Lecture 4 - Ankle/leg/foot ax Flashcards
Main functions (2) of the foot
Propulsion and support
3 sections of the foot
Hindfoot (rearfoot)
Midfoot
Forefoot
Three principal functions of the lower leg, ankle, and foot
- Impact absorption and adaptation to uneven surfaces
- Propulsion: act like a flexible lever
- Support: act like a rigid structure that holds up the entire body
What 3 joints are included in the hindfoot?
Tibiofibular
Talocrural
Subtalar joint
Review chart p.10,12,14
Joints of the hindfoot
Components of the midfoot (7)
Talocalcaneonavicular
Cuneonavicular
Cuboideonavicular
Cuneocuboid
Calcaneocuboid
Chopart joint
Components of the forefoot (4)
Tarsometatarsal
Intermetatarsal
Metatarsophalangeal
Lisfranc joint
What questions to ask when looking at activity level for the ankle/foot?
Level of runner
Mileage/changes
Terrain
Warm up/Stretching
Shoes suited to sport
Training schedule (next race)
Swing phase is OKC or CKC
Open chain (NWB)
Stance phase is OKC or CKC
Closed chain (FWB)
What is pump bumps
Prominence on calcaneus due to tight ice skates
Normally, in standing, __ to ___% of weight is taken on the heel and __ to ___% is taken by the metatarsal heads.
50 to 60%
40 to 50%
What is a normal fick angle?
12 to 18 degrees from the axis of the body
Foot loading during gait - walking
1.2 times BW
Foot loading during gait - running
2 times BW
Foot loading during gait - jumping (from 2 feet/60 cm)
5 times BW
What do you look for in the shoe exam? (4)
Size matching feet
Wear and tear patterns
Age
Sports and walking shoes
What is included in the medial longitudinal arch? (5)
Calcaneal tuberosity
Talus
Navicular
3 cuneiforms
1-3 muscle tendons
What is included in the lateral longitudinal arch? (3)
Calcaneus
Cuboid
4-5 metatarsal
What is included in the transverse arch? (4)
Navicular
Cuneiforms
Cuboid
Metatarsal bones
Stages of Stance phase (5)
Initial contact (heel strike)
Load response (foot flat)
Midstance (single-leg stance)
Terminal stance (heel off)
Pre-swing (toe off)
Which stage of the stance phase supports the more BW?
Midstance/single-leg stance = 1.2 times BW
Swing is __ to __% of gait
35-40%
Parts of the swing phase (3)
Initial swing (acceleration)
Mid-swing
Terminal swing (deceleration)
Temporal parameters - Step width
5-10 cm
Temporal parameters - Step length
72 cm
Temporal parameters - Stride length
144 cm
Temporal parameters - Lateral shift
2.5-5 cm
Temporal parameters - Vertical shift
5 cm
Temporal parameters - Pelvic rotation
8 degrees
Temporal parameters - Vertical/horizontal displacement
See fig. 14.8 = 5 cm
Temporal parameters - Cadence
90-120
Abnormal causes of pattern in gait (3)
- Pathology or injury to joint
- Compensation to pathology/injury to joints
- Compensation to pathology/injury to limb
Types of abnormal gaits (15)
Antalgic
Arthogenic
Ataxic
Contracture
Equinus
Glut max
Glut med
Hemiplegic/hemiparetic
Parkinson
Plantar flexor
Psoatic
Quad avoidance
Scissors
Short leg
Drop foot
What is antalgic
Painful
What is arthogenic
Joint - hip or knee
What is ataxic
Neurological - sensation, motor control
What is contracture
Muscle - immobilized, etc.
ex: if tight quad, hip could go in circumduction to avoid going into hip flexion
What is equinus
Toe walking
What is glut max (gait problem)
Trunk extends
What is glut med (gait problem)
Hip drop
What is Parkinson (gait problem)
Flexed, shuffle
What is plantar flexor (gait problem)
Limited push off
Functional testing examples (7)
Squatting
Stairs (DF 20°)
Standing one foot
Walking (DF 10°, PF 20-25°)
On toes/heels (muscle action, joint integrity)
Run, add turns
Jumping
Ankle dorsiflexion: ankle lunge test = explain
Measurement of distance of toes from wall - ankle fully dorsiflexed, knee against the wall
Name the weight-bearing active movements that need to be done (6)
PF
DF
Sup
Pron
Toe ext.
Toe flex.
Name the non weight-bearing active movements that need to be done (8)
PF
DF
Sup
Pron
Toe ext.
Toe flex.
Toe ADD
Toe ABD
Passive NWD movements that need to be done at foot
Talocrural DF/PF
Subtalar In/Ev
Mid-Tarsal ADD/ABD
Toe F/E + ADD/ABD
Resisted movements that need to be done at the foot
Knee flexion
PF/DF
Sup/Pron
Toe F/E
See p.67 for cross section
Motion diagram of the ankle
Special tests for ligament laxity (3)
Ant/Post. drawer
Kleiger
Squeeze test
What ligament does anterior drawer tests
ATF
What is injured for a positive test of Kleiger’s test
Can be HAS or deltoid lig. sprain
What is injured for a positive test of squeeze and bump test
Syndesmosis injury
Which special test testes for laxity of medial and lateral ligaments
Talar tilt
What is the buerger’s test
Circulatory - testing arterial blood supply
- Leg elevation (45°) = draining of blood
- Sitting over edge - return of blood longer than 2 minutes = +
Nerve test for upper motor lesion
Babinski
Nerve test - reflexes (2)
Achilles tendon
Tibialis posterior
Nerve test - Tinel’s sign
Tap test on 3 nerves
What is the tarsal tunnel syndrome
Compression of tibial nerve resulting in tightness in Tom, Dick and Harry or ABD
What are the joint play (7)/
Long axis extension
AP/PA glide
Talar rock
Side tilt
Rotation
Side glide
Tarsal mobility