Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK 2 > MSK2 Week 8 > Flashcards

MSK2 Week 8 Flashcards

1
Q

Arthroplasty

A

Prosthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Accelerated rehab for Achilles’ tendon repair

A

Better outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Tarsal tunnel syndrome

A 
Posterior tibial nerve (or med/lat plantar nerve) entrapment as it passes posterior to medial malleolus 
Causes:
Trauma 
Excessive pronation/pes planus 
Tight laced shoes
Local edema/inflammation 
Space occupying lesion (ie tumor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PHP (plantar heel pain)

Objective exam common findings

A 
Pain with palpation of plantar fascia Insertion 
Limited DF ROM 
Higher BMI in non-athletes 
Positive windlass test
Negative tarsal tunnel test 
Positive impaired neurodynamics

Assumes cleared up through lumbar spine
US thickness >4mm at calcaneal attachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms begin 10 min into exercise and resolve 30 min after exercise
Sensory or motor loss
Elevated anterior compartment pressures

A

Exertional compartment syndrome

Tissue Origin: muscle and fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 primary components of CAI

A

Mechanical instability (pathologic instability, impaired arthrokinematics, and degenerative joint changes)

Functional instability (altered neuromuscular control, strength deficits, deficient postural control)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Category 3 red flag

A

Require further physical testing and differential analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PF

A

Ankle or talocrural joint
Sagittal ply
Coronal axis
~50*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Moderate talipes equinovarus intervention

A

Weekly application of plaster casts for ~6 weeks
Denis Brown splinting with feet fixed to brace and progressively turned outward into Valgus for 12 weeks
Use of Denis Brown splint day and night for 3 months, in static position after initial 12 weeks
Straight last or outflare shoes/boots for day wear until 3 years
Semi-rigid orthodics to maintain soft tissue position and length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Grade I lateral ankle sprain

A 
Mild symptoms 
Microscopic tearing of ATFL (anterior talofibular ligament) 
No functional loss or instability 
Recovery time: 2-10 days 
Rarely seen in PT: self treat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Shin pain : treatment

A 
RICE
Flexibility program for GS complex 
Retrain and strengthen inhibited musculature 
Restore CKC DF 
Improve intrinsic foot strength 
Short term: low-dye taping 
Running evaluation and retraining 
Address associated trigger points 
Footwear change if necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Talar chondral repair

A

Chondral defects of talar dome
Requires donor tissue- usually from less weight-bearing of knee (OATS)
Rehab considerations: tissue/osteotomy healing; ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lis Franc Stabilization

A

Tarsometatarsal joints
Fusion- decreased chance of 2nd surgery
Vs
ORIF

6 weeks immobilization
Orthodics not bad idea for support post-op
Slowly regain ROM, flexibility, normalize gait, and improve proprioception and gait.
~6 mo return to sport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Vague, diffuse pain along middle-distal tibia

Worse at beginning of exercise, decreased during training

A

Medial tibial stress syndrome

Tissue Origin: periosteum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

West Point Sprain Grading

Grade II

A

Partial tearing
Moderate/severe swelling
Mild/Moderate joint instability
Partial/Unable WB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Inflammation/infection red flags

A 
Osteomyelitis 
Septic arthritis 
Cellulitis 
Gout 
Ingrown toenail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The talocrural joint has a _____.

The tenon is ___

A

Mortise (rectangular cavity)

Tenon (projection shaped for Insertion into mortise) is Trochlea talus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of MTSS (medial tibial stress syndrome

A 
Improper footwear 
Muscle weakness 
Poor running mechanics
Improper training 
Tight gastrocs 
Weak tibialis anterior/posterior 
Hypermobile or pronated feet 
Excessive supination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hallux Valgus

A

1% adults in US
Incidence increases with age:
3% under 30, 9% 31-60, 16% > 60 yo
Female to male 2:1 to 4:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Achilles’ tendon rupture

A

Chronic degeneration due to inflammation
Forceful, sudden contraction
Audible pop: “who did that?”
Risk factors: cortisone injection; 30-40 year old male

Palpable and/or visual defect 
Gait changes: unable to push off 
Swelling and ecchymosis 
Can PF 2ndary to 2ndary muscles, albeit weak 
\+ Thompson test 
Most treated surgically
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tibialis Anterior Tendinopathy

A

Presentation very similar to MTSS
Overuse due to training or faulty mechanics

Differential diag:
Reproduced w/ resisted testing
Palpation
L4 myotome issue (DF, eversion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Talocrural capsular pattern

A

PF limited more than DF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Subtalar supination: closed chain

A

ER of tibia and fibula

Talar abduction and DF
Calcaneal inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Midfoot is made up of

A

Navicular, cuboid, cuneiforms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Inversion sprain
Stress greatest in _____
_____ rotatory instability

A

Combined INV/PF

Anterolateral rotatory instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Tarsometatarsal joint function

A

Augment transverse tarsal joint function
Position metatarsals and phalanges
Maintain forefoot contact with ground: rotate to adjust forefoot positioning when transverse tarsal joint cannot fully compensate for rearfoot positioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Bones of hindfoot

A

Talus

Calcaneus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Posterior tibialis dysfunction

A

Pain, inflammation along posterior tibialis tendon and sheath - May show anywhere along tendon to plantar aspect of foot
Can have pain with weight bearing, which may ease through day
Gait, push-off deficits
Decreased posterior tibialis length with testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Achilles tendonitis

A

Inflammation of Achilles’ tendon
Overuse/overload
Gradual onset
Decreased flexibility exacerbates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Category 1 red flag

A

Requires immediate medical attention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Severe talipes equinovarus intervention

A

Surgical treatment if non-surgical methods fail
Meticulous soft tissue release of tendons and joint contractions
Post-op the non-op methods are resumed
Semi-rigid orthodics to maintain soft tissue length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Charcot foot

A

Neurogenic arthropathy that affects the joints in the foot.
Rapidly progressive degenerative arthritis that results from neuropathy

Pain perception, motor function and proprioception of foot are severely impaired
Loss of these motor and sensory nerve functions allow minor traumas to go undetected/untreated- leading to laxity, dislocations, bone erosion, cartilage damage and deformity of foot.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Lateral ankle sprain

A

Least stable in loose packed position: PF with inversion

Progression of severity from ATFL to CFL to PTFL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Hallux rigidus/limitus

A

Degenerative Arthrosis 1st MTP
2nd most common great toe disorder
Effects 1/45 over age 50
Most common great toe injury to great toe in athletes
Limited evidence for conservative management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Ankle injury prevention programs are effective at reducing the risk of ankle injuries by ___% in soccer players

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Metatarsalpharengeal joints are ____ joints.

Motions:

A

Condyloid synovial
Extension: body passes over foot during late stance of gait
Flexion: return to neutral from extension
ABD/ADD: grasping; absorb some force on metatarsals as they undergo pronation/supination twist at TMT joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Syndesmotic “High” ankle sprains

A

Rarest sprain
Injury to anterior tibiofibular ligament and/or syndesmosis
Hyper-dorsiflexion
Rotation and PF
Recovery >6 mo
Often surgical candidate
Special test: syndesmotic squeeze, ER stress test, fibular translation test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Pressure sensation exam for diabetic

A

10 g nylon Senses-Weinstein monofilament at a right angle to the skin
Apply pressure until monofilament buckles.
Inability to perceive the 10g of force applied by the monofilament is associated with clinically significant large fiber neuropathy and increased risk of ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

FO were found to be effective in reducing overall _____, but not ___

A

Reduce overall injuries and stress fractures

But NOT with preventing soft tissue injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Differential diagnosis of PHP

A

Systemic conditions- incl neuropathy and inflammatory arthritis
Fat pad syndrome- age related or trauma induced degeneration of fat pad
Tarsal tunnel syndrome- compression and/or stretching of posterior tibial nerve (Tinels and DF/EV tests)
Calcaneal stress fracture- overuse vs insufficiency
Posterior tibialis dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Ankle arthrodesis and arthroplasty rehab considerations

A

Longer recovery after fusion
Risk of nearby joint OA after fusion
NWB: 2-8 weeks
Arthroplasty rehab progression faster than fusion : 4-6 mo respectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

The ___ Ray is the least mobile

A

2nd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Talar ____ component of pronation causes ____ of superimposed __

A

Talar Adduction

Causes IR tibia/fibula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

CAI prevention

A

Closed chain DF
38* tibial shaft angle
9-10 cm knee to wall

Athletes: at least 3 month multi intervention focusing on balance and neuromuscular control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Inversion grade I/II ankle sprain MT/exercise intervention

A 
MT:
Proximal and distal tibial/fibular mobilizations 
Mobilize with movement 
Posterior glide talocrural 
Rear foot distraction 
Eversion mobilization 
Exercise: 
Achilles stretch 3x30 sec (2x day)
Ankle alphabet (2x day) 
Self mobilization TC and ST 3x30 reps 
Maintain activity as tolerated 
Ice and elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

The deltoid ligament has ___ strength. It is comprised of the ___ ligaments

A 
Great tensile strength 
Tibionavicular ligament
Tibiocalcaneal ligament 
Anterior tibiotalar ligament
Posterior tibiotalar ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Assessment for PVD (peripheral vascular disease) in diabetic assessment

A

History: claudication (calf pain after walking a specific distance) relieved by rest. However this is uncommon in people with diabetes due to concomitant neuropathy

Exam: palpate foot for temp (cool in PVD)
Palpate dorsalis pedis pulse, and if absent the posterior tibial pulse

Reactive hyperemia (leg turns bright red when going from elevated position to declining back to ground)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

L4 myotome

A

DF

eversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Talocrural coupling axis

A

Axis shifts slightly with motion

Transverse plane motion of lower extremity changed into frontal plane motion of the foot.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

For patients with chronic ankle instability and limited DF, using talocrural thrust manipulation is superior to DF mobilization with movement

True or false?

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

FO can be used to prevent

A

1st incident of overuse injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Tibialis Posterior tenonopathy etiology and exam

A

tibialis posterior is an anti-pronatory muscle
Pain with AROM and/or MMT
Repetitive stress
Pes planus, hypermobile feet
Irritation at insertion on navicular or behind medial malleoli
Look at resting and dynamic foot posture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Mobility functions of foot

A

Dampening rotations from proximal joints
Flexible enough to absorb shock
Foot conform to terrain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Tibialis Anterior tendonopathy presentation

A 
Will look similar to MTSS 
MMT testing should provoke 
Palpation key 
Be sure to screen lumbar 
Gait and running analysis key
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Deltoid ligament strongly resists

A

Eversion

Side to side movement or rotation of mortise on talus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Effects (potential) of pes planus

A

Overly mobile or flexible foot
Foot may require contraction during stance
Possible decreased push off during gait (foot not a rigid lever during push off)
Increased tibial IR; increased Q angle at knee; potentially altered patellar tracking
Excessive mobility may stress ligaments, tendons, and muscles that control motion of rear foot
Increased magnitude and rate of pronation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

The lateral collateral ligament (ankle) is comprised of __ ligaments. The ____.

A

3 separate bands/ligaments
Anterior talofibular ligament
Posterior talofibukar ligament
Calcaneofibular ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Forefoot made up of

A

Metatarsals and phalanges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Sources of foot stability

A

Wedge shaped mid-tarsal bones
Inclination of calcaneus and 1st MT (med longitudinal arch)
Ligamentous support (incl plantar aponeurosis)
Intrinsic foot muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

High arch

A

Cushioning; less effective shock absorption capability

> 0.3862

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

VINDICATES

A 
Vascular 
Inflammatory/infection 
Neoplasm
Degenerative 
Intoxication 
Congenital 
Autoimmune/Allergic
Trauma 
Endocrine 
pSychological
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Category 2 red flag

A

Require subjective questioning and precautionary exam and treatment procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

The subtalar joint dampens ____ and ___ contact with ____.

A

Dampens rotational forces

Maintain foot contact with supporting surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Plantar heel pain, prevalence and presentation

A

Pain arises from insertion of plants fascia with or without heel spur.
10%
Presentation:
Progressive pain with WB
Especially 1st steps in am
Presenting body athletic and non-athletic populations
Rarely a case of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Grade III lateral ankle sprain

A 
Unstable, multi-ligamentous sprain
Anterior capsule involvement 
Unable to fully WB 
Diffuse edema/tenderness 
Frequent concomitant fracture 
Recovery time: 30-90 days 
Typically managed by ortho first
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Stages of ulcer development

A
  1. Callus formation
  2. Subcutaneous hemorrhage
  3. Breakdown of skin
  4. Deep foot infection with osteomyelitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

DF

A

Ankle or talocrural joint
Sagittal plane
coronal axis
~20*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Eversion of foot

A

Frontal plane
AP axis
Plantar surface away from midline
~10*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

____ is most common cause of Charcot foot. ___% of people with this develop peripheral nerve damage that can lead to Charcot foot.
Onset usually age ____ , patient has been __ for ___ years

A

Diabetes
60-70%
50 years old or older
Has been diabetic for 15-20 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Achilles tendonosis treatment

A

IASTM
Stretching
No NSAIDs, no ice

Eccentric training: 
3 sets of 15 eccentric heel drops 
2x daily 
12 weeks 
It should hurt more when done (+2~3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Foot has ___ bones and ___ joints

A

28 bones

25 joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Ray

A

Functional unit formed by:
(1st-3rd)metatarsal and associated cuneiforms
(4th-5th rays) metatarsals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

The 1st and 2nd rays …

A

Invert/extend and evert/flex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

MT for ankle sprains

Precautions and red flags

A

Acute: avoid increased pain
Severe, grade III sprain
Fracture and syndesmotic injury; Ottawa ankle rules
Screen for associated injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Syndesmotic/High ankle pain usually caused by

A

External rotation

Or forced DF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Sesamoids

A

2 pea sized bones maintained by ligamentous masses in grooves along plantar aspect of 1st MT
Anatomic pulley for flexor hallucis brevis
Protect FHB tendon from WB trauma, which passes through tunnel formed by sesamoids and intersesmoidal ligament joining their plantar surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Talocrural closed/open pack

A

Closed pack: DF

Open pack: PF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Calcaneal Varus

A

Distal segment toward midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

The lateral collateral ligament (ankle) counters:

A

Varus/inversion stresses or

Lateral ankle joint distraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Plantar heel pain and FO

Short, medium and long term research

A

Short and long term: very low quality evidence..DO NOT reduce pain or improve function

Medium-term: moderate evidence FO more effective than sham FO in reducing pain- but no improvement in function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Hip joint ____ May be related to medially facing ____ and patients ___ pain

A

Hip joint IR May be related to

Medially facing patellae and patient’s Knee pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Transverse tarsal joint separates ___ from ___

A

Hindfoot from rearfoot

83
Q

Immobilization after lateral ankle sprain

A

May be indicated in Grade III injuries as well as syndesmotic injuries
Leads to protracted recovery in grade I and II injuries
Protected WB ideal immediately post-injury

84
Q

Chronic ankle instability (CAI)

A

Characterized by residual symptoms that include feelings of giving away and instability as well as repeated ankle sprains, persistent weakness, pain during activity, and self-reported disability

85
Q

For grade I/II ankle sprain, ___ and ___ are both effective; however ____ better

A

Manual therapy + exercise
Home exercise program

Manual therapy + exercise more effective

86
Q

Closed chain talocrural coupling

A

Leg internally rotates, talus glides inward, foot pronation

Leg externally rotates, talus glides upward, foot supination

87
Q

Ultrasound, laser therapy and electro therapy have ____ acute ankle injuries.
____ recommended for return to sport

A

No effect treating acute ankle injuries

Lace-up or semi-rigid brace recommended for return to sport

88
Q

Functions of transverse tarsal joint

A

Transitional link between hindfoot and forefoot
Increases supination/pronation range of subtalar joint
Compensates (within forefoot) for hindfoot positioning
Theoretically enables forefoot to remain flat on ground regardless of hindfoot pronation/supination

89
Q

Talar tilt test tests

A

CFL or deltoid ligament

90
Q

Morton’s Neuroma

A

Pain and paresthesia in interdigital space (typically 2-3 or 3-4) with fibrous entrapment of interdigital Nerve

Conservative management: decompression vs footwear modification, metatarsal pads, MT mobilization, IASTM

Surgical excision if don’t improve (but often return after surgery)

91
Q

Transverse tarsal joint activity: late stance of gait

A

Subtalar and transverse tarsal supination increase stability of stance limb
Bony surface congruent and joints locked in closed-pack position
Locking if joints enable weight transfer to forefoot as foot becomes rigid lever for push off

92
Q

Medial/Eversion sprain

A 
Less common due to decreased eversion ROM and bony architecture 
5-10% of all ankle sprains 
Strong deltoid ligament 
Potential for mortise instability 
Medial malleolar fracture 
Localized pain over deltoid 
Positive eversion (talar tilt) Test
93
Q

Achilles’ tendon repair recovery time

A

boot in PF for 2 weeks, potential for full WB
Limited DF to 0 first 3 weeks
Week 7 wean out of boot, ROM progressed as tolerated
6-9 month recovery
Return to sport 1 year

94
Q

Ankle ligament CPG

Progressive loading/Sensorimotor training phase

A

MT: graded mobilization/manipulation, mobilization with movement
EX: reinforce MT, functional retraining, strength and balance

95
Q

Pain with running, point tenderness, “dreaded black line” on lateral X-ray

A

Tibial or fibular stress fracture

96
Q

Vascular red flags

A 
Acute compartment syndrome 
DVT
Aneurysm 
PVD
Necrosis 
Thrombophlebitis
97
Q

Subtalar pronation: open chain

A

Calcaneus moves on fixed talus/leg

Calcaneus DF, everts, abducts

98
Q

Deltoid ligament
Eversion sprains are ____, ___% of all sprains.
High risk of bony trauma to ____ with eversion sprains.

A

Rare
5-10% of all sprains
Medial malleolus and fibula

99
Q

Fat pad syndrome

A 
Generally degenerates > 40 yrs, after injury or recurrent stress 
Reduced cushioning
Hard training surfaces
PT management may include:
Activity modification 
Doughnuts, heel cups or pads 
Cushioned footwear 
Ice
100
Q

West Point Sprain Grading

Grade III

A

Complete rupture
Severe swelling
Moderate/Severe joint instability
Unable to WB

101
Q

Talocrural coupling

A

Lower leg rotation initiates movement of talus which causes simultaneous motion in all 3 joints.

102
Q

Worse with lumbar tension position (sitting)

A

Lumbar radiculopathy

103
Q

Hallux abductovalgus

A

Medial deviation of 1st metatarsal head in relation to center of body

Types:
Adolescent: familial and may require surgical intervention. Often assoc with hyperpronation of rearfoot
Degenerative: DJD of 1st MT head and base of proximal phalanx

104
Q

Lateral stabilization surgery

A 
When indicated surgical outcomes good 
Brostrom technique, popular, reroutes peroneals 
Immobilize 2 weeks in eversion 
Consider bracing 1st 3 months 
No inversion ROM for 6 weeks 
3-6 month recovery
105
Q

The talocrural joint is a ____ ____ joint.

A

Synovial, modified saddle of hinge

106
Q

Common sequelea

A 
Nerve: superficial peroneal/fibular nerve involvement 
Bony:
Based of5th MT
Spiral fracture of fibula 
Lateral malleoli 
Navicular
107
Q

This joint is “the most congruent joint in the body” with a close fit throughout ROM.

A

Talocrural joint

108
Q

Stability functions of foot

A

Stable BOS for WB

Act as rigid lever for effective push-off during gait

109
Q

4 predictor variables for MT and exercise interventions for inversion ankle sprain

A

Symptoms worse when standing
Symptoms worse in evening
Navicular drop > 5mm
Distal tibiofibular joint hypomobility

110
Q

Custom FO are effective for

A

Painful pes cavus
Rear foot pain in RA
Foot pain in juvenile idiopathic arthritis (JIA)

111
Q

Cuboid syndrome presentation

A

Pain during gait; reduced push-off
Localized pain and tenderness
Pain with passive physiological and accessory motion testing
May or may not show up on imaging.

Differentiate other causes: accessory ossicles, peroneal tendon dysfunction

112
Q

Heel spur present in ___% symptomatic and ___% asymptomatic plantar heel pain.

A

89% symptomatic

39% asymptomatic

113
Q

Lateral ankle reconstruction

Week 6

A

Begin proprioceptive/balance activities
Slide board
Hopping (side to side, front to back, diagonal)
Mini-tramp jogging
Ankle eversion (complete rehab if peroneals essential l)

114
Q

Tarsometatarsal joints are ____ joints, formed by ___ and ____.
AKA _____

A

Planar synovial joints
Distal tarsals and bases of metatarsals
Lisfranc’s joint

115
Q

1st MTP arthrodesis and arthroplasty

A

Arthrodesis: good at reducing pain and avoiding revises. Not good bc lose ROM
10* DF, 15* abduction

Choice of several methods for arthroplasty or re-surfacing. Goal is to maintain ROM and function but none of them are ideal.

Rehab:
Early NWB to allow healing
Gait training while avoiding stressing healing tissues

116
Q

Lateral ankle reconstruction

Weeks 8-12

A

Return to sport/dancing

Can only return if peroneal strength is normal and symmetric with uninvolved limb

117
Q

The transverse tarsal joint acts with the ___ joint

A

Subtalar joint

118
Q

Talonavicular joint is a ____ joint. It Is enhanced by the ____ which functions to ____.

A

Ball-socket joint
Enhanced by spring ligament (plantar calcaneonavicular ligament) which
Supports the joint and the medial longitudinal arch

119
Q

Mild talipes equinovarus intervention

A

Initiation of treatment within 1st few day of life with gentle passive correction of the deformities
Maintenance of correction for a long period and supervision of child until end of growth period

120
Q

Achilles’ tendon repair indications

A

Rupture
Young, active
Not musculotendinous junction - these heal well without surgery

121
Q

Supinates or high arch foot

A

Pes cavus

122
Q

Chronic exertional compartment syndrome etiology and exam

A

Typically anterior
2 year history prior to diag
Common in runners and soccer players
Muscle herniation can be palpated in 40-60%
Neurologic weakness and numbness in respective compartment
Pain comes at predictable periods

Test with Wick catheter before and after treadmill test
Treatment: consider transition to forefoot running

123
Q

Causes of medial tibial stress syndrome (MTSS)

A 
Inappropriate footwear 
Muscle weakness 
Poor running mechanics 
Improper training (hard surfaces, poor dosage) 
Tight gastrocnemius 
Weak tibialis anterior and posterior 
Hypermobile or pronated feet 
Excessive supination
124
Q

Diabetic foot neuropathy

A

Motor: limited joint mobility, postural and coordination deviation
Sensory: decreased protective sensation

Lead to foot deformities, shear and stress pressure…
Lead to callus and contribute to injury and ulcers

Autonomic: diminished sweating, altered blood flow regulation, microvascular dysfunction
Lead to skin fissuring and cracking…ulcer

125
Q

Calcaneal Valgus

A

Distal segment away from midline

126
Q

The middle tibiofibular joint is ____. It ___.

A

Interosseous membrane

Supports proximal and distal joints

127
Q

Calcaneal stress fracture

A

Sudden or gradual onset pain
Typically associated with increase in load > normal bone capacity. Falls/impact
Pain with all weight bearing activities
Exam: pain with…
Calcaneal palpation along medial/lateral aspect
Calcaneal squeeze, percussion

128
Q

Hallux abductovalgus interventions

A 
Strengthen intrinsic muscles 
Manual therapy of foot and ankle
Modify footwear 
Custom orthodics 
Splinting
129
Q

PHP (plantar heel pain) potential underlying factors

A

Pes planus with subsequent overstretch of fascia
Rigid, cavus foot with tight fascia
Sudden increase in frequency, intensity, duration of activity (esp hill or speed work for runners)
Calcaneal spur may develop due to chronic pull of fascia on calcaneus

130
Q

Anterior drawer tests

A

ATFL

Anterior talofibular ligament

131
Q

Lateral ankle reconstruction

Week 4

A

Remove walking boot at 4-6 weeks
Use air splint for protection from weeks 6-8 weeks
Start gentle ROM ankle exercises
Isometric peroneal strengthening
Avoid adduction/abduction of ankle until 6 weeks
Start stationary bike and light swimming

132
Q

Pes planus

A

Flexible flat feet (arch disappears when WB)
Excessive pronation at subtalar joint can depress navicular
Depressed navicular prevents transverse tarsal joint from reversing or supinating to absorb excessive tear foot pronation
Prevents transverse tarsal “counter movement” that would otherwise enable normal WB through forefoot.

133
Q

Cuboid syndrome intervention

A

Manipulation (black snake whip)

134
Q

Subtalar joint closed pack

A

Closed: supination
Locks talocalcaneal joint surfaces
Foot becomes “rigid lever”

135
Q

The distal tibiofibular joint is a ___ joint, between ___ and ___.
It’s ligaments (___) function ___

A

Syndesmosis/fibrous union
Distal fibula and fibular notch PF tibia
Anterior and posterior tibfib ligaments restrict motion and stabilize mortise

136
Q

Arch height and related injuries: Planus

A

Plantar fasciitis
Knee pain
Patellar tendinitis
Stress fractures (2nd/3rd MTs)

137
Q

Ottawa ankle rules

A

Pain in malleolar or midfoot area, and any 1 of the following:
Inability to WB both immediately after injury and in ER for 4 steps
Bone tenderness: distal 6 cm of posterior edge of tibia or tip of medial malleolus
Bone tenderness: distal 6 cm of posterior edge of fibula or tip of lateral malleolus
Bone tenderness: base of 5th metatarsal or navicular

138
Q

Vague, diffuse pain along anterolateral tibia, worse at beginning of exercise
Decreases during training

A

Anterior tibial stress syndrome

Tissue Origin: periosteum

139
Q

Arthrodesis

A

Bone glue/grafts and screws

“Fusion”

140
Q

Functional segments of foot

A

Forefoot
Midfoot
Hind/rearfoot

141
Q

Grade II lateral ankle sprain

A 
Moderate functional loss
Involves ATFL (anterior talofibular ligament) and CFL (calcaneofibular ligament) 
May have initially “walked it off” 
Diffuse swelling/tenderness 
Recovery time: 10-30 days 
Commonly managed in PT
142
Q

PHP (plantar heel pain) “grade A” interventions

A

Manual therapy

Stretching
Target: plantar fascia, gastroc/soleus
Short term relief

Taping
Antipronation (low-dye)
Short term benefit (~48 hrs)
May benefit early in care to ease pain/restore function

Foot orthoses- potentially useful to those who respond favorably to taping

Night splints- 1-3 mo for those w/consistent 1st step pain

143
Q

Pronated or flat foot.
Decreased or absent medial longitudinal arch
Talus depresses navicular and minimizes potential for transverse tarsal counter rotation to offset subtalar pronation

A

Pes planus

144
Q

PHP interventions (non grade A)

A

Physical agents
Therapeutic exercise
Trigger point dry needling

145
Q

Achilles tendonosis

A 
Chronic in nature 
Hypovascular zone 2-6cm from Insertion 
May present crepitus 
Often lack of CKC DF 
Thickening of Achilles’ tendon 
Tight, painful gastroc/soleus with TPs 
Painful resisted PF

Anti-inflammatories don’t work

146
Q

Post-op hallux Valgus priorities

A

Bone healing
Great toe extension
Gait training
Neuromuscular re-education

147
Q

The 4th and 5th rays

A

Evert/extend and invert/flex

148
Q

Subtalar supination: open chain

A

calcaneus moves on fixed talus/leg

Calcaneus PF, inverts, adducts

149
Q

There are ___ Tibiofibular joints: _____.

A

3
Proximal
Middle/interosseous
Distal

150
Q

Tib-fib posterior support muscles

A

Posterior tibialis

Popliteus

151
Q

The ___ joint of the transverse tarsal joint, is more restrictive motion, and the ___ ligament functions to ____

A

Calcaneocuboid joint

Long plantar ligament supports the lateral longitudinal arch

152
Q

Indications for ankle/foot surgery

A

Pain
Loss of function
Instability

153
Q

Bones of midfoot

A

Tarsals: cuneiforms 1-3, cuboid, navicular

154
Q

Tarsal tunnel syndrome etiology and exam

A

Aka: posterior tibial neuritis
Lesion to posterior tibial nerve in flexor retinaculum : entrapment or traction; behind medial malleoli
Analogous to carpal tunnel syndrome

Indirect trauma: running on hard surfaces, or poor fitting shoes; overpronation

Localized swelling (sometimes) 
Medial ankle and heel pain 
Positive sensory loss to medial heel
\+ Tinel’s sign 
Possible adverse neural tension
155
Q

The ____ joint has a risk for delayed or nonunion fracture.

A

Talocrural joint

156
Q

Subtalar pronation: closed chain

A

IR of tibia and fibula

Talar adduction and PF
Calcaneal eversion

157
Q

Acute lateral ankle sprain testing

A

Anterior drawer: tests for ATFL - better diagnostic accuracy 5 days post-injury compared to 2 days post-injury

Talar Tilt Test

158
Q

The talocrural joint is wider ____.

It is a ___ joint, with ___ muscular attachment.

A

Anteriorly
Uniaxial Oblique hinge joint
No muscular attachments

159
Q

Subtalar capsular pattern

A

Varus limited more than Valgus

160
Q

5 pillars: prevent foot problems in diabetes

A
  1. Identify high risk patient
  2. Regular inspection/examination of foot and footwear
  3. Education of patient, family and health providers
  4. Appropriate footwear
  5. Treatment of non ulcerative pathology
161
Q

Calcaneal apophysitis - Sever’s disease, signs/symptoms and management

A 
Antalgic gait- heel pain during walking/running 
Swelling 
Localized pain/tenderness 
\+ AROM/PROM test for tight Achilles 
(Children)

Initial- restrict DF by elevating heel
Will resolve when apophysis closes
Modification of activity level
Non-irritating stretching if GS complex

162
Q

The transverse tarsal joint is comprised of the

A

Talonavicular joint and
Calcaneocuboid joint

Midtarsal joint - Chopart joint

163
Q

Cuboid syndrome

location, mechanism, prevalence

A 
Pain plantar region of cuboid 
Mechanism: forceful contraction of peroneus longus with plantar subluxation 
Prevalence: 
Dancers 17% of foot/ankle injuries 
Athletes 4% of foot injuries 
Lateral ankle sprains 7%
164
Q

Shock-absorbing insoles …

A

Not effective for prevention of any injuries

165
Q

Inversion of foot

A

Frontal plane
AP axis
Plantar surface moves toward midline
~20*

166
Q

Tarsal tunnel syndrome exam

A

Burning, N/T in medial ankle and/or plantar foot
Plantar foot paresthesia
(+) Tinnels to Posterior tibial Nerve w/ simultaneous DF/EV and toe extension
MMT changes (rare)
Max passive ankle EV/DF and MTP/IP extension held 5-10 sec

167
Q

Subtalar joint is a ____ joint with ___ motions ____.

A

Functional synovial joint
Triplanar motions
Posterior, (then tarsal canal) middle, and anterior articulations.

168
Q

Calcaneal abduction

A

Transverse plane
Vertical axis
Distal segment away from midline of body

169
Q

Tarsal tunnel release surgery indications

A

Tarsal tunnel syndrome
Increased motor nerve latency on EMG
Early diagnosis
Identifiable lesion

170
Q

Subtalar joint

Plane, axis, type, normal, capsular pattern

A 
Plane: frontal plane 
Axis: sagittal axis 
Joint type: gliding synovial 
Movement: inversion and eversion 
Normal range: 20* and 10* respectively 
Capsular pattern: increased limitation of inversion, eventual fixation into full eversion
171
Q

____ FO compared to ___ FO caused greater reduction in ___ pain a 6 weeks, but not 1 year f/u

A

Contoured
Flat
Knee pain

172
Q

Infection, ulceration or destruction of deep tissues associated with neurological abnormalities and various degrees of peripheral vascular diseases in the lower limb

A

Diabetic foot

173
Q

Tarsal tunnel release post-op

A 
3 weeks immobilization, NWB 
Tissue mobility (incision, mobilization, gentle nerve guides) 
Progression into DF, and start gait training and functional re-training
174
Q

Diabetic neuropathy

A

History and careful foot exam mandatory to diag neuropathy
Up to 50% of patients with type 2 diabetes have significant neuropathy and are at risk of foot ulcer
Sensorimotor and peripheral sympathetic neuropathy are major risk factors for ulcer

175
Q

The 3rd Ray…

A

Extends and flexes

176
Q

Low arch

A

Motion control; excessive mobility in foot

< 0.3058

177
Q

The proximal tibiofibular joint is ___, and comprised of the ___ and ___.
Motions:

A

Synovial
Fibular head and fibular articulating facet of tibia
Motions: superior and inferior gliding, fibular rotation

178
Q

Non-custom FO appear just as effective (as custom) for

A

JIA (juveniles idiopathic arthritis)
Plantar fasciitis
MTP pain in RA

179
Q

Plantar aponeurosis extends from____ to ____, then via ___ to ___.

A

Calcaneus to plantar plates at MTP joints, via plantar plates to proximal phalanges

180
Q

Pes cavus

A

Increased medial longitudinal arch height
Subtalar and transverse tarsal joints excessively supinates
Rearfoot varus
Potential ER stress on leg
Rigid or flexible

181
Q

Diabetic foot…
___% of all non-traumatic lower limb amputation
___% of diabetic related foot amputation are preceded by foot ulcer
__ our of ___ ulcers in diabetics are precipitated by trauma
___% prevalence of foot ulcers in diabetics

A

40-60% of all non-trauma lower limb amputations
85% preceded by ulcer
4 out of 5 precipitated by trauma
4-10% prevalence of foot ulcers in diabetics

182
Q

Rigid pes cavus

A

Increased loading on lateral structures

Less effective shock absorption capacity

183
Q

Endocrine red flags

A

Diabetes
Gout
Vitamin D deficiency

184
Q

Ankle ligament CPG

Acute/Protected Stage

A

Manual therapy for lymph drainage, edema reduction, pain-free soft tissue and joint mobilizations.

Exercise: reinforce MT; appropriate for stage and goals

185
Q

The at-risk foot

A

Deformities s/b accommodated in properly fitting footwear
Clawed toes need wide, deep, soft toe box to reduce pressure on dorsum of toes. Extra depth shoes to protect apices of toes
Prominent metatarsal heads: extra depth stock shoe with cushioning insole

Callus: most important pre-ulcerative lesion. S/b regularly and sufficiently removed by trained pro with a scalpel

Dry skin/fissure: treat with emollient, reduce fissure margins with scalpel

186
Q

Arch height and related injuries: Cavus

A

Plantar fasciitis
Ankle INV sprains
ITBS
Stress fractures (5th MT)

187
Q

Subtalar joint maintained in WB, pronation imposes ___ force of leg that can affect ___

A

IR force

Knee and hip

188
Q

Subtalar joint open pack

A

Midway between pronation and supination, and 10* talar PF

189
Q

The ___ is typically stronger than the ankle lateral collaterals or distal fibula

A

Distal tibiofibular joint

190
Q

Medial tibial stress syndrome

A

Inflammatory, traction event on tibial aspect of leg: common in runners
Tightness/tenderness, throbbing along tibial crest that comes on with activity and settles with rest

More accurately named: medial tibial traction periostitis or medial tibial periostitis

191
Q

Lateral ankle reconstruction Days 0-7

A

Ankle in neutral DF in walking boot and WBAT in boot with crutches
Elevate and use cryotherapy often
Wean crutches at days 7-10 to walking boot only WBAT

192
Q

Talipes Equinovarus

A

Aka “clubfoot”
Incidence: 2 per 1,000; and boys 2:1
Populations: cerebral palsy, cerebral vascular accidents and children (congenital)

Posterior and medial muscles are unduly short. Caps of affected joints become thick and contracted on concave side of deformity.
Soft tissue contracture become progressively resistant to correction as weeks go by before/after birth
2* changes in shape of actively growing bones and involved joints

Frequently associated with internal tibial rotation

193
Q

FO mechanisms

A

Biomechanical change
Shock attenuation
Neurosensory input

194
Q

PHP (plantar heel pain) risk factors

A 
Limited ankle DF 
Runners with PHP had either < 5* DF, or side-side difference of 10* or more 
If 0* or less DF (high high odds ratio) 
Prolonged standing during the day 
Associated with poor shock absorption 
BMI > 30
195
Q

West Point Sprain Grading System

Grade I

A

Microscopic tearing
Minimal swelling
No joint instability
Full/partial WB

196
Q

Increases foot stability during MTP extension in push off

A

Plantar aponeurosis

Windlass effect

197
Q

Calcaneal adduction

A

Transverse plane
Vertical axis
Distal segment toward midline of body

198
Q

Peroneal tendonopathy etiology and exam

A

Occurs in sulcus behind lateral malleoli or at cuboid
Overuse or friction
Often after inversion sprain
Can rupture at retinaculum, leading to peroneal subluxation

199
Q

Hindfoot made up of

A

Talus

Calcaneus

200
Q

Anterior shin pain

A

Medial tibial stress syndrome
Tendonopathies: tibialis anterior, tibialis posterior, peroneals
Exertional compartment syndrome

201
Q

____ sprains are 85% of all ankle sprains.
The ____ is weakest and most commonly injured.
The ____ is strongest and least frequently injured

A

Weakest: ATFL (ant talo-fib)
Strongest: PTFL (post talo-fib)

202
Q

Transverse tarsal joint activity: early to mid stance phase of gait

A

During level surface stance, subtalar and transverse tarsal joints each pronate
Enables foot to absorb BW
Subtalar and transverse tarsal pronation absorb shock during early stance
Transverse tarsal then supinates to ensure contact between lateral border of foot and ground
“Counter movement” enables normal WB through forefoot while rearfoot absorbs tibial IR.

203
Q

The ___ is weaker and more commonly injured than the deltoid ligament

A

Lateral collateral ligament

204
Q

Calcaneal apophysitis

A

Sever’s disease
Commonly seen in skeletally immature
Direct trauma (repetitive heel strike during WB activities)
Repetitive traction through Achilles’ tendon
Inflammation of apophysis of calcaneus
Apophysis May fragment

MSK 2 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions