The Foot and Ankle

Question 1

Achilles tendinopathy differential diagnosis

Answer 1

Differential Diagnosis
* Rule out Achilles rupture (Thompson test) or calf strain
* Plantar fasciopathy
* Tarsal tunnel sd.
* Ankle OA

Question 2

Lateral ankle sprain differential diagnosis

Answer 2

• Syndesmosis injury
• Fracture
• ## Lisfranc injury (metatarsal & tarsal bones connect)

Question 3

Plantar heel pain

Answer 3

• Fat pad contusion
• Tarsal tunnel
• Calcaneal stress fracture
• Achilles tendinopathy/rupture

Question 3

Normal foot ROM: Dorsiflexion, plantarflexion, inversion & eversion

Answer 3

Inversion = 30 degrees
Eversion = 15 degrees
Dorsiflexion = 10-15 degrees
Plantarflexion = 40-55 degrees

Question 4

In dorsiflexion the talus….

Answer 4

Slides back & rolls forward

Question 5

In plantarflexion the talus….

Answer 5

Slides forward and rolls backward

Question 6

For the anterior draw have the patient - how should the patient be positioned? Where are your hands? What is a positive test?

Answer 6

Lying down in supine
Stabilise at the tibia
Draw foot anteriroly

Question 7

Talar tilt? How should you position the patient? How is the foot positioned? What is a positive test? Where are your hands

Answer 7

Seated
10-20 degrees of plantarflexion
Laxity
Stabilise just above malleoli and cup heel

Question 8

For the thompson test the patient should be positioned?

Answer 8

Prone with the foot relaxed over the edge of the plinth

Question 9

For gap palpation test the patient should be positioned?

Answer 9

In prone with the foot relaxed over the edge of the plinth

Question 10

For the matles how should the patient lie? What is the procedure? What is a positive?

Answer 10

Patient lies in prone position, actively or passively flexing the knee to 90° with both feet and ankles in a neutral position according to the patient.

When an absence of plantar flexion (foot is naturally in plantarflexion) is observed, the test proves positive. The rupture will tend the foot more into dorsal flexion.

Question 11

How is the Royal London conducted? What is the procedure? What is a positive?

Answer 11

Prone with foot over the edge of the bench (ankle in neutral)

1. Palpates the Achilles tendon for tenderness
2. Hold tender spot & move into max dorsiflexion
3. Then moves the foot into maximum plantarflexion and the therapist palpates the tender spot again.

The test is considered positive for achilles tendinopathy if the pain on the previously found tender spot is absent in the maximally dorsiflexed position.

Question 12

How is the arc test conducted for achilles tendinopathy?

Answer 12

Prone - palpate 2-6cm above calcaneus insertion (looking for localised thickening of the tendon).

Then the palpating fingers stay on the area of swelling and the patient is asked to dorsiflex and plantarflex the ankle.

Positive = the area of swelling moves with dorsiflexion and plantarflexion.

Question 13

Windlass test: seated position instructions? What is a positive?

Answer 13

Seated, knee is flexed to 90°
Stabilise the ankle (with one hand placed just behind the calcaneus)
Extend the MTP joint while allowing the interphalangeal joint to flex

Heel pain reproduced with passive dorsiflexion of the toes (movement tightens plantarfascia)

Question 14

In a squeeze test what do the results indicate? How should you be positioned?

Answer 14

When pain is at anterior the test is positive and suggests syndesmosis injury. When pain locally over fibula is can suggest a fracture.

Supine, knee flexed.

Question 15

In the tinels sign test what is the nerve involved?

Answer 15

Posterior tibial nerve