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Ortho Tx 700 > Foot & Ankle > Flashcards

Foot & Ankle Flashcards

1
Q

Muscles of the anterior compartment of the lower leg

A

Tibialis anterior
Extensor digitalis longus
Extensor hallucis longus
Fibularis tertius

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2
Q

Innervation of the anterior compartment

A

Deep fibular

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3
Q

Muscles of the lateral compartment of the lower leg

A

Fibularis longus

Fibularis brevis

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4
Q

General actions of the lateral compartment of the lower leg

A

Eversion, plantarflexion

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5
Q

Innervation of the lateral compartment of the lower leg

A

Superficial fibular nerve

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6
Q

Muscles of the posterior compartment of the lower leg

A

Soleus
Gastrocnemius
Plantaris

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7
Q

What innervates the posterior compartment?

A

tibial nerve

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8
Q

Muscles of the deep posterior compartment?

A

Popliteus
Tibialis posterior
Flexor digitorum longus
Flexor hallucus longis

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9
Q

What innervates the muscles of the deep posterior compartment?

A

tibial nerve

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10
Q

Tom, Dick & Harry (anterior)

A

Tibialis anterior
Extensor Digitorum longus
Extensor hallucis longus

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11
Q

Tom, Dick & Harry (posterior)

A

Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus

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12
Q

Intrinsic muscles of the dorsal foot:

A

Extensor digitorum brevis

Extensor hallucis brevis

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13
Q

Intrinsic plantar muscles: 1st layer

A

Abductor hallucis (medial arch)
Abductor digiti minimi pedis (lateral arch)
Flexor digitorum brevis

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14
Q

Intrinsic plantar muscles: 2nd layer

A

(Quad Lum)

Quadratus plantae (inserts into FDL)
Lumbricals pedis (arises from tendon of FDL)
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15
Q

Intrinsic plantar muscles: 3rd layer

A

(FlexAddFlex)

Flexor Hallucis brevis
Adductor Hallucis
Flexor Digiti Minimi brevis

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16
Q

Intrinsic plantar muscles: 4th layer

A

Plantar interossei pedi (adduction)

Dorsal interossei pedii (abduction)

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17
Q

The tibial nerve innervates

A 
Posterior compartment
Plantar intrinsics (medial and lateral plantar)
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18
Q

The superficial fibular nerve innervates

A

Lateral compartment

Dorsal cutaneous nerves (lateral and medial)

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19
Q

The deep fibular nerve innervates

A

Anterior compartment

Dorsal intrinsic muscles

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20
Q

Inferior Tibiofibular Joint

A

Fibrous syndesmosis

Fibular notch articulates with medial surface of tibia, separated by fat pad

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21
Q

Inferior TibFib joint: movement

A

Minimal.
Spreads 1-2mm, allowing for dorsi and plantarflexion

Fibular moves superiorly with dorsiflexion, inferiorly with plantarflexion

With dorsiflexion carries 17% more axial load

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22
Q

Inferior TibFib joint: ligaments

A 
Interosseous tibiofibular (strongest)
Anterior and posterior tibiofibular
(prevent excess gapping of joint and posterior glide)
Transverse tibiofibular (lined with cartilage). Articulates with talus in extremem plantarflexion
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23
Q

Talocrural Joint

A

Synovial, modified hinge

inferior articular surface of the tibia and malleolar surfaces of tibia and fibula (concave) with trochlea of the body of the talus (convex)

one degree of freedom (dorsi/plantarflexion)

Resting: 10º dorsiflexion

Capsular pattern: plantar>dorsi

Firm end feel

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24
Q

Ligaments of the medial talocrural joint

A

Deltoid ligament (anterior and posterior tibiotalar, tibiocalcaneal, tibionavicular).

Collectively check eversion

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25
Q

Ligaments of the lateral talocrural joint

A

Anterior talofibular
Calcaneofibular
Posterior talofibular

Collectively check inversion

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26
Q

Most commonly sprained ligament

A

Anterior talofibular

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27
Q

What does the anterior talofibular ligament check?

A

inversion and plantarflexion

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28
Q

What does the calcaneofibular ligament check?

A

inversion and dorsiflexion

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29
Q

What does the posterior talofibular ligament check?

A

inversion and dorsiflexion

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30
Q

What ligament tends to get taken out with grade three ankle sprains?

A

Calcaneofibular.

Becomes vertically aligned with dorsiflexion

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31
Q

Talocalcaneal Joint

A

AKA subtalar

Synovial plane joint with gliding and rotational movements

Movements: inversion/eversion

Corresponding facets of the talus and calcaneus

anterior and middle facets share joint capsule with talocalcaneonavicular joint

Closed pack: inversion

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32
Q

Subtalar ligaments

A

Talocalcaneal (medial and lateral)
Interosseus
Talocalcaneal
Cervical

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33
Q

Midfoot

A

Refers to midtarsal joints between navicular, talus, cuboid, calcaneus, as well as between the cuneiforms

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34
Q

Talocalcaneonavicular Joint

A

compound ball and socket, synovial joint

Ball: head of talus
Socket: navicular + spring ligament

Closed pack position: supination

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35
Q

Spring ligament

A

AKA plantar calcaneonavicular ligament

Ant/med sustentaculum tali to the inferior/inf-med navicular

Maintains the arch of the foot.

When lax, medial separation; forefoot abducts from hindfoot, talar head moves inferiorly, arch drops

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36
Q

All midfoot joints closed packed in:

A

supination

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37
Q

Calcaneocuboid Joint

A

Saddle (sellar) joint

Has its own joint capsule

Calcaneus: concave superiorly, convex mediolaterally
Cuboid: convex superiourly, concave mediolaterally

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38
Q

What ligaments reinforce the calcaneocuboid joint capsule

A

Short and long plantar

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39
Q

Cuboideonavicular Joint

A

Fibrous syndesmosis, sometimes synovial

Closed pack in supination, with slight gliding, rotational movement

Supported by planter and dorsal cubonavicular and interosseus ligaments,

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40
Q

Cuneonavicular Joints

A

Plane synovial

Closed pack in supination, with slight gliding, rotational movement

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41
Q

Intercuneiform Joints

A

plane synovial

Closed pack in supination, with slight gliding, rotational movments

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42
Q

Cuneocuboid Joints

A

Plane synovial

Closed pack in supination, with slight gliding and rotational movements

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43
Q

Lisfranc’s joints are also known as

A

Tarsometatarsal joints

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44
Q

Tarsometatarsal joints

A

Plane synovial

Closed pack: supination, with slight rotation and gliding

Supported by dorsal and plantar ligaments

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45
Q

Cuneiform Mortise

A

At TMT2. In the tarsometatarsal/lisfrancs joint, the 2nd MT lies 2-3 mm proximally

Increases stability

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46
Q

Tarsometatarsal joint capsules

A

One capsule for TMT 1
One capsule for TMT 2 & 3
One capsule for TMT 4,5 and cuboid

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47
Q

Midline of the foot

A

MT2 (hand: MC3)

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48
Q

Intermetatarsalphalangeal Joints

A

Plane synovial joints

Closed packed in supination, with slight gliding

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49
Q

Metatarsalphalangeal Joints: dorsal capsule reinforced by:

A

Extensor hood expansion

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50
Q

MTP Joints: reinforced laterally by

A

Collateral ligaments

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51
Q

Plantar plate

A

Fibrocartilageous plantar MTP ligament
Continuous with the plantar aponeurosis

Toe dorsiflexion tenses plantar aponeurosis through it, stabilizing longitudinal arch.

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52
Q

MTP closed pack

A

extension

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53
Q

Interphalangeal Joints: closed pack

A

extension

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54
Q

Interphalangeal joints: reinforced laterally by

A

collateral ligaments

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55
Q

Plantar Fascia

A

Planter surface of calcaneal tuberosity, branches at MTP joints into 5 bands (one per toe)

medial, central and lateral compartments

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56
Q

Which plantar fascia compartment is more prone to pain?

A

Central

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57
Q

Plantar fascia and foot stability

A

MTP hyperextension loads into plantar fascia

Increases longitudinal arch, hindfoot inversion, and lateral rotation of low leg

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58
Q

The plantar fascia supports stability in what part of the gait cycle?

A

Supports stability and supination during pre-swing/toe-off

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59
Q

Tibialis Anterior

A

O: Lateral tibial condyle, proximal 2/3 anterior tibia, proximal 2/3 of the interosseous membrane
I: 1st cuneiform and 1st metatarsal

Crosses in front of medial malleolus

Dorsiflexion and inversion/supination

Deep fibular nerve (L4,5)
Anterior tibial artery

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60
Q

Fibularis Tertius

A

O: distal 1/3 of anterior fibula and interosseous membrane
I: Dorsal base of MT5

Dorsiflexion, eversion

Deep fibular nerve (L4,5)
Anterior tibial artery

Actually the most distal belly of the EDL

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61
Q

Fibularis Longus

A

O: fibular head and prox 1/2 of the lateral fibula
I: First cuneiform and MT1

Plantarflexion and eversion

Superficial fibular nerve (L5, S1)
Fibular artery

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62
Q

Fibularis Brevis

A

O: Distal 1/2 of lateral fibular
I: lateral base of MT5

Eversion and plantarflexion

Superficial fibular nerve (L5, S1)
Fibular artery

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63
Q

Gastrocnemeus

A

Medial and lateral femoral condyles
to the calcaneus via achilles tendon

Plantarflexion, knee flexion, inversion

Tibial Nerve (S1-2)
Popliteal artery
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64
Q

Soleus

A

Soleal line of the tibia, head and prox 1/3 fibula
to the calcaneus via achilles tendon

Plantarflexion, inversion

Tibial nerve (S1-2)
Popliteal artery
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65
Q

Plantaris

A

Lateral condyle and distal lateral supracondylar line of the femur
to posterior calcaneus

Plantarflexion, knee flexion, inversion

Tibial nerve (S1-2)
Popliteal artery
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66
Q

Tibialis Posterior

A

Proximal 2/3 of tibia, fibula, interosseous membrane
to
Navicular tuberosity

Plantaflexion, inversion

Tibial nerve (L4,5)
Posterior tibial artery
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67
Q

Extensor Digitorum Longus

A

O: Proximal 2/3 fibula, 1/3 interosseous membrane, lateral tibial condyle
I: Dorsal toes 2-5

Extends toes 2-5 @ MTP and IP, dorsiflexion, eversion

Deep fibular nerve (L5, S1)
Anterior tibial artery

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68
Q

Extensor Hallucis Longus

A

Middle 1/3 anterior fibula and interosseous membrane
to Dorsal big toe

Extends big toe at MTP and IP, dorsiflexion, inversion

Deep fibular nerve (L5, s1)
Anterior tibial artery

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69
Q

MMT Tibialis anterior

A

Supine or seated.
Support just above ankle
Starting: dorsiflexion, inversion (without big toe extension)
Pressure: against medial dorsal surface, towards plantarflexion and eversion.

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70
Q

MMT Tibialis posterior

A

Supine
Support just above ankle
Starting: Inversion, plantarflexion
Pressure: against medial and plantar side, toward dorsiflexion and eversion

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71
Q

MMT Fibularis longus

A

Supine, with leg medially rotated, or side-lying
Support just above ankle
Starting: plantarflexion, eversion
Pressure: against lateral border and sole, toward inversion and dorsiflexion

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72
Q

MMT soleus

A

Prone, knee flexed to at least 90º
Support proximal to ankle
Starting: plantarflexion, neutral in/eversion
Pressure: against calcaneus, pulling heel caudally

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73
Q

Supination

A

Subtalar: inversion
Forefoot: adduction
Talocrural: plantarflexion
Leg: laterally rotated (vis a vis the foot)

Increases medial long arch
Subtalar joint more stable, so less muscle work required

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74
Q

Pronation

A

Subtalar: eversion
Forefoot: abduction
Talocrural: dorsiflexion
Leg: medially rotated (vis a vis the foot)

Decreases medial long arch
Subtalar joint less stable, so more muscles need to maintain stance stability

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75
Q

During subtalar pronation/eversion, what happens at the midtarsal joints?

A

ROM is increased, creating flexibility

Occurs with midstance, allows adaptation to adapt to ground

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76
Q

During subtalar supination/inversion, what happens at the midtarsal joints?

A

ROM is decreased, creating rigidity

Occurs with toe-off to allow for stability and propulsion

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77
Q

Progressive stabilization describes events at what joints?

A

talocrural
superior tibfib
inferior tibfib

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78
Q

Progressive stabilization describes events at what points of the gait cycle?

A 
initial contact (heel strike)
load response (footflat)
midstance
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79
Q

Progressive stabilization

A
  1. Initial contact: ankle in dorsiflexion – very stable.
  2. Load response: ankle plantarflexes as body moves forward. Talocrural joint less stable.
  3. Body continues to move forward, increases dorsiflexion, which increases stability.
  4. The talus is wedge shaped – as the tibia and fibula move forward they spread apart 1-2mm at the inferior TibFib joint.
  5. At the same time the fibular moves superiorly, checked by interosseous membrane
  6. Taut interosseous membrane creates more stability for the superior and inferior tibfib joints, creating a stable leg for MidStance.
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80
Q

The arches allow for:

A

Shock absorption
Adjustment to the terrain, balance
Propulsion

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81
Q

The arches of the feet are maintained by what three mechanisms:

A
  1. wedging of the interlocking tarsal and metatarsal bones
  2. tightening of plantar ligaments
  3. intrinsic and extrinsic muscles of the foot and their tendons, which helps to support the arches
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82
Q

Longitudinal Arches of the foot

A

Medial and longitudinal
Form a cone as a result of the angle of the MT bones in relation to the floor (the medial arch more evident)

Lateral arch: more stable and less adjustable

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83
Q

Medial Longitudinal Arch: structures

A

Calcaneal tuberosity, talus, navicular, three cuneiforms, and MT1-3

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84
Q

Medial longitudinal arch: stabilized by

A
  1. Muscles: tibialis anterior, tibialis posterior, FDL, FHL, Abductor hallucis, FDB
  2. Spring ligament
  3. Plantar fascia
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85
Q

Lateral longitudinal arch: structures

A

Calcaneus, cuboid, MT4&5, talus

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86
Q

Lateral longitudinal arch: stabilized by

A
  1. Muscles: fibularii, ADMin, FDB
  2. Short and long plantar ligaments
  3. plantar fascia
87
Q

Keystone of the lateral longitudinal arch

A

Cuboid

88
Q

Transverse arch of the foot: structures

A

Navicular, cuneiforms, cuboid, metatarsals

89
Q

Transverse arch of the foot: stabilized by

A

Tibialis posterior, tibialis anterior, fibularis longus

Plantar fascia

90
Q

Gait cycle

A

Sequence of movements between two consecutive initial contacts of the same foot.

91
Q

Step

A

1/2 of a gait cycle (foot contact of one foot to the foot contact of the other foot)

92
Q

Stride length

A

linear distance between successive point of foot-to-floor contact of the same foot

93
Q

Two phases of gait cycle

A 
Swing phase (35-40% -- double leg)
Stance phase (60-65% -- single leg)
94
Q

Phases of Stance (traditional/RLA)

A 
Heel strike/Initial Contact
Foot flat/Loading Response
Midstance
Heel-off/Terminal Stance
Toe-off/Preswing
95
Q

Phases of Swing (traditional/RLA)

A

Acceleration/Initial Swing
Midswing
Deceleration/Terminal swing

96
Q

Heel contacts the ground

A

Heel strike/initial contact

97
Q

Plantar surface of the foot in contact with the ground

A

Foot flat

98
Q

From entire foot making contact with the ground to the opposite foot leaving the ground

A

Loading response

99
Q

Point of which the body passes over the weight-bearing leg

A

Midstance (traditional)

100
Q

From opposite foot leaving the ground to body being directly over the weight bearing limb

A

Midstance (RLA)

101
Q

Heel leaves the ground, while toes remain in contact

A

Heel off

102
Q

From weight bearing heel rising, to initial contact of the opposite foot.

A

Terminal stance

103
Q

Toes leave ground

A

Toe-off

104
Q

From initial contact and weight shifting onto the opposite leg, to just before toes of the weight-bearing leg leave the ground

A

Preswing

105
Q

Swing leg begins to move forward

A

Acceleration

106
Q

From toes leaving the ground to swing foot being opposite the weight bearing foot, with knee in maximum flexion

A

Initial swing

107
Q

Swing of the non-weightbearing leg is directly under the body

A

Midswing (traditional)

108
Q

From swing foot being opposite weight-bearing foot, to the swing leg being in front of the body and the tibia being vertical

A

Midswing (RLA)

109
Q

Leg slowing down in preparation for heel strike

A

Deceleration

110
Q

From the vertical tibia to just prior to initial contact

A

Terminal swing

111
Q

Initial contact: joint action

A

Hip: flexion
Knee: full extension
Ankle: dorsiflexion moving into plantarflexion
Foot: supinated,

112
Q

Loading Response: joint action

A

Hip: decreasing flexion
Knee: flexion
Ankle: plantarflexed
Foot: pronated

113
Q

Midstance: joint action

A

Hip: neutral
Knee: slightly flexed
Ankle: slight dorsiflexion
Foot: neutral

114
Q

Terminal stance: joint actin

A

Hip: extension
Knee: flexion
Ankle: dorsiflexion moving toward plantarflexion
Foot: Supination

115
Q

Pre-swing: joint action

A

Hip: extension
Knee: slight flexion
Ankle: plantarflexion
Foot: supination

116
Q

Initial contact: muscle action

A

Hip: Glute max – eccentric
Knee: Quads – eccentric
Ankle/Foot: anterior compartment – eccentric

117
Q

Loading Response: muscle action

A

Hip: glute max – concentric
Knee: quads – concentric (prep for extension)
Ankle/Foot : Deep posterior compartment – eccentric

118
Q

Midstance: muscle action

A

Hip: Iliopsoas – eccentric; IL glute med – concentric
Knee: Gastrocs – eccentric (prevents terminal knee extension)
Ankle/Foot: Gastrocs – eccentric (because of slight dorsiflexion)

119
Q

Terminal stance: muscle action

A

Hip: iliopsoas – eccentric
Knee: Gastrocs –concentric (start of knee flexion)
Ankle/Foot: Gastrocs – concentric

120
Q

Preswing: Muscle action

A

Hip: iliopsoas – eccentric (resist hip extension); ADD MAG (to control and stabilize pelvis)
Knee: quads – eccentric
Ankle/Foot: Gastrocs – concentric

121
Q

Initial Swing: Joint Action

A

Hip: slight flexion moving towards increased flexion
Knee: increasing flexion
Ankle: plantarflexion moving into 20º dorsiflexion and slight pronation

122
Q

Midswing: joint action

A

Hip: flexion
Knee: flexion
Ankle: neutral
Foot: slight supination

123
Q

Terminal swing: joint action

A

Hip: increased flexion
Knee: decreased flexion to almost full extension, slight lateral rotation
Ankle: dorsiflexion

124
Q

Initial Swing: Muscle action

A

Hip: Hip flexors – concentric; CL glute med – concentric
Knee: Hamstrings – concentric
Ankle: Dorsiflexors – concentric

125
Q

Midswing: Muscle action

A

Hip: hip flexors – eccentric; IL glute med – eccentric
Knee: quads – concentric; hammies – eccentric
Ankle: dorsiflexors – isometric

126
Q

Terminal swing: muscle action

A

Hip: glue max – eccentric
Knee: quads – concentric; hammies – eccentric
Ankle: dorsiflexors – isometric

127
Q

Hindfoot varus

A

Inversion of the calcaneus when the subtalar joint is neutral

Hindfoot rigid –> decreased pronation ROM

128
Q

Hindfoot varus presents as

A

pec cavus (increased medial long. arch)

129
Q

Hindfoot varus may result in _______ at the knee

A

Genu varum

130
Q

Hindfoot varus may contribute to what pathologies?

A

Plantar fasciitis
Shin splints
Hamstring strain
Knee pathologies

131
Q

Hindfoot valgus

A

Eversion of the calcaneus when the subtalar joint is neutral
* less problematic than hindfoot varus *

Hindfoot mobile –> excess pronation and decreased supination ROM

132
Q

Hindfoot valgus presents as

A

pes planus (decreased medial long. arch)

133
Q

Hindfoot varus may result in _____ at the knee

A

Genu varum

134
Q

Hindfoot varum may contribute to what pathologies?

A

tibialis posterior tendon insufficiency

135
Q

Forefoot varus

A 
Inversion of the forefoot (vis a vis the hindfoot)
Metatarsal abduction
Medial longitudinal arch decreases
Occurs with hindfoot valgum, pes planus
In stance, completely pronated
136
Q

Forefoot valgus

A

Eversion of the forefoot (vis a vis the hindfoot)
Medial longitudinal arch increases
Occurs with hindfoot varus, pes cavus
In stance, completely supinated

137
Q

Pes planus: observation

A 
decreased medial longitudinal arch
Hindfoot valgus (calcaneal eversion)
Metatarsal abduction (forefoot varus)
Subtalar dorsiflexion

Common with genu valgum, anteverted hip, PFPS (movie theatre sign)

138
Q

Rigid vs Flexible flatfoot

A

Congenital vs Acquired

Rare, boney changes, soft tissue contracture
vs
Mobile, rarely involves soft tissue contractures

139
Q

Pes planus: associated muscle,soft tissue, etc

A

Lax spring ligament

Weak tib post, abdHalbrev (decreased inversion)

140
Q

Differentiating between Rigid and Flexible flat foot

A

Observe standing
Ask client to stand on tiptoes
Observe effect on arch
If arch appears –> flexible

141
Q

Pes Cavus: observation

A

Longitudinal arch accentuated
Plantar soft tissue shortened, bones may alter in shape
Leads to rigid foot – very little ability to adapt to stress and absorb shock

142
Q

What pathologies may result from pes cavus?

A

Claw toes

OA at tarsus

143
Q

Bunion

A

Bony exostosis/spur
Increase in bone mass at the site of irritation (usually MTP #1 joint line)
Occurs with valgus toe

144
Q

Tailor’s Bunion

A

Bunion on the 5th digit (little toe)

145
Q

Pump Bump/Runner’s Bump

A

Bunion on the 1st digit (big toe)

146
Q

Abnormal gait occurs for what three reasons?

A
  1. pathology or injury in a specific joint
  2. compensations for IL injury/pathology
  3. compensations for CL injury/pathology
147
Q

Antalgic Gait

A

Protective
Injury to pelvis, hip, knee, ankle, foot
Stance phase on affected leg shorter
On unaffected side, shorter swing phase and shorter step length

148
Q

Steppage Gait

A

Pathologies involving doriflexors, deep fibular N –> lack of dorsiflexion –> knee lifts higher in midswing

149
Q

Circumducted/Trendelenburg’s Gait

A

AKA Lurching Gait

Weak glute med –> leg swing out and around
Common with advanced OA

150
Q

Gait: lack of plantar flexion

A

Excess plantarflexion on unaffected side

151
Q

Gait: tight hip flexors

A

Forward lean

152
Q

Hemiplegic Gait

A

AKA neurogenic or flaccid gait
Swings leg outward and ahead; leg medially rotated
Affected upper limb carried across body

153
Q

Scissor Gait

A

Spastic paralysis of hip adductors

154
Q

Festinating Gait

A

AKA Parkinsonian Gait
Shuffling or short rapid steps
Arms held stiffly

155
Q

Functional tests for foot and ankle:

A

Squat (SL, BL)
SL balance progression
Proprioception

156
Q

L4 Dermatome

A

Over patella to big toe

157
Q

L5 Dermatome

A

down tibialis anterior

158
Q

S1 Dermatome

A

Lateral side of foot

159
Q

L4 Myotome

A

Dosiflexion

160
Q

L5 Myotome

A

Extension of big toe

161
Q

S1 Myotome

A

Eversion of foot

162
Q

S1 Reflex

A

Achilles tendon

163
Q

Pain in foot/ankle may refer from

A 
Glute Min
TFL
Piriformin
Extrinsic calf mm
Locally from instrinsic mm
164
Q

To rule out the knee as a source of ankle/foot pain

A

AF flexion, extension, with POP

165
Q

To rule out superior TibFib as source of ankle/foot pain

A

PR anterior/post glide, looking for movement at ankle

166
Q

To rule out MTP as source of pain

A

AF flexion, toe extension, followed by POP

167
Q

DDx Fracture

A

Tuning fork, tapping bone along length

168
Q

What three conditions can fall under the category “shin splints”.

A

Compartment syndrome
Tibial stress fracture
Periostitis

169
Q

Acute compartment syndrome.

A

Buildup of pressure on all four compartments.

Medical emergency

Can follow trauma.

170
Q

Acute compartment syndrome: Sx

A

Shiny, hot, hard, blanched, taut skin

Paresthesia
Motor loss
Pain with passive stretch.

171
Q

Chronic exertion all compartment syndrome

A

Overuse
Buildup of pressure in anterior (45%) or deep posterior compartment

Exercise induced

172
Q

Compartment syndrome

A

Inflammation and hypertrophy in muscles creating abnormally high intramuscular pressure within fibro-Osseous space
–> ischemia

173
Q

CECS (anterior): Sx

A

Anterior/lateral tibial pain that increase with activity (at constant interval), decreases with rest

Ache, tightness
Poss: paresthesia

174
Q

What does stress do to postural muscles (like the Gastrocs)?

A

Short and tight

175
Q

What does stress do to the phasic muscles (like tib ant)?

A

Long and weak

176
Q

CECS (anterior compartment) special tests

A

MMT tib ant, gastroc, gastroc length

177
Q

Gastroc length test

A

A/PROM greater than 20° dorsiflexion with knee extension

178
Q

CECS: hallmark sign

A

Pain occurs at same interval of activity.

179
Q

CECS (posterior): Sx

A

Pain along post-Med tibia
Swelling and palpable tenderness along tendon

Weak plantarflexion and inversion

180
Q

Anterior CECS: contributing factors

A

Hard surfaces

Imbalance between weak ant tib and short superficial posterior compartment

181
Q

Posterior CECS: contributing factors

A

Valgus subtalar joint
Running terrain
Poor flexibility
Overpronation (overworked tib post)

182
Q

CECS (posterior) special tests

A

MMT tib post

Observe pronation vs supination (tiptoe test)

183
Q

Tibial stress fracture: Sx

A

Pain and discomfort – initially with activity, relived with rest, progresses to longer duration with possible nocturnal pain.

184
Q

Tibial stress fracture: special tests

A

Tuning fork (2-3 inches above med mall)
Knock test
Lever test

185
Q

Tibial Periostitis

A

Inflammation of tibial periosteum near tib post origin

18% running injuries
May progress to stress fracture

186
Q

Tibial Periostitis: Sx

A

Pain local to distal postmed tibia

Often BL and accompanied by over pronation

Pain in the morning and with exercise, decreases with activity. Returns with fatigue and continues afterward. As it progresses pain continues through activity

187
Q

Tibial Periostitis: special tests

A

Stress fracture tests
MMT
Foot alignment

188
Q

Tibial Periostitis: hallmark

A

Morning pain

189
Q

Tibial stress fracture: hallmark sign

A

Nocturnal pain

190
Q

Achilles tendonitis

A

Overuse injury of the Achilles’ tendon

Commonly at avascular zone (1-4” above insertion), or insertion

Forced dorsiflexion (eccentric contraction + excess pronation), tight calves, high impact sports.

191
Q

Tibialis posterior tendinitis: Sx

A

Pain along medial border of tibia (mid-distal 1/3), especially with loading response in gait

Weak and painful plantar flexion and inversion

Crepitus, swelling, nodular tendon

Pain in tarsal tunnel

192
Q

Dynamic stabilizers of longitudinal arch

A

Tib post
FHL
FDL

193
Q

Tib post is important in what phases of gait?

A

Load response

Mid stance

194
Q

Tarsal tunnel is outlined by

A

Medial malleolus
Calcaneus
Flexor retinaculum
Talus

195
Q

What travels through the tarsal tunnel?

A

Tib Post, FDL, FHL
Post Tib artery
Post tib vein
TIbial nerve

196
Q

Plantar Fasciitis

A

Acute strain or chronic overuse condition caused by repetitive plantarflexion + MTP extension

May cause development of boney spurs at origin

197
Q

Plantar Fasciitis: pes planus/cavus

A

Pes planus may cause microtears

Pes cavus – chronically shortened fascia unable to dissipate force

198
Q

Plantar Fasciitis: Sx

A

Unilateral or bilateral

Pain at anterolateral surface of calcaneus, along medial border toward metatarsal head.

Pain worse first thing in the morning, and with activity (esp pre-swing/toe off)

199
Q

What muscle would you strengthen after an inversion sprain?

A

Fibularii

200
Q

What muscle would you strengthen after an eversion sprain?

A

Tib Post

201
Q

Most commonly sprained ligament

A

anterior talocrural

202
Q

Ankle sprains: POP

A

Grade 1 no instability
Grade 2 no instability
Grade 3 no end range —> severe pain, instability (chronic: pain free and unstable)

203
Q

Syndesmotic Ankle Sprain

A

AKA high ankle sprain

Overstretch of sydesmotic ligaments of distal tibfib joint

MOI: rotation of lower leg and foot

204
Q

Syndesmotic Ankle Sprain: Sx

A

dull or sharp pain in ant-lat lower leg; sharper when twisting

Pain increases with ankle rotation

205
Q

Stable vs unstable high ankle sprain

A 
Stable = Grade 1/2.  Tib and fib maintain positions
Unstable = Grade 3.  Two or three of the three ligaments torn; tibia fibula move freely
206
Q

Pes Planus

A

Flat foot
Decreased medial longitudinal arch;
Functional: lax spring ligament

Hindfoot valgus
Knee valgus
Forefoot varus
Possible anteversion, coxa varum;

207
Q

What other paths tend to accompany pes planus?

A

PFPS
Tib post tendinopathy
Achilles tendonitis

208
Q

HT/short muscles with pes planus

A

fibularii
gastrocs/soleus
(decreased dorsiflexion; evertors compensate)

209
Q

Long and weak muscles with pes planus

A 
Deep posterior: 
Popliteus
Tibialis posterior
Flexor digitorum longus
Flexor hallucus longis
210
Q

Pes Cavus

A

Excessive inversion of the foot; high medial arch
Due to increased supination of the foot

Hindfoot varus, calcaneal inversion

211
Q

What muscles are shortened in pes cavus?

A

tibialis anterior, posterior, toe flexors

212
Q

Morton’s Neuroma

A

Swelling of interdigital nerves of the foot
Usually between 3rd and 4th metatarsal

Sx; cramping pain up side of foot to tip of affected toe
Compression pain when weight bearing; exacerbated by tight shoes

(yoga toes)

213
Q

Tarsal Tunnel Syndrome

A

AKA joggers foot

Tibial nerve compressed within tarsal tunel

214
Q

Tarsal Tunnel Syndrome: Sx

A

Pain in medial ankle (mimics plantar fasciitis)
Weak toe flexion
** night pain
Altered sensation over sole of foot and toes

Increased Sx with forces eversion and/or dorsiflexion

Ortho Tx 700 (12 decks)

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