Foot and Ankle Pathophysiology and Assessment Flashcards
What are some typical joints in the foot and ankle?
- Talocrural
- Inferior tibiofibular
- Subtalar
- Transverse tarsal joint
What four ligaments make up the deltoid ligament?
- Tibiocalcaneal
- Tibionavicular
- Tibiotalar (ant and pos)
What is the PTFL and what does it do?
Posterior talofibular ligament - limits seperation of fibula from talus and ankle inversion
What is the ATFL and what does it do?
Anterior talofibular ligament - limits ankle inversion
What is the CFL and what does it do?
Calcaneofibular ligament - limits ankle inversion
True or false, high ligament sprains mainly occur at the anterior and superior tibiofibular ligament
True! Syndesmosis is a common injury that occurs alongside
What can clicking in the ankle mean?
Joint laxity, peroneal tendons not being held down by the retinaculum (sup. and inf. fibular retinaculum)
What muscles are responsible for dorsiflexion?
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
What muscles are responsible for plantarflexion?
Gastrocnemius Soleus Tibialis posterior Peroneus longus Peroneus brevis Flexor digitorum longus Flexor hallucis longus Plantaris
What muscles are responsible for inversion?
Tibialis anterior and posterior
Flexor digitorum longus
Flexor hallucis longus
Extensor hallucis longus
What muscles are responsible for eversion?
Peroneus brevis
Peroneus longus
Extensor digitorum longus
What is the mechanism of injury for an achilles tendinopathy?
Change in loading and failure of tendon to adopt
What is the difference between a mid-portion and insertional achilles tendinopathy?
Mid-portion = near ankle joint, hypovascularity, bowstringing causing a curve and causes stretching forces Insertional = near calcaneus, compression of tendon, bursa and fibrocartilage against one another
What should you avoid in insertional achilles tendinopathies that you would do in mid-portion achilles tendinopathies?
Dorsiflexion stopping at 90 degrees
What are some subjective tests for an achilles tendinopathy?
Localised pain, stiffness in the morning, pain with running and jumping
Name some objective tests for an achilles tendinopathy?
Heel raise, hopping, knee-to-wall, palpation, swelling, calf bulk and foot pronation
What is Sever’s disease?
Self-limiting heel pain most commonly found in children and occurs during peak growth spurt. Overloading of achilles tendon through childhood from high activity
What are some subjective tests for Sever’s disease?
Localised pain over calcaneal apophysis, heel ache, pain through heel, calf tightness
What are some objective tests for Sever’s disease?
Pain on palpation of achilles insertion, knee-to-wall, poor gastrocnemius length, pain with hopping or calf raises, swelling
What are some common acute ankle injuries?
ATFL, CFL, PTFL, lateral ligament sprain
What are some less common ankle injuries?
AITFL, medial ligament sprains, fractures
What is the mechanism of injury for a lateral ankle sprain?
Plantarflexion with inversion (can also be in dorsiflexion)
What are some subjective tests for a lateral ankle sprain?
Landing or jumping, ankle giving way, pain and swelling around lateral malleolus, might hear pop or crunch
What are some objective tests for a lateral ankle sprain?
Anterior drawer test, talar tilt, palpation, heel raises, knee-to-wall
What is the mechanism of injury for a syndesmosis tear?
Weightbearing injury combined dorsiflexion and external rotation of the tibia
What are some subjective tests for syndesmosis injuries?
Pain and swelling, pain with weightbearing, pain over anteriolateral ankle joint, pain around proximal fibula
What are some objective tests for syndesmosis injuries?
Dorsiflexion + external rotation, knee-to-wall with compression, cottons test, mid-shin squeeze test, palpation
What is the mechanism of injury for a tibialis posterior injury?
Excessive pronation, training load problem, hypovascularity of tendon
What are some subjective tests for a tibialis posterior injury?
Pain along the length of tendon, pain with prolonged time on feet, pain along medial arch of the foot
What are some objective tests for a tibialis posterior injury?
Heel raise, swelling along tendon, reduced navicular height, reduced MMT
What is the mechanism of injury for plantar fasciitis?
Excessive pronation or high arch, dysfunction of windlass mechanism and not being able to absorb shock and produce force
What are some subjective tests for plantar fasciitis?
Morning heel pain when first weightbearing, pain during first few steps, aching around the heel, radiating along the foot
What are some objective tests for plantar fasciitis?
Windlass test, calf bulk, calf leg raise, palpation, knee-to-wall
What are the Ottawa ankle rules?
Pain at medial or lateral malleolus (up to 6cm), navicular pain, base of 5th metatarsal pain, cannot weight bear for four steps = must go for an xray
True or false. A squat has more achilles compression then a countermovement jump?
False! 0.167 (squat), 0.474 (CMJ)
True or false. Hopping single leg has more achilles compression then a bilateral forward jump?
True! 0.764 (hopping single leg), 0.414 (bilateral forward jump)
