Foot and Ankle Flashcards
Ottawa ankle rules
Xray indicated if pain in the malleolar zone and…what?
- bone tenderness of posterior lateral malleolus or…
- bone tenderness of posterior medial malleolus or…
- unable to bear weight both immediately in the ER for four steps
Ottawa ankle rules
Xray indicated if pain int the midfoot zone and… what?
- bone tenderness of the based of the fifth metatarsal
- bone tenderness at the navicular
- inability to bear weight both immediately and in the emergency dept. for four steps
Talonavicular joint supported mostly by what ligament?
Plantar calcaneonavicular ligament (spring ligament)
Calcaneocuboid joint supported by what two ligaments (mostly)?
Short and long plantar ligaments
What ligament runs through the tarsal sinus superiorly and inferiorly between the talus and calcaneus?
Interosseous talocalcaneal ligament
Two main ligaments that support the lateral ankle
ATFL and CFL
In what position is the PTFL put into a strained/taut position?
ER of the talus relative to the tibia
The facets between the subtalar joint result in what kind of joint motion?
A uni-axial or hinge, screw motion, of the subtalar joint
Spring ligament frequently involved with what type of foot deformity?
Flat foot deformity
What is the Lisfranc joint?
First set of joints between the tarsals and the metatarsals (transitioning from the hind- to/from the midfoot)
What joint is frequently injured between the midfoot and hindfoot (most often)?
The ligaments stabilizing the second metatarsal and medial cuneiform bone.
What is the Lisfranc ligament?
Strong interosseous ligament between the 1st and 2nd metatarsal that links to the medial cuneiform.
Flexor digitorum longus
- Compartment
- Attachments (origin insertion)
- Action
- Nerve supply
- Deep posterior
- Posterior medial tibia<>plantar aspect, lateral four toes
- Flexes lateral four toes
- Tibial n.
Posterior tibialis
- Compartment
- Attachments (insertion and origin)
- Action
- Nerve supply
- Deep posterior
- Interosseous membrane<>plantar foot, medial side
- Subtalar supination/inversion
- Tibial n.
Flexor hallucis longus
- Compartment
- Attachments (insertion and origin)
- Action (importance with gait)
- Nerve supply
- Deep posterior
- Posterior fibula<>plantar aspect of hallux
- Hallux flexion (important for toe off with gait)
- Tibial n.
Tibialis anterior
- Compartment
- Attachments (insertion and origin)
- Action (importance with gait)
- Nerve supply
- Anterior compartment (pray to God you didn’t answer this wrong)
- Lateral tibia<>medial first metatarsal/medial cuneiform
- Dorsiflexion, inversion
- Deep fibular n.
Extensor digitorum longus
- Compartment
- Attachments (insertion and origin)
- Action
- Nerve supply
- Anterior compartment
- Lateral tibia and medial fibula
- DF, extension of lateral 4 toes
- Deep fibular n.
Extensor hallucis longus
- Compartment
- Attachments (insertion and origin)
- Action
- Nerve supply
- Anterior compartment
- medial fibula<>distal phalanx of hallux
- DF, extension of hallux
- Deep fibular n.
Fibularis tertius
- Compartment
- Attachments (insertion and origin)
- Action
- Nerve supply
- Anterior compartment
- Distal medial fibular<>5th met
- DF, eversion
- Deep fibular n.
Anterior compartment innervation and blood supply
- Deep fibular n.
2. Blood supply: anterior tibial a., dorsalis pedis
Which part of the trochlea is wide in the TCJ? Why is this important and when?
Anterior portion is wider resulting in increased congruence with the mortise of the ankle with DF resulting in greater stability during PF.
True or False: Static foot posture has a low correlation to dynamic foot posture
If false, why?
False: Recent studies have demonstrated a HIGH correlation to foot postures during mobility without having to singularly identify foot postures throughout motion (easier).
Clinical significance of Chaveaux-Liet Angle
- what lines are used to find the angle?
Clinical significance: determine likelihood of impingement of soft tissue along the calcaneus
- Calcaneal pitch angle minus the vertical pull of the Achilles tendon = Chaveaux-Liet angle
Most adult onset pes planus associated with what factor/dysfunction?
Tibialis Posterior Tendon Dysfunction
Possible factors contributing to pes planus not associated with TPTD? (4)
Midfoot arthritis
Rearfoot arthritis
Spring ligament dysfunction
Tight heel cord
Most common ankle injury
Lateral ankle sprain
Post lateral ankle sprain at 3 years - % of people with full recovery
only 55-85%
Acute/Protected motion subgroup
<72 hours since injury
Progressive Loading/sensorimotor training phase
> 72 hours post-injury
Ligaments commonly injured with LAS
CFL and ATFL
FAAM or LEFS with chronic ankle instability
FAAM as there is evidence for chronic instability; validity with LEFS primarily taken from acute populations
Chronic Ankle Instability Tool (CAIT)/Scale - validity and reliability pt dx
Evidence for validity and reliability reported using pts with CAI
CAIT good for
- Determining if someone had an ankle sprain or not
2. Differentiating between individuals with/without FAI
Grade of ankle sprain with ATFL involved, but not CFL
Grade 2
Grade of ankle sprains with positive anterior drawer and talar tilt tests
Grade 3
Risk factors of plantar fasciitis
- High BMI
- Limited ankle DF
- Work related WB (poor shock absorption)
