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SCS Prep > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

1
Q

Supination NWB

A

stationary talus

Calc - inv/add/pf

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2
Q

Supination WB

A

calc inv
talus abd/df
tibfib er

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3
Q

Pronation NWB

A

stationary talus

calc - eve/abd/df

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4
Q

Pronation WB

A

calc eve
talus add/pf
tibfib IR

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5
Q

1st ray

A

DF - inv and slight add

PF - eve and slight abd

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6
Q

5th ray

A

DF - eve and slight abd

PF - inv and slight add

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7
Q

Supination Twist

A

hindfoot pronates, TT supinate - if not sufficient, med/lat FF and rays respond

1st two rays - DF, add, INV
last 2 - PF, add, INV

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8
Q

Pronation Twist

A

hindfoot sup, TT reacts

1st two rays - PF, eve, abd
last 2- DF, eve abd

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9
Q

FPI

A

pronation (+), neutral 0, supination (-)

normal 0-5
pronated 6-9
supinated -1 to -4

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10
Q

Orthotics

A

med post/wedge for pronation (arch) or varus (RF/FF)

lat for sup or valgus

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11
Q

Orthotics Evidence

A

helps with PF and heel pain
weak for achilles
inconclusive for PFPS
prefab vs custom makes no difference

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12
Q

Ankle Sprain Grade I

A

no loss of function, lig lax, pt tender
little or no hemorrhage, swelling < .5
dec total ROM < 5 deg

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13
Q

Ankle Sprain Grade II

A

some loss of function, + ant draw, - talar tilt, pt tender
hemorrhaging, swelling .5-2 cm
dec total ROM 5-10

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14
Q

Ankle Sprain Grade III

A

near total loss of function, + ant draw/talar tilt, extreme pt tender
hemorrhaging, swelling > 2
dec total ROM > 10

IIIA < 3 mm ant draw
IIIB > 3 mm

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15
Q

Ankle Sprain Acute Phase

A

A - early supported WBing, cryo, US (not), therex
B - MT
C - shortwave diathermy
D - estim/laser

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16
Q

Ankle Sprain Post Acute

A

A - MT
C - progressive loading/sensorimotor training phase
D and F - therex

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17
Q

Heel Pain/PF - A

A 
plantar medial heel pain - 1st step/inactivity
worse after prolonged activity
pain at prox insertion of PF
\+ windlass test
- tarsal tunnel test

FAAM

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18
Q

Heel Pain/PF - B

A

limited DF, high BMI
more pronated feet

VAS

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19
Q

Heel Pain/PF Tx

A

A - MT, stretching, taping (up to 3 wks), foot orthoses (2 wks to 1 yr)
C - laser, US (not)
D - estim (2-4 wks), phono, footwear (rocker bottom, shoe rotation), weight loss
F - therex, dry needling

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20
Q

Compartment Syndrome

A

symptoms subside, tightness/cramping, pain predictable

needle manometer
tib ant - deep fibular nerve
> 15 pre, > 30 1 min post, > 20 5 min post

full rehab 3 mo; training at 6 wks

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21
Q

Lisfranc

A

slight ER with PF and axial loading (blunt trauma in nonathletes)

I - min/no diastasis or arch height loss, increased bony uptake
II - 2-5mm diastasis between first 2 MTs; no loss of arch
III > 5 mm
IV - no such thing

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22
Q

Lisfranc anatomy and Tx

A

runs between medial cuneiform and base of 2nd MT

I - cast and protected WBing 8 weeks; 4-8 wks NWB

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23
Q

Anterior: Deep Peroneal

A

L5-S1

tib ant, EHL, EDL, fib tert

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24
Q

Superficial Post: Tibital

A

L5-S1

gastroc/sole, plantaris

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25
Q

Deep Post: Tibial

A

L5-S1

pop, FHL, FDL, tib post

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26
Q

Lateral: Sup Peroneal

A

fib long, fib brev

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27
Q

Lateral Ligaments

A

ATFL, CFL, PTFL

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28
Q

Medial Ligaments

A

A/P tibtal, tibcalc, tibnav

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29
Q

Ottawa Ankle Rules

A

malleolar zone - tender post 1/2 distal tib or fib, tip of med/lat mall
midfoot - tender nav, 5th met
4 step

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30
Q

Morton’s Test

A

possibility of MTgia or neuroma

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31
Q

Achilles Tendon Reflex

A

S1 nerve root

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32
Q

Tinel’s Sign

A

may indicate tarsal tunnel syndrome

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33
Q

Anterior Drawer

A

ATFL

34
Q

Calf Squeeze Test

A

Achilles tendon rupture

35
Q

ER test

A

syndesmotic/high ankle sprain

36
Q

Impingement Test

A

TC jt impingement

37
Q

Navicular Drop Test

A

assess med long arch by looking at nav height

38
Q

Squeeze Test (Iower leg)

A

tibfib syndesmotic injury

39
Q

Squeeze Test (calcaneus)

A

stress fx

40
Q

Talar Tilt

A

lat lig of ankle

41
Q

Windlass Test

A

presence of fascial and lig impairments

42
Q

Maisonnuerve Fx (DCE)

A

D - tearing of IO and prox fib fx
C - ER force (force through IO membrane and exits through prox fib)
E - palpate prox fib near knee

43
Q

Tillaux Fx (DCI)

A

D - SH III fx of A/L tib epip (avulsion)
C - avulsion of ATFL from ER injury
I - plain X-ray followed by CT if needed

44
Q

Jones Fx (DCEIT)

A

D - 5th met base fx
C - FF add with ankle PF
E - swelling and pain over 5th MT
I - A/P, lat, mortise view of ankle; A/P, lat, oblique of foot
T - non-op (cast 6-8 weeks, crutches, increase WBing as pain subsides)

45
Q

Lisfranc Fx (DCEI)

A

D - TMT fx w/ dislocation - dorsal displacement of prox end of MTs
C - crush to midfoot, sudden rotation force on a PF FF
E - alignment, medial plantar bruising, swelling/tenderness at dorsum of foot
I - MRI (sometimes missed on X-ray)

46
Q

Talar Dome Fx (CET)

A

C - severe inv/DV or inv/PF
E - pain with WBing, catching, swelling after activity
T - NWBing and immob, surgery if conservative tx fails or has loose bodies

47
Q

Sever’s Disease (DCET)

A

D - calc apop (similar to knee OS)
C - common 8-14 yo, traction injury
E - pain at post heel below Achilles; swelling at calc
T - expected RTP 2-8 weeks

48
Q

MT Stress Fx (aka March Fx) (DCEIT)

A

D - most common 2nd MT
C - change in training, more prone with FF varus, hallux valgus, flat foot
E - dull pain w/ gradual onset progressing to pain at rest - pain diffuse at rest, then localizes
I - bone scan
T - rest, possible boot and restricted WBing, orthotics if needed

49
Q

Critical Stress Fx Areas

A

tib ant, med mall, talus
5th MT, nav, sesamoids
requires special attention due to possibility of non union

50
Q

Calc Fx (CET)

A

C - landing after jump/fall
E - swelling, inability to WB
T - non-displaced (immob, early ROM)

51
Q

Cuboid Subluxation (CET)

A

C - pro w/ trauma; often w/ inv
E - pain along 4th/5th MT over cuboid, inc pain when standing after prolonged sitting
T - cuboid manip, orthotics

52
Q

Hallux Rigidus (CET)

A

C - DF loss due to degenerative process and changes in articular cartilage
E - when restricted, caused foot to roll laterally, great toe can’t DF, forced DF causes pain
T - stiffer shoe w/ larger toe box, orthotics, in same cases osteotomy

53
Q

Turf Toe (1st MTP jt sprain) (CET)

A

C - forced DF of MTP, player hit from behind during plant
E - pain with DF, pain at 1st met head, antalgic gait
T - stiffer shoe, steel/graphite insert, taping to prevent DF

54
Q

MTgia (DCET)

A

D - general term for pain at ball of foot
C - restricted DF, shortened midstance phase of gait
E - possible callous formation in FF
T - r/o stress fx, MT pad, alleviate restricted DF

55
Q

Lateral Ankle Sprain (CES)

A

C - PF/INV
E - lat swelling/tender, antalgic gait, ATFL/PFL/CTFL tender
S - talar tilt, ant draw

56
Q

Medial Ankle Sprain (CES)

A

C - EVE
E - med swell/bruise, delt lig tender, possible pain lat due to compression injury
S - talar tilt, Kleiger’s

delt lig helps support arch - injury may cause inc pro or dec arch

57
Q

Syndesmotic Ankle Sprain (CESI)

A

C - ER/forced DF
E - dec PF, A/P tibfib lig tender, pain between distal tib and fib, pain post med at level of ankle jt
S - Squeeze, ER, crossed-leg cotton tests
I - X-rays may show inc tibfib clear space, dec tibfib overlap, inc med clear space
more common with sports that involved limited motion of foot (hockey, skiing)

58
Q

Achilles Rupture (CETI)

A

C - pushing off WBing foot with knee ext, unexpected DF
E - pop, “felt like being shot”
T - Thompson
I - MRI

59
Q

Retrocalc Bursitis (CET)

A

C - inflammation of bursa between Achilles and calc, pressure and rubbing from heel counter of shoe, can cause exostosis (Haglund’s deformity)
E - pain with palpation, swelling, noticeable bump
T - RICE, NSAIDS, stretching, heel lift

60
Q

Sublungal Hematoma (DCET)

A

D - blood under toenail
C - stepped on, repeated shear force (ie kicking, running)
E - area under nail accumulates blood
T - drilling of small hole (if no fx present)

61
Q

Hammer Toe

A

flex contracture of PIP

62
Q

Mallet Toe

A

flexion contracture of DIP

63
Q

Claw Toe

A

flexion contracture of DIP, hyperext MP

64
Q

Joggers Foot (DCE)

A

D - local nerve entrapment of med plantar nerve at runnel of abd hall and nav tub
C - running induced nerve pain
E - pain med arch into med toes

associated with valgus hindfoot deformity and long distance running

65
Q

Haglund’s Deformity

A

bony enlargement on back of heel “pump bump”

66
Q

Morton’s Neuroma

A

3rd and 4th met heads; associated with excessive pronation

67
Q

MTSS (shin splints)

A 
repetitive microtrauma (common with running/jumping)
I - 3 phase X-ray (sometimes see cloudiness), MRI
68
Q

Compartment Syndrome

A

D - inc pressure in compartment leads to compression of muscular and NV structures

Acute - secondary to direct trauma (medical emergency)
Acute Exertional - evolves with min-mod activity
Chronic - consistently at certain point during activity

E - deep aching pain, swelling/tightness in compartment, pain with passive stretching
pre-exercise > 15, 1 min post > 30, 5 min post > 20

T - fasiotomy (may not return 2-4 mo)

69
Q

Turf Toe Orthotics

A

TCO (total contact orthotic) w/ carbon fiber plate
Rocker sole
extended steel shank

70
Q

Morton’s Toe Orthotics

A

TCO w/ MT pad prox to 2nd met head

71
Q

Bunion Orthotics

A

larger toe box
stretch shoe
TCO w/ med posting

72
Q

Sesamoiditis Orthotics

A

custom TCO w/ met pad
viscoelastic polymer under sesamoids
full length steel shank
ant rocker bottom

73
Q

Pes Cavus Orthotics

A

OTC w/ shock absorption

TCO w/ lat FF posting

74
Q

Pes Planus Orthotics

A

OTC full insoles w/ med posting

75
Q

Achilles Tendinopathy Orthotics

A

firm heel cusion, heel elevation

custom TCO w/ med posting and heel cup

76
Q

Sever’s Orthotics

A

OTC insole w/ good arch support and absorption

77
Q

Modified Brostrom for CAI Protocol

A

Day 0-4 - WBAT w/ walking boot and crutches
Day 7-14 - wean crutches
Wk 4-6 - remove walking boot, gentle ROM, peroneal isos, cycling and light swimming (avoid abd/add until wk 6)
Wk 6-8 - air splint, proprioception
Wk 8-12 - RTP

78
Q

Non-Op Achilles Ruptures Protocol

A

initially - cast foot w/ DF block, NWB
Wk 2 - boot with 20 deg PF, WBAT
Wk 4 - boot removed 5 min/hr for DF to neutral, PF passively
Wk 6 - remove 1 wedge, NWB strengthening
Wk 10 - discontinue boot, 1 cm heel wedge (continue for 3 mo)

79
Q

Achilles Tendon Debridement Protocol

A

Day 7-10 - WBing when pain/swelling dec
Wk 2-3 - begin strengthening (CKC/OKC)
Wk 6-10 - running
Mo 3-6 - RTP

80
Q

Achilles Repair Protocol

A

initially - leg placed in post splint with stirrup
Wk 2-6 - WBAT in boot w/ weaning of crutches
Wk 6 - wean from boot, strengthening resistance tubing, progress ROM, cycling, begin heel raise B when weaned from boot
Mo 3 - uni heel lift
Mo 6-12 - resume recreational activities when heel raise is 80%

SCS Prep (16 decks)

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