Osteopathic Testing of the Foot and Ankle OSCE Flashcards
what makes up the medial longitudinal arch?
- talus
- navicular
- cuneiforms 1-3
- metatarsals 1-3
what makes up the lateral longitudinal arch?
- calcaneus
- cuboid
- metatarsals 4-5
what makes up the transverse distal tarsal arch?
- navicular
- cuboid
- cuneiforms 1-3
- proximal metatarsals
where is the deltoid ligament and what is its job?
- over medial malleolus
- primary stabilizer of medial ankle
what ligament is harmed in an inverse ankle sprain most often?
-anterior talofibular ligament
“Always Tears First”
What 3 tendons pass through the tarsal tunnel?
Tom, Dick, Harry
- Posterior Tibialis Tendon
- Flexor Digitorum Longus tendon
- flexor hallucis longus tendon
ROM for dorsiflexion of ankle
15-20 deg
ROM for plantar flexion of ankle
50-65 deg
ROM for inversion of ankle
35 deg
ROM for eversion of ankle
20 deg
what motions make up supination?
- plantar flexion
- ADduction
- inversion
what motions make up pronation?
- dorsiflexion
- ABduction
- eversion
what muscles of the ankle are dorsiflexors and what are the nerves?
- anterior compartment
1. tibialis anterior m
2. extensor hallucis longus m
3. extensor digitorum longus m
-deep peroneal/fibular n
what muscles of the ankle are plantar flexors and what are the nerves?
- posterior compartment
1. gastrocnemius m
2. soleus m
3. flexor hallucis longus m
4. flexor digitorum longus m
5. tibialis posterior m
-tibial nerve
what muscles of the ankle are everters and what are the nerves?
- lateral compartment
1. peroneus (fibularis) longus m
2. peroneus (fibularis) brevis m
-superficial peroneal/fibular n
g. Perform the anterior/posterior lateral malleolus (distal fibula) evaluation of the ankle joint for somatic dysfunction and document appropriately.
- Doctor standing at side of table and patient supine with knee flexed and foot flat on table.
- Doctor contacts the lateral malleolus (distal fibula) with the thumb and index finger of one hand
- Doctor slowly applies an anterior then posterior force to assess for gliding motion of the lateral malleolus (distal fibula) with the tibia.
- Doctor notes if there is asymmetry between anterior and posterior glide.
- Doctor notes an ease of anterior glide with posterior glide restriction defines an anterior lateral malleolus (distal fibular) somatic dysfunction
- Doctor notes an ease of posterior glide with anterior glide restriction defines a posterior lateral malleolus (distal fibular) somatic dysfunction
- Doctor notes an anterior or posterior lateral malleolus (distal fibular) somatic dysfunction will be documented in the objective portion of the chart with the side of laterality noted.
h. Perform the talus evaluation of the foot joint for somatic dysfunction and document appropriately.
-Doctor is standing at the foot of the table with the patient in a supine position.
-Doctor contacts the foot and applies a passive force to place the ankle into dorsiflexion and
states 15‐20 degrees expected range of motion.
-Doctor contacts the foot and applies a passive force to place the ankle into plantar flexion
and states 50‐65 degrees expected range of motion.
-Doctor states the motion is occurring between the talus and the tibia/fibula.
-Doctor states a talus plantar flexion dysfunction is defined as ease of motion to plantar
flexion and restriction to dorsiflexion.
-Doctor states a talus dorsiflexion dysfunction is defined as ease of motion to dorsiflexion
and restriction to plantar flexion.
-Doctor states a talus dorsiflexion or plantar flexion somatic dysfunction would be
documented in the objective portion of the chart with the side of laterality noted.
i. Perform the calcaneus evaluation of the foot joint for somatic dysfunction and document appropriately.
-With the patient in a supine position, the doctor is standing at the foot of the table placing the ankle in a standing posture position (dorsiflexion, 90 degree angle between tibia and foot) to avoid excess laxity in the subtalar joint.
-Doctor contacts the calcaneus and applies a passive force to place the calcaneus into inversion, noting 35 degrees expected.
-Doctor contacts the calcaneus and applies a passive force to place the ankle into eversion, noting 20 degrees expected.
-Doctor states the motion is occurring between the talus and the calcaneus (subtalar joint).
-Doctor states a calcaneus inversion dysfunction is defined as ease of motion to inversion
and restriction to eversion.
-Doctor states a calcaneus eversion dysfunction is defined as ease of motion to eversion and
restriction to inversion.
-Doctor states a calcaneus inversion or eversion somatic dysfunction would be documented in the objective portion of the chart with the side of laterality noted.
j. Perform the navicular evaluation of the foot joint for somatic dysfunction and document appropriately.
- With the patient in a supine position, the doctor is standing at the foot of the table
- Doctor contacts the navicular bone with the thumb and index finger.
- Doctor applies a passive force to place the navicular into dorsal and ventral gliding motion.
- Doctor states the motion should demonstrate symmetry in the glide range of motion
- Doctor states a dorsal navicular dysfunction is defined as ease of motion to dorsal glide and restriction to plantar glide.
- Doctor states a plantar navicular dysfunction is defined as ease of motion to plantar glide and restriction to dorsal glide.
- Doctor notes more common to have a plantar glide dysfunction.
- Doctor states a navicular dorsal or plantar glide somatic dysfunction would be documented in the objective portion of the chart with the side of laterality noted.
k. Perform the cuboid evaluation of the foot joint for somatic dysfunction and document appropriately.
- With the patient in a supine position, the doctor is standing at the foot of the table
- Doctor contacts the cuboid bone with the thumb and index finger.
- Doctor applies a passive force to place the cuboid into dorsal and ventral gliding motion.
- Doctor states the motion should demonstrate symmetry in the glide range of motion
- Doctor states a dorsal cuboid dysfunction is defined as ease of motion to dorsal glide and restriction to plantar glide.
- Doctor states a plantar cuboid dysfunction is defined as ease of motion to plantar glide and restriction to dorsal glide.
- Doctor notes more common to have a plantar glide dysfunction.
- Doctor states a cuboid dorsal or plantar glide somatic dysfunction would be documented in the objective portion of the chart with the side of laterality noted.
l. Perform the cuneiform evaluation of the foot joint for somatic dysfunction and document appropriately.
- With the patient in a supine position, the doctor is standing at the foot of the table
-Doctor contacts the cuneiform bone with the thumb and index finger.
-Doctor applies a passive force to place the cuneiform into dorsal and ventral gliding motion.
-Doctor states the motion should demonstrate symmetry in the glide range of motion
-Doctor states a dorsal cuneiform dysfunction is defined as ease of motion to dorsal glide and
restriction to plantar glide.
-Doctor states a plantar cuneiform dysfunction is defined as ease of motion to plantar glide
and restriction to dorsal glide.
-Doctor notes more common to have a plantar glide dysfunction.
-Doctor states a cuneiform dorsal or plantar glide somatic dysfunction would be documented
in the objective portion of the chart with the side of laterality noted and numbered 1‐3.
m. Perform the metatarsal evaluation of the foot joint for somatic dysfunction and document appropriately.
-With the patient in a supine position, the doctor is standing at the foot of the table
-Doctor contacts the distal aspect of the metatarsal bone with the thumb and index finger.
-Doctor blocks linkage at the neighboring metatarsals with opposite thumb and index finger
while inducing a dorsal and ventral glide motion.
-Doctor applies a passive force to place the metatarsal into dorsal and ventral gliding motion.
-Doctor states the motion should demonstrate symmetry in the glide range of motion
-Doctor states a dorsal metatarsal dysfunction is defined as ease of motion to dorsal glide
and restriction to plantar glide.
-Doctor states a plantar metatarsal dysfunction is defined as ease of motion to plantar glide
and restriction to dorsal glide.
-Doctor notes more common to have a plantar glide dysfunction.
-Doctor states a metatarsal dorsal or plantar glide somatic dysfunction would be
documented in the objective portion of the chart with the side of laterality noted and numbered 1‐5.
n. Perform the metatarso‐phalangeal evaluation of the foot joint for somatic dysfunction and document appropriately.
- With the patient in a supine position, the doctor is standing at the foot of the table
- Doctor contacts the metatarsal‐phalangeal joint with the thumb and index finger.
- Doctor blocks linkage at the associated metatarsal head with opposite thumb and index finger while inducing motion.
- Doctor applies a passive force to place the joint into dorsiflexion/plantar flexion, adduction/abduction, internal/external rotation motions.
- Doctor states the motions should demonstrate symmetry in the range of motion
- Doctor states a dorsiflexion metatarsal‐phalangeal dysfunction is defined as ease of motion to dorsiflexion glide and restriction to plantar flexion.
- Doctor states a plantar flexion metatarsal‐phalangeal dysfunction is defined as ease of motion to plantar flexion and restriction to dorsiflexion.
- Doctor states an adduction metatarsal‐phalangeal dysfunction is defined as ease of motion to adduction and restriction to abduction.
- Doctor states an abduction metatarsal‐phalangeal dysfunction is defined as ease of motion to abduction and restriction to adduction.
- Doctor states an external rotation metatarsal‐phalangeal dysfunction is defined as ease of motion to external rotation and restriction to internal rotation.
- Doctor states an internal rotation metatarsal‐phalangeal dysfunction is defined as ease of motion to internal rotation and restriction to external rotation.
- Doctor states a metatarsal‐phalangeal dorsiflexion/plantar flexion, adduction/abduction, internal/external rotation somatic dysfunction would be documented in the objective portion of the chart with the side of laterality noted and numbered 1‐5.
Anterior lateral malleolus dysfunction
- Freedom of motion: The lateral malleolus has free anterior glide relative to the distal tibia o
- The distal medial border of the talus is more prominent
- Dysfunction: Anterior lateral malleolus
- Restriction: Lateral malleolus restricted in posterior glide
