Foot And Ankle Lecture Flashcards
What percent of the population has foot problems?
Up to 80%
What are ankle injures commonly due to?
High loads and repetition of loading
What are the functions of the foot?
- support base that provides the necessary stability for upright posture with minimal muscle effort
- provides a mechanism for rotation of the tibia and fibula during the stance phase of gait
- provides flexibility for shock absorption
- acts as a lever during push off
- accommodates to different terrains
What are red flags for ankle/foot injuries?
- inability to bear weight
- history of cancer
- recent trauma
- erythema
- infection
- decreased distal pulses (decreased venous return)
- change in skin color
- unusually cool/warm extremity
- calf pain/tenderness: increased with walking decreased with laying down
- unrelenting pain
Differential diagnosis of foot/ankle
-DVT (warmth, redness, swelling in calf)
-cellulitis (inflammation of skin tissues, red, swollen)
-peripheral arterial occlusive disease (claudication, circulatory)
-compartment syndrome
-fracture
-septic arthritis (staph infection or streppe that attacks a joint in the body)
-tumor
-restless leg syndrome
-peripheral neuropathy (pinched nerve)
-Morton’s neuroma:
Chondromalacia patella: patellofemoral pain syndrome
-metatarsalgia: irritation of soft tissue structures
-ligaments: deltoid ligament, anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament
-bone spurs
-bunions: big toe abducted too much
-toe deformities
-plantar fasciitis
-gout
-tarsal tunnel syndrome: trapped nerve under flexor retinaculum
What are questions to ask in the interview?
- MOI: traumatic, chronic
- did person continue with activity after injury
- numbness or tingling
- clicking or cracking
- PMHx: frequent ankle sprains, diabetes, CHF
- orthotics
- activity level: change with activities or rest, distance
- pain: chief complaint, location of pain, severity
- what increases or decreases pain
- any change with or without shoes
- occupation
- are symptoms getting better or worse or staying about the same?
- return to play
What things should you look for when you first observe the patient?
-look at feet in weight bearing and non weight bearing
-weight bearing position may show how the body compensates for problems
-gait
-static stance
-arch height
-deformities of toes or foot
-swelling
-vasomotor changes: changes in circulation
-anterior view:
-observe alignment of trunk, hips, knees, ankle and feet
-look for signs of torsion: toe in of toe out
-fick angle:toe out position relative to Sagittal plane (12-18 degrees)
-posterior view:
-varicose veins, differences in calf muscle bulk, Achilles’ tendon
location, position of malleoli
-pes planus : “flatfoot”, medial longitudinal arch is decreased
-pes cavus: “hollow foot”, high medial longitudinal arch, claw toes
-“mobile foot”: in NWB, have an arch, in WB probation occurs and no arch present
-“rigid foot”: in NWB, have an arch, in WB arch height doesn’t change
What does a mobile foot require?
- requires a control shoe
- may or may not cause problems
What does a rigid foot require?
- little ability to absorb shock and adapt to stress
- difficulty with repetitive activities
- requires a cushioning shoe: b/c needs shock attenuation to come from somewhere
Measuring medial longitudinal arch height: Goniometer
SA: medial malleolus
A: navicular tuberosity
MA: 1st metatarsal head
What is the normal end feel of the ankle joint?
Firm end feel with all directions
What movements does supination incorporate?
Combines inversion, adduction, plantar flexion
What movements does pronation incorporate?
Combines eversion, abduction, dorsiflexion
What does genu valgus result in?
Forced pronation
Knock kneed
What does genu varus result in?
Compensatory pronation
Bow-legged
What is the anterior Talar drawer test?
Test: ankle in 10-20 degrees of plantar flexion, pull the calcaneus anterior, assess the forward translation of the talus
Results: laxity or tear of the ATFL is pain in the area of the ligament
(+) test= if greater than 3mm of forward translation (greater movement than other side)
What is the squeeze test?
Test: patient lies in supine, grasp lower leg at midcalf and squeeze the tibia and fibula together, Apply the same load at more distal locations (move toward ankle)
Results: (+) test= pain with squeeze
-pain may indicate s syndesmosis injury
-may need to rule out fractures, contusions, and compartment syndrome
(Used for high ankle sprains)
What is the Talor tilt test?
Test: patient lies in supine or side lying, flex knee slightly to relax gastric, foot held at 90 degrees, talus is tilted from side to side into adduction and abduction
Results: (+) test= pain or increased motions
-adduction stresses the calcaneofibular ligament and the anterior talofibular ligament
-abduction stressed the deltoid ligament
-if acute ankle sprain, it will be painful on both sides of the ankle
