S3_L4: Ankle and Foot Flashcards by Mind Med

What is the direction of arthrokinematics during OKC
Dorsiflexion?

Roll Anteriorly, Glide Posteriorly

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What is the direction of arthrokinematics during CKC
Dorsiflexion?

Roll and Glide Anteriorly

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What is the direction of arthrokinematics during CKC
Plantarflexion?

Rolls and Glides Posteriorly

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Which muscle provides the most dynamic
stabilization on the medial longitudinal arch?

Tibialis Posterior Muscle

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TRUE or FALSE: Pronation and Supination of the foot during ambulation increases the tension in plantar fascia?

TRUE.

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This is when the plantar fascia tightens up, acting as a guy-wire to make the foot stable and rigid to generate
enough force for push-off

Windlass Effect

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Gout is caused by high levels of _____

uric acid

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The following are associated impairments with plantar fasciitis, EXCEPT:

A. Hypomobile gastrocsoleus muscle
B. Pes Cavus
C. Heel spur
D. Avoids heel-strike during the loading response

B. Pes Cavus

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Where is pain felt in achilles tendinopathy?

midportion of the tendon or at the calcaneal
insertion

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The following are associated impairments with achilles tendinopathy, EXCEPT:

A. Decreased ankle DF
B. Abnormal subtalar ROM
C. Decreased strength in ankle plantarflexion
D. Foot pronation
E. None

E. None

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Determine whether the following ligaments are lateral or medial ligaments of the ankle.

Posterior talofibular ligament
Inferior tibiofibular ligaments
Calcaneofibular ligament
Deltoid ligaments
Anterior talofibular ligament

A. Lateral Ligaments
B. Medial Ligaments

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In the protection phase of an ankle sprain, what is the best intervention scenario?

Primary: Compensatory
Secondary: Preventive

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CASE: D.C. a 21 y/o male has been referred for PT mx 2° Gr. 2 (R) ankle sprain. Condition started 2 years ago when he fell from spike landing during volleyball practice. Pt continued to train and asked for a manghihilot to treat his sprain afterwards. Pain was relieved and pt continued to live normal s difficulties. After 2 months, pt suddenly experienced pain on his (R) lateral malleolus during swimming. Since then, pt reports of pain upon jumping and heavy impact on foot.

Based on the scenario, the following may be used as PT tx, EXCEPT:

A. Cryotherapy on (R) ankle in supine x 15 mins to decrease pain.
B. Cryotherapy on (R) ankle in sitting x 10 mins to decrease pain.
C. HMP on (R) ankle in supine x 20 mins to decrease pain.
D. HMP on (R) ankle in sitting x 20 mins to decrease pain.
E. C & D
F. All of the Above
G. None

G. None

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Based on the scenario, the following interventions are indicated for the pt on the 1st PT session, EXCEPT:

A. Ankle Rotations in clockwise and counterclockwise direction in supine x 10 reps x 3 sets to facilitate ROM
B. Mechanical Resistance using red theraband towards inversion in supine x 10 reps x 3 sets to strengthen ankle
C. Partial wall squats x 6 SH x 10 reps to increase ankle stability
D. Toe raises x 10 SH x 10 reps to increase ankle stability

B. Mechanical Resistance using red theraband towards inversion in supine x 10 reps x 3 sets to strengthen

NOTE: since inversion is MOI, it’s best to stabilize ankle first rather than strengthen it on the 1st session.

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OI > discoloration on ® lateral malleolus
> swelling on anterolateral aspect of ® ankle

Based on the scenario, what is the chronicity of the condition?

Chronic

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Determine which of the following lateral ligaments are first to get injured or sprained.

A. PTFL > ATFL > CF
B. ATFL > CF > PTFL
C. CF > ATFL > PTFL
D. ATFL > PTFL > CF
E. CF > PTFL > ATFL

B. ATFL > CF > PTFL

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What are the risk factors in achilles tendinopathy that makes up the metabolic triad?

obesity, Htn, DM

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What structure tries to prevent the excessive supination of the foot?

Plantar fascia

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Excessive pronation is counteracted by (1-3)___?

Plantar fascia
Tibialis posterior
Intrinsics

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Determine how long is the period of immobilization for each condition:

Tibiofibular syndesmosis or subtalar fusion
Cementless Fixation
Achilles tendon lengthening or ligament repair
No bony fusion or soft tissue repair

A. ~6 weeks
B. >6 weeks
C. ~2-3 weeks
D. 6 weeks

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After ligamental repair, compression dressing &
protective cast is worn. How many days is this usually donned by the patient?

3-5 days Post-op, up to 10 days

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_____ is the close-packed, stable position of the talocrural joint.

Dorsiflexion

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This deformity in the great (large) toe
develops as the proximal phalanx shifts laterally toward
the second toe.

Hallux valgus

Source: Kisner 7th ed p856

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This deformity is characterized by narrowing and eventual
obliteration of the first MTP joint space occur with
progressive loss of extension. This affects terminal stance
by not allowing the foot to roll over the metatarsal heads
and great toe for normal push-off.

Hallux limitus / hallux rigidus

Source: Kisner 7th ed p856

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Match the toe deformity with its corresponding presentation 1. MTP hyperextension, PIP flexion, and DIP hyperextension 2. MTP hyperextension and IP flexion A. Claw toe B. Hammer toe

1. B 2. A

During the normal gait cycle, the ankle goes through a ROM of?

32-35 degrees Note: Approximately 7° of dorsiflexion occurs at the end of midstance, as the heel begins to rise, and 25° of plantarflexion occurs at the end of stance (toe off) Source: Kisner 7th ed p854

In MWM for plantarflexion, which of the ff are the correct: I. Patient position: Supine with hip and knee flexed and heel on the table II. Therapist handling: Contact the patient’s anterior tibia with the palm of your hand III. Motion: passive end-range plantarflexion movement IV. PT produces a pain-free graded anterior glide of the tibia on the talus. A. I and III B. II and IV C. I, II, III D. IV E. All of the above

C. I, II, III

In MWM for dorsiflexion, which of the ff are the correct: I. Patient position: Standing with the affected foot placed on a chair or stool II. Therapist handing: Place the web space of both hands around the neck of the talus with the palms on the dorsum of the foot III. Motion: patient lunges forward IV. PT produces a pain-free graded anterior gliding force to the ankle joint A. I and III B. II and IV C. I, II, III D. IV E. All of the above

E. All of the above

It is a combination of plantarflexion, inversion, and adduction

Supination

It is a combination of dorsiflexion, eversion, and abduction

Pronation

In the closed-chain, weight-bearing foot, supination of the subtalar and transverse tarsal joints with a pronation twist of the forefoot (plantarflexion of the first metatarsal and dorsiflexion of the fifth metatarsal) increases the arch of the foot. This is the ___ position of the joints of the foot.

Close-packed or stable Note: This is the position the foot assumes when a rigid lever is needed to propel the body forward during the push-off phase of ambulation Source: Kisner 7th ed p851

During weight bearing, pronation of the subtalar and transverse tarsal joints causes the arch of the foot to lower, and there is a relative supination of the forefoot with dorsiflexion of the first metatarsal and plantarflexion of the fifth metatarsal. This is the ___ position of the joints of the foot.

Loose-packed or mobile Note: This position is assumed when the foot absorbs the impact of weight bearing and rotational forces of the rest of the lower extremity and when the foot conforms to the ground. Source: Kisner 7th ed p851

TRUE OR FALSE: Anatomically, the superior and inferior tibiofibular joints are separate from the ankle, but they provide accessory motions that allow greater movement at the ankle.

True Source: Kisner 7th ed p851

_____ is the loose-packed position of the talocrural joint

Plantarflexion

TRUE OR FALSE: When a person walks in high heels, the ankle joint is more vulnerable to injury, because the talocrural joint is in a less stable, plantarflexed position while the subtalar and transverse tarsal joints are in a close-packed position.

True Source: Kisner 7th ed p852

TRUE OR FALSE: Frontal plane inversion (turning heel inward) and eversion (turning heel outward) can be isolated with passive and active motion.

False These can be isolated only with passive motion Source: Kisner 7th ed p852

In closed-chain activities, what joint attenuates the rotatory forces between the leg and foot so that, normally, excessive inward or outward turning of the foot does not occur as the foot maintains contact with the supporting surface?

Subtalar / Talocalcaneal joint Source: Kisner 7th ed p852

Determine which of the ff anatomical structures is convex or concave 1. Mortise (distal end of tibia and malleoli) 2. Facet on the bottom of the talus in the posterior compartment 3. Head of the talus 4. Body of the talus 5. Proximal articulating surface of the navicular A. Convex B. Concave

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

TRUE OR FALSE: In the weightbearing foot, subtalar motion and tibial rotation are interdependent.

True Source: Kisner 7th ed p853

Supination of the subtalar joint results in or is caused by what motion of the tibia?

Lateral rotation Source: Kisner 7th ed p853

Pronation of the subtalar joint results in or is caused by what motion of the tibia?

Medial rotation Source: Kisner 7th ed p853

What is the primary support of the arches of the foot?

Spring ligament Note: Additional support is from the long plantar ligament, the plantar aponeurosis, and short plantar ligament Source: Kisner 7th ed p853

What is the phenomenon where during push-off, the foot plantarflexes and supinates and the MTP joints go into extension and increased tension is placed on the plantar aponeurosis, which helps increase the arch of the foot?

Windlass effect Source: Kisner 7th ed p853

A person with a ___ deformity of the calcaneus (observed nonweight bearing) may compensate by standing with a pronated (or everted) calcaneus posture.

Varus Source: Kisner 7th ed p853

With pronated foot posture, what three motions may be seen in the 1. hip 2. knee 3. leg?

1. Internal rotation of the femur 2. Valgus at the knee 3. Internal rotation of the leg Source: Kisner 7th ed p853

What muscle is a strong supinator and invertor that supports the medial longitudinal arch during weight bearing and controls and reverses pronation during the loading response of gait?

Tibialis posterior Source: Kisner 7th ed p853

During normal standing, the gravitational line is anterior to the axis of the ankle joint, creating a dorsiflexion moment. What muscle will then contract to counter the gravitational moment through its pull on the tibia?

Soleus muscle Source: Kisner 7th ed p853

TRUE OR FALSE: During the loading response (heel strike to foot flat), the heel strikes the ground in neutral or slight supination. As the foot lowers to the ground, it begins to pronate to its loose-packed position. The entire lower extremity rotates inward, reinforcing the loose-packed position of the foot.

True Source: Kisner 7th ed p854

During midstance and continuing through terminal stance, the tibia begins to rotate ____, initiating supination of the hindfoot and locking of the transverse tarsal joint. This brings the foot into its close-packed position, which is reinforced as the heel rises and the foot rocks up onto the toes.

Externally Source: Kisner 7th ed p854

A condition commonly affecting the MTP joint of the great toe, causing pain during terminal stance, resulting in decreased stance time and lack of smooth push-off.

Gout Source: Kisner 7th ed p855

TRUE OR FALSE: In joint hypomobility pathologies, passive plantarflexion is more limited than dorsiflexion

True Note: This is unless the gastrocnemius-soleus muscle group also is shortened, in which case dorsiflexion is limited accordingly. Source: Kisner 7th ed p855

What is the most common cause of ankle and foot arthritis?

Trauma Note: Unlike the hip and knee joints, the ankle is rarely affected by primary idiopathic arthritis, even in the elderly Source: Kisner 7th ed p856

For symptomatic stage __ ankle arthritis, ankle arthrodesis and ankle arthroplasty become the most viable surgical options.

3 Note: Arthrodesis is typically performed in younger patients with high functional demands. Source: Kisner 7th ed p859

TRUE OR FALSE: As with replacement of other joints, TAA is contraindicated for the skeletally immature individual.

True Source: Kisner 7th ed p860

What is the most frequently used surgery for late-stage arthritis of the ankle or foot and toe joints?

Ankle arthrodesis (fusion) Source: Kisner 7th ed p865

Following an ankle or hindfoot arthrodesis, the most prevalent practice is to substantially restrict weight bearing for a minimum of ___?

6 weeks Source: Kisner 7th ed p867

Following a midfoot or forefoot arthrodesis, partial to full weight bearing is initiated earlier, either immediately or within the first ___?

4 weeks Source: Kisner 7th ed p867

In most cases of Total Ankle Arthroplasty, full weight bearing is generally achieved by ___ following surgery.

6 weeks Note: Weight bearing is initiated with the leg in an ankle immobilizer. After the initial period of restricted weight bearing, a patient gradually progresses to full weight bearing over several weeks while remaining in the immobilizer. Source: Kisner 7th ed p862

A condition where pain is usually experienced along the plantar aspect of the heel. Pain occurs on initial weight bearing after periods of rest (start-up pain), then decreases, but returns as weight-bearing activity increases.

Plantar fasciitis Note: The plantar fascia inserts on the medial tubercle of the calcaneus Source: Kisner 7th ed p869

Overuse of the ___ muscle is the most common type of shin splint

Tibialis anterior Source: Kisner 7th ed p870

A tight gastrocnemius-soleus complex and a weak or inflamed posterior tibialis muscle, along with increased foot pronation, are associated with ___ shin splints.

Posteromedial Source: Kisner 7th ed p870