Lower Eval Week 4

Question 1

Talocrural Joint Ligaments

Answer 1

Deltoid (tibionavicular, tibiocalcaneal, posterior tibiotalar, anterior tibiotalar)
Anterior talofibular
Posterior talofibular
Calcaneofibular

Question 2

Talocrural Joint Info

Answer 2

Branches of tibial and deep peroneal nerves
Most stable in dorsiflexion
More mobile in plantarflexion
Close packed in dorsiflexion
Capsular pattern more a limitation of plantar flexion than of dorsiflexion

Question 3

Subtalar Joint Ligaments

Answer 3

Lateral talocalcaneal
Medial talocalcaneal
Interosseous talocalcaneal
Cervical

Question 4

Subtalar Joint Info

Answer 4

Gliding and rotation
Hypomobility common post injury
Joint axis is 40-45º vertically and 15-18º sagitally
Close packed position in supination
Routine needs joint mobilization

Question 5

History needs to include

Answer 5

Standing time, foot position, transient or fixed deformity, ability to bear weight, boundaries of pain, effects of change in surface, shoes, socks

Question 6

Observation needs to include

Answer 6

Closed chain position, standing hip and trunk alignment, foot and ankle malalignment, normal toe is 12-18º sagitally, determine if it is functional or structural asymmetry, function is when loaded

Question 7

Index Plus

Answer 7

1>2>3>4>5 Egyptian Foot

Question 8

Index Plus-Minus

Answer 8

1=2>3>4>5 Shared foot

Question 9

Index Minus

Answer 9

1<2>3>4>5 Morton’s Foot

Question 10

Foot Deformities

Answer 10

Hindfoot varus/valgus
Forefoot varus/valgus
Metatarsus Adductus
Pes cavus/planus
Rocker-bottom foot
Splay foot

Question 11

AROM lower extremity

Answer 11

Ankle foot and toes both WB and non WB

Question 12

PROM Lower Extremity

Answer 12

Ankle, foot, and toes
NWB
Test Achilles in calcaneal neutral
Pronation/supination can be tested as combined movement
Tarsal mobility

Question 13

Kaltenborn’s 10 tests for tarsal mobility

Answer 13

1. Fix 2nd and 3rd cuneiform, mobilize 2nd metatarsal
2. Fix 2nd and 3rd cuneiform, mobilize 3rd metatarsal
3. Fix 1st cuneiform, mobilize 1st metatarsal
4. Fix navicular, mobilize 1-3rd metatarsal
5. Fix talus, mobilize navicular
6. Fix cuboid, mobilize 4th and 5th metatarsal
7. Fix navicular and 3rd cuneiform, mobilize cuboid
8. Fix calcaneus, mobilize cuboid
9. Fix talus, mobilize calcaneus
10. Fix talus, mobilize tibia and fibula

Question 14

Functional Assessment

Answer 14

Squat
Stand on toes
Squat with bounce
One leg stance
One leg stance on toes
Running
Agility
Jumping
Jumping into full squat

Question 15

Special Test

Answer 15

Neutral position of talus WB and NWB
Leg-heel alignment
Tibial torsion
Drawer sign
Talar tilt
Leg length
Thompson test
Fibular translation test

Question 16

Clinical Prediction Rules

Answer 16

Ottawa Ankle Rules- Utility Score of 1

Bernese Ankle Rules- Not much published evidence

Question 17

Ankle Sprain Complications

Answer 17

Limited dorsiflexion, need 10º for walking and at least 20º for running
Failure to train eccentric response
Failure to complete rehab
Syndesmosis sprain failing to heal

Question 18

Plantar Fasciitis

Answer 18

Function is to stabilize and lock foot into supination prior to toe-off
Strained by windlass mechanism
Found in rigid and hypermobile feet
Biomechanical abnormalities
Tarsal mobilization is crucial in care
Golf ball best treatment

Question 19

Plantar Fasciitis Injury

Answer 19

Cause- overuse
Pain- plantar foot, anterior calcaneus, worsens w/ walking, running, morning, no pain medial side
Electrodiagnosis- normal
AROM- full
PROM- full
Resisted Isometric- normal 
Sensory deficits- no
Reflexes- normal

Question 20

Tarsal Tunnel Syndrome

Answer 20

Cause- trauma, lesion, inflammation, inversion, pronation, valgus deformity
Pain- medial heel and long arch, worse with standing
Electrodiagnosis- prolonged motor/sensory latencies
AROM- full
PROM- may have pain with pronation
Resisted isometric- may be weakness of intrinsics
Sensory deficits- possible
Reflexes- normal

Question 21

Midfoot Sprains

Answer 21

Lisfranc
Need stabilization of foot
Need intrinsic muscle strengthening
Emphasize normal gait

Question 22

Navicular Fracture

Answer 22

Difficult to diagnose
Can be complete, stress, traction apophysitis
Nonunion is common
Need bone stimulation for healing
Adolescent w/ excessive foot pronation likely to develop traction stress at tibia post navicular

Question 23

Kohler’s Disease

Answer 23

Another name for osteochondritis of the navicular

Look to vitamin D supplementation to support fracture healing in younger athletes

Question 24

Freiburg’s Infarction

Answer 24

Painful avascular necrosis of 2nd or 3rd metatarsal head
Osteochondrosis
Occurs in adolescents or young adults
Caused by running or jumping
Detected by x-ray later shows a flattening of metatarsal head
If caught early can treat with exercise modification, otherwise requires surgery

Question 25

Sesamoiditis

Answer 25

Includes stress fractures
Contusion
Osteonecrosis
Chondromalacia
Osteoarthritis
Local tenderness to medial or lateral sesamoid, localized swelling while WB especially on toes
Requires bone scan to confirm
Treated by unloading the sesamoid
Chronic pain not relieved with conservative treatment
Might require surgical excision
Fractures usual involve the tibial sesamoid

Question 26

Spurs

Answer 26

Talotibial spur creates impingement with dorsiflexion also known as footballer’s ankle
Retrocalcaneal spur causes haglund syndromes, also known as a pump bump

Question 27

Haglund Syndromes

Answer 27

Bursal projection
Retrocalcaneal bursitis
Thickening of Achilles