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Clin Ass Sean > Lecture 3: Ankle and Foot > Flashcards

Lecture 3: Ankle and Foot Flashcards

1
Q

What are the main ligaments of the ankle?

A

Anterior Talofibular Ligament
Calcaneofibular Ligament
Posterior Talofibular Ligament
Deltoid Ligament (medial)

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2
Q

In dorsiflexion which way does the talus slide and roll?

A

Slides posteriorly and rolls upwards

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3
Q

In plantarflexion which way does the talus slide and roll?

A

Slides anteriorly and rolls downwards

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4
Q

What movement occurs at the subtalar joint?

A

Pronation (eversion, abduction)

Supination (inversion, adduction)

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5
Q

What bones make up the subtalar joint?

A

Calcaneus and Talus

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6
Q

Common causes of plantar heel pain?

A

Plantar fasciopathy
Fat pad contusion (heel pain)

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7
Q

Common causes of acute lateral ankle sprain?

A

Lateral ligament sprain
- ATFL
- CFL
- PTFL

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8
Q

Common causes of Achilles region pain?

A

Midportion and Insertional Achilles Tendinopathy

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9
Q

Common causes of medial ankle pain?

A

Tibialis posterior tendinopathy
Flexor hallucis longus tendinopathy

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10
Q

What are some differential diagnoses for an acute ankle sprain?

A

Lisfranc, fracture, subtalar dislocation

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11
Q

Acute Ankle Sprain Diagnosis (Patient history, Observation, Palpation, AROM/PROM, MMT/IMT, Special test, Functional Testing)

A

Patient history: mechanism of injury, pain, swelling, limited ROM, difficulty weight bearing

Observation: observe for swelling (figure 8)

Palpation: tenderness/pain near ligament

AROM/PROM: limited ROM actively and passively

MMT/IMT: reduced, but limited by pain/swelling

Special test: anterior drawer test, talar tilt test

Functional Testing: single leg stance, gait, stairs

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12
Q

What test would you perform to confirm an acute ankle sprain?

A

Anterior drawer test

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13
Q

When would you use the Ottawa Ankle Rules

A

To predict which patients require X rays to exclude fracture

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14
Q

Normal ROM of the ankle
(PF, DF, Inv, Ev)

A

10-20 degrees dorsiflexion (DF)
40-55 degrees plantarflexion (PF)
30 degrees Inversion
18 degrees Eversion

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15
Q

Mechanisms of injury for ligament injuries

A

ATFL
CFL
PTFL
Deltoid:

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16
Q

Risk factors of plantar fasciopathy

A

Lifestyle: runners, military, dancers, sedentary
Elderly
High arc and excessive foot pronation
Overweight/obese

17
Q

Plantar Fasciopathy Diagnosis (Patient history, Observation, Palpation, AROM/PROM, MMT/IMT, Special test, Functional Testing)

A

Patient history: Gradual onset heel pain. Typically worse in morning or after long periods of rest, improves with activity but worsens at end of day
- Aggravating factors: prolonged standing, walking or running especially on hard surfaces
- Alleviating factors: rest, stretching and sometimes ice
- ASx: Stiffness in heel or arch of foot, swelling and tenderness

Observation: flat feet or high arches, overpronation during gait can be present

Palpation: point tenderness at anteromedial aspect of calcaneal tubercle

AROM/PROM: active toe extension may provoke symptoms, normal ROM

MMT/IMT: normal or some weakness in intrinsic foot muscles

Special test: Pain during Windlass Test

Functional Testing: pain during heel raise test, pain in single leg stance

18
Q

What is a special test for Plantar Fasciopathy

A

Windlass test

19
Q

What are some differential diagnoses for Plantar fasciopathy?

A

Tarsal tunnel syndrome
Calcaneal Stress fracture
Neuropathies
Trauma

20
Q

Achilles Tendinopathy Diagnosis (Patient history, Observation, Palpation, AROM/PROM, MMT/IMT, Special test, Functional Testing)

A

Patient history: Gradual onset of pain, often worsening with increased activity. Pain located 2-6cm above the calcaneal insertion. Morning stiffness, pain after periods of inactivity that may decrease with mild activity but worsens with vigorous use. Localised pain. History of overload. Pain presenting after activity (hours after or next day)

Questionnaires (PROMs): VISA-A

Observation: Swelling or thickening along the tendon, altered gait pattern to avoid pain

Palpation: tenderness on midportion of achilles, 2-6cm above insertion

AROM/PROM: pain reproduced with active movements

PAM: normal

MMT/IMT: weakness may be present in plantarflexion strength due to pain inhibition

Special test: Royal London Hospital Test, Arc Sign Test, Gap Palpation

Functional Testing: Difficulty with activities requiring forceful plantarflexion of the ankle, such as hopping, running or push offs

21
Q

Differential diagnosis for Achilles tendinopathy

A

Rule out Achilles rupture (Thompson test) or calf strain
Plantar fasciopathy
Tarsal tunnel syndrome
Ankle OA
Deep vein thrombosis

22
Q

What tests can be performed for Achilles Tendinopathy

A

Thomson Test (achilles rupture)
Royal London Hospital Test
Arc Sign Test
Gap Palpation test (rupture)

23
Q

What is tarsal tunnel snd.

A

Compression of posterior tibial nerve through tarsal tunnel

24
Q

What is in the Tarsal Tunnel? (Tom, Dick and Very Naughty Harry)

A

Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibial artery & vein
Tibial nerve
Flexor hallucis longus tendon

25
Q

Diagnosis of Tarsal Tunnel Syndrome

A

Patient history: Burning, tingling or a sensation of pins and needles in the foot and toes. Pain can also radiate up leg
o AF: activities that involve prolonged standing or walking, repetitive foot flexion
o ALF: Rest, foot elevation and non-weight bearing activities
o ASx: Numbness or weakness in foot, sometimes worsening at night

Questionnaires (PROMs): Foot and ankle ability measure, lower extremity functional scale

Observation: possible swelling in ankle area. Gait may be altered due to pain or numbness in foot

Palpation: Tenderness and pain along course of posterior tibial nerve

AROM/PROM: Active and passive ROM may reproduce symptoms of tingling or pain

PAM: Normal, but can produce tingling or pain

MMT/IMT: Weakness in toe flexion, particularly flexor hallucis longus and flexor digitorum longus, which are innervated by branches of the tibial nerve

Special test: Tinel’s Sign

Functional Testing: Standing, walking, decreased sensation may affect balance and proprioception

26
Q

Special test for Tarsal Tunnel Syndrome

A

Tinel’s Sign

27
Q

Tibialis Posterior Tendinopathy Diagnosis

A
  • Medial ankle pain often arising from behind the medial malleolus and extending towards the medical midfoot to the insertion of the tendon at the navicular bone
  • Common swelling in the later stages and is often diffuse around and below the medial malleolus
  • Tenderness along the tendon is usual, most prominent posterior and inferior to the medial malleolus or at the insertion onto the navicular bone
  • Resisted inversion will elicit pain and relative weakness comparted with the contralateral side
  • A single heel raise test viewed from behind will reveal lack of inversion of the hindfoot, and if severe the patient may have difficulty performing a heel raise. In the normal ankle, the calcaneus moves into varus position during a single heel raise; in patients with tibialis posterior tendinopathy, this does not happen and the heel remains in the valgus position
  • MRI has a sensitivity of 95%, a specificity of 100% and an accuracy of 96%
28
Q

If there is an ATFL sprain, what will you feel in an anterior drawer test

A

Calcaneus will translate up the heel

29
Q

What ligament sprain does anterior drawer test

A

ATFL

30
Q

What ligament sprain does talar tilt test

A

ATFL, CFL and deltoid

31
Q

What does the Matles test do? When is it positive?

A

Tests for Achilles rupture
Ruptured foot tends to remain dorsiflexed instead of plantarflexed

32
Q

What is done in a Windlass test

A

Passive extension of 1st MTP

33
Q

What test would you use to identify a syndesmosis injury?

A

Squeeze test

34
Q

What is the mechanism of injury for a syndesmosis injury?

A

Dorsiflexion and Eversion

Clin Ass Sean (4 decks)

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