Foot and Ankle - Assessment Flashcards
Talocrural Snapshot: ROM and End Feel
- Dorsiflexion =
- Plantarflexion =
- Inversion =
- Eversion =
Dorsiflexion = 0 – 20 / Firm
Plantarflexion = 0-50 / Firm
Inversion = 0-35 / Firm
Eversion = 0-20 / Firm
Talocrural Snapshot:
Talocrural loose and close pack postions?
Loose pack = 10 degrees plantarflexion, midway between maximum inversion and eversion.
Close pack = Maximum dorsiflexion
Talocrural Snapshot:
Talocrural capsular pattern
Plantarflexion > dorsiflexion
Talocrural Snapshot:
Talocrural athrokinematics
Convex on concave; rolling and sliding occur in opposite directions.
Subtalar Snapshot: ROM and End Feel
- Inversion =
- Eversion =
- Inversion = 5 / Firm
- Eversion = 5 / Firm
Subtalar Snapshot:
Subtalar loose and close pack positions?
- Loose pack = midway between extreme ranges of motion
- Close pack = supination
Subtalar Snapshot:
Subtalar capular pattern?
Limitation of varus ROM
Subtalar Snapshot:
Subtalar athrokinematics
Triplanar movement into pronation and supination.
Midtarsal Snapshot: ROM and End feel
- Inversion =
- Eversion =
- Inversion = Minimal / Firm
- Eversion = Minimal / Firm
Midtarsal Snapshot:
Midtarsal Loose and Close pack positions?
- Loose pack = Midway between extreme ranges of motion (accommodating uneven surfaces during gait).
- Close pack = supination (rigid lever for push-off during gait)
Midtarsal Snapshot:
Midtarsal Arthrokinematics
- Talonavicular joint: concave navicular moving on convex talus.
- Calcaneocuboid joint: both articulating surfaces have convexity and concavity
1st Metatarsophalangeal Snapshot: ROM and End Feel
- Flexion
- Extension
- Abduction
- Adduction
- Flexion = 0-45 / Firm
- Extension = 0-70 / Firm
- Abduction = n/a , n/a
- Adduction = n/a , n/a
1st Metatarsophalangeal Snapshot:
1st MTP Loose and Close pack positions.
- Loose pack = 10 degrees extension
- Close pack = full extension
1st Metatarsophalangeal Snapshot:
1st MTP capsular pattern
Extension > flexion
1st Metatarsophalangeal Snapshot:
1st MTP Arthrokinematics
Concave on convex; roll and glide occur in the same direction
Surface Anatomy:
Dorsal Anatomy
- Metatarsals
- Cuneiforms
- Navicular
- Phalanges
Surface Anatomy:
Anterior lower leg and foot
- Talus = Identify medial and lateral malleolus and feel for the dome that lies between them
- Anterior Tibialis = Large tendon anteromedially; attaches to base of 1st MT
- Metatarsals = Locate the MTP joint and move proximally for each of the 5 MT
- Extensor Digitorum Longus = Follow all tendons from digits 2 – 5 proximally to the lower leg.
- Extensor Hallucis Longus = Follow the tendon from the great toe proximally to the lower leg
Surface Anatomy:
Medial Lower Leg and Foot
- Medial Malleolus = Bony prominence of the distal tibia
- Deltoid Ligament = Distal to medial malleolus; evert the ankle
- Tibialis Posterior = Muscle belly on the distal 1/3 of tibia; tendon is immediately posterior to medial malleolus; follow to navicular tubercle
- Flexor Digitorum Longus = Immediately posterior to tibialis posterior; have patient flex digits 2-5 to assist in identifying
- Flexor Hallucis Longus = Posterior to FDL; have patient flex great toe against resistance to assist in identifying
Surface Anatomy:
Posterior Lower Leg and Foot
- Gastrocnemius = Medial and lateral heads can be palpated on the proximal ½ of the lower leg
- Soleus = Deep to gastrocnemius and can be palpated on either side; have patient plantarflex in prone with knee flexed
- Calcaneal (Achilles) Tendon = Wide band connecting posterior leg muscles to calcaneus
- Calcaneus = Move distal from calcaneal tendon; identify medial and lateral borders, as well as the base.
Surface Anatomy:
Lateral Lower Leg and Foot
- Lateral Malleolus = Prominent bony structure of the distal fibula
- Lateral Ligaments of the Ankle = Calcaneofibular: just distal to the lateral malleolus; Posterior talofibular: posterior and inferior surface of lateral malleolus to the talus; Anterior talofibular: anterior lateral malleolus to talus
- Tuberosity of 5th Metatarsal = Locate 5th MT and palpate proximally until you feel a “step off”
-
Fibularis (Peroneus) Brevis = Distal 2/3 of fibula, traveling posterior to lateral
malleolus, attaches at tuberosity of 5th MT. - Fibularis (Peroneus) Longus = Proximally attaches to fibular head, tendon palpated posterior to lateral malleolus and lateral aspect of the foot
- Cuboid = From the tuberosity of 5th MT, move proximally
Assessing ROM: Goniometer and ROM
Ankle Dorsiflexion
Assessing ROM: Goniometer and ROM
Ankle Plantarflexion
Assessing ROM: Goniometer and ROM
Ankle Inversion
Assessing ROM: Goniometer and ROM
Ankle Eversion
Assessing ROM: Goniometer and ROM
Subtalar Inversion
Assessing ROM: Goniometer and ROM
Subtalar Eversion
Assessing ROM: Goniometer and ROM
1st MTP Flexion
Assessing ROM: Goniometer and ROM
1st MTP Extension
Assessing MMT:
Grading Plantarflexion 0-5
Assessing MMT:
Plantarflexion 3 – 5
Assessing MMT:
Plantarflexion 3 – 5: Soleus Bias
Assessing MMT:
Plantarflexion 0 – 2
Assessing MMT:
Dorsiflexion: Anterior Tibialis 3 – 5
Assessing MMT:
Dorsiflexion: Anterior Tibialis 0 – 2
Assessing MMT:
Subtalar Inversion: Posterior Tibialis 0 – 2
Assessing MMT:
Subtalar Eversion: Fibularis/Peroneals 3 – 5
Assessing MMT:
Subtalar Eversion: Fibularis/Peroneals 0 – 2
Assessing MMT:
MTP Flexion 0 – 5
Assessing MMT:
IP Flexion 0 – 5
Assessing MMT:
MTP Extension
Assessing MMT:
MTP/IP Extension
Assessing Joint Play:
Proximal Tibiofibular Joint - Posterior Glide
Assessing Joint Play:
Distal Tibiofibular Joint - Posterior Glide
Assessing Joint Play:
Proximal Tibiofibular Joint - Anterior Glide
Assessing Joint Play:
Distal Tibiofibular Joint - Anterior Glide
Assessing Joint Play:
Talocrural Joint Distraction
Assessing Joint Play:
Talocrural Joint - Posterior Glide
Assessing Joint Play:
Talocrural Joint - Anterior Glide
Assessing Joint Play:
Subtalar Joint Distraction
Assessing Joint Play:
Subtalar Joint Lateral Glide
Assessing Joint Play:
Subtalar Joint Medial Glide
Assessing Joint Play:
Metatarsalphalangeal Joint Anterior (Dorsal) Glide
Assessing Joint Play:
Metatarsalphalangeal Joint Posterior (Plantar) Glide
Special Test:
Tibial Torsion
Special Test:
Forefoot Varus/Valgus
Special Test:
Thompson Test of Calf Squeeze Test
Special Test:
Anterior Drawer
Special Test:
Talar Tilt (Varus) Stress Test (Lateral Ligaments)
Special Test:
Talar Tilt (Valgus) Stress Test (Medial Ligaments)
Special Test:
Subtalar Joint Neutral in Weightbearing
Special Test:
Figure 8 Girth