Foot and Ankle Pathophyisology Flashcards
How many bones are in the foot?
26 total; 14 phalanges; 5 metatarsals; 7 tarsals
What is the Big Toe aka?
Hallux, 1st toe, Great toe
What does the Great Toe contain?
2 sesmoid bones, under the 1st MPJ
Metatarsal Bone facts
1 starting with great toe going laterally. 1st is the strongest and 5th is the most fractured.
Name all 7 Tarsal bones
3 cuneiform bones, navicular, calcaneous, talus, cuboid
What is the largest tarsal bone, supports talus and shapes heel. Provides attachment for achilles tendon?
calcaneous
How many cuneiform’s are in the foot?
3; 1st is the most medial then goes laterally.
IP Joint Movements an location.
Interphalageal Joint (IPJ) can be distal or proximal depending upon which toe. Can only Flexion and Extension.
MP Joint movements.
Metatarsalsophalangeal Joint (MPH) can Flexion , Extension, Abduct, or Adduct.
Where is the medial malelous?
At the distal part of the tibia
Where is the lateral maleolus?
At the distal part of the fibula
What is the main weight-bearing bone of the ankle? located just below tib/fib.
Talus.
What 5 ligaments are located on the lateral side of the ankle?
The ligaments of the lateral side of ankle are: ATF, PTF, CF, Anterior tibiofibular ligament, and Posterior tibiofibular ligament.
What is the CF ligament and how can it be tested?
Calcaneofibular ligament, Can be tested with resisted inversion.
What is the PTF ligament and how can it be tested?
Posterior talofibular ligament, Can be tested with resisted inversion.
What is the ATF ligament and how can it be tested?
Anterior talofibular ligament, most commonly sprained in the ankle. Can be tested with resisted inversion.
Which ligaments are located just above the PTF and ATF?
Posterior and anterior tibiofibular ligaments.
What ligaments are located on the medial side of the ankle and how can they be tested?
Deltoid ligaments. Can be tested via resisted eversion.
How many deltoid ligaments are there?
There are 3
What are the anterior muscles of the foot?
Extensor Hallucis Longus, Extensor Hallucis Brevis, Extensor Digitorum Longus, Extensor Digitorum Brevis. Tibialis Anterior
What are the Extensor Hallucis Longus and Brevis mostly responsible for moving?
The Great Big Toe.
What are the Extensor Digitorum Longus and Brevis responsible for moving?
The other 4 phalanges.
What is the Tibialis Anterior responsible for moving?
Inversion and Dorisflexion of the ankle.
What are the medial muscles of the foot and what do they do?
Tibialis Posterior, Flexor Hallicus Longus, and the Flexor Digitorum Longus, and all help each other in the plantar flexion of the foot.
What is the Tibialis Posterior responsible for moving?
Plantar Flexoin and Inversion.
What is the Flexor Hallicus Longus responsibe for?
Plantar flexion of the ankle and Flexion of the Big Toe.
What is the Flexor Digitorum Longus responsible for?
Plantar Flexion of the ankle and Flexion of the other 4 phalanges.
What are the posterior muslces of the ankle/ calf and what do they do?
Gastrocnemicus and Soleus, which are responsible for Plantar flexion of the foot.
What are the lateral muscle of the ankle and what are they responsible for?
Peroneus Longus and Peroneus Brevis, both are responsible for the eversion and plantar flexion of the ankle.
What are the 2 arches of the foot?
High arch (Supination) Low arch(Pronation)
What is flat foot known as?
Pes Planus
MOI: extreme inversion or eversion of the ankle. Patient is complaining of edema, ecchymosis, laxity, inabilty to walk or run.
Diagnosis: Ankle Sprain. Treatment: RICE, NSAID’s, and PT. Prevention: stregthening and supporive shoes.
1st degree ankle sprain
ATF is most likely involved can go back to daily activity as tolerated.
2nd degree ankle sprain
ATF and CF are involved, X-Ray for a possible fracture of ankle, Short period of NWB on crutches.
3rd degree ankle sprain
ATF, PTF, and CF are involved. possible rupture of a ligament, X-ray for fractures, Extended NWB period.
MOI: Repetitive high impact activities like running or jumping. Patient will most likely complain of edema, crepitus, pain, pain with dorsiflexion, weak plantar flexion
Diagnosis: Achilles tendonitis. Treatment: RICE, NSIAD’s, activity modifications, agressive stretching of the heel cord TID. Prevention: Achilles and Gastroc/Soleus Stretching three times a day.
MOI: Sudden forceful plantarflexion of the ankle with a chronically tight tendon. The patient will likely complain of feeling or hearing a pop during the injury, extreme pain, inability to plantarflex foot.
Diagnosis: Achilles Rupture. Treatment: Surgery or Immobilization. Prevention: Daily stretching and proper treatment of any tendonitis.
PE shows: PIPJ is flexed; MPJ and DIPJ are both hyperextended.
Hammer-Toe
Patient complains of pain, errythema, and edema near the nail bed.
Diagnosis: Ingrown Toe Nail. Treatment: Hot water soaking, antibiotics, matricectomy
Surgical Removal of a nail
Matricectomy
Patient complains of bony enlargement of the 1st metatarsal.
Diagnosis: Bunions aka HAV caused by wearing shoes that are not the right size.
What to look for in a visual Inspection of a typical foot exam.
Assymetry, Atrophy, Effusion, Edema, Ecchymosis.
What to look for in a palpation Inspection of a typical foot exam.
TTP over the (specific area)
what to look for in a neurological inspection of a typical foot exam.
Strength of separate muscle groups against resistance.
PE: Tests ligament instability, mainly used for testing of the ATF. However if injury is severe enough PTF of CF may trigger as well. Ankle is relaxed and slightly plantar flexed.
Anterior Drawer Test
Tests for lateral ankle instability, if + indicates a tear of ATF/CF ligaments.
Talar Tilt Test
Tests for Achilles rupture. Forced Achilles firing by manupulation of the gastrocnemicus and soleus complex by squeezing.
Thompson’s Test.
