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ROM
- DF - 20
- PF - 50
- Inversion - 35
- Eversion - 15
- Subtalar inversio/eversion - 5
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Talocrural jt - formed by what? what motions?
- Tibia + Fibula + Talus
- DF + PF ONLY
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Subtalar jt - formed by what? what motions?
- Talus + Calcaneus
- Inversion + eversion ONLY
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Talocrural jt - Loose-packed & closed-packed position
- Loose - 10 PF + Mid bet inversion/eversion
- Closed - Full DF
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Subtalar jt - Loose-packed & closed-packed position
- Loose - Mid ROM
- Closed - Supination
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Mid foot movements - 2
- Inversion + ADD
- Eversion + ABD
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Ankle - Articular innervation comes from - 2
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Dorsalis pedis artery - Location; palpate where; important why
- Passes over navicular& cuneiform bones just lateral to extensor hallucis longus tendon
- Palpation - On dorsum of foot
- Rule out - intermittent claudication
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Ligaments - check DF, PF, Inversion, Eversion
- DF - posterior talofibular
- PF - anterior talofibular
- Inversion - calcaneofibular + anterior & posterior talofibular
- Eversion - deltoid
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Longitudinal arch - supported by what ligament?
- Long plantar ligament
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What bone is key to lateral arch?
Cuboid
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Ankle inversion - prime movers - 1
Posterior tibialis
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Fibula rotates how w/DF to accommodate wider portion of talus?
Laterally
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Early stance - position at subtalar jt; midfoot jt; tibial rotation; calcaneus; Transmetatarsals
- Pronation (subtalar jt)
- Tibial IR
- Midfoot ADD
- Calcaneal eversion
- TT unlocked
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Late stance - position at subtalar jt; midfoot jt; tibial rotation; calcaneus; Transmetatarsals
- Supination (subtalar jt) - foot goes into rigidity to push off
- Tibial ER
- Midfoot ABD
- Calcaneal inversion
- TT locked - for push off
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Pronation - Open-chain - position at talocrural, subtalar & midfoot jts
- DF (talocrural jt)
- Eversion (subtalar jt)
- ABD (midfoot)
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Supination - Open-chain - position at talocrural, subtalar & midfoot jts
1 thing different in closed-chain
- PF (talocrural jt)
- Inversion (subtalar jt)
- ADD (midfoot)
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Closed chain - ABD (midfoot) - to push off toe
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Tibial rotation - pronation vs supination; at what jt?
- Pronation - IR
- Supination - ER
- Subtalar joint
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Subtalar pronation - what other compensations in leg? - 3
- Tibial, Femoral, & pelvic IR
- Opposite for subtalar supination
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TO INC mobility of mortise when it is restricting ankle DF do what glide?
Distal tibiofibular anterior or posterior
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Talocrural posterior glide INC what?
DF
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Talocrural anterior glide INC what?
PF
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Medial Subtalar glide INC what?
Eversion
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Lateral subtalar glide INC what?
Inversion
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Achilles' Tendon Rupture - mechanism of injury - 2
- Sudden DF stress while gastroc contracted
- Direct blow
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Achilles' Tendon Rupture - S/S - 5
- Swelling/discoloration within 24 hours
- Severe distal calf pain
- Sense of snapping
- Weak PF
- No push-off during gait
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Ankle sprain - inversion - mechanism of injury; what ligament; special test; PT CONTRA
- Foot is PF/inverted
- ATFL + Calcaneofibular
- Talar tilt - Subtalar inversion + Talar ADD
- NO STRETCHING
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Ankle sprain - eversion - mechanism of injury; what ligament; special test; PT CONTRA
- Deltoid ligament
- Talar tilt - Subtalar eversion + Talar ABD
- NO STRETCHING
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Plantar fasciitis - S/S (4); d/t what?
- Pain where?
- PT initial & later
- Heel pain w/WB
- Pain worse upon initial WB after rest - in am
- Point tenderness over medial calcaneal plantar tuberosity
- Tight triceps surae (soleus)
- D/t Excessive pronation
- PT - initial = casting at night
- PT - later = Flexibility of plantar fascia for pes cavus foot; Careful flexibility exercises for triceps surae; Strengthening of invertors of foot
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Plantar fasciitis - diff from tarsal tunnel syndrome
(-) Tinel's sign
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Pes planus - another name; 2 types + differentiate bet them
- Flatfoot or "Fallen arches"
- Flexible - Medial arch/foot pronates w/WB but reforms w/NWB
- Rigid - deformity persists in WB/NWB & during active supination
- Talus ADD/PF on everted calcaneus
- Foot fatigue
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Pes cavus - another name; what arches are involved & how
- “Hollow foot”
- Longitudinal arch - INC height
- Transvere (anterior) arch - dropped = splayed forefoot
- Ankle PF
- Claw toes
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Hallux Valgus - S/S (3); Normal angle?; D/t what? (3)
- Pain/bunion @ 1st MP joint
- Medial deviation of 1st metatarsal
- Lateral deviation/rotation of hallux
- Normal angle - 8-20 deg
- D/t - Abnormal foot mechanics; Pointed toe shoe wearers; Excessive pronation
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Morton's Neuroma - pain where; pain INC w/what? what arch involved; subtalar jt in what position
- U/L - Tenderness at 3rd/4th metatarsal heads & web spaces
- Numbness/pain INC w/WB
- Antalgic gait
- Flat transverse arch
- Pronated foot
- 3rd/4th metatarsal calluses
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Metatarsalgia - S/S - 4
- Plantar foot pain & fatigue w/WB
- Antalgic gait
- Callus over middle metatarsals
- Hypermobile or pronated foot
-
Metatarsalgia - mechanical etiologies - 5
- Tight triceps surae group and/or Achilles' tendon
- Collapse of transverse arch
- Short first ray
- Pronation of forefoot
- Changes in footwear
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Metatarsus Adductus - Rigid vs Flexible foot position
- RigidMedial subluxation of TMT jts
- Hindfoot - in slight valgus
- Navicular - lateral to head of talus
- FlexibleADD of all 5 metatarsals at TMT jt
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Charcot-Marie-Tooth disease - definition + S/S (4); d/t what
- Slowly progressing degenerative nn disease of peroneals
- MM - weakness + DEC mm size
- High arches
- Hammertoes
- D/t DEC sensation
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Talipes equinovarus vs Talipes Equinus
- 1 vs 2
- 1 - Talipes equinovarus (clubfoot) - PF, ADD, and inverted foot
- 2 - Talipes Equinus - PF; Subtalar pronation
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Tibial fx - spiral - mechanism of injury
- Severe torsion during a skiing accident
- Slow healing - tibia has a relatively poor blood supply
-
Trimaleolar fx - mechanism of injury?
- Fracture of both malleoli & posterior tubercle of distal tibia
- Falling off of something & landing on feet
-
Trimaleolar fx - what is best radiograph view?
AP & lateral
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Bimalleolar fx - mechanism of injury
Coming down on ankle – really bad inversion sprain
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Name & describe - S/S - 5; pain where?
- Tarsal Tunnel syndrome - entrapment of posterior tibial nn in tarsal tunnel - tibial neuritis
- Pain/numbness along medial ankle to plantar surface of foot
- PROM - pain w/PF & eversion
- (+) Tinel's over tarsal tunnel
- MIMICKS PLANTAR FASCITIS
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Pain location difference for:
- plantar fasciitis vs tarsal tunnel syndrome vs. posterior tibial tendonitis
- Plantar fasciitis - medial calcaneal plantar tuberosity
- Tarsal tunnel syndrome - medial ankle to plantar surface of foot
- Posterior tibial tendonitis - medial ankle & up into calf
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This pain referral suggests what pathology?
- Tarsal Tunnel Syndrome
-
This pain referral suggests what pathology?
- Plantar fascitis
-
This pain referral suggests what pathology?
- Posterior tibial tendonitis
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Lisfranc injury/fx (midfoot injury; tarsometatarsal injury) - define; mechanism of injury (3); S/S (2)
- 1 or all metatarsal bones displaced from tarsus
- Mechanism of injury - crush injury (heavy object on foot) or landing on foot from significant height
- Athletes - PF + another player lands on their heel (football/soccer)
- Bruising on BOTTOM of foot
- Pain INC w/standing or walking
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Name test; tests what; describe; (+)
- Anterior drawer test
- ATFL - Anterior talofibular ligament
- Pt supine, w/heel just off edge of table in 20° PF
- PT stabilizes lower leg/Pulls talus anterior
- (+) Excessive anterior glide; Pain
-
Name test; tests what; describe; (+)
- Talar tilt
- CFL ligament w/ADD
- Deltoid ligament w/ABD
- Pt sidelying, knee slightly flexed, ankle in neutral
- (+) Excessive ADD/ABD + Pain
-
Name test; tests what; describe; (+)
- Thompson's
- Achilles' tendon
- Pt prone, w/foot off edge of table
- PT squeezes calf muscles
- (+) No movement of foot while squeezing calf
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Name test; tests what; describe; (+)
- Morton's test
- Identifies stress fx or neuroma in forefoot
- Pt supine, w/foot supported on table
- PT grasps around metatarsal heads & squeezes
- (+) Pain in forefoot
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Tinel's sign @ ankle - tests what? - 2
- Posterior tibial nn - posterior to medial malleolus
- Deep fibular nn - anterior to talocrural joint
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Name test; tests what; describe; (+)
- Squeeze Test
- Injury of syndesmosis ligament
- Pt sitting, PT grasps anterior leg proximally & squeezes fibula & tibia together (squeezing interrosseous ligement)
- (+) Pain at ankle
-
Name test; tests what; describe; (+)
- Homan's Sign
- Tests for DVT
- Pt supine
- Pt DF ankle as PT squeezes calf
- (+) Pain in back of leg
-
Name test; tests what; describe; (+)
- Navicular drop test
- Medial longitudinal arch
- Pt standing, Subtalar jt in neutral
- Measure navicular height in full WB & relaxed
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Grade II inversion ankle sprain - subacute phase - PT - 2
- Subacute - 2 weeks
- Closed-chain strengthening
- Proprioceptive exercises
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Anterior drawer test - done in what position of foot?
20 PF
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Fixed forefoot varus malalignment - compensatory motions/postures - 4
- Excessive mid tarsal or subtalar pronation
- PF 1st ray
- Hallux valgus
- Excessive tibial; tibial & femoral; or tibial, femoral & pelvic IR
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