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Ortho 1- second half > Foot/ankle > Flashcards

Foot/ankle Flashcards

1
Q

talocrural joint

A

distal fibula
tibia
talus

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2
Q

midfoot

A

navicular
cuboid
3 cuneiforms

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3
Q

forefoot

A

5 metatarsals

phalanges

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4
Q

medial ligaments

A

deltoid ligament

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5
Q

lateral ligaments

A

anterior talofibular lig
calcaneofibular lig
posterior talofibular lig

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6
Q

anterior muscles

A

anterior tibialis
extensor hallucis longus
extensor digitorum longus
peroneus tertius

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7
Q

anterior open chain actions

A

dorsiflexion/inversion
extension of phalanges
everts foot

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8
Q

lateral muscles

A

peroneus longus and brevis

EVERSION

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9
Q

posterior muscles

A

gastrocnemius
soleus
plantaris

DEEP:
post tibialis
flexor hallucis longus
flexor digitorum longus

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10
Q

posterior open chain action

A

plantar flexion
PF and inversion
flexion of phalanges

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11
Q

talocrural/subtalar/midtarsal joint functions

A
  • shock absorption
  • absorb LE rotary forces
  • provide lever for effective propulsion
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12
Q

pronation

A

eversion
abduction
dorsiflexion

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13
Q

supination

A

inversion
adduction
plantar flexion

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14
Q

talocrural

A

Pronates (DF most dominant with eversion and abduction)

Supinates (dominated most by plantar flexion with inversion and adduction)

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15
Q

subtalar

A

closed chain pronation (calcaneus everts, talus adducts and dorsiflexes)
*medial longitudinal arch lowers and IR of tibfib

Closed chain supination (calcaneus inverts, talus abducts and PFs)
*med longitudinal arch elevates and ER of tibfib

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16
Q

midtarsal joint (MTJ)

A

depends on subtalar joint biomechanics

subtalar pronation: promotes mobility in MTJ and forefoot

Subtalar supination: promotes stability in MTJ and forefoot

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17
Q

kinetics and kinematics of gait cycle

A

slide 14

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18
Q

alignment

A
  • must be assessed from subtalar neutral position (neither pronated nor supinated)
  • subtalar jt assessed in both prone and WBing positions
  • forefoot and rearfoot alignment are evaluated separately
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19
Q

ideal rearfoot alignment

A

the plumb line bisects the calcaneus and talus

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20
Q

alignment of tibia, foot and ankle in the sagittal plane

A
  • plumbline alignment is slightly anterior to midline through knee and lateral malleolus
  • navicular tubercle, line from medial malleolus to where MTP jt of great toe rests on floor
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21
Q

alignment of tibia, foot and ankle in the frontal plane

A
  • distal 1/3 of tibia is in sagittal plane
  • great toe is not deviated toward midline of foot
  • toes are not hyperextended
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22
Q

forefoot varus

A

excess forefoot mobility –> supporting structures strained –> LE IR

compensation= excessive pronation

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23
Q

forefoot valgus

A

rigid lever –> less shock absorption –> lateral forces increased –> lateral stability decreased

compensation= excessive supination

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24
Q

history and exam

A 
history
inspection
palpation
clearing tests
joint integrity & mobility
neurological 
functional tests
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25
Q

history

A 
MOI
onset
increase/decrease symptoms
VAS
self report measures
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26
Q

inspection

A 
postural alignment (NWB/WB)
scars
wound
calluses
swelling
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27
Q

palpation

A

tenderness
temp
tissue density/adherence

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28
Q

clearing tests

A

lumbar spine
hip
knee

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29
Q

ROM

A

Active
Passive
resisted

30
Q

joint integrity and mobility

A

special tests and accessory motions

31
Q

neurological

A

reflexes
sensation
myotomes

32
Q

functional tests

A 
gait
double/single limb heel raise
double limb squat
double/single limb balance 
step down tasks
SEBT-star excursion balance test
hop testing
agility testing
33
Q

lateral step down test

A

arm strategy:
-removal of hand off waist

trunk alignment
-leaning in any direction

pelvis plane
-loss of horizontal plane

knee position

  • tibial tuberosity medial to 2nd toe
  • tibial tuberosity medial to border of foot

steady stance
-step down on untested limb or foot wavers side to side

  • each tab is scored as -1
  • also used in knee instability
34
Q

star excursion balance test (SEBT)

A

performed on individuals with and w/out chronic ankle instability (CAI)

  • posteromedial component highly representative of all 8 components of the test in limbs with and without CAI
  • anteromedial, medial and posteromedial reach tasks be used clinically to test for functional deficits related to CAI in lieu of all 8 tasks. (also used for knee instability)
35
Q

ROM and muscle length

A

*examination of the knee, hip, ankle and spine are essential!!

  • hip and knee ROM & muscle length
  • calcaneal inversion and eversion ROM
  • midtarsal joint supination and pronation ROM
  • 1st ray position & mobility
  • hallux dorsiflexion ROM
  • 1st-5th ray mobility
  • ankle dorsiflexion and plantar flexion ROM with knee flexed and extended
36
Q

therapeutic intervention for balance impairment

A
  • restoration requires positional sense (proprioception)

- balance macine, balance board, external perturbation

37
Q

balance home exercises

A
  • balancing on 1 leg with eyes open –> closed in door frame

- standing on 1 leg on a pillow or couch cushion with eyes open –> closed

38
Q

therapeutic exercise for intrinsic muscles

A
  • pt flexes at proximal MTP jt before distal MTP jt
  • draw towel under foot, pick up marbles
  • using resistance bands to resist proximal MTP joint flexion (long sit)

**great for post-op its that are limited for a few weeks. working intrinsics helps to maintain strength and mobility as much as possible

39
Q

therapeutic exercise for extrinsic muscles

A
  • resisted talocrural plantar flexion with slow eccentric return to talocrural dorsiflexed position.
  • closed chain exercises (double leg heel rises, etc.)
40
Q

pain

A
  • exercise initiated in pain free range
  • soft tissue mobilization
  • cryotherapy
  • NMES/TENS
  • exercise of neighboring regions!
  • patient education
41
Q

posture and movement impairment

A
  • excessive pronation and supination are most commong
  • exercises developed from components of gait: while assessing strength/mobility deficits
  • goal is to control motions in/out of static positions at varying speeds
  • static weight shifting on bathroom scale
  • circular weight shifting drill
  • functional drills (retrowalking, sidestepping, etc)
42
Q

acute phase hyper/hypo mobility

A
  • hypermobile segment should be protected (taping, bracing, casting, footwear, etc)
  • adjacent hypomobile segments should be mobilized with manual therapy or mobility exercise
  • dynamic stabilization exercise should be initiated at the hypermobile segment.
43
Q

talocrural dorsiflexion

A

joint mobilization–> TCJ dorsiflexion ROM (soleus stretch w/ talar joint in neutral or slightly supinated position–> step down training to facilitate eccentric control of dorsiflexion

44
Q

subtalar joint

A
  • full active/active assisted supination can be performed
  • pronation mobility active/active assisted
  • progressions involve functional training of new mobility in appropriate phase of gait cycle
45
Q

plantar fasciitis

A

overuse caused by excessive pronation, obesity (BMI>30), malalignment, decreased dorsiflexion ROM, prolonged time on feet

S&S: pain medial heel, 1st steps in AM, and after rest

46
Q

plantar fasciitis treatment

A
  • decrease pain and inflammation, reduce tissue stress, restore muscle strength
  • NSAIS, US, iontophoresis, deep tissue massage- for pain & tissue extensibility
  • taping, orthoses, night splint, modified footwear to reduce tissue stress

**treat all LE biomechanical impairments!

if pronated:

  • mobilize TCJ
  • address all LE malalignment!
  • stretch gastroc, soleus and PF
  • strengthen tibialis anterior and extensor digitorum
  • initiate functions and proprioceptive activities
47
Q

plantar heel pain study: agents & exercise vs. manual therapy & exercise

A

electrophysiological agents & exercise (EPAX): US, ionto, dexa, stretching, intrinsic stretching, ice, HEP (3x/day)

manual therapy & exercise (MTEX): agressive soft tissue mob for 5 min & rearfoot eversion mobs. MT approach to hip, knee, ankle and foot. HEP (self eversion mob, self-soft tissue mob, stretching)

**MTEX favored

48
Q

posterior tibial tendon dysfunction

A

usually excessive subtalar joint pronation and result in acquired flatfoot deformity.

S&S: TTP to tendon, resisted inv & pflx, PRONATION, absent inversion w/ heel raise

49
Q

post tibial tendon dysfunction treatment

A
  • NWB short leg casting may be necessary for 4-6 wks (pts w/ partial tears)
  • meds and modalities for inflammation
  • arch strapping to control end range pronation
  • pain-free, low intensity, high rep open kinetic chain plantar flexion
  • proprioception, strength, coordination

**big time pronators. eccentrically trying to stop rolling in

50
Q

achilles tendinosis

A

=overuse pathology of achilles tendon (insertional vs. non)

S&S: runners and jumpers (training errors),

  • NON INSERTIONAL: TTP 2-6 cm above insertion, palpable defects
  • INSERTIONAL: lower, slower prognosis
51
Q

achilles tendinosis treatment

A

-address acute symptoms (low level laser therapy, into, heel lift, night splint)
-restore TCJ mobility and biomechanical faults (taping, orthoses)
-stretching is essential after TCJ mobility is restored
-strengthening exercises following inflammation recovery
-eccentric training *** promotes correct orientation of collagen fibers (fewer motor units but produce more force.
(Alfredson: 3 x 15 bent/straight leg unilateral calf raise 2x/day)

52
Q

achilles tendinosis prognosis

A

favorable for acute to subchronic; surgery increased with age and duration of symptoms

53
Q

functional nerve disorders

A

-assessment should include spine and hip involvement

nerve involvement may result in shoe changes, orthotics, alteration of impairments in alignment, mobility, and movement pattern exercises

affected nerves include:

  • tibial nerve (tarsal tunnel syndrome): where wraps around post tibialis
  • peroneal nerve
54
Q

ligament sprains

A

70-80%involve anterior talofibular ligamanet (ATFL), calcaneal fibular ligament (CFL), posterior talofibular ligament (PTFL)

55
Q

grade 3 ligament sprains

A

are further classified:

1st degree: complete rupture of ATFL

2nd: complete rupture of ATFL and CFL
3rd: dislocation in which ATFL, CFL, and PTFL are ruptured.

*pain and improvement in DF

56
Q

ligament sprain treatment

A

grade 1-2, 1st 4 days: P R I C E

severe grade 1/2 may need crutches in early stage.

open kinetic chain inversion ROM as tolerated

progress as pain and swelling are controllled and WBing tolerance increases

grade 3 rehab similar.

pt ed:

  • many reinjure at 3-6 wks
  • external support ofr 6-8 wks
57
Q

syndesmotic ankle sprain

A

=high ankle sprain; disruption of distal tibiofemoral ligaments

diastasis=mortise widening

58
Q

S&S of syndesmotic ankle sprain

A

MOI: ER and/or DF on fixed foot

+ ER stress test or squeeze test

59
Q

syndesmotic ankle sprain treatment

A

reduce lower leg ER stres

lateral ankle sprain- 2-3x longer

60
Q

turf toe

A

hyperextension sprain of the 1st MTP usually due to flexible footwear

mild-mod-severe injury may take from several weeks to months to return to sport

treatment= RICE, rigid shoe insert, ROM

**difficult healing bc need to walk

61
Q

ankle fractures

A
  • supination adduction injury
  • supination ER injury
  • pronated abduction injury
  • pronated ER injury
62
Q

ankle fracture tx:

A
  • edema massage, scar mobilization, edema reduction
  • AROM begins mid range, low intensity/high reps
  • as function normalizes, ROM exercise is generally more tolerable
63
Q

Ottawa ankle rules

A

pain in malleolar zone AND

-bone pain in posterior edge or tip of med or lat malleolus

AND/OR

-can’t bear weight immediately and in clinic

64
Q

Ottowa foot rules

A

pain in midfoot zone AND

-bone pain in base of 5th MT or navicular

AND/OR

-can’t bear weight immediately and in clinic

65
Q

anatomic impairments

A

forefoot varus/valgus

hindfoot varus/valgus

hallux valgus

pes planus/cavus

hammer toe

claw toe

66
Q

adjunctive interventions

A

adhesive strapping
wedges and pads
biomechnical foot orthotics
heel and full sole lifts

67
Q

3 main joints of foot/ankle

A

TCL
ST
MTL

subdivided into calcaneocuboid and talonavicular

68
Q

extrinsic muscles

A

anterior groups: DF
lateral groups: evert
posterior groups: PF

69
Q

functions of foot during gait:

A

shock absorption
surface adaptation
propulsion

70
Q

common physiologic impairments

A

include loss of mobility, force, torque, balance, impaired balance, posture

Ortho 1- second half (5 decks)

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