Foot/Ankle

Question 1

Ottawa ankle rule

Answer 1

Radiograph indicated if:

TTP along distal 6cm posterior edge of tibia or tip of medial malleolus, OR

TTP along distal 6cm posterior edge of fibula or tip of lateral malleolus, OR

inability to weight bear both immediately and for 4 steps in ED

If negative for all, pt unlikely to have a fx

Question 2

Ottawa foot rule

Answer 2

Sn = 97.6%, Sp = 31.5

Radiograph indicated if pt has:
TTP at base of 5th metatarsal
TTP at navicular bone
Inability to weight bear both immediately and in ED for 4 steps

For use in adults

Question 3

Risk factors of peripheral arterial disease

Answer 3

**Abnormal pulses in both feet (most predictive)
Male > female
Age> 60
Intermittent claudication
Ischemic heart disease
History of smoking or diabetes

Question 4

Peripheral arterial disease
Walking program

Answer 4

At least 3x/week
At least 30min of working/walking time
Walking to near-maximal pain
Sustained at least 6 months

Question 5

Neurogenic claudication exercise program

Answer 5

Restore lumbar mobility to reduce strain/load on structures that can contribute to stenosis
Consider inclined treadmill walking for increased tolerance

Question 6

Risk factors stress fracture

Answer 6

Leg length discrepancy
Amenorrhea
Past hx stress fracture
History of osteoporosis
High training volume (or recent increase)

Question 7

Critical stress fractures

Answer 7

Have higher rates of non union
Includes anterior tibia, medial malleolus, talus, navicular, 5th metatarsals, and sesamoids

May require up to 4-6 months rest/immobilization

Question 8

Exertional compartment syndrome.
Clinical presentation

Answer 8

Recurrent exercise induced leg discomfort that occurs at a reproducible point in exercise and increases if training persists. Typically tight, cramp like, or squeezing ache over specific compartment. Relief occurs after discontinuation of activity

Question 9

Anterior compartment syndrome
Clinical presentation

Answer 9

Weakness of dorsiflexion or toe extension
Paresthesia over dorsal foot.
Numbness and first web space.
Transient or persistent drop foot

(Compartment innervated by deep peroneal nerve, contains EHL, EDL, fibularis tertius, tibialis anterior)

Question 10

Deep posterior compartment syndrome
Clinical presentation

Answer 10

Paresthesia in plantar aspect of foot
Weakness of toe flexion and foot inversion

Compartment contains posterior tibial nerve, posterior tibialis, FHL, FDL

Question 11

Superficial posterior compartment syndrome.
Clinical presentation

Answer 11

Dorsolateral foot hypoesthesia
Plantar flexion weakness

Compartment contains gastrocnemius, soleus, and sural nerve

Question 12

Lateral compartment syndrome
Clinical presentation

Answer 12

Sensory changes of anterolateral leg
Weakness of ankle aversion

Compartment contains fibularis longus, fibularis brevis, superficial fibular nerve

Question 13

Exertional compartment syndrome treatment

Answer 13

Relative rest for up to 6 to 12 weeks.
Anti-inflammatories
Stretching and strengthening of involved muscles,
Possibly orthotics

Question 14

Plantar fasciitis and heel pain cpg

Answer 14

Strong evidence for manual therapy techniques, stretching, short-term anti-pronation, low-dye, or gastroc taping, use of foot orthoses, night splints 1-3mo

Weak evidence laser therapy, ultrasound, patient edu for activity mod, physical agents

Conflicting evidence for e-stim, phonophoresis, footwear, weight loss

Expert opinion for foot strengthening to control pronation, against use of FDN

Question 15

Lisfranc fracture

Answer 15

Midfoot fracture. May accompany ankle sprain

Question 16

Sever’s disease

Answer 16

Calcaneal apophysitis due to repetitive stress of Achilles tendon in young (roughly 8-14 years old) or physically active people

Question 17

Avulsion fracture of 5th metatarsal

Answer 17

Occurs at base of 5th met, likely due to inversion ankle sprain and pull of peroneal brevis tendon

Question 18

Jones fracture

Answer 18

Midshaft fracture of 5th metatarsal
Takes longer to heal

Question 19

Tarsal tunnel syndrome
Differential diagnosis

Answer 19

Commonly will see sensory changes of medial or lateral plantar nerve (no sensory changes will occur with posterior tibialis tendonitis)

Positive tinels

Commonly will see pronated foot

Question 20

Lateral ankle sprain CPG

Answer 20

Strong evidence: investigating balance ability to jump in land in initial assessment, outcome measures FAAM, LEFS, exam of rom, arthrocinematics, SLS, weight bearing dorsiflexion, dynamic balance; interventions: prophylactic bracing for high risk patients, exercise and manual therapy, bracing or external supports and progressive weight bearing based on tissue healing, possible immobilization up to 10 days for severe, strong evidence not to use ultrasound

Moderate evidence: activity limitation and participation restrictions, should not use bracing or external supports as standalone intervention

Weak evidence: cryo, diathermy, laser, NSAID, FDN

Conflicting evidence: electrotherapy