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OCS > Foot and ankle > Flashcards

Foot and ankle Flashcards

1
Q

Risk factors for plantar fasciitis

A
  • Limited DF
  • High BMI
  • Running
  • Work related weight bearing activities
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2
Q

Symptoms of plantar fasciitis

A
  • Plantar medial heel pain (especially with initial steps)
  • Hell pain precipitated by a recent increase in weight bearing activity
  • Pain w/ palpation of the proximal insertion of the plantar fascia
  • Positive windlass
  • Negative tarsal tunnel
  • Limited active and passive talocrural joint dorsiflexion
  • Abnormal FPI
  • High BMI
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3
Q

Treatment for plantar fasciitis

A
  • Manual therapy
  • Stretching
  • Taping
  • Foot orthoses
  • Night splints
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4
Q

Examination of achilles tendinopathy

A
  • Measure ankle DF ROM
  • Subtalar joint ROM
  • Plantar flexion strength and endurance
  • Static arch height
  • Forefoot alignment and pain with palpation
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5
Q

Achilles tendinopathy treatment

A
  • Eccentric exercise or a heavy load slow speed exercise program.
  • Stretching can help with pain management
  • Minimal evidence supporting NMR and manual therapy
  • Iontophoresis
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6
Q

Risk factors for acute ankle sprain

A
  • Hx of previous ankle sprain
  • Does not use an external support
  • Does not properly warm up
  • Does not have normal ankle DF ROM
  • Does not participate in a balance/proprioception prevention program.
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7
Q

Risk factors for ankle instability

A
  • Increased talar curvature
  • Not using external support
  • Did not perform balance or proprioception exercises
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8
Q

Interventions for ankle sprain

A
  • Cryotherapy
  • DO NOT use US
  • Manual therapy with graded joint mobs
  • Progressive loading
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9
Q

Ottawa foot and ankle rules

A
  • TTP at the posterior edge or tip of the lateral malleolus
  • TTP at the posterior edge of tip of the medial malleolus
  • Inability to weight bear after initial injury or in the ER for four steps
  • TTP at the base of the 5th metatarsal
  • TTP at the navicular
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10
Q

Deltoid ligament

A
  • Posterior tibiotalar ligament
  • Tibiocalcaneal ligament
  • Anterior tibiotalar ligament
  • Tibionavicular ligament
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11
Q

Grade I ankle sprain

A
  • no loss of function
  • no ligamentous laxity
  • little or no hemorrhaging
  • no point tenderness
  • decreased total ankle ROM of <5 degrees
  • Swelling of 0.5 cm or less
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12
Q

Grade II ankle sprain

A
  • Some lack of function
  • (+) anterior drawer test
  • (-) talar tilt
  • Hemorrhaging
  • Point tenderness
  • Decreased total ankle ROM >5 but <10 degrees
  • Swelling between 0.5-2.0 cm
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13
Q

Grade III ankle sprain

A
  • Near total loss of function
  • (+) anterior drawer and talar tilt test
  • Hemorrhaging
  • Extreme point tenderness
  • Decreased total ankle ROM >10 degrees
  • Swelling >2.0 cm
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14
Q

Anterior drawer test

A

Specificity: 58%-80%
Sensitivity: 74%-94%

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15
Q

Star balance test with ankle sprain

A
  • > 4cm differences between sides pt is 2.5 times more likely to sustain and injury on the short side.
  • Deficits with medial diagonal range has highest correlation with injury.
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16
Q

Antipronation taping

A

Can use antipronation taping for short term relief with plantar fasciitis, up to 3 weeks.

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17
Q

Night splints

A
  • Helpful for those with 1st step pain with plantar fasciitis.
  • Can be used for 1-3 months
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18
Q

Changes in plantar fascia thickness…

A
  • Associated with symptoms and altered compressive properties of the fat pad.
  • Positively associated with changes in heel pain
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19
Q

Windlass test

A

Specificity: 100%
Sensitivity: 32%

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20
Q

Tarsal tunnel syndrome

A

Specificity: 99%
Sensitivity: 92%

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21
Q

L1 dermatome

A

groin

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22
Q

L2 dermatome

A

anterior thigh

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23
Q

L3 dermatome

A

medial femoral condyle

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24
Q

L4 dermatome

A

medial malleoli

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25
Q

L5 dermatome

A

2nd-3rd web space

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26
Q

S1 dermatome

A

medial heel

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27
Q

L2 myotome

A

hip flexion

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28
Q

L3 myotome

A

knee extension

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29
Q

L4 myotome

A

ankle dorsiflexion

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30
Q

L5 myotome

A

great toe extension

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31
Q

S1 myotome

A

plantarflexion

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32
Q

S2 myotome

A

knee flexion

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33
Q

Tarsal tunnel syndrome symptoms

A

Burning pain in medial arch and ball of foot

34
Q

Baxter’s N entrapment

A

acute pain felt where the 1st branch of the lateral plantar N becomes entrapped in the medial heel

35
Q

Kleiger test

A

Dorsiflexion and external rotation stress test used to test for syndesmotic sprain

36
Q

Fat pad atrophy

A

-Increased pain with prolonged standing, usually bilaterally.

37
Q

Chopart’s joint

A

Midtarsal joints between the talus, calcaneus, and the navicular cuboid

38
Q

Hindfoot varus can contribute to…

A
  • Retrocalcaneal exostosis (pump bump)
  • Shin splints
  • Plantar fasciitis
  • Hamstring strains
  • General knee and ankle pathologies
39
Q

Cotton test

A
  • Used to assess syndesmotic instability

- Stabilize distal tibia and fibula and apply medial and lateral translation to the foot

40
Q

Anterior tarsal tunnel syndrome

A
  • Compression of deep peroneal N
  • Motor symptoms: high steppage gait, inability to control ankle movement
  • Sensory: sensory loss of small triangular area between 1st and 2nd toes
  • Pain: pain between 1st and 2nd toes can refer to dorsum of foot
41
Q

Sural N injury

A

Shooting pain and parasthesia

42
Q

Medial plantar N injury

A

Can be entrapped in medial longitudinal arch->aching in arch, burning, pain in heel, and altered sensation in the sole of the foot behind the hallux.

43
Q

Bones of hindfoot

A

Talus and calcaneus

44
Q

Bones of midfoot

A

navicular, cuboid, cuneiform

45
Q

Bones of forefoot

A

Metatarsals and phalanges

46
Q

Osteochondritis dessicans

A

Articular cartilage separates from bone and results in decreased blood flow

47
Q

Lisfranc fx

A
  • 1st-3rd metatarsal joints with cuneiforms, 4th-5th and cuboid.
  • Most common fx
48
Q

Cuboid syndrome

A
  • May feel like a pebble under that area
49
Q

Jone’s fx

A
  • Fracture on the 5th metatarsal though more distal towards phalanges
50
Q

Dorsiflexion/plantar flexion

A
  • DF: 15-25 degrees
  • PF: 40-55 degrees
  • sagittal plane movement
  • rotate around the frontal oblique axis
51
Q

Inversion/eversion

A
  • Inversion: 40 degrees
  • Eversion: 20 degrees
  • Frontal plane movement
  • Rotate around longitudinal axis
52
Q

ABDuction/ADDuction

A
  • Transverse plane movement

- Rotate around vertical axis

53
Q

Pronation

A
  • Dorsiflexion
  • Eversion
  • ABDuction
  • Tibia is rotated medially
54
Q

Supination

A
  • Plantar flexion
  • Inversion
  • ADDuction
  • Tibia is rotate laterally
55
Q

Ligamentous support of tarsal joints

A
  • Plantar calcaneonavicular ligament (spring ligament)
  • Dorsal talonavicular ligament
  • Bifurcate ligament (calcaneocuboid and calcaneonavicular ligament)
56
Q

Spring ligament

A
  • Calcaneonavicular ligament

- Supports the head of the talus and helps support medial longitudinal arch of the foot

57
Q

Spring ligament diagnosis

A
  • Persistent medial midfoot pain with associated pes planus foot posture following trauma
  • Neutral heel lateral push test: hold calcaneus in neutral position and laterally push forefoot, positive if unequal ROM.
58
Q

Pronation twist

A
  • Compensation for excessive hindfoot supination
  • 5th ray dorsiflexes, everts, and ABDucts
  • 1st ray plantarflexes, inverts, and ADDucts
59
Q

Supination twist

A
  • Compensation for excessive hindfoot pronation
  • 5th ray plantarflexes, inverts, and ADDucts
  • 1st ray dorsiflexes, everts, and ABDucts
60
Q

Foot posture index

A
  • Pronation (+), supination (-), neutral (0)
    1. Talar head position
    2. Supra and infra lateral malleolar curvature
    3. calcaneal frontal plane position
    4. Prominence n region of talonavicular joint
    5. Height and congruence of medial longitudinal arch
    6. ABD/ADD of the forefoot on the rearfoot.
61
Q

Reasons for orthotics

A
  • Control excessive motion in joints of foot/ankle
  • force/shock reduction
  • decrease soft tissue loading
  • control muscle activity
  • knee pain (sometimes LBP)
  • foot deformities
62
Q

Objective info to gather for orthotics

A
  • gait assessment
  • static posture assessment
  • talocrural, subtalar, tarsal ROM
  • ray mobility, 1st MTP ROM
  • strength testing
  • balance testing
  • functional tasks
63
Q

Sciatic nerve roots

A

L4-S3

64
Q

Common peroneal nerve roots and what it divides into

A
  • L4-S2

- Becomes deep and superficial peroneal nerve

65
Q

Deep peroneal nerve

A
  • innervates muscles in anterior compartment
  • anterior tibialis
  • extensor digitorum longus and brevis
  • extensor hallucis longus
  • peroneus tertias
66
Q

Superficial peroneal nerve

A
  • Provides sensory info for skin on the dorsal and lateral aspects of leg and foot.
  • peroneus longus and brevis
67
Q

Tibial nerve roots and innervations

A
  • L4-S3
  • gastrocnemius
  • soleus
  • small plantaris
  • tibialis posterior
  • flexor hallucis longus
  • flexor digitorum longus
68
Q

Tibial nerve splits

A
  • medial plantar N L4-S2

- lateral plantar N L5-S3

69
Q

Lateral plantar nerve

A
  • Supplies sensation to the skin on most of the plantar surface of the foot
  • innervates all foot intrinsics except for the extensor digitorum brevis.
70
Q

Presentation of injury to deep branch of peroneal N

A
  • Paralysis of pretibial nerves

- Results in drop foot

71
Q

Presentation of injury to the superficial branch of peroneal N

A
  • Paralysis of peroneus longus and brevis

- Results in inversion of the foot

72
Q

Presentation of injury to the common peroneal N

A
  • Paralysis of all dorsiflexors and evertors

- Results in PF of the talocrural joint and inversion of the foot.

73
Q

Presentation of injury to the proximal portion of tibial N

A
  • Paralysis of ALL plantar flexor and supinator muscles

- Dorsiflexion of talocrural joint and eversion of the foot

74
Q

Presentation of injury to the middle portion of tibial N

A
  • Paralysis of supinator muscles

- Eversion of the foot

75
Q

Presentation of injury to the medial and lateral plantar N’s

A

-Hyperextension of the MTP joints and flexion of the interphalangeal joints

76
Q

Most superficial of intrinsic foot muscle (layer 1)

A
  • flexor digitorum brevis
  • ABD hallucis
  • ABD digit minimi
77
Q

Layer 2 of intrinsic foot muscles

A
  • quadratus plantaris

- lumbricals

78
Q

Layer 3 of intrinsic foot muscles

A
  • ADD hallucis
  • Flexor hallucis brevis
  • Flexor digit minimi
79
Q

Layer 4 of intrinsic foot muscles

A
  • Plantar interossei

- Dorsal interossei

80
Q

Muscles innervated by the medial plantar nerve

A
  • flexor digitorum brevis
  • ABD hallucis
  • flexor hallucis brevis
  • 2nd digit of lumbricals
81
Q

Muscles innervated by the lateral plantar nerve

A
  • ABD digiti minimi
  • quadratus plantae
  • 3rd-5th lumbricals
  • ADD hallucis
  • flexor digiti minimi
  • plantar interossei
  • dorsal interossei

OCS (11 decks)

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