What are the 4 common effects of immobilization to a structure?

Answer 12

1. Cartilage Degeneration
2. Decreased Mechanical and Structural Properties of Ligaments
3. Decreased Bone Density
4. Weakness/Atrophy of Muscles

Question 13

Upon Assessing a patient, what are the general techniques from start to finish? (beginning of assessment to the end of the process)

Answer 13

1. Gait Analysis
2. Observation (could be postural)
3. Edema Assessment
4. Neurological Screen (determine if needed)
5. ROM Measurements
6. Manual Muscle Testing
7. Special Tests

Question 14

If a patient suffers from Inadequate ROM, what 4 things can therapists provide?

Answer 14

1. Joint Accessory Motion
2. Soft Tissue Mobilization of the Muscle
3. Weakness: unable to move through AROM
4. Motor Re-Education/Education

Question 15

What are the 6 Categories for the FOOT POSTURE INDEX?

Answer 15

1. Talar Head Palpation
2. Supra and Infra Lateral Malleolar Curve
3. Calcaneal Frontal Plane Position
4. Bulge in Region of TNJ
5. Height of Congruence of MLA
6. Abduction/Adduction of the FF on RF
   (Optional) 7. Forefoot Assessments for Forefoot

Question 16

Describe how to perform a Forefoot Position Assessment?

Answer 16

1. Bisect the Calcaneus and Draw a vertical line
2. Place the ankle into STN
3. Use index finger along metatarsal heads 2-5 to formulate line.
4. Assess weather the foot is Neutral, Varus, or Valgus
   - Neutral: Forefoot line and Calcaneal line = Perpendicular
   - Varus: Supinated midfoot
   - Valgus: Pronated Midfoot

Question 17

A patient presents to you with limited dorsiflexion. When you place them into Subtalar Neutral, they are able to actively attain 0-5° of Dorsiflexion. However, when the patients knee is flexed, they are able to attain 0-10° of active ankle Dorsiflexion. Explain why you think this is and what treatment you will perform.

Answer 17

Gastroc-Soleus complex is tight, restricting ankle dorsiflexion.
Assessment:
-Soft-Tissue Mobilization of the Gastroc-Soleus Complex
-Self-Stretch Gastroc-Soleus Complex Seated/Standing
-Soft-Tissue Mobilization of the Plantar Fascia
-Self-Stretch of Plantar Fascia

Question 18

Soft-Tissue Mobilization: Gastroc-Soleus Complex

Explain how to perform this test

Answer 18

Patient: Prone or side-lying w/pillow under foot
Therapist: Stride Stance at foot of table
Mobilizing hand: Distal to proximal calf
Variations: Ulnar Border, Flat Fist, Thumbs

Question 19

Self-Stretch: Gastroc-Soleus Complex

Explain how to perform this test and its variations

Answer 19

Patient: Long sitting, with towel/rope wrapped around forefoot and ends held in both hands
Action: Keeping knee extended, pull o ntowel with both hands, until stretch is felt in calf
Compensations: Kne