foot and ankle Flashcards
what muscles make up the lateral compartment and what nerve innervates them?
fibulas longus and brevis, superficial fibular nerve
what muscles make up the deep posterior compartment and what nerve innervates them?
tib posterior, flexor hallucis longus, flexor digitorum, tibial nerve
what muscles make up the anterior compartment and what nerve innervates them?
tib anterior, extensor hallucis longus, extensor digitorum longus, fibula’s Tertius, deep fibular nerve
what muscles are a part of the superficial posterior compartment and what nerve innervates them?
gastroc, soleus, plantaris, tibial nerve
a surgical release of the plantar fascia will likely lead to failure of which ligament?
spring ligament
do passive or active structures support the medial longitudinal arch?
both! Research supports that both contribute but to what degree and when is still not established.
if someone is weak in ankle plantar flexors how will they usually compensate during walking?
You will notice an increased hip pull with increased activity of the hip flexors
is pes cavus flat foot or high arch?
high arch
is pes planus flat foot or high arch?
flat foot
how big of a difference on the navicular drop test is considered abnormal?
greater than 10mm
what does decreased heel height possibly mean during heel raise?
decreased ability to lift weight, decreased length of plantar flexors, mid foot instability
what angle is considered hallux limitus?
less than 40 degrees of DF of 1st met
what are you assessing the integrity of with the anterior drawer test on the ankle?
ATFL
how do you perform the cotton test? What does it test for?
hold tibia, move talus medially and laterally. Tests for syndesmotic instability
what does the arc sign test for? How do you perform it?
test for achilles tendinopathy. Lay on stomach, look for bulge in tendon, DF and PF, if the bulge moves it is positive
what does a Bohlers angle of less than 20 degrees on radiographs indicate?
a broken calcaneous
what factors in women predispose them to hallux values?
low BMI, wearing high heels
what factors in men predispose them to hallux values?
higher BMI, hx of pes planus
what does current evidence support in relation to hallux valgus and conservative care?
the valgus will get worse unless corrected by surgery
what are two treatment options for hammer toes?
larger toe box in the shoes, taping of the MTP joint into flexion
what are the basic principles of high ankle sprains?
avoid DF, progress slowly
what are the Bernese Ankle Rules?
one of the following has to be positive - indirect fibular stress (10cm proximal), direct medial malleolar pressure, compression of mid and forefoot
what ligament is at risk of not healing properly after a lateral ankle sprain?
ATFL
what is the only relevant prognostic factor at 4 weeks associated with outcome at 16 weeks
pain during weight bearing ankle DF and medial joint line pain
what 5 factors put you at risk for re injury after a lateral ankle injury?
hx of ankle sprains, failure to use a brace, failure to warm up, lacking ankle DF, failure to participate in balance and proprioceptive prevention program after last injury
is joint laxity or mechanical instability associated with the development of CAI?
no
to return to sport after CAI what activity is very important to integrate?
plyometrics
what movement indicates anterior ankle impingement?
forced DF
what is the primary cause of ankle OA?
previous fx
what is the main treatment for ankle osteoarthritis?
surgery
what are three factors associated with plantar fasciopathy?
obesity, limited DF, time spent on feet at work
what is the biggest risk factor for plantar fasciopathy?
limited DF
what is the normal age range for plantar fasciopathy?
45-65 y/o
are orthotics helpful in plantar fasciopathy?
yes, if they person has excessive pronation
what surgery has shown some promise for plantar fasciopathy?
gastroc recession
what is tarsal coalition?
when bones from the mid foot and hind foot fuse
what are the symptoms of tarsal coalition?
vague hind foot pain, repeated ankle sprains, family hx of TC, hind foot valgus
what is the MOI for a lisfranc injury?
axial load to a PF foot
what is the mid foot squeeze test used to screen and haw is it performed?
used to screen for Lisfranc injuries, grab the dorsum of foot and squeeze
what does severs disease effect?
the calcaneous where the achilles tendon inserts
what is the prognosis for Severs?
2 - 8 weeks
who is most at risk for Severs?
6-8 year old boys
what two test combined have almost 100% sensitivity for severs?
one leg heel standing test, squeeze test
what is kohlers disease?
osteochondritis of the navicular bone
what is the prognosis for kohlers disease?
8 months
who is usually affected by kohlers disease?
boys between 2-10 y/o
how will kohlers disease present?
gradual onset, swelling over dorsum of foot, tender navicular
what is the goal of conservative treatment for hallux rigidus?
limit first MTP joint motion
who will you typically see a Morton neuroma in and what will they complain of?
45-50 y/o female, sharp burning pain between 3rd and 4th toe
what is the typical treatment for a Morton neuroma?
steroid injection
what is a primary risk factor for non insertional achilles tendinopathy?
obesity
what 4 risk factors are present in runners for the development of non insertional achilles tendinopathy?
limited DF ROM, abnormal subtaler ROM, decreased PF strength, foot pronation
patients who are frequently less active and overweight typically present with insertional or non insertional achilles tendinopathy?
insertional
what is the typical patient you will see with an achilles tendon rupture?
40-60 y/o male
what is the recommended treatment for subluxing peroneal tendons?
surgery
do men or women have a worse outcome after ankle fracture?
men
how often should shoes be replaced to avoid excessive loading and potential stress fractures?
300-500 miles
what two things during running predispose someone to a stress fx?
excessive hip adduction and rear foot eversion
what 4 characteristics are associated with MTSS?
previous injury, female gender, higher BMI, below average activity history
