foot and ankle. Flashcards
anatomical area where dorsal surface of leg ends and dorsal surface of foot begins?
subtalar joint line.
Serious Dx of foot and ankle?
Fractures
Bone tumore
POSTop sepsis/DVT
How to rule out Fx with what appears to be lateral ankle sprain?
-pain in lateral malleolus
AND
-unable to WB after injury or in ER
-Tenderness on posterior edge of malleolus.
observations for foot/ankle?
-skin breakdown
-corn/callus
-excessive dryness/moisture
-edema
-color change of foot/toenail
-shoes
pes planus/cavus
Pes planus vs. Cavus?
flat feet (pronated) vs high arch (supinated)
skin color change indicative of
loss of circulation to foot
corns/callus indicative of?
what about over 1st metatarsal head?
increased friction
hyperpronating.
accessory motions of proximal tib fib?
distal?
Proximal: ant/post glide.
Distal: Ant/post glide. Sup/inf glide.
Talocrural jt accessory motion?
compression/distraction test
post glide/ 2 ant glides
Subtalar jt acc motion
compress/distract
med/lateral gap/glide
MTP accessory motion
IP
dorsal/plantar/med/lateral glide.
dorsal/plantar.
ST of ankle/foot?
Anterior drawer Talar Tilt Talar neutral (prone and WB) Navicular Drop Test Feiss's Line Windlass Test
Flexion contracture of PIP and DIP of toe?
What is it due to?
where is pain?
Hammer Toe
capsular restriction
on pressure areas.
An extension contracture of MTP jt accompanied by flexion contracture of IP jt?
due to what?
where is pain?
Claw toe
Pes Cavus alignment creating windlass effect
pressure area.
Condition where second toe is longer than 1st toe .
what does it affect?
moron’s toe
Affects push off during gait.
alignment impairment of 1st MTP where MT joint positions farther toward midline of body than what is considered normal?
Hallux Valgus.
pain on MTP/ pressure area.
Pain in first or 2nd Metatarsal head after long period of WB?
what is it caused by
Metatarsalgia
- from hyperpronation
- collapse of transverse arch
- tight achilles.
Congenital condition where tarsal bones fuse together.
what is result of this?
tarsal coalition
causes rigid flat foot.
lateral ankle sprain is combination of what?
at how many days post injury?
+anterior drawer test
Tenderness over ATFL
Presence of ecchymosis
5 days post injury.
Treatments of Lateral ankle sprain?
PRICE for first 48 hrs
Mobs for DF/ mobility of talus/pain
strengthen/stretch/proprioception.
Pain at mortise.
ankle DF and tibial ER on talus with foot planted on ground?
High ankle sprain.
What do you look for in high ankle sprain?
hypermobile distal tib/fib
Tx for high ankle sprain?
cast/ORIF
limit WB and DF
Diagnostic criteria of plantar fasciitis?
- medial heel pain with initial steps or prolonged WB.
- pain with palp of insertion
- Positive Windlass test
- neg. tarsal tunnel syndrome
- limited act/pass DF ROM
- abnormal foot posture index
- high BMI
- increase in WB activity.
Tx of plantar fasciitis
- Manual PT to jt and calves and for pain
- stretching
- antipronation taping.
- orthotics
- night splint for 1-3 months
- laser
- strengthen intrinsics
- rocker bottoms
- lose weight.
common stress fracture sites? cause?
metatarsals/tibia/fibula
overuse or biomechanical factors.
Dx of stress fractures?
why is X ray not effective?
Bone scan/MRI.
point tenderness
only shows up on Xray after 10 days.
Entrapment of deep perineal nerve between metatarsal shafts?
cause?
Dx?
Mortons neuroma.
tight shoes/heels.
tapping on nerve (tinels sign)
Entrapment of posterior tibial nerve at medial mal?
Dx?
Tarsal tunnel syndrome
Tinels sign
tendinopathy of soleus/tib post caused by excessive pronation.
Tx? strengthen tib post and provide arch support
Post shin splints/ Medial Tibial Stress Syndrome
strengthen tib post and provide arch support and education.
tendinopathy of tib ant. possibly from compartment syndrome?
Tx?
Anterior shin splints.
strengthen tib ant. and arch support.edu.
tendinopathy of gastroc?
how is it Dx if muscle is torn?
Achilles tendinopathy
Thompson test.
inflammation of bursa
common site?
Bursitis
calcaneal
Common OA sites?
Talocrural Jt.
1st MTP (Hallux rigid)
IP
hyperpronation can cause:
- pain at 1+2 MT heads
- Hallux Valgus
- Plantar Fasciitis
- Navicular Tuberosity
- Shin splint
- knee pain
common reason for hyperpronation?
Forefoot and rear foot varus. tight gastric congenital flat feet mid foot ligament laxity. leg length discrepancy
How is mid foot laxity and congenital flat feet tested?
location of navicular tuberosity in relation to Feiss’s line
Navicular Drop Test
With tight gastrocs, when trying to go to DF foot will likely go to
eversion/abd.
Interventions for ankle strength.
Ankle pumps Toe curls AROM calve raises balance Plyos.
functional tests of foot?
stand on hee;s/toes/lateral/medial foot/flex and extend toes.
