Foot & Ankle Flashcards by Aaron Simon

Bones of shank

tibia and fibula

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bones of hindfoot

talus and calcaneus

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bones of midfoot

navicular, cuboid, 3 cuneiforms
-and their articulations

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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

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Midtarsal (Chopart) joint

medial talonavicular joint and lateral calcaneocuboid joint

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forefoot

medial forefoot
-1st metatarsal and great toe

lateral forefoot
-metatarsals and toes 2-5

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Muscles of anterior compartment of lower leg

-tibialis anterior
-EHL
-EDL
-fibularis tertius

innervated by deep fibular nerve

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muscles of lateral compartment of lower leg

-fibularis longus
-fibularis brevis

innervated by superficial fibular nerve

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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

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Dorsal intrinsic foot muscles

-EDB
-EHB
-dorsal interossei

innervated by deep fibular nerve

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First plantar layer foot muscles

-abductor hallucis
-FDB
-abductor digiti minimi

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Second plantar layer foot muscles

-quadratus plantae
-4 lumbricals

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Third plantar layer foot muscles

-ADDuctor hallucis
-FHB
-FDM

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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 hip and knee

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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

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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