Foot and ankle Flashcards by Talia Holze

hindfoot and forefoot varus and valgus

Varus = eversion/inversion
Valgus = eversion/inversion

varus = inversion 
valgus = eversion

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Finding subtalar neutral

pt in prone
make sure their limb is in neutral torsion
put them in neutral DF
middle finger and thumb anteriorly on talus
grab with your other hand on the 4th and 5th ray
move left and right until you feel talus equally under each finger

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what are you looking at to find rearfoot angle at subtalar neutral?

you are looking at calcaneus in relation to the tibia

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what is normal hindfoot and forefoot varus and valgus?

rearfoot varus

forefoot varus

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what does “normal” rearfoot and forefoot varus lead to in gait

Varus means inversion, therefore

leads to more pronation during walking, because your foot needs to meet the ground

if you have severe varus in both hindfoot and forefoot thats going to lead to A TON of pronation

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severe hindfoot and forefoot varus is going to lead to what motion at the foot during gait

excessive pronation! they have to get their foot to the ground

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what if you have a severe mismatch of varus and valgus btwn hindfoot and forefoot?

every time you put your foot down there is a torsional effect on the midfoot which could cause irritation.

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internal tibial torsion is going to cause the subtalar joint to what?

pronate!

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what position is the patient in when measuring LAA (longitudinal arch angle)

standing!

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as the angle gets more obtuse or acute in LAA, that signals that the arch is dropped

acute

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what are the four points you mark to measure static rearfoot angle.

1) base of calcaneous
2) achilles tendon insertion
3) achilles at height of medial mal
4) 15 cm above mark 3

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too many toe sign assesses for what related set of issues?

excessive pronation due to collapsed arch causing forefoot ABD

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how do you perform the navicular drop test

pt is in sitting

find subtalar neutral

palpate navicular and measure from the ground to this point

have pt stand

measure again

> 5cm difference is signifcant

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how many cm is significant for navicular drop test?

5 cm from sitting to standing

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two main actions of the posterior tib

PF and inversion

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where does posterior tib insert?

plantar surface of navicular, cuniforms and base of 1st and2nd met

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if pt has pain right on the plantar surface of their medial arch what are you thinking?

insertional inflammation of posterior tib

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posterior tib

origin
where it runs
insertion

origin: interosseous membrane btwn tib and fib posteriorly

tendon runs posterior to medial mal, wraps around

inserts: plantar surface of navicular, cuniforms and base of 1st and 2nd met

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every time someone w/pes plantus takes a step, what is happening to the posterior tib muscle?

its being stretched out its full length and trying to work eccentrically.

Recipe for overuse!

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over the counter vs custom inserts for pes planus?

over the counter is fine for most people.

if they have a severe deformity hen youd consider custom

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if someone has notable rear foot and forefoot varus, what would you want to maybe recommend they use everday

orthotic in their shoe on the medial side to bring the floor to their foot!

pes planus or posterior tib overuse

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if someone is overpronating, what other motion do you want to make sure you’re also looking at?

DF, lack of DF could cause someone to have to excessively pronate to get their foot to meet the ground

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general purpose of orthotic

bring the floor to the foot to reduce stress

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who might benefit more from an orthotic someone with a flexed or rigid deformity?

rigid! flexible you’d probably only want it temporarily

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what are two pathoanatomic diagnoses that might benefit from an orthotic

posterior tib overuse pes planus

name the three ways to assess DF motion in weight bearing

anterior lunge test half kneel lunge test; SFMA WBing DF w/ inclinometer

What is normal DF for anterior lunge test? what is a significant difference side to side or one foot overtime

9-14 cm someone who is taller is going to have more 2cm is significant difference

explain the half kneel lunge test; SFMA

they go in half lunge keep heel on the ground you put dowel at their knee 5 inch cut off is normal

Explain wt bearing DF w/ inclinometer

pt half kneels DF as much as possible with heel still on ground place inclinometer on tibia

what is normal DF in degrees?

20-25 (higher than this if you're a runner)

how to assess subtalar motion

stabilize the talus, cup the calcaneus and twist to get supination and pronation

midfoot has what kind of axis

oblique

what would the limiting muscular structure be for hallux limitus?

flexor hallicus longus on the plantar aspect of the foot

define hallux limitis

limited mobility of the 1st MTP extension when 1st met head is LOADED, but NOT when unloaded

explain what the thompson test is and what it is for

testing for a complete rupture of the achilles tendon. pt is in prone, relaxed, and you grab the calf looking for PF highly specific

explain achilles tendon palpation test and what it is for

for achilles tendinitis palpate their tendon in prone, if they have pain midtendon its positive test

explain royal london hospital test and what it is for

for achilles tendinopathy (more specific than just palpation) pt is prone, you find the midpoint that is tender on their achilles ask them to actively DF, and palpate the same spot that hurt before a reduction in pain by 2/10 is a positive test for achilles tendinopathy

explain the Arc sign and what it is for

used in a pt that has achilles tendinopathy and you want to decide if its the tenon itself or the sheath ask them to actively move in and out of DF and PF if the point of swelling on the tendon moves, its the tendon itself if the point of swelling does not move it is the sheath

achilles tendionpathy intervention big points what are you doing how many days how many x a day how many sets how many reps

eccentric PF progressive program 6 days a week 2x a day 3 sets of 15

how to do you assess for high ankle sprain?

literally squeeze fib and tibia together (this stresses ankle syndesmoses) if this hurts this indicates high ankle sprain

what is the MOI for high ankle sprain

forced eversion/ER

how can you assess for lateral ankle sprain

talar tilt test: can look at ATFL, calcaneofibular and PTFL

explain how to test ATFL in talar tilt test

make sure pt is sitting with knees off the table put them into PF (so the ligament is perpendicular to the motion you're going to do) Grab calcaenous put them into inversion

explain how to test the calcaneofibular ligament as part of the talar tilt test

make sure pt is sitting with knees off the table put them into neutral DF. stabilize the malleoli and bring foot into inversion and eversion eversion: stresses the deltoid ligament inversion: stersses calcaneofibular

explain how to test the PTFL as part of the talar tilt test

make sure pt is sitting with knees off the table max DF move them into eversion and inversion

are high grade manipulations indicated in low irritability ankle sprains

YES!

Describe the thrust distraction of talocrural Good for what motion?

make sure their hip is IR you're wrapping their foot up, your palm on top of talus thrusting towards you good for DF

Anterior to posterior talocrural mobilization is good for what motion?

posterior to anterior talocrural mob is good for what motion

what direction does distal and proximal fibula go in wt bearing DF

proximal: anteriorly distal: posteriorly

for all tibiofibular thrusts, which bone are you mobilizing?

fibula! Stabilize the tibia and move the fibula.

subtalar joint needs to be able to do what motion so the netire midfoot can unlock

evert can do a distraction or a side tilt mob to get this

explain how to do a subtalar side tilt mobilization

pt is is sidlying you're working on bottom foot lock the talus with one hand moving the calcaneous with the other

explain what two joints are part of midtarsal motion and why they are so important

talonavicular calcaneocuboid when hindfoot is everted, the axis are parallel, allowing for flexible foot in midstance which is what we want when hindfoot is inverted, the axis are opposed, so the midfoot becomes rigid.

true or false, as long as the ankle fracture is stable, it is appropriate to do a low grade mob on any ankle joint?

true!

what does the clinical prediction rule say about short term response to using mobs and maips on lateral ankle sprains

3/4 has best likelihood ratio/is the strongest predictor

what are the four predictors for the CPR for positive response to manual therapy post lateral ankle sprain

sx worse standing sx worse in evening navicular drop >5mm distal tib fib hypomobile

how would you MMT the posterior tib?

have them seated, put them in inversion maybe a tiny bit of PF, do a make test with HHD Take three and average it

normal DF ROM

15-25 you should see more with knee bent cause gastroc is out of the picture

normal PF ROM

40-50

Normal inversion ROM

~30 | should be double eversion

Normal eversion ROM

~15

at what angle of LAA is the arch considered dropped?

90 degrees

best way to measure forefoot angle

put them in prone and use the table as an external horizontal to compare it to rearfoot angle