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MSK II - FOOT and ANKLE > Foot and Ankle- Intro thru Lateral Sprains > Flashcards

Foot and Ankle- Intro thru Lateral Sprains Flashcards

1
Q

How much dorsiflexion is needed with the knee extended during heel/toe off?

A

10-15 degrees

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2
Q

What happens if you dont have the required DF for heel/toe off?

A
  • compensating somewhere, could be a problem in the knee
  • body is good at hiding things, can turn into symptoms on down the road
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3
Q

What is the required plantarflexion for walking and stairs?

A

~ 15-30 degrees

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4
Q

How much 1st MTP hyperext is needed for heel/toe off?

A

at least 65 degrees

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5
Q

How much dorsifleixon is needed with the knee flexed during stair ascent?

A
  • 15-25 degrees
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6
Q

How much dorsiflexion is needed during stair descent with the knee flexed?

A
  • 20-35 degrees
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7
Q

How can we assess differently to address DF functionally (such as stair ascent/descent)

A

Measure with the knee flexed!!

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8
Q

What are the three foot arches?

A
  • medial, lateral and transverse
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9
Q

What are the three foot arches maintained by?

A
  • ligaments and aponeurosis
  • shape of the bones and their relation to eachother
  • muscles
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10
Q

What provides MOST of the support for the three arches of the foot?

A
  • ligaments and aponeurosis
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11
Q

What should we know about muscle support of the arches?

A
  • only 15-20% of support so minimal ability to strengthen abnormal arch flattening
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12
Q

What is subtalar joint neutral?

A
  • talus centered in talocrural and on calcaneus
  • aka the position the talus should be in
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13
Q

What should we know about measuring subtalar neutral?

A
  • common and widely taught
  • POOR RELIABILITY and VALIDITY
  • may produce positive results but is NOT measuring or assessing what is proposed
  • A better method should be pursued
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14
Q

What should we know about measuring the medial longitudinal arch?

A
  • Standing position is NOT predictable of dynamic function
  • Dynamic 2D such as measuring from a video or 3D analysis are a reliable measure of MLA
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15
Q

What is a grade 1 / 1st degree sprain?

A
  • mild S&S, activity may continue; fibers are stretched but not torn so minimal to no change during ligamentous special tests
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16
Q

What is a grade 2 / 2nd degree sprain?

A
  • Moderate S&S; activity stops, fibers stretched and torn so increased laxity with a softer/later end feel during ligamentous tests
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17
Q

What is a grade 3/ 3rd degree sprain?

A

Severe S&S; activity stops; fibers torn completely with possible avulsion; significant increase in laxity with empty end feels during ligamentous tests

18
Q

What are some functional questionnaires for sprains?

A
  • Cumberland ankle instability tool
  • foot and ankle ability measure
  • lower extremity functional scale
19
Q

What is the incidence / prevalence of ankle sprains?

A
  • one of the MOST frequent injuries in sports
20
Q

How many people miss work due to sprains?

A
  • Up to 1/4 of people unable to attend work for > 1 week
21
Q

How many individuals have persistant symptoms after an ankle sprain?

A
  • 30-72%
22
Q

What is the re-injury rate following an inversion sprain?

A

80%, due to lack of control and stability

23
Q

What are risk factors for ankle sprains?

A
  • previous ankle sprain(S)
  • lack of external support
  • lack of warm up
  • lack of coordination training
  • Impaired DF
24
Q

What are some reasons for impaired dorsiflexion?

A
  • shortened triceps surae (calf)
  • Talar hypomobility
    > decreased posterior glide
    > decreased ER
  • Fibrosed capsule
    > universal hypomobility
    > no distraction and limited glides in all directions
25
Q

What can limited dorsiflexion delay? excessively load?

A
  • delays pronation and excessively loads the lateral foot
26
Q

What is the etiology of lateral sprains?

A

excessive PF and IV

27
Q

What are the structures involved with a lateral sprain?

A
  • talocrural ligaments: ATF, CF, PTF
  • Subtalar/ talocalacneal ligaments
  • bone, capsule, other ligaments, muscle tendons
28
Q

What is the MOST commonly torn lateral ligament of the ankle?

A

ATFL

29
Q

What ligament is primarily torn with pure IV and will be slack in PF?

A

CFL

30
Q

What are the subtalar or talocalcaneal ligaments involved with a lateral ankle sprain?

A
  • Anterior: Interosseous lig
  • Lateral - attaches and runs parallel to CF lig so they will likely be damaged together
31
Q

What are some fx of bone issues that can happen with a lateral sprain?

A
  • avulsion fx of lateral malleolus due to ligamentous attachment
  • avulsion fx of 5th metatarsal from excessive action of peroneus brevis
  • medial malleolus fx due to compression with excessive IV
32
Q

What bony structures can be displaced or subluxed with a lateral ankle sprain?

A
  • cuboid displacement due to excessive action of peroneus longus
  • fibular anteriorly subluxed on tibia by reversal of muscle action of peroneals
33
Q

What are some muscles/tendons that can be impacted by a lateral ankle sprain?

A
  • possible peroneal strain and/or subluxation if retinaculum torn
34
Q

What can happen to the epiphyseal plate with a lateral ankle sprain?

A
  • epiphyseal plate avulsions - lateral malleolus and 5th metatarsal
35
Q

What are some symptoms of a lateral ankle sprain?

A
  • sudden onset with trauma by “rolling ankle” and the foot turning inward
  • lateral ankle pain and swelling
  • limited and painful ROM, esp pointing foot and turning inward
  • difficult and painful WB
36
Q

What are some signs of a lateral ankle sprain with observation?

A
  • swelling and possible ecchymosis
  • antalgic and asymmetrical gait
37
Q

What is the CDR for imaging for the lateral ankle called?

A
  • Ottawa and Bernese Ankle Clinical Decision Rules - determine need for radiographs
38
Q

What will we find in our ROM with a lateral ankle sprain?

A
  • primarily limited and painful in PF and IV
39
Q

What will with find in our resisted testing/MMTs with a lateral ankle sprain?

A
  • possibly weak and painful eversion
40
Q

What are some special tests for the lateral ligamentous structures?

A
  • talocrural: generally with anterior and reverse anterior drawer
  • ATF with antlat drawer and reverse antlat drawer, and the antlat talar palpation
  • CF with medial talar tilt
  • PTF
41
Q

What are some subtalar ligaments we need to do special testing for with a lateral ankle sprain?

A
  • anterior interosseous
  • lateral talocalcaneal
42
Q

What will be TTP with a lateral ankle sprain?

A

INVOLVED STRUCTURES

MSK II - FOOT and ANKLE (6 decks)

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