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Extremity Adjusting > Foot and Ankle Q and A's Gindl > Flashcards

Foot and Ankle Q and A's Gindl Flashcards

1
Q

Draw Sign (Drawer Test of the Ankle)

  • Positive
  • Indication
A

Stabilize the tibia and grab the calcaneus and shear the ankle P-A to check for motion

  • Excess motion P-A at the ankle
  • Instability of the anterior talofibular joint
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2
Q

How would you verify an anterior talofibular ligament tear?

A

Utilize the lateral stability test

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3
Q

Lateral Stability Test Positive

-What does it indicate?

A

Excess motion at the lateral aspect of the ankle upon inversion

-Instability of primarily the anterior talofibular ligament, also the calcaneal fibular ligament, and the posterior talofibular ligament. If there is an increase in pain the ligaments are still attached. If there is no increase in pain, the ligaments are completely torn.

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4
Q

What ROM does the doctor stress the patient’s ankle in for the Lateral Stability Test?

A

Inversion

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5
Q

What does a positive Lateral Stability Test most often indicate?

A

Ligament tears from front to back. The first one would be the anterior talofibular ligament sprain or tear. The second one would be the calcaneofibular sprain or tear, and then the posterior talofibular ligament sprain or tear

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6
Q

How would you verify an anterior talofibular ligament tear?

A

Utilize the Draw sign for the ankle

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7
Q

Medial Stability Test Positive

-What does it indicate?

A

Excess motion at the lateral aspect of the ankle upon eversion

-Instability of the Deltoid Ligament. If there is an increase in pain the ligaments are still attached, if there is no increase in pain there is a complete tear.

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8
Q

What ROM does the Dr stress the patients ankle in for the Medial Stability Test?

A

Eversion

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9
Q

What does a positive Medial Stability Test indicate?

A

Deltoid Ligament Tear

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10
Q

Fluid motion for Talus A

A

One hand of the Dr holds underneath the distal end of the tibia for stabilization. The other hand (the hand used should correspond to the foot being palpated) will be on the anterior aspect of the talus. Press A-P on the talus to feel for loss of motion.

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11
Q

Fluid motion for Calcaneus L

A

Upon performing the medial stability test, you ntoe loss of motion upon eversion of the calcaneus

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12
Q

Fluid motion for Calcaneus M

A

Upon performing the Lateral Stability Test, you notice loss of motion upon inversion of the calcaneus

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13
Q

Fluid motion for Navicular AM

A

Stand on the lateral side of the foot, reach across to the medial aspect grasping the navicular. Stabilize the segments around the navicular (the talus and cuneiforms) and attempt to rotate the navicular in relationship to those segments (one group at a time, i.e. Navicular to talus, then navicular to cuneiform

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14
Q

Fluid motion Cuboid AL

A

Stand on the medial side of the foot, reach across to the lateral aspect grasping the cuboid. Stabilize the segments around the cuboid (the calcaneus and the 4th and 5th metatarsals) and attempt to rotate the cuboid in relationship to those segments.

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15
Q

Fluid motion for the Cuneiforms

A

Listing them 1st, 2nd, 3rd according to the metatarsals they articulate with. Stabilize the surrounding bones (metatarsals, navicular) one at a time and shear them P-A and A-P past each other. The cuneiforms will have loss of motion P-A

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16
Q

Which ankle adjustments MUST have 3rd party stabilization?

A

Talus A

Navicular AM

Cuboid AL

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17
Q

Which ankle adjustments may have 3rd party stabilization?

A

Talus Traction

Cuneiform P

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18
Q

Indications that Talus Traction is needed?

A
  • Usually a history of inversion ankle sprain
  • Pain or tenderness across the anterior aspect of the ankle (talotibial joint)
  • Edema at the anterior ankle
  • Loss of dorsiflexion ROM
  • Loss of fluid motion from A-P
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19
Q

Indications that Talus A is needed

A
  • Usually a history of inversion ankle sprain
  • Pain or tenderness across the anterior aspect of the ankle (talotibial joint)
  • Edema at the anterior ankle
  • Loss of dorsiflexion ROM
  • Loss of fluid motion from A-P
  • Failure of Talus traction to improve fluid motion
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20
Q

Indications of Calcaneus L

A
  • History of inversion ankle sprain
  • Tenderness below the lateral malleolus
  • Loss of eversion ROM
  • Restricted fluid motion on the medial stability test
  • Possibly edema below the lateral malleolus
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21
Q

What is the CP for Calcaneus L?

A

Thenar of the hand opposite the side of involvement

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22
Q

What does the SH do to the ankle for Calcaneus L?

A

Dorsiflex and evert

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23
Q

The Calcaneus L has restricted fluid motion during what orthopedic test?

A

Medial Stability Test

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24
Q

Indications for Calcaneus M

A
  • Usually a history of eversion ankle sprain
  • Tenderness below the medial malleolus
  • Loss of eversion ROM
  • Restricted fluid motion on the lateral stability test
  • Possibly edema below the medial malleolus
25
Q

What is the CP for Calcaneus M?

A

The thenar of the hand corresponding to the side of involvement.

26
Q

What does the SH do to the ankle for Calcaneus M?

A

Dorsiflex and invert

27
Q

The Calcaneus M will have restricted fluid motion during which orthopedic test?

A

The lateral stability test

28
Q

Indications of Navicular AM

A
  • Usually a history of kicking injury
  • Pain or tenderness over the navicular tuberosity
  • Edema over the navicular
  • Loss of fluid motion of the navicular bone
29
Q

What is the LOD of the thrust for the Navicular AM

A

A-P and M-L

30
Q

Indications for a Cuboid AL

A
  • Loss of fluid motion
  • Point tenderness over the cuboid
  • Dull ache referred deep in the posterior calf musculature
31
Q

Where should the thumbs be for Cuboid AL?

A

One under the 4th and 5th metatarsals and one under the cuneiforms and navicular.

32
Q

What is the CH for the Cuboid AL?

A

The CH is the hand opposite the side of involvement

33
Q

Indications for Cuneiform P

A
  • Visually see a fallen arch
  • Pain and swelling on the plantar surface of the foot (plantar fasciitis)
  • Loss of fluid motion P-A
34
Q

Where should the stabilization fingers be for Cuneiform P?

A

On the dorsum of the foot. in particular over the proximal end of the metatarsals, navicular, and cuboid

35
Q

Positive Part 1 Morton’s Test

-What does it indicate?

A

A palpable mass/cyst (like a gummy worm or soft eraser)

-Morton’s Neuroma

36
Q

Positive Part 2 Morton’s Test

-What does it indicate?

A

Compress the medial and lateral sides of the metatarsal heads together produces pain between the metatarsal heads.

-Pain between the metatarsal heads

37
Q

Where is Morton’s Neuroma most commonly found?

A

Between the 3rd and 4th metatarsal heads

-However it can be located between any of them

38
Q

What would you want to differentiate a Morton’s Neuroma from?

A

Differentiate it from a stress fracture, subluxation (MT-P), and plantar fasciitis

39
Q

What does a positive Morton’s Test indicate?

A

Morton’s Neuroma

40
Q

Positive Strunsky’s Test

-What does it indicate

A

Rapid plantar flexion of the metatarsal phalange joints produces pain in the metatarsal arch.

-Metatarsalgia

41
Q

Fluid motion for T-MT A

A

One hand of the Dr holds underneath the distal end of the tibia for stabilization. The other hand (the hand used correspond to the foot palpated) will be on the anterior aspect of the talus. Press A-P to feel for loss of motion

42
Q

Fluid motion for MT-P P

A

One hand stabilizes the metatarsal(s). The other hand grasps the phalange (toe). Move the phalange P-A, A-P, M-L, L-M, and check rotation.

43
Q

Fluid motion of I-P subluxation

A

One hand stabilizes the proximal phalange. The other hand grasps the distal phalange. Move the phalange P-A, A-P, M-L, L-M, and check rotation

44
Q

Indications of a T-MT A

A
  • Pain point over the joint space
  • Loss of fluid motion
45
Q

What are some possible causes of T-MT A?

A

Hard shoes that don’t allow the foot to flex, disuse, and the foot being stepped on.

46
Q

What is the PP for T-MT A?

A

Supine

47
Q

What is the CP for T-MT A?

A

Chiropractic index finger (#5)

48
Q

What is the thrust LOD for T-MT A?

A

LOD is A-P

49
Q

Indications of a MT-P P

A
  • Pain point over the joint space
  • Loss of fluid motion
  • Callus build up over the metatarsal head
50
Q

What ways are there to adjust the MT-P joint?

A

MT-P Traction

MT-P P Thrusting move

51
Q

What types of pathologies may MT-P traction take care of?

A
  • MT-P P
  • DJD
  • Bunion
  • Arthritides
52
Q

What is the CP for MT-P P?

A

9 of the hand corresponding to the side of involvement

53
Q

Indications for a Bunion Adjustment

A
  • Valgus deformity of the great toe
  • Callus at the medial portion of the 1st MT-P joint
  • Fixation in the joint in most directions
  • X-ray shows a Bunion formation
54
Q

What is the PP for the Bunion adjustment?

A

Prone

55
Q

Describe Bunion Adjustment Part 1

A

Patient is prone. With the knee bent to 90 degrees, stabilize the 1st metatarsal. Grasp the 1st phalange and traction is S-I and plantar flex at the joint. Repreat until most aberrant motion is removed from the joint and until the patient can tolerate Bunion Part II maneuver (may take one or several visits)

56
Q

Describe the Bunion Part II Manuever

A

Patient is in the same postion as Bunion Part 1 (prone, knee bent at 90, stabilize the 1st metatarsal). Stabilize the foot against the Dr’s hip. The hand on the metatarsal side will pre-stress it in rotation away from the Dr’s body. The hand on the phalange will traction it S-I and thrust will take the phalange away from the other toes (L-M in relationship to the foot) pivoting at the MT-P joint.

57
Q

What is Bunion Part 2 intended to do?

A

Intended to align the proximal phalange onto the metatarsal head.

58
Q

What pathology may I-P Traction (in the foot) take care of?

A
  • Hammertoes
  • DJD
  • Subluxations
  • Jammed toes

Extremity Adjusting (5 decks)

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