Knee, ankle and foot pain

Question 1

Q angle of knee

Answer 1

Normal= 15 degrees. Straight line from ASIS to center of patella, and another line is extrapolated up from tibial tuberosity and center of patella.

Question 2

Patellar reflex

Answer 2

L4

Question 3

Achilles tendon

Answer 3

S1

Question 4

Valgus test of knee

Answer 4

(+) test = increased laxity, soft endpoint. Indicates MCL (tibial) pathology.

Question 5

Varus test of knee

Answer 5

(+) test = increased laxity, soft endpoint. Indicates LCL (fibular) pathology.

Question 6

Lachman’s Test

Answer 6

Patient is supine… places cephalad hand on distal thigh, caudal hand grasps the proximal tibia. Knee is flexed to 30 degrees.
(+) test = increased laxity, soft endpoint. Indicates ACL pathology.

Question 7

McMurray’s Test

Answer 7

Patient is supine, with hip and knee flexed.

Medial meniscus = rotates the tibia into ER (AKA lateral rotation) and apply a valgus stress, then continues the leg into extension.

Lateral meniscus= rotates the tibia into IR (AKA medial rotation) and apply a varus stress, then continues the leg into extension.

Question 8

Apley’s Grind Test

Answer 8

Compression: Flex the knee to 90 degrees, place force down while rotating the foot internally and externally. (+) test = pain, possible meniscal injury or collateral ligament.

Distraction= Same as before, but pull upwards. This reduces meniscal pressure, but increases the strain on ligaments. (+) test = pain, indicates collateral ligament damage.

Question 9

Patellar Laxity and Apprehension test

Answer 9

Laxity: one hand on either side of the joint. Push the patella laterally and assess ROM.

Apprehension: When testing laxity, ask the patient if this promotes any discomfort.

Question 10

Patellar compression

Answer 10

Patient is supine and knee is extended. provide downward force on patella with one hand, while moving the patella medial and lateral. (+) test = pain with compression.

Question 11

Patella-femoral grinding test

Answer 11

Hold superior patella and apply superior/inferior force while the patient attempts to tighten quadriceps against resistance.
(+) test = pain/crepitus. This can indicate OA or chondromalacia (runner’s knee).

Question 12

Patellar glide test

Answer 12

Patient will slowly extend and flex the knee while physician notes quality of the articular motion. (+) test = crepitis.

Question 13

Anterior Drawer Test for ankle

Answer 13

Grasp posterior calcaneus and distal tib/fib with other hand. Provide anterior force on calcaneus while stabilizing distal tib/fib. Too much laxity= torn ATF ligament

Question 14

Talar tilt test

Answer 14

AKA inversion test. Grasp distal tib/fib with one hand and inferior calcaneus with the other, blocking motion of the calcaneus on the talus. Then force the talus to invert. (+) test = increased laxity. Indicates calcaneofibular ligament pathology, possibly ATF too.

Question 15

Eversion test

Answer 15

Graps distal tib/fib with one hand and plantar surface of foot with the other hand and induce eversion. (+) test = excess eversion. Indicates deltoid ligament pathology, although this is unlikely to tear.

Question 16

Squeeze test

Answer 16

Squeeze tib/fib, this should elicit pain at the syndesmosis. This indicates a high ankle sprain.

Question 17

Cross leg test

Answer 17

Patient crosses affected ankle over the opposite knee, then apply downward force over knee and ankle. (+) test = pain. Indicates syndesmosis (high ankle sprain).

Question 18

Thompson test

Answer 18

Patient is prone with foot off the table, then squeeze patients calf. What does the foot do? it should elicit plantarflexion.
(+) test = absence of plantarflexion. This indicates a ruptured achilles tendon.

Question 19

Homan’s sign

Answer 19

Force dorsiflexion of foot. (+) test = pain with dorsiflexion. This can indicate a DVT, although this is kinda risky…

Question 20

Moses Sign

Answer 20

Patient is seated or supine with knee slightly flexed or extended. Hold foot up, and apply squeezing force on gastrocnemius. (+) test = pain with anterior compression. This can indicate DVT of the posterior tibial vein.

Question 21

Genu Valgum

Answer 21

Increased Q angle. Lateral deviation of tibia and fibula.

Grace Hesse.

Question 22

Genu Varum

Answer 22

Genu varus (bow legs) is normal in babies, but they grow out of it.

Question 23

Osgood Schlatter

Answer 23

AKA osteochondrosis of tibial tubercle.
Seen in young teenage boys. Caused by secondary ossification of the tibial tubercle.
Starts to form a callous

Question 24

Ottawa knee rules

Answer 24

55+
Tenderness at fibula
Tenderness at patella
Inability to flex knee to 90 degrees
inability to walk up steps

Question 25

Diabetic neuropathy

Answer 25

Complication of uncontrolled DM II
Detailed skin exam, pulses etc.

Neuro Testing:

• Pressure sensation using monofilament test. Placed on first and third pad of toes, and base of 1,3 and 5th MTP joints.
• Vibration sensation with tuning fork
• Superficial pain using pinprick

Question 26

Ottowa Ankle/Foot rules

Answer 26

High sensitivity
Should image ankle if: 
- Unable to bear weight four steps
- Pain over malleolar area
- Pain over midfoot

Question 27

Morton Neuroma

Answer 27

• Pain between metatarsal heads from the overuse. Affects the plantar digital nerve.
• Most commonly affects the third web space (i.e. between 3rd and 4th toe)
• Caused by trauma, high heels, or tight fitting shoes.

Question 28

Tinea pedis

Answer 28

Fungal infection of the foot.

Question 29

Onychomycosis

Answer 29

Fungal infection of the nail