Foot and Ankle Pathophysiology and Assessment

Question 1

What are some typical joints in the foot and ankle?

Answer 1

• Talocrural
• Inferior tibiofibular
• Subtalar
• Transverse tarsal joint

Question 2

What four ligaments make up the deltoid ligament?

Answer 2

• Tibiocalcaneal
• Tibionavicular
• Tibiotalar (ant and pos)

Question 3

What is the PTFL and what does it do?

Answer 3

Posterior talofibular ligament - limits seperation of fibula from talus and ankle inversion

Question 4

What is the ATFL and what does it do?

Answer 4

Anterior talofibular ligament - limits ankle inversion

Question 5

What is the CFL and what does it do?

Answer 5

Calcaneofibular ligament - limits ankle inversion

Question 6

True or false, high ligament sprains mainly occur at the anterior and superior tibiofibular ligament

Answer 6

True! Syndesmosis is a common injury that occurs alongside

Question 7

What can clicking in the ankle mean?

Answer 7

Joint laxity, peroneal tendons not being held down by the retinaculum (sup. and inf. fibular retinaculum)

Question 8

What muscles are responsible for dorsiflexion?

Answer 8

Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus

Question 9

What muscles are responsible for plantarflexion?

Answer 9

Gastrocnemius
Soleus
Tibialis posterior
Peroneus longus
Peroneus brevis
Flexor digitorum longus
Flexor hallucis longus
Plantaris

Question 10

What muscles are responsible for inversion?

Answer 10

Tibialis anterior and posterior
Flexor digitorum longus
Flexor hallucis longus
Extensor hallucis longus

Question 11

What muscles are responsible for eversion?

Answer 11

Peroneus brevis
Peroneus longus
Extensor digitorum longus

Question 12

What is the mechanism of injury for an achilles tendinopathy?

Answer 12

Change in loading and failure of tendon to adopt

Question 13

What is the difference between a mid-portion and insertional achilles tendinopathy?

Answer 13

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

Question 14

What should you avoid in insertional achilles tendinopathies that you would do in mid-portion achilles tendinopathies?

Answer 14

Dorsiflexion stopping at 90 degrees

Question 15

What are some subjective tests for an achilles tendinopathy?

Answer 15

Localised pain, stiffness in the morning, pain with running and jumping

Question 16

Name some objective tests for an achilles tendinopathy?

Answer 16

Heel raise, hopping, knee-to-wall, palpation, swelling, calf bulk and foot pronation

Question 17

What is Sever’s disease?

Answer 17

Self-limiting heel pain most commonly found in children and occurs during peak growth spurt. Overloading of achilles tendon through childhood from high activity

Question 18

What are some subjective tests for Sever’s disease?

Answer 18

Localised pain over calcaneal apophysis, heel ache, pain through heel, calf tightness

Question 19

What are some objective tests for Sever’s disease?

Answer 19

Pain on palpation of achilles insertion, knee-to-wall, poor gastrocnemius length, pain with hopping or calf raises, swelling

Question 20

What are some common acute ankle injuries?

Answer 20

ATFL, CFL, PTFL, lateral ligament sprain

Question 21

What are some less common ankle injuries?

Answer 21

AITFL, medial ligament sprains, fractures

Question 22

What is the mechanism of injury for a lateral ankle sprain?

Answer 22

Plantarflexion with inversion (can also be in dorsiflexion)

Question 23

What are some subjective tests for a lateral ankle sprain?

Answer 23

Landing or jumping, ankle giving way, pain and swelling around lateral malleolus, might hear pop or crunch

Question 24

What are some objective tests for a lateral ankle sprain?

Answer 24

Anterior drawer test, talar tilt, palpation, heel raises, knee-to-wall

Question 25

What is the mechanism of injury for a syndesmosis tear?

Answer 25

Weightbearing injury combined dorsiflexion and external rotation of the tibia

Question 26

What are some subjective tests for syndesmosis injuries?

Answer 26

Pain and swelling, pain with weightbearing, pain over anteriolateral ankle joint, pain around proximal fibula

Question 27

What are some objective tests for syndesmosis injuries?

Answer 27

Dorsiflexion + external rotation, knee-to-wall with compression, cottons test, mid-shin squeeze test, palpation

Question 28

What is the mechanism of injury for a tibialis posterior injury?

Answer 28

Excessive pronation, training load problem, hypovascularity of tendon

Question 29

What are some subjective tests for a tibialis posterior injury?

Answer 29

Pain along the length of tendon, pain with prolonged time on feet, pain along medial arch of the foot

Question 30

What are some objective tests for a tibialis posterior injury?

Answer 30

Heel raise, swelling along tendon, reduced navicular height, reduced MMT

Question 31

What is the mechanism of injury for plantar fasciitis?

Answer 31

Excessive pronation or high arch, dysfunction of windlass mechanism and not being able to absorb shock and produce force

Question 32

What are some subjective tests for plantar fasciitis?

Answer 32

Morning heel pain when first weightbearing, pain during first few steps, aching around the heel, radiating along the foot

Question 33

What are some objective tests for plantar fasciitis?

Answer 33

Windlass test, calf bulk, calf leg raise, palpation, knee-to-wall

Question 34

What are the Ottawa ankle rules?

Answer 34

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

Question 35

True or false. A squat has more achilles compression then a countermovement jump?

Answer 35

False! 0.167 (squat), 0.474 (CMJ)

Question 36

True or false. Hopping single leg has more achilles compression then a bilateral forward jump?

Answer 36

True! 0.764 (hopping single leg), 0.414 (bilateral forward jump)