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MSPT > The Foot and Ankle > Flashcards

The Foot and Ankle Flashcards

1
Q

What land mark serves as the point of reference when referring to medial/lateral and abduction/adduction relative to the foot?

A

2nd ray

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2
Q

What three motions make up the triplanar motion of PRONATION around the longitudinal axis of the foot?

A
  1. Dorsiflexion
  2. Abduction
  3. Eversion
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3
Q

What three motions make up the triplanar motion of SUPINATION around the longitudinal axis of the foot?

A
  1. Plantarflexion
  2. Adduction
  3. Inversion
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4
Q

What landmark serves as the end of the dorsal surface of the leg and the beginning of the dorsal surface of the foot?

A

Subtalar Joint

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5
Q

What are 3 serious diagnoses that can affect the foot and ankle?

A
  1. Traumatic/Stress Fractures
  2. Bone tumors
  3. Post op: sepsis, DVT
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6
Q

What are the Ottowa Ankle Rules when there is pain in the malleolar zone?

A
  1. Tenderness at Posterior edge or tip of lateral mallelolus (6cm)
  2. Inability to WB both immediately and in emergency department
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7
Q

What are the Ottowa Ankle Rules when there is pain in the mifoot zone?

A
  1. Bone tenderness at base of fifth metatarsal
  2. Bone tenderness at navicular
  3. Inability to WB both immediately and in emergency department
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8
Q

What 3 criteria warrant referring a patient for a X-ray after a lateral ankle sprain?

A
  1. Reports pain in the area of the lateral malleolus
  2. Unable to weight bear immediately after the injury and in the ‘emergency room’ (in this case, your clinic)
  3. Tenderness at the posterior edge or tip of lateral malleolus
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9
Q

What 8 things should be examined at the ankle/foot in addition to ROM/Strength, Sensation etc.?

A
  1. Presence of skin breakdown
  2. Presence of corns/calluses
  3. Presence of excessive dryness/moisture
  4. Effusion/Edema
  5. Color changes in foot/toenails
  6. Shoe wear
  7. Assess for pes planus (flat feet) vs pes cavus (high arch)
  8. Gait Analysis
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10
Q

What is hammer toe? What can this cause?

A
  1. A flexion contracture of the PIP or DIP joint of the toe due to a capsular restriction
  2. Causes pain on pressure areas caused by the altered alignment
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11
Q

What is claw toe? What can cause this?

A
  1. An extension contracture of the MTP joint accompanied by a flexion contracture of the IP joints due to pes cavus alignment creating a windlass effect
  2. Causes pain on pressure areas caused by the altered alignment
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12
Q

What is the treatment for claw toe?

A
  1. Instruct patient to purchase shoe with high toe box

2. Stretch out toes and plantar fascia

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13
Q

What is Morton’s toe?

A

A condition where the second toe is longer than the 1st toe, adversely affecting push off during gait

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14
Q

What is Hallux Valgus/Abductus? What can this cause?

A
  1. An alignment impairment of the 1st MTP joint in which the MT joint is positioned farther toward the midline of the body than what is considered normal
  2. Causes pain in the MTP joint, or pain on pressure areas caused by the altered alignment
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15
Q

How is Hallux valgus/abductus treated?

A

Alleviate the pressure off of the metatarsal head using a metatarsal head pad

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16
Q

What is metatarsalgia? What can this cause?

A
  1. Pain in the first and/or second metatarsal head after long periods of weight bearing
  2. Caused by hyperpronation, collapse of the transverse arch of the foot, or a tight Achilles’ tendon
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17
Q

What is tarsal coalition? What is the result of this condition?

A
  1. A congenital condition in which any two tarsal bones are fused together
  2. Result of this condition is usually a rigid flat foot
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18
Q

What 3 signs/symptoms make up the lateral ankle sprain cluster?

A

Combination of all 3 at 5 days post injury:

  1. Positive Anterior Drawer Test
  2. Tenderness over ATFL
  3. Presence of ecchymosis
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19
Q

What is the biggest predictor of having an ankle sprain?

A

Having had a prior ankle sprain in the past

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20
Q

What is the typical mechanism of injury for lateral ankle sprains?

A

Plantarflexion and inversion

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21
Q

What ligament is most commonly injured with a lateral ankle sprain? 2nd most commonly injured?

A
  1. ATFL is most commonly injured

2. CFL is 2nd most commonly injured

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22
Q

What percent of ankle sprains seen in the ER are referred for PT?

A

Less than 5%

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23
Q

What are 3 treatment considerations for lateral ankle sprain?

A
  1. PRICE (elevation for 48+ hours)
  2. Manual therapy: mobilization/thrust manipulation to improve dorsiflexion ROM and mobility of the talus, and to decrease pain
  3. Exercise for stretching, strengthening and proprioception
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24
Q

Where will pain be present in a high ankle/syndesmotic sprain? What population are these sprains common in? MOI?

A
  1. Occurs rarely when compared with lateral ankle sprains
  2. Characterized by pain at the mortise
  3. More common in athletes (football, hockey, skiing)
  4. Mechanism of injury: ankle DF and tibial ER on the talus with foot planted on the ground
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25
Q

How should high ankle/syndesmotic sprains evaluated? What is needed to confirm this diagnosis?

A
  1. Evaluate by looking for the presence of distal tibial-fibular hypermobility
  2. Stress radiographs are needed to confirm
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26
Q

What are 3 ways high ankle/syndesmotic sprains treated?

A
  1. Cast immobilization or ORIF
  2. Initially, limit weight bearing and movement into dorsiflexion
  3. Then treat the same as any condition involving inflammation and/or immobilization
27
Q

What are 8 diagnostic criteria for plantar fasciitis?

A
  1. Plantar medial heel pain, most noticeable with initial steps after a period of inactivity but also worse following prolonged WB
  2. Heel pain precipitated by a recent increase in WB activity
  3. Pain with palpation of the calcaneal insertion of the plantar fascia
  4. Positive Windlass Test
  5. Negative tarsal tunnel syndrome (compression of the tibial nerve behind the medial malleolus) tests
  6. Limited active and passive talocrural joint DF ROM
  7. Abnormal Foot Posture Index score (to determine if the foot is excessively supinated or pronated)
  8. High body mass index in nonathletic individuals
28
Q

What are 9 treatment options for plantar fasciitis?

A
  1. Manual therapy to treat relevant LE joint mobility and calf flexibility impairment, and decrease pain
  2. Stretching of the gastrocsoleus/plantar fascia
  3. Anti-pronation taping/kinesiotape to the gastroc-soleus and plantar fascia
  4. Orthotics to support the medial arch/heel cushion
  5. Night splinting for 1–3 months if pt. has pain with first step upon arising from sleep
  6. Laser, phonophoresis with ketoprofen gel
  7. Recommend wearing a rocker bottom shoe with a foot orthosis, and wearing different shoes if standing for long periods of time
  8. Address weight loss if overweight
  9. Strengthening exercises that control pronation and attenuate forces during WB activities.
29
Q

What is another name for a stress fracture?

A

Hairline fracture

30
Q

What are 3 areas stress fractures commonly occur?

A
  1. Metatarsals
  2. Tibia
  3. Fibula
31
Q

______ fracture is a stress fracture that takes place at the metatarsals.

A

March Fracture

32
Q

What typically causes stress fractures?

A

Caused by overuse or by biomechanical factors

33
Q

What are 2 ways stress fractures are diagnosed?

A
  1. Diagnosed by a bone scan or MRI

2. Point tenderness at the location of the fracture

34
Q

What is the problem with using x-rays to diagnose stress fractures?

A

Fracture line does not show up on X-ray until about 10 days after the fracture occurred

35
Q

What is Morton’s Neuroma? What is the common cause?

A
  1. Entrapment of the deep peroneal nerve between the metatarsal shafts
  2. It is usually caused by wearing shoes that are too tight or from wearing heels.

***Wearing heels causes the foot to move forward in the shoe, compressing the metatarsal shafts against one another

36
Q

What test is used to diagnose Morton’s Neuroma and tarsal tunnel syndrome? What is considered a positive test?

A
  1. Tinel’s sign: Diagnosed by tapping on the nerve at the site of the lesion
  2. Positive test: Patient experiences tingling distal to the tapping
37
Q

What is tarsal tunnel syndrome?

A

Entrapment of the posterior tibial nerve at the medial malleolus

38
Q

_________ syndrome is another name for posterior shin splints.

A

Medial tibial stress syndrome

39
Q

What is medial tibial stress syndrome/posterior shin splints? Cause?

A
  1. Tendinopathy of the soleus, tibialis posterior, and/or other posterior compartment muscles,
  2. Caused by excessive pronation
40
Q

How is medial tibial stress syndrome/posterior shin splints diagnosed?

A
  1. Diagnosed by reproducing symptoms when palpating the proximal attachment of the tendon (medial shin)
  2. Performing resisted isometric testing to appropriate musculature
  3. Passively stretching the appropriate musculature
41
Q

What 3 ways is medial tibial stress syndrome/posterior shin splints treated?

A
  1. Strengthen the tibialis posterior (low speed, high load)
  2. Provide arch support and cushioning to the foot
  3. Educate re: activity level
42
Q

______ syndrome is also known as anterior shin splints.

A

Anterior tibial stress syndrome

43
Q

What is Anterior Shin Splints/Anterior Tibial Stress Syndrome?

A

A tendinopathy of the tibialis anterior and/or other anterior compartment muscles

44
Q

What 3 ways is Anterior Shin Splints/Anterior Tibial Stress Syndrome diagnosed?

A
  1. Diagnosed by reproducing symptoms when palpating the proximal attachment of the tendon (lateral shin)
  2. Performing resisted isometric testing to appropriate musculature
  3. Passively stretching the appropriate musculature
45
Q

What 2 diagnoses can also be responsible for symptoms associated with Anterior Shin Splints/Anterior Tibial Stress Syndrome?

A
  1. Stress fracture

2. Compartment Syndrome

46
Q

What are 3 possible treatments for Anterior Shin Splints/Anterior Tibial Stress Syndrome?

A
  1. Strengthen the tibialis anterior (low speed, high load)
  2. Correct hyperpronation if present and provide cushioning to the foot
  3. Educate re: activity level
47
Q

What is Achilles tendinopathy?

A

Tendinopathy of the gastrocsoleus muscle

48
Q

How is Achillies tendinopathy diagnosed?

A
  1. Reproducing symptoms when palpating the tendon 2. Performing resisted isometric testing to
  2. Passively stretching the gastrocsoleus
49
Q

What special test is used to diagnose an Achilles tendon tear?

A

Thompson’s Test

50
Q

What is bursitis? What 2 bursae are most commonly affected?

A
  1. An inflammation of the bursa
  2. Usually of the calcaneal bursa, which lies on top of the Achilles tendon
  3. The retrocalcaneal bursa, which lies underneath the Achilles tendon
51
Q

What symptom does bursitis often elicit?

A

Often elicits a painful response above the heel with resisted isometric testing

(which is a false positive finding, because bursa are not contractile tissue)

52
Q

What 3 joints in the foot are often affected by OA?

A
  1. Talocrural Joint
  2. 1st Metatarsophalangeal Joint = Hallux Rigidus
  3. Interphalangeal Joints
53
Q

What 7 impairments are commonly associated with LE immobilization?

A
  1. Pain
  2. Activity and Participation Limitations
  3. Swelling
  4. Gait impairments
  5. Decreased range of motion
  6. Decreased accessory motion
  7. Decreased strength
54
Q

What is hyperpronation?

A
  1. When the “normal” foot is in midstance, it moves slightly beyond subtalar neutral in the direction of pronation.
  2. A foot that hyperpronates moves more than slightly beyond subtalar neutral in the direction of pronation during mid stance.
55
Q

What 6 conditions can occur as a result of hyperpronation?

A
  1. Pain at the 1st/2nd metatarsal heads
  2. Hallux Valgus, which often causes the pt. to have pain at the 1st/2nd MTP joints
  3. Plantar Fasciitis
  4. Pain at the navicular tuberosity
  5. Shin Splints
  6. Knee pain, which is often due to PFPS
56
Q

What are 6 common reasons for hyperpronation?

A
  1. Forefoot varus
  2. Rearfoot varus
  3. Midfoot ligament laxity
  4. Congenital Flat Feet
  5. Tightness in the gastrocsoleus
  6. Leg length discrepancy
57
Q

How does forefoot varus contribute to hyperpronation? How is the presence of this condition determined?

A
  1. The foot will tend to pronate in an attempt to get as much of the surface of the forefoot in contact with the ground.
  2. The presence of this condition is determined with subtalar neutral testing.
58
Q

How does rearfoot varus contribute to hyperpronation? How is the presence of this condition determined?

A
  1. The foot will tend to pronate in an attempt to get as much of the surface of the rearfoot in contact with the ground, assuming that there is enough range of motion in the subtalar joint to allow this to happen.
  2. The presence of this condition is determined with subtalar neutral testing.
59
Q

How does midfoot ligament laxity contribute to hyperpronation? How is the presence of this condition determined?

A
  1. The foot will tend to pronate in weight bearing because the ligaments are not able to support the longitudinal arch of the foot. 2. The presence of this condition is determined by examining the location of the navicular tuberosity in relation to Feiss’s line in weight bearing and in non‑weight bearing, and navicular height in subtalar neutral and normal stance.
60
Q

How do congenital flat feet contribute to hyperpronation? How is the presence of this condition determined?

A
  1. the longitudinal arch of the foot is congenitally absent. 2. The presence of this condition is determined by examining the location of the navicular tuberosity in relation to Feiss’s Line in WB and in non-WB, and navicular height in subtalar neutral and normal stance.
61
Q

How does tightness in the gastrocsoleus contribute to hyperpronation? How is the presence of this condition determined?

A

If when the foot is on the ground and the intended motion is DF, and DF cannot occur because of tightness in the gastrocsoleus, the motion will come from one of the other components of the triplanar motion.

The foot will therefore tend to go into eversion and abduction (i.e.: pronation) to compensate for a lack of DF.

This is a common occurrence during the mid-stance to terminal stance stages of the stance phase of gait.

The presence of gastrocsoleus tightness is determined with range of motion testing into DF.

62
Q

How does leg length discrepancy contribute to hyperpronation?

A

The shorter leg will bear more weight, increasing the pronatory forces on the shorter leg.

63
Q

What is one treatment option for problems with foot alignment?

A

Foot orthotics

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