Lecture 5 Flashcards
Key structures to consider following injury of the foot and ankle
-talus position
-cuboid position
-navicular position
-base of the 5th
-sesamoid bones
What to look for in terms of talus position
-is it anterior
What to look for in terms of cuboid position
-is it rotated
What to look for in terms of navicular position
-is it rotated or dropped
What to look for in terms of base of the 5th
-tender on palpation
What to look for in terms of sesamoid bones
-pain
Where are the sesamoid bones located
-within flexor hallucis brevis tendons
What is the origin of the plantar fascia
-medial process of calcaneal tuberosity
What is the insertion of the plantar fascia
-proximal aspect of digits
Lateral ligaments of the ankle
-anterior talofibular lig (ATFL)
-calcaneofibular lig (CFL)
-posterior talofibular lig (PTFL)
-anterior inferior tibiofibular lig (AITFL)
-posterior inferior tibiofibular lig (PITFL)
What are the 2 most common ligaments sprained in the ankle
-ATFL
-CFL
Ligaments of the medial ankle
-deltoid ligament
-spring ligament
What 4 ligaments make up the deltoid ligament
-tibionavicular
-tibiocalcaneal
-tibiospring
-tibiotalar
What is the spring ligament also known as
-plantar calcaneonavicular lig
What are the different types of tibiotalar ligaments
-anterior tibiotalar
-posterior superficial tibiotalar
-posterior deep tibiotalar
What makes up tom dick and harry
-tibialis posterior
-flexor digitorum longus
-flexor hallucis longus
When to check
-when looking at medial aspect of foot ankle
What are the movements of tibialis posterior
-plantar flexion and inversion
Deep plantar flexors
-tom dick and harry
What are the movements of the flexor digitorum longus
-plantar flexion and toe flexion
What are the movements of the flexor hallucis longus
-plantar flexion and big toe flexion
What are the movements of the tibialis anterior
-dorsi flexion and inversion
What is the movement of achilles tendon
-plantar flexion
What are the peroneal tendons
-peroneus longus
-peroneus brevis
What is the movement of peroneus longus
-eversion
What is the movement of peroneus brevis
-plantar flexion and eversion
Functional anatomy of the tibialis anterior
-eccentrically lowers the longitudinal arch
Functional anatomy of tibialis posterior
-stabilizer of longitudinal arch
-absorbs weight of step
Functional anatomy of anterior talus
-what happens up the chain
What is an eccentric contraction
-lengthening of the muscle as it contracts
Ranges of motion of the toes
-flexion
-extension
-abduction
-adduction
Joints of the ankle
-tibiotalar joint
-subtalar joint
Ranges of motion of the tibiotalar joint
-dorsiflexion
-plantarflexion
Ranges of motion of the subtalar joint
-inversion
-eversion
What is supination
-combination of plantarflexion, inversion, and adduction
-causes the sole of foot to face medially
What is pronation
-combination of dorsiflexion, eversion, and abduction
-causes the sole of foot to face laterally
What is important when looking at someones arches and looking at pronation and supination
-have them walk
-not just stand
Turf toe MOI
-hyperextension of big toe
Signs and symptoms of turf toe
-swelling
-brusing
-pain
-loss of toe dorsiflexion ROM
-weak hallux flexion
What can turf toe lead to
-can result in instability of 1st metatarsal-phalangeal joint
Treatment of turf toe
-limit hyperextension
-decrease inflammation (ice, massage)
Runners toe MOI
-repeat trauma to end of toe
-(hematoma under nail)
Signs and symptoms of runners toe
-pain and pressure under nail
-discolouration of nail
What toe is runners toe most common in
-big toe
What usually happens in runners toe
-nail usually falls off
How can runners toe be relieved
-drill hole in nail to drain it
How is runners toe caused
-foot sliding in shoe
-tight or loose toe box
-toes rubbing against end of shoe or each other
-running downhill
Prevention of runners toe
-proper shoe fitting
-varied course/terrain
What do sesamoid bones act as
-pulleys
Sesamoiditis MOI
-repeat trauma to ball of the foot
What does sesamoiditis result in
-inflammation of sesamoid bones, FHB tendons and digits
Signs and symptoms of sesamoiditis
-pain over sesamoids
-swelling
-limited big toe extension
-weak/painful flexion
Treatment for sesamoiditis
-rest
-treat inflammation
-padded insoles
Role of the plantar fascia
-shock absorber
-support long arch
How can plantar fasciitis start
-as inflammation and degeneration of the plantar fascia
Plantar fasciitis MOI
-poor biomechanics
-overuse/stress
Signs and symptoms of plantar fasciitis
-tender on palpation medial calcaneus or along longitudinal arch
-pain with first steps in morning
-ankle/toe dorsiflexion pain
What often happens up the chain with plantar fasciitis
-tight achilles
Treatment for plantar fasciitis
-find the cause
-retrain biomechanics
-shockwave
-soft tissue mobility of tight structures
-night splints/orthotics
What is the anatomical term for bunions
-hallux vagus
Signs and symptoms of bunions
-big toe aligns towards 2nd toe
-tender bump medial metatarsal-phalangeal joint
What can bunions be a result from
-genetics
-poor foot mechanics
-tight/narrow footwear
How can bunions be used as a red flag
-they may have excessive pronation causing other issues
-alter how they’e walking
How to progress foot mechanics
-foot balance, eyes open
-single leg hip hinge
How to properly stand on one foot
-abduct toes (maximize feedback from ground)
-stack hip over knee over ankle (athletic position)
-tighten through core chest up
Tendonitis and shin splints MOI
-poor mechanics
-overuse
Common structures affected in tendonitis and shin splints
-peroneal tendons
-tibialis anterior
-tom dick and harry
-achilles
Signs and symptoms of tendonitis and shin splints
-tenderness on palpation over inflamed tissues
-pain with running
-pain with resisted muscle testing or stretch of affected structure
What does tendonitis and shin splints open up potential for
-stress fractures
Treatment of tendonitis and shin splints
-correct foot/lower extremity mechanics
-taping
-proper footwear
-insoles/orthotics
Lateral ankle sprains MOI
-ankle inversion
-can be in neutral, plantar flexion, or dorsi flexion
Possible structures affected in lateral ankle sprains
-ATFL
-CFL
-PTFL
-AITFL
-PITFL
-peroneals
Signs and symptoms of lateral ankle sprains
-pop
-giving out
-swelling
-bruising
-limping
Treatment for lateral ankle sprains
-sideline management
-inflammation
-healing
-return to play
Return to play test for ankle injury
-make them do a big loopy figure 8 hopping
-have them do it tighter and tighter to show more ROM more strength
Medial ankle sprains MOI
-ankle eversion
Possible structures affected in medial ankle sprain
-deltoid lig
-spring lig
-TDH
-navicular position
-fibula fracture
Signs and symptoms of medial ankle sprains
-pop
-giving out
-swelling
-bruising
-limping
Fractures of the ankle and foot
-jones fracture
-metatarsal fracture
-talus
-calcaneus
-fibula
-tib-fib
What should be considered for injury management of fractures
-urgent?
-distal ciculation?
-monitor for shock
-splint and send for x-rays
Surgical management of unstable fractures
-reduction
-fixation
Surgical management of stable fractures
-immobilization
What is a jones fracture
-peroneus brevis avulsion of base of 5th metatarsal
Jones fracture MOI
-inversion sprain
Signs and symptoms of jones fracture
-tender on palpation base of 5th metatarsal
-pain in weightbearing
What to be sure to rule out in jones fracture
-ankle sprain
Talus fracture MOI
–severe ankle sprains
-land from height
-forced dorsiflexion
Signs and symptoms of talus fracture
-vary with severity
-pain with weight bearing
-loss of ROM
Calcaneus fracture MOI
-fall/jump from height
Signs and symptoms of calcaneus fracture
-extreme pain
-unable to weight bear
Fibula fracture MOI
-direct blow
-ankle sprain mechanism
Signs and symptoms of fibula fracture
-vary with severity
What shape does the deltoid ligament make
-triangle
Special tests for the ankle
-drawer sign
-talar tilt
-wedge test
What is drawer sign used for
-ATFL
How to perform drawer sign
-hand over ankle
-hand cupping calcaneus
-try and pull calcaneus away from foot
-no movement should be seen
What is talar tilt for
-CFL
How to perform talar tilt
-same position as drawer sign
-try to tilt foot into plantar flexion and inversion
-see if joint gaps
What is wedge test used for
-AITFL
How to perform wedge test
-stabilize tib fib and push talus from bottom of foot upwards
-pain indicates positive test
