Week 4 Flashcards
Describe the two main functions of the ankle and foot and how it achieves those functions.
Is to promote stability and mobility to the human body. It does this by supporting body weight and providing a stable lever for push off. Also the ankle and foot absorbs forces from above and below and conforms to the terrain.
Describe the axis of motion for the TC joint and how that and the size and shape of the joint surfaces affects the overall plane of motion of the joint.
Modified hinge joint with one degree of freedom (dorsiflexion/plantarflexion). Shape of talus and tibial palon is larger anterior than posterior. Lateral facet is larger than the medial facet. Dorsiflexion comes with pronation/eversion and abduction. Plantarflexion comes with supination/inversion and adduction. Weaker in PF vs DF.
In the rearfoot, appreciate the relative contributions of the talus and calcaneus at the TC and ST joints to the composite motions of supination and pronation.
TC joint Subtalar joint has 1 degree of freedom: IV/EV. ST joint has 3 facet articulations (posterior, middle, anterior) pronation/supination is trip-planar motion. At TC joint DF/PF are major movements, at ST joint ADD/ABD and EV/IV are major. When you combine these motions you get supination/pronation.
Explain the arches of the foot, their components and the static structures that maintain those arches.
Each arch has a keystone bone/joint that gives it the most structure. Transverse arch: intermediate cuneiform. Medial longitudinal arch: talonavicular joint, plantar aponeurosis.
Compare and contrast the Pes Planus and Pes Cavus positions, and how resting position in one or the other will impact the position and pressures in the other segments of the foot as well as the leg.
Pes planus: flat feet. Pes Cavus: high arches. Pes planus lacks supination and mobility and will normally lack push off for gait and running. Will correlate with increased Q-angle, tibial IR, patellar symptoms.
Compare and contrast the movements that occur in the rearfoot during the composite motions of supination and pronation, particularly as it relates to the open kinetic change compared to the closed kinetic chain.
CLOSED CHAIN: Supination: talus is ABD&DF, calcaneus is inverted, navicular is raised, lisfranc pronates, arch is high. Pronation: Talus is ADD&PF, calcaneus is everted, navicular is lowered, lisfranc supinates, Arch is low.
OKC Supination: Calc IV, Talar ADD/PF. CKC Supination: Tib-fib ER, Talar DF/ABD, Calcaneal IV.
OKC Pronation: Calc EV, Talar ABD/DF. CKC Pronation: Tib-fib IR, Talar PF/ADD, Calcaneal EV.
Describe red flag conditions that may affect the ankle and foot region, including key historical and physical examination findings for each.
Neoplastic disease: persistent ankle or foot pain, no MOI. Not easily reproduced. Infections, cellulitis: pain, fever, chills, recent wounds. Tenderness of skin, swelling, warmth. Reactive arthritis: constant aching or throbbing pain, fever, chills. Reactive history of recent infection somewhere. Septic recent surgery, injection. Tenderness swelling in joints. Rheumatoid Arthritis. Pain and stiffness in more than 1 joint, fever, weight loss. Tenderness and swelling in multiple joints, bilateral symptoms. Gout: sudden onset of pain, great toe, chronic with interval attacks. Very painful, warm, red, swollen. Osteochondritis Dissecans: painful ankle or talus, acute trauma or repetitive stress. Mild effusion, special tests normally negative. Acute Compartment Syndrome: 6 P’s (pain, pressure, paresthesia, pulselessness, and paralysis) recent blunt trauma, fracture, casting. Peripheral arterial Occlusive Disease PAD: LE pain, cramping, numbness, age above 60, Type 2 DM. Shiny LE skin, decreased pulse. Superficial Vein Thrombophlebitis. Inflammation of superficial vein due to blood clot, pain in area of vein. Swelling, tenderness to palpate. DVT: Blood clot of deep vein, mostly large veins in LE, Deep pain and cramping in area of DVT, Wells criteria, swelling, warmth, discoloration. Pulmonary embolism: sudden blockage of pulmonary arteries, shortness of breath, chest pain, light headed dizziness. Wells Criteria.
Recognize the two types of diabetes and how their management differs, including the impacts of exercise and activity on their blood glucose levels.
Type 1: insulin is not produced by the beta cells in pancreas, no insulin in the bloodstream. Type 2: cells are no longer allowing insulin to bind in the cell, the channel is not open in the cell. Type 2: Blood sugar rises -> pancreas makes more insulin -> pt gets hypoglycemia cause body can’t keep up with insulin production. Exercise changes blood glucose.
Associate hypoglycemia with its set of symptoms and hyperglycemia with its set of symptoms and plan an appropriate response if your patient experiences either.
Hypoglycemia: Hunger, shaking or tremors, sweating, dizziness, fast HR, anxiety, blurred vision, weakness, headache, irritability. Hyperglycemia: excessive hunger, thirst, weakness, frequent urination, blurred vision, dry skin, sores not healing, nausea, sleepiness after eating. Have emergency glucose ready for hypoglycemia.
Describe the appropriate screening procedures for patients with diabetes, including peripheral vascular and peripheral neurogenic conditions (among other affected systems) that affect the health of their feet.
Vascular screening for diabetic foot: Peripheral ischemia, claudication symptoms or signs, assess pulse, capillary refill time, temperature, Buerger’s test, ankle-brachial index. Neurologic screening for diabetic foot: 10g monofilament testing, temperature, vibratory sense, proprioceptive testing, reflexes, MMT, Semmes-Weinstein foot test locations.
Describe appropriate management strategies, including prevention methods, that physical therapists should implement with their diabetic patients, particularly those with foot wounds or pathology.
Wound care: callus removal, wound management, infections. Accommodate by offloading: offload, immobilize, compliance. Prevention: Identify high risk pt, inspect feet regularly, educate, appropriate footwear, treat quickly.
Identify impaired structures in children with talipes equinovarus and the tissues involved.
Clubfoot (talipes equinovarus) keeps the foot in an inverted position. Posteromedial muscles are pulling feet in this position. Joint capsule changes length. Tibia IR.
Describe a management strategy that involves both physical therapy interventions as well as bracing or casting techniques for patients with talipes equinovarus.
Ponsetti method: manipulation, serial casting, achilles tenotomy, bracing, normal 5-7 castings to normal position. Educate, taping, motor skill development, ROM, strength.
Recognize the signs and symptoms of, and the appropriate management strategies for patients with calcaneal apophysitis.
Calcaneal growth plate is disrupted. Local pain, antalgic gait, swelling, ROM limitation and pain with DF. Management is to restrict DF with heel lift, modify activity level, stretch GS complex, gradual return to full DR.
Describe common conditions that occur in each of the 3 ankle regions and 3 foot regions described in this lecture.
ANKLE: Lateral ankle pain: ankle sprains, fib fracture, peroneal tendinopathy, osteochondritis dissecans talar dome. Posterior ankle pain: Achilles tendinopathy or rupture, sever’s disease, calcaneal fracture, posterior ankle impingement. Medial ankle pain: Medial tibial stress syndrome, anterior tib tendiopathy, posterior tib tendiopathy, exertional compartment syndrome, FHL tendiopathy, medial ankle sprain. FOOT: Heel pain: Plantar heel pain, heel fat pad syndrome, tarsal tunnel syndrome. Midfoot pain: Cuboid syndrome, Charcot injuries, Lisfranc fracture or injury. Forefoot pain: Hallux valgus limitus & rigidus (bunion), Morton’s neuroma, Claw toes, Hammer toes.
