Week 2 Masterclass Flashcards
What are the 3 joints of the midfoot
tibiofibular, talocrural, subtalar
What movements can the talocrural joint perform
DF and PF
What is the nerve supply for toe ext
Deep peroneal nerve
How much dorsiflexion ROM do you typically need to descend stairs?
20 degrees
How can muscle tightness or contractures be identified during an assessment of range of motion in the calf?
If gastroc is tight, the ankle ROM is limited with the knee extended.
If soleus is tight, ankle ROM is limited with knee flexed
What movement injures ATFL
flexed, inverted and adducted position
What movement injures deltoid ligament
flexed, everted and abducted
What bony landmark does the flexor hallicus run underneath
Sustentaculum Tali
Describe what happens to the talus during DF
Talus slides posteriorly on the tibia causing the anterior surface to become compressed
Describe what happens to the talus during PF
Talus glides anteriorly on the tibia, causing the anterior surface to become stretched
What movements make up pronation
Dorsiflexion, Eversion and abduction
What movements make up supination
Plantarflexion, Inversion and adduction
What are the joints of the foot
Subtalar (rearfoot)
Transverse Intertarsal (mid foot)
Tarsometatarsal
Metatarsophalangeal (MTP)
Interphalangeal
What are causes of pain in the achilles which is often missed
Achilles rupture
Referred pain from peripheral nerves or lumbar spine
Sever’s disease
Soondyloarthropathy
What is the Ottawa ankle rule
X-ray if:
There is pain/tenderness over malleoli 6cm proximally
There is pain/tenderness over navicular
Tenderness over base of 5th metatarsal
Inability to weightbear for at least 4 steps after the time of injury and at time of evaluation
How to rule out ligament rupture of the ankle
No haematoma
No pain on palpation
Negative anterior drawer test approximately 5 days after the trauma
What is the Ottawa ankle rule used for
To rule out fracture, subtler dislocation or lisfranic injury (high sensitivity. Rule out. SnOUT)
What is your diagnosis if the pt hears a popping sound in their ankle?
Does not mean fracture, acute ankle sprain is still a possibility
What movement would cause pain in a lateral ankle sprain
Supination
Special tests for ATFL
Anterior Draw Test
Special tests for Calcaneofibular ligament injury
Talar tilt test
When is pain most common in plantar fasciopathy pt
Start and end of day
Do heel spurs contribute to plantar fasciopathy
No. Heel spurs are normal
What can be observed in plantar fasciopathy pt
Flat feet or high arches. Overpronation during gait
Where would a plantar fasciopathy pt be tender
Calcanea tubercle
Special test of plantar fasciopathy
windlass test
What joint action may provoke symptoms of plantar fasciopathy pt
Toe ext, heel raise, single leg standing (sometimes)
Achilles rupture special test
Thompson test
Where would an Achilles tendinopathy pt feel pain
2-6cm above the calcaneal insertion
How is pain described to be in plantar fasciopathy
poking hot pain in foot
How is pain described to be in plantar fasciopathy
Stiff in the morning but ‘warms up’. Pt can also pinpoint exactly where the pain is
What is a PROM for achilles tendinopathy
VISA-A
Achilles Tendinopathy Special tests
Royal London Hospital Test, Arc Sign Test
Description of pain for Tarsal tunnel syndrome
Burning, tingling, or a sensation of ‘pins and needles’ in the foot and toes. Pain can also radiate up leg
Tarsal Tunnel Special Test
Tinel’s sign
What does SCEBS stand for
Somatic
Cognitive
Emotional
Behavioural
Social
What are somatic q’s (SCEBS)
When did it begin?
How often do symptoms occur?
What is the pain like?
T1, T2, T3
What are cognitive q’s (SCEBS)
What do you expect from the treatment?
Is there anything you do to improve the symptoms?
Do you think you have any influence on the pain?
What are Emotional q’s (SCEBS)
How do you feel when you have symptoms?
Do you think about _______ all the time?
What are Behavioural q’s (SCEBS)
What do you do when you have symptoms?
What activities are hindered by your complaint?
Do you think that exercise is harmful for someone with your condition?
What are social q’s (SCEBS)
What does your partner think about your complaint?
Does the complaint affect your social life?
What are the 9 physical examinations that you have to go through when assessing a pt
- Observation
- Palpation
- Passive ROM
- Active ROM
- Passive Accessory Movements
- MMT
- Neurological Screening
- Special Tests
- Functional Tests
What does it mean if PROM is greater than AROM
Muscular weakness
What does it mean if PROM and AROM is limited
Structural deformity
What are you looking for when assessing passive ROM
What ROM is available
Is there any resistance through ROM
Can you apply over pressure
What is the end feel (e.g soft, spasm, bony etc.)
Ankle P+AROM Dorsiflexion ROM
0-20 degrees
Ankle P+AROM PF
45 degrees
Ankle P+AROM Inv
0-30 degrees
Ankle P+AROM Ev
0-15 degrees
Can PAM’s be performed by the pt?
No
Nerve supply of PF muscles
Tibial nerve
Nerve supply of DF muscles
Deep peroneal nerve
Nerve supply of Inv muscles of the ankle
Tibial
Nerve supply of Ev muscles of the ankle
Fibularis longus + brevis - Superficial fibularis
Fibula’s terminus, Extensor digitorum longus - Deep Fibularis
