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Musculoskeletal I (second exam/practical) > The Ankle and Foot > Flashcards

The Ankle and Foot Flashcards

1
Q

What bones make up the talocrural joint?

A
  • Distal fibula
  • Tibia
  • Talus
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2
Q

What bones make up the midfoot?

A
  • Navicular
  • Cuboid
  • 3 cuneiform
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3
Q

What bones make up the forefoot?

A
  • Metatarsals

- Phalanges

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4
Q

What ligaments supports the medial ankle?

A
  • Deltoid ligament
  • Plantar calcaneonavicular ligament (spring)
  • Plantar aponeurosis
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5
Q

What ligaments support the lateral aspect of the ankle?

A
  • Anterior talofibular
  • Calcaneofibular
  • Bifurcate ligament
  • Posterior talofibular ligament
  • Dorsal calcaneocuboid ligament
  • Short plantar ligament
  • Long plantar ligament
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6
Q

What muscles cross the anterior aspect of the ankle?

A
  • Anterior tibialis
  • Extensor hallicus longus
  • Extensor digitorum longus
  • Peroneus tertius
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7
Q

What muscles are found in the lateral compartment of the ankle?

A
  • Peroneus longus

- Peroneus brevis

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8
Q

What muscles are in the posterior compartment of the leg?

A
  • Gastronemius
  • Soleus
  • Plantaris
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9
Q

What muscles are found in the deep compartment of the shank?

A
  • Posterior tibialis
  • Flexor hallucis longus
  • Flexor digitorum longus
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10
Q

What is the action of the posterior tibialis?

A
  • Plantar flexion and inversion
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11
Q

What are the 3 functions for the talocrural/ subtalar/ mid-tarsal joints?

A
  • Shock absorption
  • Absorb lower extremity rotary forces
  • Provide lever for effect propulsion
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12
Q

What are the 3 components of open chain pronation?

A
  • Calcaneal Eversion
  • Talar Abduction
  • Talar Dorsiflexion
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13
Q

What are the 3 components of open chain supination

A
  • Calcaneal Inversion
  • Talar Adduction
  • Talar Plantar flexion
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14
Q

What occurs at the talocrural joint during pronation?

A
  • Mostly dorsiflexion

- Some eversion and abduction

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15
Q

What occurs at the talocrural joint during supination?

A
  • Mostly plantar flexion

- Some inversion and adduction

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16
Q

What are the 3 components of closed chain pronation at the subtalar joint?

A
  • Calcaneal eversion

- Talar adduction and dorsiflexion

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17
Q

What occurs at the medial longitudinal arch during closed chain pronation?

A

Lowers

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18
Q

What occurs at the tib/fib joint during closed chain pronation?

A

IR of the tib/fib

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19
Q

What are the 3 components of closed chain supination at the subtalar joint?

A
  • Calcaneal inversion

- Talar abduction and plantar flexion

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20
Q

What occurs at the medial longitudinal arch during closed chain supination?

A
  • Elevates
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21
Q

What occurs at the tib/fib during closed chain supination?

A
  • ER of the tib-fib
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22
Q

What does the function of the mid-tarsal joint depend on in closed chain pronation and supination?

A
  • Subtalar joint mechanics
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23
Q

What is the effect subtalar pronation on the mid tarsal joint?

A
  • Mobility
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24
Q

What is the effect subtalar supination on the mid tarsal joint?

A
  • Stability
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25
Q

What joints are involved int he initial phase of gait?

A
  • Talocrural

- Subtalar

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26
Q

What is the position of the TC and ST joint during the initial phase of gait?

A

TC: 0 degrees dorsiflexion
ST: Supination

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27
Q

What is the overall position of the ankle in the initial phase of gait?

A

Plantar flexion

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28
Q

What muscles are active in the initial phase of gait? What types of contractions?

A

TCJ: Isometric dorsiflexors
ST: Isometric everters

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29
Q

What is the ROM of the TCJ and STJ during the loading response of gait?

A

TCJ: Flexes from 0 - 15 degrees plantar flexion
STJ: Begins pronation

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30
Q

What is the position of the ankle during loading response?

A
  • Plantar flexion with some valgus movement
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31
Q

What muscles are active during the loading response of gait? What type of contraction?

A

TCJ: Eccentric dorsiflexors
STJ: Eccentric inverters

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32
Q

What is the ROM of the TCJ and STJ during the midstance phase of gait?

A

TCJ: 10 degrees dorsiflexion
STJ: Begins supination

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33
Q

What is the overall position of the ankle during the midstance phase of gait?

A
  • Moving to dorsiflexion with a valgus to varus movement
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34
Q

What muscles are active during the midstance phase of gait? What types of contraction?

A

TCJ: Eccentric plantar-flexors
STJ: Eccentric into concentric inverters

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35
Q

What is the ROM of the TCJ and STJ during terminal stance?

A

TCJ:15 degrees dorsiflexion
STJ: Supinating

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36
Q

What is the position of the ankle during the terminal stance of gait?

A

TCJ: Dorsiflexion
STJ: Varus

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37
Q

What muscles are active during the terminal stance of gait? What type of contraction?

A

TCJ: Eccentric into concentric plantar flexors
STJ: Isometric Everters

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38
Q

Which muscle group eccentrically contracts to prevent pronation?

A
  • Everters
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39
Q

How is alignment of the ankle assessed?

A
  • From the subtalar neutral position
    (neither supinated nor pronated)
  • Assess rearfoot and forefoot
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40
Q

Describe alignment of the tibia, foot, and ankle in the sagittal plane.

A
  • Plumb line slightly anterior to midline through knee and malleolus
  • Navicular tubercle should rest in a line from the medial malleolus to the the point of the MTP joint that rests on the floor
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41
Q

Describe alignment of the tibia, foot, and ankle in the frontal plane.

A
  • Distal 3rd of tibia is in sagittal plane
  • Great toe not deviated toward midline of foot
  • Toes are not hyperextended
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42
Q

Describe uncompensated forefoot varus.

A
  • Hind foot in normal alignment

- Forefoot raised off floor

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43
Q

What supports are being stretched in forefoot varus? What is the effect?

A
  • Plantar fascitis
  • Posterior tibialis
  • LE is internally rotated
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44
Q

What is the compensation for forefoot varus?

A
  • Pronation
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45
Q

Describe forefoot valgus.

A
  • Lateral forefoot raised off the ground
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46
Q

What is the compensation for forefoot valgus?

A

Excessive supination.

47
Q

What is the structural effect of excessive supination, what 3 effects does this have on the function of the joint, and what are the 2 clinical implications?

A
  • Rigid lever
  • Less shock absorption
  • Lateral forces increased
  • Lateral stability decreased
  • More at risk for ankle sprains
  • More at risk for stress fractures
48
Q

What are the 8 components of the history and examination of an ankle impairment?

A
  • History
  • Inspection
  • Palpation
  • Clearing tests
  • A/P/R ROM
  • Joint integrity/ mobility
  • Neurological examination
49
Q

What 4 components should be assessed during the history portion of a patient with an ankle injury?

A
  • Mechanism of injury
  • Onset
  • What increases/ decreases symptoms
  • Self-report measures
50
Q

What 5 things should be assessed during inspection of the ankle?

A
  • Postural alignment
  • Scars
  • Wounds
  • Calluses
  • Swelling
51
Q

What 3 things should be assessed during palpation of the ankle?

A
  • Tenderness
  • Temperature
  • Tissue density/ adherence
52
Q

What joints should be cleared when assessing the ankle?

A
  • Lumbar spine
  • Hip
  • Knee
53
Q

What 3 tests should be used when assessing neurological impairment of the ankle?

A
  • Reflexes
  • Sensation
  • Myotomes
54
Q

List 8 functional tasks for the ankle from easy to hard .

A
  • Gait
  • Double/ Single limb heel raise
  • Double limb squat
  • Double/ single limb balance
  • Step-down tasks
  • Star Excursion balance test
  • Hop testing
  • Agility testing
55
Q

Describe the 5 compensatory movements that may occur during the lateral step-down test.

A
  • Arm strategy (removal of hand from waist)
  • Trunk alignment (leaning in any direction)
  • Pelvis plane (loss of horizontal plane)
  • Knee position (tibial tuberosity medial to second toe or border of foot)
  • Steady stance *step down on untested limb foot wavers side to side
56
Q

What functional test is especially good for assessing patients with chronic ankle instability?

A

Star excursion balance test.

57
Q

Which side is medial and which side is lateral in the start excursion balance test?

A

Medial is ipsilateral open chain limb

Lateral is contralateral the open chain limb

58
Q

What are the 8 positions of SEBT?

A
  • Anterior
  • Anteromedial/ lateral
  • Posterior
  • Posteriomedial/lateral
  • Medial
  • Lateral
59
Q

Which 3 components are representative of all 8 tests in SEBT?

A
  • Anteromedial
  • Medial
  • Posteromedial
60
Q

Which single component is representative of all components of the SEBT?

A
  • Posteromedial
61
Q

What 7 ROM and muscle lengths should be assessed in a patient with an ankle impairment?

A
  • Hip and Knee ROM
  • Calcaneal inversion/ eversion ROM
  • Midtarsal ROM
  • Hallux dorsiflexion ORM
  • Ankle dorsiflexion and plantar flexion ROM with knee flexed and extended
  • First ray position and mobility
  • 1st through 5th ray mobility
62
Q

What sense is important to restoring balance of the ankle?

A

Proprioception

63
Q

What 3 methods can be used in ankle balance treatment in the clinic?

A
  • Balance machine
  • Balance board
  • External pertubations
64
Q

What are 2 exercise progressions for balance at home?

A
  • Balance on one leg with eyes open, progress to door frame with eyes closed
  • Stand on one leg on a pillow or couch cushion with eyes open; progress to eyes closed
65
Q

What are 3 exercises to work the intrinsic muscles of the foot?

A
  • Flex proximal MTP before IPs
  • Draw towel under foot or pick up marbles
  • Use therabands to resist proximal MTP joint flexion
66
Q

What are 2 extrinic foot muscle exercises?

A
  • Resisted talocrural plantar flexion with slow eccentric return to talocrural dorsiflexed position
  • Close chained exercises (heel rises)
67
Q

What are 6 treatments for pain of the ankle?

A
  • Exercise in pain free range
  • Soft tissue immobilization
  • Cryotherapy
  • NMES/ TENS
  • Exercise neighboring regions
  • Pateient ed about discomfort
68
Q

What types of excessive movements are the most common?

A
  • Pronation

- Supination

69
Q

What is the basis for the development of exercises for posture and movement?

A
  • Using components of gait
70
Q

What is the goal of posture and movement exercises?

A
  • Control motions into and out of static positions at various speeds.
71
Q

What 4 examples of posture and movement exercises?

A
  • Static weight shifting on bathroom scale
  • Forward and backward stepping
  • Circular weight- shifting drill
  • Funcitonal drills (such as: retrowalking, sidestepping, etc.)
72
Q

How are hypo and hyper mobile segments on the ankle treated?

A
  • Hypermobile segment protected with (taping, bracing, casting, or footwear)
  • Hypomobile segments mobilized with manual therapy or mobility exercises
  • Dynamic stabilization exercise initiated at the hypermobile segment
73
Q

How is talocrural joint dorsiflexion restored (3-step process)?

A
  • Joint mobilization
  • TJC dorsiflexion ROM with talar joint in neutral or slightly supinated
  • Step- down training to facilitate eccentric dorsiflexion
74
Q

What is the 2 step progression of subtalar joint supination or pronation mobility restoration?

A
  • Full active/ active assisted supination/ pronation performed
  • Progress to functional training of mobility in appropriate phase of gait cycle
75
Q

What are 5 causes of plantar fascitis?

A
  • Excessive pronation
  • Obesity
  • Malalignment
  • Decreased dorsiflexion ROM
  • Prolonged time on feet
76
Q

What are 2 signs or symptoms of plantar fascitis?

A
  • Pain in medial heel

- Pain on 1st steps in am and after rest

77
Q

What are 4 methods of pain control and tissue extensibility for plantar fascitis?

A
  • NSAIDS
  • US
  • Iontophoresis
  • Deep tissue massage
78
Q

What 4 pieces of equipment can be used to help correct the alignment of the ankle?

A
  • Taping
  • Orthoses
  • Night splints
  • Modified footwear
79
Q

If patient has plantar fascitis and is pronated, what is the 5 step progression?

A
  • Mobilize talocrural joint
  • Address LE malalignment
  • Stretch gastroc, soleus, PF
  • Strengthen tib anterior, and extensor digitorum
  • Initiate functional and proprioceptive activities.
80
Q

Are electrophysiological agents and exercise, or manual therapy and exercise preferred for heel pain?

A

Manual therapy and therex.

81
Q

What tendon is affected in excessive subtalar joint pronation and results in flat foot deformity?

A
  • Posterior tibial tendon dysfunction
82
Q

What action will a patient with posterior tibial tendon dysfunction be unable to perform?

A

Inversion with a heel raise

83
Q

What What is the 5 step treatment progression for a patient with posterior tibial tendon dysfunction?

A
  • NWB short leg casting may be necessary if there is a tear for 4 - 6 weeks
  • Medicaiton/ modalities for inflammation
  • Arch strapping to control end-range pronation
  • Pain-free, low-intensity, high-repetition open kinetic chain plantar flexion
  • Proprioception, strength, coordination
84
Q

What type of injury is an achilles tendinosis?

A
  • Overuse pathology of Achilles tendon
85
Q

What are the two types of ahilles tendinosis? Which has a worse prognosis?

A
  • Insertional (worse)

- Non-insertional (at musculotendinous junction)

86
Q

What are 2 signs and symptoms of achilles tendinosis? Who typically presents with this impairment?

A
  • Runners and jumpers at risk due to training errors
  • Tender to palpation 2 - 6 cm above insertion
  • Palpable defects
87
Q

What factors correlate to indications of surgery in achilles tendinosis?

A
  • Age and duration of symptoms
88
Q

What is the 5 strep treatment progression of achilles tendinosis?

A
  • Address acute symptoms with
  • Restore TCJ mobility and biomechanical faults
  • Stretching
  • Strengthening exercises following inflammation recovery
  • Eccentric training
89
Q

How can the acute symptoms of achilles tendinosis be addressed? (4 methods)

A
  • Low level laser therapy
  • Iontophoresis
  • Heel lifts
  • Night splints
90
Q

How can the mechanical faults of achilles tendinosis be addressed?

A
  • taping

- orthoses

91
Q

Describe the specific training protocol for achilles tendinosis.

A
  • 3 X 15 bent/straight leg unilateral eccentric calf raise 2X/ day
92
Q

What changes can help resolve nerve disorders at the ankle?

A
  • Shoe changes
  • Orthotics
  • Alignment cahnges
  • Mobility
  • Movement pattern exercises
93
Q

What should be assessed when neurological problems arise at the ankle?

A
  • The spine

- The hip

94
Q

What 2 nerves are typically affected at the ankle?

A
  • Tibial nerve

- Peroneal nerve

95
Q

What 3 ligaments account for 70 - 80 % of ligament sprains?

A
  • Anterior talofibular ligmament
  • Calcaneal fibular ligament
  • Posterior talofibular ligament
96
Q

What are the 3 degrees of grade III sprains at the ankle?

A

1st: Complete rupture of ATFL
2nd: Complete rupture of ATFL and CFL
3rd: Complete rupture of ATFL, CFL< and PTFL with a dislocation

97
Q

What is the treatment for a mild grade I or II ankle sprain?

A 
Protect
Rest
Ice
Compress
Elevate
98
Q

What device may be required in severe grade I or II sprains?

A
  • Crutches
99
Q

What exercise is indicated following grade I - II sprain?

A
  • Open chain kinetic inversion ROM
100
Q

When do patients typically reinjure a ligamen sprain?

A

At 3 - 6 weeks when they start feeling better

101
Q

How long will a patient require external support in a grade 3 sprain?

A

6 - 8 weeks.

102
Q

What is a high ankle sprain?

A

Syndesmotic ankle sprain

103
Q

What are the 2 signs and symptoms of a high ankle sprain?

A
  • MOI of ER and/or dorsiflexion on a fixed foot

- + ER or squeeze test

104
Q

Which ligament is disrupted in a high ankle sprain?

A
  • Distal tibiofibular
105
Q

What are the 2 treatments for high ankle sprains?

A
  • Same as lateral ankle sprains, but 2 - 3 x longer

- Reduce lower leg ER stress

106
Q

What is turf toe?

A

Hyperextension sprain of the 1st mtp due to flexible footwear

107
Q

How long does it take for the patient to return to sport following turf toe?

A
  • Several weeks to months
108
Q

What is the treatment for turf toe?

A
  • RICE
  • Rigid toe insert
  • ROM
109
Q

What are the 4 typical mechanisms of injury of ankle fractures?

A
  • Supination, adduction injury
  • Supination, ER injury
  • Pronation, abduction injury
  • Pronation, ER unjury
110
Q

What is the typical treatment of ankle fractures post op?

A
  • Edema massage, scar mobilization, edema reduction
  • AROM in mid-range, low intensity/ high reps
  • ROM exercise as function improves
  • Make sure patient is following through with precautions from surgeon
111
Q

What is the rule for obtaining an imaging series for the ankle?

A
  • Pain in malleolar zone

AND

Bone pain on posterior edge or tip of medial or lateral malleolus

OR

Can’t bear weight immediately and in clinic

112
Q

What is the rule for obtaining an imaging series for the foot?

A

Pain in the midfoot zone

AND/OR

Bone pain in bose of 5th MT or navicular

AND/OR

Can’t bear weight immediately and in clinic

113
Q

What are the 6 anatomic impairments of the foot and ankle?

A
  • Forefoot varus/ valgus
  • Hindfoot varus/ valgus
  • Hallux valgus
  • Pes planus/ cavus
  • Hammer toe
  • Claw toe
114
Q

What are the 4 basic adjunctive interventions for the ankle?

A
  • Adhesive strapping
  • Wedges and pads
  • Biomechanical foot orthotics
  • Heel and full sole lifts

Musculoskeletal I (second exam/practical) (7 decks)

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