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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
Deep Post: Tibial
L5-S1 | pop, FHL, FDL, tib post
26
Lateral: Sup Peroneal
fib long, fib brev
27
Lateral Ligaments
ATFL, CFL, PTFL
28
Medial Ligaments
A/P tibtal, tibcalc, tibnav
29
Ottawa Ankle Rules
malleolar zone - tender post 1/2 distal tib or fib, tip of med/lat mall midfoot - tender nav, 5th met 4 step
30
Morton's Test
possibility of MTgia or neuroma
31
Achilles Tendon Reflex
S1 nerve root
32
Tinel's Sign
may indicate tarsal tunnel syndrome
33
Anterior Drawer
ATFL
34
Calf Squeeze Test
Achilles tendon rupture
35
ER test
syndesmotic/high ankle sprain
36
Impingement Test
TC jt impingement
37
Navicular Drop Test
assess med long arch by looking at nav height
38
Squeeze Test (Iower leg)
tibfib syndesmotic injury
39
Squeeze Test (calcaneus)
stress fx
40
Talar Tilt
lat lig of ankle
41
Windlass Test
presence of fascial and lig impairments
42
Maisonnuerve Fx (DCE)
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
Tillaux Fx (DCI)
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
Jones Fx (DCEIT)
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
Lisfranc Fx (DCEI)
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
Talar Dome Fx (CET)
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
Sever's Disease (DCET)
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
MT Stress Fx (aka March Fx) (DCEIT)
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
Critical Stress Fx Areas
tib ant, med mall, talus 5th MT, nav, sesamoids requires special attention due to possibility of non union
50
Calc Fx (CET)
C - landing after jump/fall E - swelling, inability to WB T - non-displaced (immob, early ROM)
51
Cuboid Subluxation (CET)
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
Hallux Rigidus (CET)
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
Turf Toe (1st MTP jt sprain) (CET)
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
MTgia (DCET)
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
Lateral Ankle Sprain (CES)
C - PF/INV E - lat swelling/tender, antalgic gait, ATFL/PFL/CTFL tender S - talar tilt, ant draw
56
Medial Ankle Sprain (CES)
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
Syndesmotic Ankle Sprain (CESI)
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
Achilles Rupture (CETI)
C - pushing off WBing foot with knee ext, unexpected DF E - pop, "felt like being shot" T - Thompson I - MRI
59
Retrocalc Bursitis (CET)
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
Sublungal Hematoma (DCET)
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
Hammer Toe
flex contracture of PIP
62
Mallet Toe
flexion contracture of DIP
63
Claw Toe
flexion contracture of DIP, hyperext MP
64
Joggers Foot (DCE)
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
Haglund's Deformity
bony enlargement on back of heel "pump bump"
66
Morton's Neuroma
3rd and 4th met heads; associated with excessive pronation
67
MTSS (shin splints)
``` repetitive microtrauma (common with running/jumping) I - 3 phase X-ray (sometimes see cloudiness), MRI ```
68
Compartment Syndrome
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
Turf Toe Orthotics
TCO (total contact orthotic) w/ carbon fiber plate Rocker sole extended steel shank
70
Morton's Toe Orthotics
TCO w/ MT pad prox to 2nd met head
71
Bunion Orthotics
larger toe box stretch shoe TCO w/ med posting
72
Sesamoiditis Orthotics
custom TCO w/ met pad viscoelastic polymer under sesamoids full length steel shank ant rocker bottom
73
Pes Cavus Orthotics
OTC w/ shock absorption | TCO w/ lat FF posting
74
Pes Planus Orthotics
OTC full insoles w/ med posting
75
Achilles Tendinopathy Orthotics
firm heel cusion, heel elevation | custom TCO w/ med posting and heel cup
76
Sever's Orthotics
OTC insole w/ good arch support and absorption
77
Modified Brostrom for CAI Protocol
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
Non-Op Achilles Ruptures Protocol
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
Achilles Tendon Debridement Protocol
Day 7-10 - WBing when pain/swelling dec Wk 2-3 - begin strengthening (CKC/OKC) Wk 6-10 - running Mo 3-6 - RTP
80
Achilles Repair Protocol
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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