OSPE - Ankle osteoarthritis

Question 1

How would you test the patient’s balance?

Answer 1

Timed Up and Go
- patient begins seated
- walk 3 metres, turn around and sit back down
- time stops when they have sat back down
Longer than 14 seconds = high risk of falls

Question 2

What walking aid would you prescribe and describe the correct gait

Answer 2

Frame; (Increase BoS, increases the balance)

• check ferrules and soundness of frame
• measurement = level with ulna styloid
• 3 point = frame, bad foot, good foot
• NEVER ATTEMPT STAIRS

Question 3

How would you measure ROM at the ankle?

Answer 3

Small Goniometer;
- the patient sits on plinth with foot overhanging
- axis on the lateral malleolus
- moving arm is parallel to 5th metatarsal
- stationary arm parallel to fibular
COMPARE WITH GOOD ANKLE

Question 4

What pulses can be found in the ankle?

Answer 4

Pedal pulse: Found on top of your pulse in the space for the first metacarpal. Between the 1st and 2nd metatarsal.
Posterior tibial pulse: Between the medial malleolus and the Achilles tendon insertion point

Question 5

Name the main muscle involved in dorsiflexion, and give the origin and insertion

Answer 5

Tibialis anterior
Origin: lateral condyle of the tibia
Insertion: medial cuneiform by tendon

Question 6

Name the 3 main muscles involved in plantar flexion, and give the origin and insertion for each

Answer 6

Gastrocnemius
Origin: by 2 heads from medial and lateral condyles of femur
Insertion: posterior calcaneus via calcaneal tendon
Soleus:
Origin: superior tibia, fibula
Insertion: posterior calcaneus via calcaneal tendon
Plantaris:
Origin: posterior femur
Insertion: via long thin tendon into calcaneus

Question 7

What is the prime mover of foot inversion, state the origin and insertion

Answer 7

Tibialis posterior
Origin: superior tibia and fibula
Insertion: tuberosity of the navicular, base of 2nd, 3rd and 4th metatarsals

Question 8

Name 2 muscles involved in plantar flexion and inverting the foot and state the origin and insertions

Answer 8

Flexor digitorium longus
Origin: posterior tibia
Insertion: distal phalanges of 2nd--> 5th toes
Flexor hallucis longus
Origin: midshaft of fibula
Insertion: distal phalanx of great toe

Question 9

How do you palpate the talocrural joint?

Answer 9

The horizontal line across anterior surface of the ankle. 2cm above tip of lateral malleolus

Question 10

How do you palpate the peroneal tubercle?

Answer 10

Bony point inferior and anterior to tips of lateral malleolus

Question 11

How do you palpate the tuberosity of navicular?

Answer 11

Anterior to the medial malleolus

Question 12

How do you palpate the sustentaculum tali and spring ligament

Answer 12

Place your thumb on the medial aspect of the calcaneus. With gentle pressure, slide your thumb dorsally until you feel the ledge forming the sustentaculum tali.
Spring ligament connects the sustentaculum tali to the navicualr. Found on the medial side of the foot, distal to the calcaneus.

Question 13

How do you palpate the cuboid bone?

Answer 13

Posterior to the base of the 5th metatarsal

Question 14

How do you palpate the head of the talus?

Answer 14

Below medial malleolus (everted)

Anterior of the lateral malleolus (inverted)

Question 15

Locate the deltoid ligament

Answer 15

Composed of 4 ligaments, from the medial malleolus.
Tibiocalcaneal ligament
Tibionavicular ligament
Posterior tibiotalar ligament
Anterior tibiotalar ligament

Question 16

Name and locate the lateral ligaments of the foot.

Answer 16

All originate from the lateral malleolus.
Calcaneofibular ligament
Posterior talofibular ligament
Anterior talofibular ligament