general ankle review Flashcards
what is Subtalar Neutral Position
The foot position where the subtalar, talonavicular, and calcanealcuboid are congruous (in position of neither pronation nor supination)
how do you place the foot in neutral
foot is placed in neutral by centering the navicular on the talus
Pes Cavus position
Fore foot is plantar flexed with respect to rear foot, rear foot supinated during wt bearing
are pt more over supinated or pronated when the have pea caves
supinated - ridged deformity
have a poor shock absorbing foot
people with pes clavus foot have les DF of PF
DF - this is beacasue most of the range is already used up
Rigid pes planus usually result of what
bony structural abnormality of the arch.
Flexible pes planus may be result of what
weak supinator muscles - tib post
pes planus - pronated or supinated
pronated
Pes planus foot during weight bearing
Flattened arch and valgus rear foot positioning during weight bearing
what is the transverse plane leads to foott pronation
hip anteversion, internal femoral torsion, internal tibial torsion
- overall: anything that makes the leg rotate medially
limited knee or hip ext does what to the ankle
decrease DF
what is Equinus
is a condition that causes limited ankle joint range of motion - ankle doesn’t flex upward (dorsiflex) as it should, and the foot ends up compensating (pronating)
Leg Injuries
Achilles tendinitis
Tibialis posterior tendinitis
Tibial/fibular stress fracture
Anterior/medial knee pain
Location of Abnormal Supination forefoot
Rigid everted forefoot
Forefoot Valgus
what does Rigid everted forefoot tell us about the midtarsal joint
implies inadequate inversion about the LMTJ axis (longitudinal)
abnormal supination 1st ray
PF
Leg Injuries associated with over supination
Achilles tendinitis
Peroneal tendinitis
Lateral knee and hip pain.
How does Limited S-T joint motion effect the calcaneus during stance
keeps it in the inverted position
Rigid Plantarflexed 1st Ray leads to what
Develop lateral instability of ankle
Callus under 1st & 5th MT heads
how to accomidate Rigid Plantarflexed 1st Ray
Requires accommodative orthotic with cut-out for 1st ray or bar from 2nd - 5th MT
when we are in resting positon what does the foot look like
eversion of heel rather than subtalar neutral (STJN)
Gait cycles operates around RSP or STJN
RSP
Low Dye taping effectivness
pronation, increase arch height before and after exercise, and decrease rear-foot motion
how can low dye taping be used as a screening tool
used to access if a pt would benefit from a orthotic
Eversion midtarsal
Navicular plantar medial
Cuboid dorsolateral
long axis
Inversion midtarsal
Navicular dorsolateral
Cuboid plantarmedial
long axis
dorsiflexion midtarsal
Navicular & Cuboid Dorsolateral
same direction
PF midtarsal
Navicular & Cuboid Plantarmedial
same direction
Ankle Sprains make up what precentage of ankle injuries
75%
inversion sprain action
in and PF
Inversion Sprains normal involve what ligaments
involves anterior talo-fibular ligament (ATF) and calcaneo-fibular ligament (CF).
Severe injury may also involve the posterior talo-fibular ligament.
Risk Factors intrinsic for inversion sprains
Limited ankle DF ROM
Reduced ankle proprioception
Decreased balance
Factors reduce the ability of the dynamic stabilizers (peroneals) to react to perturbations in ankle position
what sports do we often see intrinsic sprains
Basketball, volleyball, field sports
In soccer – being a defender and playing on natural grass as opposed to artificial increases risk for LAS
what special test might be positive if there is an inversion sprain
anterior drawer and medial talar tilt tests.
functional ankle instability can be cuased by what
caused by disturbed proprioception
PT - Balancing, single leg stance, return to position
PT aimed at co-ordination and strength of muscles around ankle to restore proprioception and thus stability
Sinus Tarsi Syndrome is normally associated with what issues
a secondary complication of chronic inversion sprain in patients who also hyperpronate.
hyperpronation, talus displaces into sinus tarsi region resulting in irritation.
what do we see with Sinus Tarsi Syndrome
Chronic pain and inflammation of lateral aspect of sub-talar joint (sinus tarsi).
eversion sprain involve which ligaments
deltoid ligament, may also involve distal tib-fib interosseous membrane
which is more present inversion or eversion sprain
inversion sprain
eversion i stabilized due to the distal fibula extends beyond the jt
Deltoid ligament complex issues are associated with what
Lateral ankle sprains
Ankle syndesmosis injuries
Maisonneuve fracture (fx of proximal fibula with widening of the ankle mortise on x-ray)
Malleolar fractures
what happens when distal tib fib joint when we DF
it opens up
Mechanism of high ankle sprain
leg IR
foot ER
