physical examination of ankle and foot Flashcards by Jock Quartermain

Anterior talofibular ligament sprain

MOI- PF AND INVERSION

localised pain and swelling
positive anterior draw test
Increase ROM/ decrease strength and balance

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calcaneofibular ligament sprain

Usually with ATFL

localised swelling
positive talar tilt test

increase rom
DECREASED STRENGTH
and balance

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posterior talofibular ligament sprain

it is rare

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ATFL MOI

HYPER DF
ER with axial load

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physical exam of the ATFL

swelling above TC joint
pain with WB DF
ER stress test
Dorsiflexion compression test

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Ottawa ankle rules

pain in malleolar region
bone tenderness- posterior edge/ tip of lateral malleoulous or posterior edge or tip of medial malleolous
inability to weight bear immediatly for 4 steps

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ottawa foot rules

pain in mid foot
bone tenderness in navicular
bone tenderness in base of 5th meta
inability to WB for 4 steps

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osteochondral lesion talar dome

compressive compartment
usually supermedial talar dome

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osteochondral lesion of talar dome exam and interview

usually 4-6 weeks
progressive pain/ stiff/ swelling
catching and locking
Decreased ROM

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medial ligament sprains

less common
MOI= forced eversion

TALAR TILT TEST

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FRACTURES OF TALUS AND CALCAENUS

MOI- force PF/ force

TOP anterior and inferior to lateral malleous

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fractures to calcenus

TOP anterior to opennin of sinus tarsi

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Tendon rupture peroneals

MOI- forced passive DF
peroneal retianculum ripped off lateral malleous
subluxation

TOP peroneal tendon

POSITIVE peroneal subluxation test

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tib posterior tendinopathy

overuse
general health- RA/ Serongative arthropathy

TOP posteriormedial to malleolous/ insertion navicular tubercle
exercessive pronation
pain resisted inversion

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tendinopathy flexor hallucis longus

overuse
shoes too big= grip with toes

pain with resisted toe flexion
pain in toe off

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tarsal tunnel syndrome

entrapment of posterior tibial nerve at medial malleolous

overuse= excessive pronation
trauma

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tarsal tunnel syndrome interview and exam

burning/ tingle/ numbness
pain with activty

altered senation along arch of foot
swelling and thickining
ganglion cyst
straight leg raise bias tibial nerve

don’t miss ankle

navicular stress fracture

complec regional pain syndrome
burning pain/ pain felt worse/ stiff/ changes to hair, nails, skin, temp changes

peroneals teninopathy

inversion ankle sprain
overuse
eversion
excessive loading

TOP
may swell
pain with resisted Eversion

anterolateral impingenemnt ankle

minor ankle sprains
pain anterior aspect of lateral malleolous
catching sensation
TOP
ROM DF combined with eversion will increase pain

anterior impingement interview and exam

vague discomfort
aggrivated by DF
stiff

tender
exostoses- bone spur
df restricted by pain
anterior impingment test

achilies tendiopathy

collagen degeneration
absent inflammatory cells

achilles teninopathy interview and exam

warm up
tendon overload- single episode
over tie

exam pain with resisted PF
TOP along tendon
Crepitus

intrinsic factors of achilles tendinopathy

central adiposity in males
peripheral adiposity in females
increased BMI
hypercholestroaemia
diabetes
genetic
old age

extrinsic factors of achilles tendin

recent changes in load activities involving high energy

achilles tendinopathy insertional exam and interview

excessive DF aggreavated by DF soft tissue swelling either side of tendon if bursitirs is present

midportion vs inerstional achilles tendinopathy

hop on toes- mid portion hop- lunge to DF- insertional

posterior impingement

secondary to PF/INV sprain posterior pain in extreme PF

achilles tendon rupture

acute incident audible snap/ tear obvious lump uNABLE TO WALK ON TOES palpable gap positive thompson test

severs disease

achilles insertion traction on calcaneal growth plate activie related pain local pain tight calf and restricted DF

plantar heal pain

plantarfacitis inflammatory response to plantar apponeurosis worse at am then pain will decrease more serve with WB worsens with activty acute tenderness medial tub of calcaneus windlass test- passive big toe extension

fat pad contusion on heal

its compressed acts as a shock absorber inferior lateral heel pain increased pain with wb MAY BE RED TENDERNESS posteirorinferior lateral heel

calcaneal stress fracture

insidous onset on pain weight bearing localised tenderness pain reduced by squeezing posterior aspect of calcaneus on both sides

navicular stress fracture

overuse spike in training insidious onset pain don't heal well

bifurcate ligament sprain

low ankle sprain negative anterior draw test pain with inversion, PF, adduction swelling over EDB

LISFRANC joint sprain

articulation of cuneiform and cuboid with metatarsals

stress fracture metatarsals

overuse weight bearing gastroc fatigue pronating foot 5th is most common- avulsion

MTP synovitis

exceesive pronation clawing/ hammar toes tight extensor tendon gradual onset pain with weight bear passive forced flexion of toe agg MET SQUEEZE TEST

First MTP SPRAIN

forced toe extension swelling weiaght bearing pain

hallux limitus

restriction of DF due to exostoses or OA trauma excessive pronation RA deep ache shoe sole wear limited joint DF

haluc valgus

moves into the other toes bony developments compression