S2_L3: Ankle and Foot Conditions Flashcards by MindMed Official

TRUE OR FALSE: The ankle and foot complex has 3 sesamoid bones. It has 28 bones in total.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

D. Only the 2nd statement is true

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Subtalar joint is a (1)_______ joint which allows movements of (2)_______ and (3)_____

plane
inversion
eversion

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The following statements are true, EXCEPT:

A. The ankle joint sustains the greatest load per surface area of any joint of the body
B. IP joints of the foot are hinge joints
C. The foot act as a lever in raising and propelling the body forward in walking and running
D. The shafts of metatarsal serve as fulcrum on which weight is lifted
E. None of the above

D. The shafts of metatarsal serve as fulcrum on which weight is lifted

NOTE: It is the head.

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Match the following subdivision of the foot to its proper descriptions.

Adjust to uneven surfaces
Convert the torque of the lower limb
Consists of the 14 bones of the toes
Consists of the 5 metatarsals
The first part of foot that touches the floor

A. Hindfoot / Rearfoot
B. Midfoot
C. Forefoot

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Match the following subdivision of the foot to its proper descriptions.

Transmits motion from the rearfoot to the forefoot
Promotes stability while the forefoot adapts to the terrain
Navicular, cuboid, 3 cuneiform
Talus and calcaneus
Convert the transverse rotations of the lower extremity into sagittal, transverse and frontal plane movements

A. Hindfoot / Rearfoot
B. Midfoot
C. Forefoot

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TRUE OR FALSE: Lisfranc’s joint divides the hind and midfoot.

False.

This is the Surgeon’s joint/Chopart’s joint.

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What is the keystone of the medial arch?

Navicular

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What is the keystone of the lateral arch?

Cuboid

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Which structures comprises the medial arch?

Calcaneus, talus, navicular (keystone), three cuneiform, and 1st 3 metatarsal bones

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Which structures comprises the lateral arch?

Calcaneus, cuboid (keystone), 4th and 5th metatarsals

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Normal longitudinal arch develops by?

3-5 years old (when the child starts walking)

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TRUE OR FALSE: Pes Planus is present in nearly all infants. It does not cause any disability.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A. Both statements are true

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Hypermobile flatfoot is associated with a contracted _____.

Achilles tendon

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What is the most common cause of an acquired flatfoot in adults?

Posterior tibial tendon dysfunction

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Clawing of the toes is characterized by (1)______ of the MTP joints and (2)______ of the IP

dorsiflexion
plantar flexion

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Determine which disease is being described.

Osteonecrosis of the calcaneal apophysis
Common cause of heel pain in children
Avascular necrosis of the metatarsal head
Frequently seen just before or during peak growth
Tenderness and thickening over navicular bone

A. Kohler disease
B. Freiberg disease
C. Sever’s disease

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Determine which disease is being described.

More common in adults
Begins about the 4th-5th year
Unilateral pain worse with activity
Achilles tendon can be removed/avulsed
Due to traction apophysitis and repetitive microtrauma experienced during gait

A. Kohler disease
B. Freiberg disease
C. Sever’s disease

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Syndesmosis ankle sprain is most commonly associated with ______ injuries

external rotation

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A distal tibiofibular syndesmosis includes which ligaments?

anterior-inferior tibiofibular ligaments (AITFL) and posterior-inferior tibiofibular ligament (PITFL)

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Which ligament is the strongest component of syndesmosis?

A. anterior-inferior tibiofibular ligaments (AITFL)
B. posterior-inferior tibiofibular ligament (PITFL)

B. posterior-inferior tibiofibular ligament (PITFL)

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The syndesmosis widens approximately _____mm during normal gait

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TRUE OR FALSE: Lateral ankle sprains are often able to bear weight

True

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An examiner grasps the patient’s leg midway up the calf and perform a compress and release motion.

What test is being done?

Squeeze test

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TRUE OR FALSE: A (-) syndesmosis tenderness is the single best predictor for return to play

True

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What ligament is most commonly involved ligament in low ankle sprains?

anterior talofibular ligament

What ligament is the 2nd most common ligament injury in lateral ankle sprains?

calcaneofibular (CFL) ligament

Determine which injury is being described. 1. difficult to differentiate from posterior ankle instability 2. laxity in dorsiflexion 3. (+) drawer’s test 4. mechanism is dorsiflexion and inversion 5. mechanism is plantarflexion and inversion A. ATFL injury B. CFL injury C. Both D. Neither

1. B 2. B 3. A 4. B 5. A

In Drawer’s test, the examiner places the patient's foot into (1)_____degrees of (2)_____ and translates the rear foot (3)_____

1. 10-15 2. plantar flexion 3. anteriorly

With the ankle in neutral, gentle inversion force is applied to the affected ankle and is compared to the opposite ankle. A + test indicates injury to ATFL and CFL. Which test is being described?

Talar tilt test

The ATFL best tested in (1)____, while the CFL in (2)_____

1. plantarflexion 2. dorsiflexion

The following is true about Achilles Tendon Rupture, EXCEPT: A. Due to degeneration and repeated microtrauma B. Due to a forceful pull of gastrocnemius C. Risk factor: Use of steroids D. Risk factor: Active Lifestyle E. None

D. Risk factor: Active Lifestyle

The following is true about Achilles Tendon Rupture, EXCEPT: A. + Simon’s sign B. + Thomson’s test/ C. + Calf squeeze test D. + Kleiger's Test E. None

D. + Kleiger's Test

What arch is depressed or collapsed in Pes Planus?

Medial arch

Determine which condition is being described. 1. TX: Stretch of heel cord 2. Forefoot abducted and dorsiflex and is not flexible 3. Most common non neuromuscular cause of pathologic pes planus 4. Sole has rocker bottom appearance 5. During adolescence, coalition starts to ossify and restricts subtalar motion A. Hypermobile flatfoot with contracted tendo-Achilles B. Vertical talus C. Tarsal coalition

1. A 2. B 3. C 4. B 5. C

Determine which condition is being described. 1. Union of 2 or more tarsal bones 2. Flatfoot when WB and corrected when patient is on tiptoe 3. seen in arthrogryposis 4. Foot is smaller, not developed and ipsilateral calf circumference is smaller 5. Calcaneus in equinus and valgus, Achilles is tight A. Hypermobile flatfoot with contracted tendo-Achilles B. Vertical talus C. Tarsal coalition

1. C 2. A 3. B 4. B 5. B

Determine which condition is being described. 1. Gastrocnemius contracture 2. Contracture of peroneal muscle 3. Antalgic gait 4. Calcaneus is in equinus while talus is plantarflexed when child stand 5. Rigid flatfoot c convex plantar aspect A. Hypermobile flatfoot with contracted tendo-Achilles B. Vertical talus C. Tarsal coalition

1. A 2. C 3. C 4. A 5. B

This is the progressive loss of the longitudinal arch of the foot resulting in a symptomatic foot

Adult acquired flatfoot

A pt, dx with pes planus, comes in with a chief complain of lateral ankle pain. Upon observation, a fixed valgus is seen. Based on Johnson's classification, in which stage of classification is this included in?

Stage 3

A pt, dx with pes planus, comes in with a chief complain of medial ankle pain. Upon observation, swelling is also palpated Based on Johnson's classification, in which stage of classification is this included in?

Stage 1

A pt, dx with pes planus, comes in with a chief complain of medial and lateral ankle pain. Pt reports of inability to do single heel rise. Based on Johnson's classification, in which stage of classification is this included in?

Stage 2

TRUE OR FALS: The plantar fascia is not contracted in claw foot.

False

In Pes Cavus, is the Achilles tendon shortened?

It may or may not be shortened

TRUE OR FALSE: Pes Cavus is d/t the imbalance of motor power involving the intrinsic and extrinsic muscles of the foot. Its symptoms are fatigue and calluses. A. Both statements are true B. Both statements are false C. Only the 1st statement is true D. Only the 2nd statement is true

A. Both statements are true

This is a disease of the epiphysis that starts with necrosis and fragmentation followed by repair and regeneration.

Osteochondritis

Why is walking or limping painful in pt's with Kohler's disease?

d/t blood supply being diminished

What is the involved structure in Kohler Disease?

navicular

In Freiberg’s infraction, which metatarsal is commonly affected?

2nd

In Sever’s disease, what is expected to be seen or observed during physical examination?

1. tight Achilles tendon 2. + squeeze test

The following is true about gout, EXCEPT: A. usually involves the 1st MTP or great toe B. deposition of lactic acid crystal (hypouricemia) in the joint C. Males > Females D. Hereditary E. None

B. deposition of uric acid crystal (hypouricemia) in the joint NOTE: It is uric acid and hyperuricemia.

This is the most painful and common type of arthritis

Gout

What is the term for gout affecting the 1st MTP joint alone?

Podagra

These are large, visible bumps made of urate crystals seen in the last stage of gouty arthritis.

Tophi of gout

Morton’s toe is also known as?

Interdigital Neuroma

The following is true about Interdigital Neuroma, EXCEPT: A. affecting the web space between 2nd and 3rd followed by 3rd and 4th. B. Characterized by sudden attacks of sharp pain C. Also known as interdigital nerve compression syndrome D. Tx: Metatarsal arch support/pads E. None

A. affecting the web space between 2nd and 3rd followed by 3rd and 4th. NOTE: It usually affects the web space between 3rd and 4th first.

Morton's neuroma is caused by the thickening of the _______ at its bifurcation in the web space

common digital nerve

The following is true about Stress Fracture, EXCEPT: A. AKA March Fracture B. Fracture of metatarsal shaft due to repeated stress from unaccustomed amount of walk C. Can also involved other bones as calcaneus, femur, tibial or fibula D. Pain on the area increasing in a week or more as callus forms E. None

E. None

Which metatarsal does Stress Fracture usually affect?

2nd or 3rd metatarsal

Determine which foot deformity is being described. 1. Medial angulation the great toe at the MTP 2. Associated with enlargement of the medial side of the head of the first metatarsal 3. Cause: paralysis of adductor hallucis 4. Cause: contracture of the flexor and extensor hallucis longus 5. Medial deviation of the first metatarsal bone and lateral deviation of the great toe A. Hallux valgus B. Hallux varus

1. B 2. A 3. B 4. A 5. A

Determine which foot deformity is being described. 1. Close shoes are better worn for this condition 2. Tx: Keller or Schanz Operation 3. Tx: Silver operation 4. Hereditary 5. Tx: osteotomy of metatarsal head and use of the 2nd extensor hallucis brevis in the presence correct alignment A. Hallux valgus B. Hallux varus

1. B 2. A 3. A 4. A 5. B

Determine the toe conditions. 1. flexion contracture of the DIP 2. involves all toes 3. dorsiflexion of the MTP and plantar flexion contracture of the IP 4. due to use of a narrow shoe at the end of the second toe 5. hyperextension of the MTP joint and flexion contracture of both the IP joints A. Hammer toe B. Claw toe C. Mallet toe

1. C 2. B 3. A 4. A 5. B

The following is true about Turf toe, EXCEPT: A. Sprain on the 2nd metatarsophalangeal joint B. Secondary to forceful dorsiflexion or sometimes forceful plantarflexion C. Pain is worse with movement of joint D. TX: Use stiff soled shoes to control plantarflexion E. None

A. Sprain on the 2nd metatarsophalangeal joint NOTE: It involves the 1st MTP

This condition is a fracture of the diaphysis of the shaft of 5th metatarsal bone due to an inversion – plantarflexion injury or due to stress fracture of the area.

Jone’s fracture

TRUE OR FALSE: Jone’s fracture is common in sprinters and jumpers.

True

In Jone’s fracture, where is pain and tenderness expected to be palpated and reported?

Pain - lateral aspect of the forefoot Tenderness - proximal 5th metatarsal bone (lateral)

Determine which condition affecting the ankle joint is being described. 1. s/sx: skin irritation like skin erythema and focal swelling 2. failure of the lateral tubercle of the posterior process to unite with the body of the talus during ossification 3. chronic inflammation of the adventitious superficial pretendinous Achilles bursa 4. developmental and aggravated by gout 5. produces impingement between tibia and talus with extreme plantar flexion A. Haglund deformity B. Os Trigonum

1. A 2. B 3. A 4. A 5. B

Determine which condition affecting the ankle joint is being described. 1. Excessive prominence of the posterosuperior aspect of the calcaneus 2. Coexists with retrocalcaneal bursitis 3. Developmental and aggravated by shoe wear 4. Pain on the posterolateral of the ankle 5. Common in young athletes who actively plantar flexes the foot such as gymnasts, ice skaters, ballet dancers, soccer players A. Haglund deformity B. Os Trigonum

1. A 2. A 3. A 4. B 5. B

The following is true about Plantar Fascitis, EXCEPT: A. women > men B. overuse leads to microtears in the origin of the plantar fascia C. first line therapy: modalities D. second line of treatment shock wave therapy E. None

A. women > men NOTE: It affects men and women equally

The following is true about Tarsal Tunnel Syndrome, EXCEPT: A. compressive neuropathy caused by compression of the sural nerve B. intermittent paresthesias and numbness in the plantar foot C. may present as part of the “heel pain triad” D. due to loss of static and dynamic stabilizers of the medial arch and subsequent traction neuropathy E. None

A. compressive neuropathy caused by compression of the sural nerve NOTE: The tibial nerve is compressed

Enumerate the "heel pain triad".

1. posterior tibial tendon deficiency 2. plantar fascitis 3. tarsal tunnel syndrome

The following are contents of the tarsal tunnel, EXCEPT: A. flexor retinaculum B. calcaneus C. talus D. adductor hallucis E. abductor hallucis

D. adductor hallucis

The following structures form the posterior tarsal tunnel, EXCEPT: A. tibialis posterior tendon B. posterior tibial artery and vein C. FDL tendon D. tibial nerve E. AHL tendon

E. AHL tendon

(1)____ and (2)_____ of the ankle and foot act as stabilizers and adapt during weight bearing activities

1. joints 2. ligaments

How many arches does the foot have?

Enumerate the arches of the foot.

1. Medial arch 2. Lateral arch 3. Transverse or metatarsal arch

Which arch is formed by the 5 metatarsal bones and most prominent at their bases? A. Medial arch B. Lateral arch C. Transverse arch

C. Transverse arch

Which arch rests on the first metatarsal and calcaneus A. Medial arch B. Lateral arch C. Transverse arch

A. Medial arch

In this condition, the stretch of the triceps surae exacerbates heel pain. Which condition is this? A. Sever’s disease B. Freiberg disease C. Kohler disease

A. Sever’s disease

Which toes is most commonly affected in hammer toe?

2nd toe

Enumerate the four plantar foot muscles that originate from the volar calcaneus.

1. Abductor hallucis 2. Quadratus plantae 3. Flexor digitorum brevis 4. Abductor digiti minimi

An Achilles Tendon Rupture is classifies as acute if the tendon is?

partially torn

TRUE OR FALSE: In Achilles Tendon Rupture, a painful pop on the distal aspect of the heel cord is felt. Other observable s/sx is a weak ankle plantarflexion. A. Both statements are true B. Both statements are false C. Only the 1st statement is true D. Only the 2nd statement is true

A. Both statements are true

Determine if the ligaments are found medially or laterally. 1. posterior talofibular ligament 2. calcaneofibular ligament 3. deltoid ligament A. Lateral B. Medial

1. A 2. A 3. B

Positive test in results of a Drawer's test are often graded on a ________.

0 to 3 scale

A.D. was dx with GrII low ankle sprain. As a physical therapist, what is the expected grading of pain during weight bearing?

Mild

A.D. was dx with GrIII low ankle sprain. As a physical therapist, what is the expected classification of ecchymosis and swelling?

Severe

A.D. was dx with GrI low ankle sprain. As a physical therapist, will there be a ligament disruption? If so, describe the severity.

None