Knee Foot Ankle Lecture Flashcards
Inspection of knee:
- Alignment (valgus or varus)
- Curvature (viewed from side)
- Swelling
- Muscle symmetry
- Patella alignment
- Flat feet?
- Gait
What is genu valgus?
Tibia is angled away from midline (knock knees)
What is genu varus?
Tibia is angled toward midline (bow legged)
What is genu recurvatum? Who is affected by this?
- Hyperextension curvature of the knee (viewed from the side)
- MC females and those w/lax ligaments
Palpation of the knee:
- Patella and patellar tendon
- Suprapatellar pouch
- Quad (while pt extends knee)
What is the apprehension test of the knee?
- Place thumb on medial patella and push laterally
- Watch pt for apprehension
- Sign of patellar instability
What can cause knee joint line tenderness?
OA, meniscal tears/cysts, synovitis
What is the Lachman’s test?
- Test for ACL injury
- Support knee with both hands
- Flex knee to 30 degrees
- Draw tibia anteriorly to check for anterior translation and laxity
In an uninjured ACL, which is more critical - degree of laxity or asymmetry?
Asymmetry
laxity is more important in an injured ACL
What is the anterior draw test?
- Another test for ACL injury
- Not as sensitive as Lachman
- Anchor foot by sitting on it
- Draw tibia anteriorly
- Compare symmetry and laxity like Lachman
Anterior draw vs. Lachman
Both tests for ACL injury
Lachman is more sensitive
MCL tear grading
Grade 2: 5 to 10 mm laxity Grade 3 (complete): Over 10 mm laxity
What is the least commonly torn knee ligament?
LCL
How to test for MCL injury?
Apply valgus stress gently
How to test for LCL injury?
Apply varus stress gently
What is McMurray’s test?
- Assess for torn meniscus in knee
- “Stirring the pot” (rotate leg internally and externally)
- Maintain small valgus stress
- Positive is pain and joint line tenderness
What is the Apley grind test?
- Assess for torn meniscus in knee
- Like McMurray’s but pt lies prone
What is the squeeze test for the knee?
- Extensor dysfunction
- Squeeze quad at attachment to patella and have pt gently tighten quad muscle
- Positive is pain
Inspection of foot and ankle:
- Shoes for abnormal wear
- Count toes
- Hallux valgus deformity
- Ingrown toenails
Flat feet patients will wear down which side of shoes?
Medial
Foot drop patients will wear down which side of shoes?
Toes of shoes will be scuffed
What is pes cavus?
Abnormally high arch in the foot
What is pes planus?
Flat feet
What is Haglund’s deformity?
- Aka pump bump
- Over achilles insertion into calcaneus
- Caused by excessive pressure/tight shoes
What are the lateral ligaments of the ankle?
-Anterior talofibular
-Calcaneofibular
-Posterior talofibular
(Not as strong as deltoid ligaments)
How are the lateral ligaments of the ankle MC injured?
Inversion injuries
MC ligament injured in the ankle?
Anterior talofibular
Where does Morton’s neuroma occur?
Between 3rd and 4th MT heads
What is the test used to determine ankle joint instability?
Anterior draw
Motions of the ankle?
Dorsiflexion and plantar flexion
Subtalar motions?
Inversion and eversion of foot
Midtarsal motions?
Forefoot abduction and adduction
Toe motions?
Flexion and extension
How to test plantar flexion and toe extension?
Pt walks on toes
How to test dorisflexion of foot?
Pt walks on heels
How to test inversion of feet?
Pt walks on lateral sides of feet
How to test eversion of feet?
Pt walks on medial sides of feet
Dorsiflexor muscles of the foot?
Tibialis anterior
EHL
EDL
Plantar flexor muscles of foot?
Peroneus longus/brevis
Gastroc and soleus
FHL
FDL
Describe Homan’s sign
- Test for DVT
- Forcibly dorsiflex foot
- Positive is pain in calf
What is Thompson’s test?
- For torn Achilles tendon
- Pt lies prone w/feet dangling
- Examiner squeezes calf muscle
- Toes will point down (normal)
- With torn Achilles, toes will not move
