Foot & Ankle Flashcards
Bones of shank
tibia and fibula
bones of hindfoot
talus and calcaneus
bones of midfoot
navicular, cuboid, 3 cuneiforms
-and their articulations
Mitered hinge
results from talocrural and subtalar joint axes
-transverse plane motion of shank(ER/IR) coupled w/ frontal plane motion of foot during gait
Midtarsal (Chopart) joint
medial talonavicular joint and lateral calcaneocuboid joint
forefoot
medial forefoot
-1st metatarsal and great toe
lateral forefoot
-metatarsals and toes 2-5
Muscles of anterior compartment of lower leg
-tibialis anterior
-EHL
-EDL
-fibularis tertius
innervated by deep fibular nerve
muscles of lateral compartment of lower leg
-fibularis longus
-fibularis brevis
innervated by superficial fibular nerve
muscles of posterior compartment of lower leg
Superficial compartment
-gastroc(medial and lateral)
-soleus
innervated by tibial nerve
deep compartment
-tibialis posterior
-FDL
-FHL
-popliteus
innervated by tibial nerve
Dorsal intrinsic foot muscles
-EDB
-EHB
-dorsal interossei
innervated by deep fibular nerve
First plantar layer foot muscles
-abductor hallucis
-FDB
-abductor digiti minimi
Second plantar layer foot muscles
-quadratus plantae
-4 lumbricals
Third plantar layer foot muscles
-ADDuctor hallucis
-FHB
-FDM
pronated vs supinated foot and general relationship w/ hip and knee
pronated foot
-more mobility and excessive IR at hip and knee
supinated foot
-more rigid and ER of the high and knee
FPI-6 findings
score >4 “pronated positive”
-abnormal pronated posture
-midfoot HYPERmobility
-decreased tibialis posterior strength
-IR position of LE
score < 0 “supinated sero”
-abnormal supinated posture
-midfoot HYPOmobility
-decreased fibularis longus/brevis strength
-ER position of LE
Normal gait criteria for foot/ankle
1st MTP joint ROM 65* extension at pre-swing
hindfoot/talocalcaneal ROM 4-6* eversion at loading response
talocrural joint DF ROM 10* at terminal stance
Ottowa foot & ankle rules
-tenderness to navicular
-tenderness to base of 5th met
-tenderness to POSTERIOR aspect of malleoli or tip of malleolus
-unable to WB 4 steps immediatly after injury or in ER
Best tests for medial ankle sprain
-anterior drawer in ER
-lateral talar tilt test
-kleiger test or DF/ER test
best tests for high ankle sprain
squeeze test
best tests for lateral ankle sprain
-reverse anterolateral drawer test
-anterolateral talar palpation test
Differentiate sever’s disease from achilles tendonopathy
Sever’s disease
-children 8-15 years old
-calcaneal apophysitis
-pain w/ palpation DISTAL to achilles insertion
-very active OR overweight children
differentiate calcaneal bone stress fracture vs achilles tendonopathy
-presents like Sever’s disease but does nto improve after several months
X-ray will not catch bone stress injuries until they are more progressed
MRI > bone scan are going to be most sensitive
os trigonum syndrome
small ossicle posterior talus that normally fuses during development
-gets pinched in end range PF
-symptoms would be present there, causing limited PF and pain w/ end range PF
“dancers” are a likely population for it
posterior ankle impingement will have similar symptoms but no bony abnormality
palpation for medial tibial stress syndrome
distal 2/3 of posteromedial tibia
-must have > 5cm consecutive tenderness
differentiate chronic exertional compartment syndrome from MTTS
compartment syndrome w/ have neurovascular symptoms
-cramping, burning, paresthesias
-no reproduction of symptoms via palpation of tibia
diagnosis for plantar heel pain
-1st step heel pain
-positive windlass test
-pain w/ prolonged activity
need to rule out baxter neuropathy and fat pad atrophy
Risk factors for lateral ankle sprain
-female sex
-younger age
-occupation
-sport type
ALSO
-high BMI
-decrease and slow eccentric ankle INV strength
-increased and fast concentric PF strength
-early reaction time of fibularis brevis
-impaired passive joint position sense
early prognostic risk factors for chronic ankle instability(CAI)
-inability to perform single leg drop landing and drop vertical jump at 2 weeks
-self reported impaired ADLS on FAAM(foot & ankle ability measure)
-decreased sagittal plane motion of hip/knee/ankle
-diminished reach distances posteriorly on SEBT at 6 months
CAI at 1 year post-injury
Weight bearing lunge test norms
5 inches or 12.5 cm normal
1.9 cm is a significant change
limb symmatry index
ratio of involved limb/ratio of uninvolved limb
multiply by 100 to get a %
> 90% desired for return to sport
90% limb symmetry considered “normal” but doesn’t guarantee that leg is at PLOF after injury
Midportion vs insertional achilles tendinopathy
midportion pain = 2-6 cm proximal to calcaneal insertion
insertional pain= within 2 cm of tendon insertion
midportion much more common than insertional
what is a haglund deformity
bony growth on calcaneus at achilles insertion
-may be present w/ insertional tendinopathy
acute vs non-acte tendinopathy
Acute
-local redness, warmth, swelling, symptoms <=3 months
-high levels of pain that limit low level activity such as walking
non-acute
-no inflammatory symptoms
-symptoms provoked only w/ high intensity activity(running/jumping)
-symptoms lasting >3 months
