Intro Lower Extremity Foot and Ankle Flashcards
Ankle PF and DF arthros for talus and fib
PF: Talus glides anterior and fib head glides inferior/anterior/IR
DF: talus glides posterior and fib head glides superior/posterior/ER
Talocrural joint AROM
DF, PF
DF: 20
PF: 50
Talocrural joint closed packed, resting, and capsular patter
Closed packed: max DF
Resting: 10 PF with mid between inv/eve
Capsular pattern: PF>DF
Pronation vs supinator tri planar motions
Pronation: DF, ABD, EVE
Supination: PF, ADD, INV
Open chain arthro in subtalar joint supination and pronation for calcaneus
Supination: calcaneus inverts and moves medial
Pronation: calcaneus everts and moves lateral
Close chain arthro subtalar joint for supination and pronation
Tibia
Talus
Calcaneus
Supination: tibial ER, talus DF/ABD, calcaneus inverts
Pronation: tibial IR, talus PF/ADD, calcaneus everts
Subtalar joint arom
Inv
Eve
Inv: 20-30
Eve: 5-10
Subtalar joint closed packed and resting
Closed: supination
Resting: midway between inversion and eversion, 10PF
Supination is a combination of
Supination: Inversion, PF, add
Pronation: eversion, DF, AND
The hind foot during gait cycle
Needs to be able to transition from torque converter in stance phase to rigid lever in toe off (driven by subtalar joint)
Heel strike and calcaneus and midfoot
Calcaneus everts to unlock midtarsal joints
Midfoot unlocks
Toe off and calcaneus and midfoot
Calcaneus inverts to lock midtarsal joints
Midfoot locks
What does subtalar dysfunction lead to and why
Leads to midfoot over pronation and forefoot abduction during toe off because there is no conversion and midtarsal joints stay unlocked
Overpronation and forefoot abduction can lead to
Lateral column compression
Elongation and tension to medial side ankle
Required amount of ankle extension for running and walking
15-20
When Talocrural extension is limited, what happens
Tibial IR
Calcaneus eversion
Midfoot pronation
(Lateral column compression)
MTP 1 flexion and extension AROM
Ext: 70 (60 required for gait)
Flx: 45
When does the first day begins to plantar flex
20-30 degrees 1st MTP extension
What has to happen for proper first ray PF
Heel lift, subtalar supination, normal seasons function
As plantar flexion of first ray continues, what way to metatarsals move
Posterior direction on seasmoids
MTP 1 closed packed position
Max extension
MTP 2-5 closed packed position
Max flexion
MTP resting position and capsular pattern
Resting: 10 degrees ext
Capsular; extension, flexion
IP closed pack position
Max extension
IP resting and capsular pattern
Slight flexion
Flexion, extension
IP 1 ext and flx AROM
Ext: 0
Flx: 90
PIP 2-5 extension and flexion AROM
Ext: 0
Flx: 35
DIP 2-5 extension and flexion AROM
Extension: 30
Flexion: 60
What kind of joint is the inferior tibiofibular joint
Syndesmosis
DF and PF
Tib/fib interosseus membrane
Fibula
DF: increased distance between medial and lateral malleolis, tension in membrane, fib ER and glides superior
PF: decreased distance between medial and lateral malleolus, fibula glides inferiorly and IR
Eversion and inversion
Head of fibula
Fibula
Eversion: fib head glides proximal and fibula medially rotates
Inversion: fib head glides inferior and fibula lateral rotates
Wells clinical prediction rule for DVT
Active cancer or within 6mos
Immobilization, paralysis, paresis
Bed>3 days or surgery in last 4 wks
Center post calf tender, popliteal space, or along femoral vein in ant thigh/groin
Entire LE swelling
U/L calf swelling > 3cm than good side
U/L pitting edema
Nonvaricose veins
Alternative diagnosis likely or more likely than DVT (-2, all others are 1)
Points on wells
-2 to 0: low prob, med consult
1-2: mod, med referral
3 or more: high, med referral
Ottawa ankle rules
Highly sensitive
Distal 6cm of posterior edge of tibia or tip medial malleolus
Distal 6cm of posterior edge of fibula or tip of lat malleolus
Base of 5th met pain
Navicular pain
(ANY of the above warrant referral)
