S3_L4: Ankle and Foot Flashcards
What is the direction of arthrokinematics during OKC
Dorsiflexion?
Roll Anteriorly, Glide Posteriorly
What is the direction of arthrokinematics during CKC
Dorsiflexion?
Roll and Glide Anteriorly
What is the direction of arthrokinematics during CKC
Plantarflexion?
Rolls and Glides Posteriorly
Which muscle provides the most dynamic
stabilization on the medial longitudinal arch?
Tibialis Posterior Muscle
TRUE or FALSE: Pronation and Supination of the foot during ambulation increases the tension in plantar fascia?
TRUE.
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
Gout is caused by high levels of _____
uric acid
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
Where is pain felt in achilles tendinopathy?
midportion of the tendon or at the calcaneal
insertion
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
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
- A
- B
- A
- B
- A
In the protection phase of an ankle sprain, what is the best intervention scenario?
Primary: Compensatory
Secondary: Preventive
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
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 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.
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.
OI > discoloration on ® lateral malleolus
> swelling on anterolateral aspect of ® ankle
Based on the scenario, what is the chronicity of the condition?
Chronic
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
What are the risk factors in achilles tendinopathy that makes up the metabolic triad?
obesity, Htn, DM
What structure tries to prevent the excessive supination of the foot?
Plantar fascia
Excessive pronation is counteracted by (1-3)___?
- Plantar fascia
- Tibialis posterior
- Intrinsics
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
- A
- D
- B
- C
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
_____ is the close-packed, stable position of the talocrural joint.
Dorsiflexion
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
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
Match the toe deformity with its corresponding presentation
- MTP hyperextension, PIP flexion, and DIP
hyperextension - MTP hyperextension and IP flexion
A. Claw toe
B. Hammer toe
- B
- 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
- Mortise (distal end of tibia and malleoli)
- Facet on the bottom of the talus in the posterior compartment
- Head of the talus
- Body of the
talus - Proximal articulating surface of the navicular
A. Convex
B. Concave
- B
- B
- A
- A
- 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?
- Internal rotation of the femur
- Valgus at the knee
- 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
