Foot And Ankle Flashcards
What motions creat pronation and supination?
What muscles pronate and supinate the foot?
PRO in BED, SUP DIP
Pronation: abduction, E version, Dorsiflexion
Supination: adduction, inversion, plantar flexion
Pronate: peroneals
Supinate: deep posterior compartment; FHL, FDL, post tibialis
What are foot mechanics during walking?
Tib anterior control foot down in early stance
Post tib control arch down
Peroneals, FHL, FDL resupinate foot
Hallucis >60 deg extension in late stance
What is he peek-a-boo sign?
What does the talar tilt test look for?
Peek-a-boo for seeing medial calcaneus in anterior view of foot posture, sign of high arch/Pes cavus
Talar tilt at 20 deg PF tests for ATFL, 10 deg DF tests for CFL
What is a sign of hallux valgus?
What is hammer toe/claw toe?
What is mallet toe?
Hallux valgus >15 deg deviation
Flexion of IP and extension of MTP
Flexion of DIP
What is a high ankle sprain?
What positions aggravate it?
What are tests for it?
Sprain of distal tib/fib joint
Agg: DF and ER of foot
Tests: DF-ER test, squeeze test, syndesmosis Palpation
Cotton test: move rear foot while stabilizing distal tibia
Fibular translation test
What are the Ottowa ankle rules?
Bernese ankle rules?
Need radiograph if:
Bone tenderness in malleolar zone
Bone tenderness at 5th met/navicular zone
Inability to weight bear
Bernese:
Pain with indirect fibular stress
Direct malleolar stress
Compression of midfoot and hind foot
How do you grade an ankle sprain?
Grade 1: no function loss, instability, point tenderness, ankle mobility decreases 5 deg or less
Grade 2: some loss of function, + anterior drawer, - talar tilt, ecchymosis, loss of motion 5-10 deg
Grade 3: near loss of function, + anterior drawer and talar tilt, extreme point tenderness, loss of motion >10
What are clinical findings of CAI?
What are tests to discriminate CAI?
- At least 1 ankle sprain
- At least 2 reports of giving way in last 6 months
- Lower self-reported function
Tests: SL balance <26 Foot lift test Figure 8 hop test >17.4 sec Side hop test >13 sec for 10 reps
What are classifications for ankle OA?
I: isolated ankle
II ankle with varus/valgus intraarticular deformity and/or tight heel cord
III ankle with hind foot deformity, tibial malunion, midfoot ABD/ADD supinated midfoot, PF of 1st ray
IV: all of I-III plus subtalar, calcaneocuboid, talonavicular arthritis
What is the differential diagnosis for plantar fasciopathy And what would you find with each?
Nerve entrapment: + tunnels and weakness of ABD minimi
Tarsal tunnel syndrom: burning
Calcaneal stress fracture: medial and lateral compression of calcaneus
What is tarsal coalition and what would patient present with?
Fusion of 2 bones during adolescence, commonly calcaneonavicular. Restricts subtalar movement
Present with hind foot valgus and decreased subtalar movement
What is a Lisfranc injury?
What is common MOI?
How is it diagnosed?
What is treatment?
Ligament between 1st cuneiform and 2nd met
MOI: PF with force (like MVA)
Dx with radiograph (>2mm between 1st and 2nd met)
Treatment is immob or internal fixation
What is Sever’s disease?
How is it diagnosed?
Treatment?
Calcaneal apophysitis, resolves in 2 weeks to 2 months
Diagnosed with radiograph
Treatment is ice and heel lift
What is Kohler’s disease?
How is it diagnosed
What is treatment?
Self-limited in kids, osteochondritis of navicular
Diagnosis is gradual onset with swelling and TTP of navicular region
Treatment might need short leg cast for 6-8 weeks with arch support after
How do you grade Hallux rigidis?
0: 1st MTP DF 40-60,no pain, normal radiograph
1: DF 30-40, dorsal osteophytes
2: DF 10-30, mild flattening of MTP
3: DF<10, severe radiographic changes, constant pain and pain at end-ranges
4: same as 3 but pain throughout ROM
Where is Morton neuroma found?
What are tests for it?
Between 3rd and 4th met
Mulder click test
Where is non-insertional Achilles’ tendinopathy?
What are causes?
What are General tendinopathy guidelines?
What is insertional Achille’s tendinopathy?
How are these patients different?
What is the classification?
Special consideration for insertional rehab?
Non-insertional - 6cm from tendon insertion
Causes: decreased DF, increased pronation, decrease PF strength, abnormal STJ mechanics
Guidelines: education, unload, reload, protect
Insertional tendinopathy: patients usually less active and overweight
Classification:
I thickened tendon (6-8mm)
II thickening >8mm, uniform intramural degeneration involving >50% of width of tendon
III thickening >8mm, degeneration is diffuse
- do not let hell raises go <0 DF because impingement of bursa
What are the Weber classifications of ankle fractures?
A lateral malleolus distal to tibial plafond
B tibial plafond
C proximal to tibial plafond
What is tibial stress syndrome?
Compartment syndrome?
True shin splints with sxs on dist 2/3 of posterior tibialis
Compartment syndrome: pressure in the muscles build up due to arterial insufficiency
5Ps: pain (disproportionate), parlor, Paresthesia, pulselessness, paralysis
