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Clinical Assessment > The foot and the ankle > Flashcards

The foot and the ankle Flashcards

1
Q

Anatomy and function of the foot and ankle:
The foot and ankle are the focal points to which the body weight is transmitted in ambulation and they are well tailored to that function
Heel and toe pads act as ____ _____

A

Shock absorbers

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2
Q

Joints are capable of making _____ ____

A

Fine adjustments

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3
Q

Both a ____ and a ______ joint

A

stable and mobile

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4
Q

Lumbar, SI jt, hip and knee can all contribute to ___ and _____ issues

A

foot and ankle

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5
Q

Ankle movements:

Dorsiflexion

A

dorsum aspect of the foot moves cephallically (towards the head)

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6
Q

Plantarflexion

A

Plantar surface of the foot moves caudally

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7
Q

Inversion

A

Plantar aspect of the foot moves towards the midline of the body

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8
Q

Eversion

A

Plantar aspect of the foot moves away from the midline of the body

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9
Q

Supination

A

Inversion of the heel, adduction of the forefoot and plantarflexion at the subtalar joint

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10
Q

In which position is the foot most stable?

A

Supination

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11
Q

Pronation

A

Eversion of the heel, abduction of the forefoot and dorsiflexion of the subtalar jt

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12
Q

In which position is the foot and ankle absorbing the ground reaction force

A

Pronation

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13
Q

what type of joint is the Talcrural Jt

A

hinge jt, formed by the talus which rests between the sitar ends of the tibia and fibula

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14
Q

The loose pack position of the talocrural jt is

A

10 degrees of plantarflexion

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15
Q

The closed packed position of the talocrural jt is

A

full dorsiflexion

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16
Q

The capsular pattern of the talocrural jt is

A

Plantarflexion then dorsiflexion

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17
Q

What type of jt is the subtalar jt

A

is modified plane jt (gliding jt) and is made up of the articulation between the talus and then calcaneus

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18
Q

What is the closed pack position of the subtalar jt

A

supination (no mm attach to the talus and therefore the ligaments are what limit eversion and elastic recoil is what will bring it back into inversion)

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19
Q

1st step in the case history, Questions to ask in determining the MOI

A

Determine the meachanism of injury (MOI) which is key in helping you develop your testing hypothesis

  • What position was the foot in? Inverted/Eversion? Plantarflexed/dorsiflexed?
  • Was there an overuse scenario?
  • Was the injured work or activity related?
  • Can the patient recreate the MOI on their uninjured side?
  • Consider the surface and footwear?
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20
Q

Questions to ask in relevance to pain

A
  • Onset and duration (AM, PM, after activities, etc)
  • Site and spread (Local, diffuse, radiating, etc)
  • Behaviour and symptoms (severity, sharp, dull, numbness, noises, etc)
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21
Q

Flick angle

A

12-18 degree of toeing out

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22
Q

Feiss line

A

Apex (highest point) of medial malleolus, plantar aspect of first MTP and navicular tuberosity. These 3 points should create a straight line in NWB and WB. If in WB it drops then the arch would be first (1/3rd of the way), second (2/3rds of the way), or third degree (resting on the floor) flat foot

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23
Q

What side are rule outs done to? and how are they performed?

A

affected side to jts above and below, performed active free with over pressure

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24
Q

Fractures- how to assess

A

use a tuning fork or compression or tapping beginning distal to site and moving closer to suspected fracture

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25
Q

Ankle x-ray is necessary if any of the following are present

A
  • Inability to bear weight of the affected side
  • Bone tenderness along the posterior aspect of the distal 6cm of either the medial or lateral malleolus
  • point tenderness at the proximal base of the 5th metatarsal
  • Pt tenderness over the navicular bome
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26
Q

Active free testing- how is the patient seated? and what are we looking for?

A

Long seated, can be done BL simultaneously, looking for willingness to move and differences BL

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27
Q

Dorsiflexion, pain or limitation can be due to

A

20 DEGREE, A MINIMUM OF 10 DEGREE IS NEEDED FOR NORMAL AMBULATION
Injury to the prime movers (tib ant) and accessory dorsiflexors (extensor hallucis longus and EDL), Posterior structures (achilles tendon, gastrocs, soleus, posterior jt capsule and ligaments) being stretched
-Intra/extra capsular swelling

28
Q

In plantarflexion during AF pain or limitation can be due to

A

50 degree, a minimum of 20-25 degree is needed for normal ambulation
Injury to the prime movers (gastrocs, and soleus)
Injury to the accessory movers (Tibialis posterior, peronerus longus/brevis)
anterior structures (anterior capsule, anterior talofibular ligament, anterior fibres of the deltoid ligament and dorsiflexors) being stretched
Intra and extra capsular swelling

29
Q

In inversion during AF pain or limitation can be due to

A

Approx 5 degree
Injury to prime movers (Tib ant, tib post)
injury to accessory movers (Flexor hallucis longus, flexor digitorum longus, and extensor hallucis longus)
The lateral structures (anterior talofibular ligament, calcaneofibular ligament, peroneal mm) being stretched
swelling

30
Q

In eversion during AF pain or limitation can be due to

A

Approx 5 degree (may vary greatly look for BL symmetry)

  • Injury to the prime movers (peroneus longus/brevis)
  • Injury to accessory movers (EDL)
  • The medial structures (tibialis anterior/posterior, deltoid ligament) being stretched
  • swelling
31
Q

How is Passive relaxed performed by the therapist

A

Long seated, therapist grasps above and below the jt and provides the movement, and provides enough force during over pressure

32
Q

Passive relaxed Dorsiflexion, pain or limitations of range due to and normal end feels

A

20 degrees
Tissue stretch end feel (achilles tendon and tricep surae)
Pain or limitation of range due to:
-injury to the posterior structures being stretched
-tight soleus, gastrocs, achilles tendon
-swelling

33
Q

What is the normal end feel of Plantar flexion in PR

A

bony end feel (talus in mortise) or tissue stretch (ankle dorsiflexors)

34
Q

What could the pain or limitation of range can be caused by in Plantar flexion PR

A

Injury to the anterior structures being stretched, injury to the anterior capsule, injury to the prime movers of dorsiflexion or the anterior talofibular ligament

35
Q

What is the normal end feel of Inverson in PR

A

5 degree

Bony end feel or tissue stretch (hypermobile)

36
Q

Pain or limitation of Inversion in PR due to

A

Injury to the lateral structures being stretched
Injury to the anterior talofinular ligament, calcaneofibular ligament, jt capsule, peroneals or extensor digitorum mm or tendons

37
Q

What is the normal end feel of Eversion in Passive relaxed

A

5 degree

Bony end feel or tissue stretch (hypermobile)

38
Q

Pain or limitation of range in Eversion during passive relaxed is due to

A

Injury to the medial structures being stretched

Injury to the deltoid ligament, tibialis anterior/posterior mm or tendons

39
Q

during active resisted pain discomfort or weakness will be caused by injury to the prime movers or the _____ supplying them

A

nerves

40
Q

Primary movers and primary nerve roots involved with Dorsiflexion during Active resisted

A

Tibialis anterior, primary nerve root is L4

41
Q

What are the primary movers of plantar flexion

A

Gastrocs and soleus (tricep surae)

42
Q

What primary nerve roots are involved with plantar flexion

A

S1 and S2

43
Q

What are the primary movers of inversion

A

Tibialis anterior and tibialis posterior

44
Q

What primary nerve roots are involved with the movement inversion

A

L4

45
Q

What nerve root is involved with toe extension

A

L5

46
Q

Muscle tests:

What mm are involved with the Dorsiflexors and what movements to test

A

muscles anterior to the malleoli

  • Tib ant (Dorsiflexion and inversion)
  • Extensor hallucis longus
  • Extensor digitorum longus
47
Q

Muscle tests for plantar flexors

A

(muscles posterior to the malleoli)

  • Gastrocs: Plantar flexed with knee extended, gastrocs crosses the knee and plays a role in knee flexion and helps to prevent knee hyperextension.
  • Soleus: Plantar flexed with knee flexed
48
Q

with weakness in _____ there is a tendancy to hyperextend the knee

A

Gastrocnemius

49
Q

Weakness in soleus will result in ankle _____ and is usually accompanies by knee flexion in standing

A

Soleus

Soleus strength may help compensate for weak quadriceps, hyperextending the knee

50
Q

What action is performed with functional strength test

A 
heel raise 
Flexor hallucis longus 
Flexor digitorum longus 
Tibialis posterior (PF and inversion)
51
Q

Muscle tests for the everters

A

Peroneus longus/brevis, little plantar flexion and eversion

52
Q

Muscle tests for the inverters

A

Tibialis anterior, resist DF and Inversion in long seated position
Tibialis posterior: Plantar flexion and inversion
ALSO: Extensor digitorum longus and brevis, extensor hallucis longus and brevis, flexor digitorum longus and brevis and flexor hallucis longus and brevis

53
Q

Neurological tests

A

Myotomes: L4, L5,S1, S2
Dermatomes: L5, L4, S1
Reflexes: S1 achilles
Done high seated, put the achilles tendon on slight stretch, by passively dorsiflexion the ankle slightly. Tap the achilles tendon with the flat end of the reflex hammer repeat 7-10 times

54
Q

Special tests:

what do talar tilts test for

A

Ankle stability, lateral ligaments: ATFL- anterior talofibular ligaments (most commonly injured ligament in the ankle) location is palpable in the sinus tarsi- injured by a combo movement- inversion and plantar flexion- ex. jumping, kicking a soccer ball

55
Q

How to test for ATFL using talar tilts, and what is a positive outcome?

A

Passive plantar flexed and inversion, positive-pain along the ligament and its attachments or excessive ROM

56
Q

testing for calcaneofibular ligament (CFL) using talar tilts

A

Passive inversion from a neutral position

57
Q

What is a positive for CFL

A

pain along the ligament and its attachments or excessive ROM

58
Q

Fan shaped ligament with a bundled attachment at the medial malleolus. The 4 ligaments are tibionavicular, tibiocalcaneal, anterior and posterior tibial talar. What is this ligament?

A

Medial deltoid ligaments

59
Q

Excessive force causing ____ may cause micro tearing of the ligamentous fibres but most likely the medial malleolus will avulse

A

eversion

medial deltoid ligaments

60
Q

Testing the posterior fibers of the medial deltoid ligament, using talar tilts, what is a positive testing?

A

Dorsiflexion and eversion, positive- pain along the ligament and its attachments or excessive ROM

61
Q

Testing the middle fibers of the medial deltoid ligament using talar tilts and what is a positive?

A

Eversion from a neutral position, positive pain along the ligament and its attachments or excessive ROM

62
Q

Testing the anterior fibers of the medial deltoid ligament using talar tilts, and what is a positive?

A

Plantar flexion and eversion, positive= pain along the ligament and its attachments or excessive ROM

63
Q

What does the anterior drawer test?

A

Test the integrity of ATFL which should be taut in all positions (keeping the talus from moving forward from the tibia)

64
Q

How to do the Anterior drawer test?

A

Grasp the calcaneous with one hand, with the clients sole resting on your forearm, the second hand stabalizes above the ankle joint which the first tractions (distracts) the ankle slightly and draws the clients foot forward anteriorly

65
Q

Another way to do the anterior drawer test is

A

Grasp the calcaneous with one hand, with the clients sole resting on your forearm, the second hand stabalizes above the ankle joint. Have the ankle in 20 degrees of Plantar flexion and draw the talus forward in the mortise

66
Q

Anterior drawer test positive

A

pain, tenderness and laxity and/or a clunk sometimes there may be a dimple or suction sign

67
Q

What do wedge tests test

A

Test the integrity of the anterior inferior tibiofibular ligament

Clinical Assessment (4 decks)

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