1. Hip joint

    (talk about joint- stability, size)
    most stable

  2. Lesions of the hip are detected during what type of activity?
    walking/ weight bearing
  3. Where do lesions of the lumbar refer to?
    lumbar spine, SI, anterior thigh and knee
  4. What type of joint is the hip?
    multiaxial ball and socket
  5. what structures form the acetabulum?
    ilium, ischium, pubis
  6. 3 ligaments that support the hip
    iliofemoral (strongest ligament)


  7. The ligaments tighten in ______ and also ______rotation

    internal rotation
  8. Resting/loose pack position of the hip
    30d flexion

    30d abduction

    slight ER
  9. forces on the hip:

    during standing
    .3 times body weight
  10. forces on the hip:

    standing on 1 limb
    2.4-2.6 times body weight
  11. forces on the hip:

    1.3-5.8 times body weight
  12. forces on the hip:

    walking on stairs
    3 times body weight
  13. forces on the hip:

    4.5 + times body weight
  14. neck shaft angle for a 1 yr old
  15. neck shaft angle for an adult
  16. neck shaft angle larger than 120-125d is termed....
    coxa valga
  17. neck shaft angle smaller than 120-125 is termed....
    coxa vara
  18. normal anteversion (femoral condyle axis/femoral head axis) of hip is _____at birth
  19. normal anteversion (femoral condyle axis/femoral head axis)of the hip is ______ for an adult
  20. muscles of the hip
    glute max, glute med, glute min, piriformis
  21. where is the trochanteric bursa?
    over greater trochanter beneath glute max
  22. Is congenital hip dysplasia more common in girls or boys and when is it more common?
    more common in girls

    during infancy
  23. presence of snapping is termed_____
    coxa saltans
  24. How do you get snapping of the hip?

    explain in detail about iliopsoas,
    iliopsoas tendon slips over the osseous ridge of the lesser trochanter or anterior acetabulum
  25. How do you get internal snapping of the hip?
    iliofemoral tendon rides over femoral head which occurs at 45d when hip goes from flexion to extension
  26. How do you get external snapping of the hip?
    Tight IT band or glute max tendon slides over the greater trochanter occurs during hip flexion and extension and is made worse if hip is in MR
  27. How do you get intra-articular snapping of the hip?
    acetabular labral tears or loose bodies-patient complains of sharp pain into the groin and anterior thigh, especially on pivoting movements

    clicking heard and felt when patient is adducted and LR
  28. Dermatomes
    • L1= groin
    • L2= medial thigh
    • L3=medial patella
    • L4=medial malleolus
    • L5=top of foot
    • S1=lateral border of foot
    • S2=behind knee
  29. Myotomes
    • L2=hip flexion
    • L3=knee extension
    • L4=dorsiflexion
    • L5=great toe extension
    • S1=ankle PF and eversion
    • S2=knee flexion
  30. Reflexes
    patellar tendon = L4

    achilles S1
  31. hip issues and gait
    painful hip is shorter on stance

    stiffness causes trunk rotation

    B hip flexor tightness increases lordosis
  32. AROM of LE
    • flexion=100-120
    • extension 10-15
    • abduction-30-50
    • adduction=30
    • ER=40-60
    • IR=30-40
  33. End feels of hip movements
    • flexion-tissue approximation or tissue stretch
    • extension-tissue stretch
    • abduction-tissue stretch
    • adduction-tissue approximation or tissue stretch
    • ER-tissue stretch
    • IR-tissue stretch
  34. capsular pattern of the hip
    flexion, abduction, and MR order may vary
  35. rectus femoris length test
    supine, 1 leg over edge of table, flex other to chest

    look for extension of lower leg at the knee joint
  36. Ober's test
    sidelying, extend and abduct upper leg, lower leg and test, leg remains abducted

    tight TFL/ITB
  37. ROM needed for tying shoes
    120d of flexion
  38. ROM needed for sitting
    112d of flexion
  39. ROM needed for stooping
    125d flexion
  40. ROM for squatting
    115 flexion

    20 abd

    20d IR
  41. ROM needed for ascending stairs
    67d flex
  42. ROM needed for descending stairs
    36d flex
  43. ROM for putting foot on opposite thigh
    120 d flex

    20 abd

    20 ER
  44. ROM needed for putting on pants
    90 flex
  45. Craig/Ryder test
    prone, knee flexed to 90d

    rotate hip until greater trochanter is parallel with table

    estimate angle of leg with the vertical hip anteversion/ MR of femur
  46. hip scourer
    hip flexed 90d

    pressure down thru femur

    look for pain
  47. piriformis special test

    hip flexed to 60d, flex at the knee and push hip into adduction

    look for pain/parasthesia-compression of sciatic nerve

    hold for 60secs, goal is reproduce radiating symptoms
  48. sign of the buttock
    SLR supine

    if limitation-bend knee

    look for instability to increase in flexion= serious pathology of hip
  49. true hip pain is referred to where?
    groin, but also ankle, knee, lumbar spine and SI joint
  50. inguinal ligament
    runs from ASIS to symphysis pubis
  51. sciatic nerve
    under piriformis or between ischial tuberosity and greater trochanter
  52. General info about Legg-Calve-Perthes Disease

    what does it lead to later? who it affects? causes?
    -self limiting

    -often leads to severe DJD later in life

    -affected children between 2-12 most commonly in boys (4 to 1 ratio)

    -causes: metabolic bone disease, thrombotic vascular insults, trauma, infection
  53. Clinical presentation of Legg-Calve-Perthes
    -child 2-12

    -gradual onset of pain, increase with activity

    -aching sensation in groin, thigh, knee

    -limited PROM abduction and IR

    -antalgic gait

    -decreasing leg length
  54. interventions for Legg-Calve-Perthes
    -skin traction

    -bracing (abduction)

    -PT for strengthening and gentle ROM
  55. General info on Slipped Capital Femoral Epiphysis

    when it occurs? what happens? what happens to growth plates and what causes it? what happens to femoral head during weight bearing? cause?
    -occurs during adolesence

    -epiphysis slips from its normal position on the femur makes the growth plate become disorganized as fibrous tissue increases

    femoral head displaces inferiorly and posteriorly during weight bearing

  56. clinical presentation of capital femoral epiphysis
    -2 to 1 ratio boys to girls

    -boys 10-17 girls 8-15

    -75% of cases occur with obese children with delayed maturation

    -usually vague pain, can be in hip but also common in knee

    -ROM limited in IR, abd and flex--ext may be increased

    -position of comfort-flex, ER, abd
  57. interventions for capital femoral epiphysis
    surgery, bracing

    seen in PT for ROM and strengthing
  58. Trochanteric bursitis
    pain over lateral hip and occasionally down the lateral thigh to the knee when the IT band rubs over the trochanter
  59. psoas bursitis
    -pain in groin or anterior thigh and possible into the patellar area

    -aggravated during activities requiring excessive hip flexion
  60. ischiogluteal bursitis
    pain is experienced around the ischial tuberosities, especially when sitting, occasional sciatica if inflammation affects nearby sciatic nerve
  61. impairments/problems with bursitis
    -pain when involved overlapping muscle contracts when stretched

    -gait deviations

    -imbalance in muscle flexibility and strength

    -decrease muscular endurance
  62. management of bursitis (acute)

    -ice, other anti-inflam tx
  63. management of bursitis (subacute and chronic)
    -stretching (psoas and ITB)

    -strengthening and endurance training (isometics, controlled WB exercise, biking walking)

    -functional activities
  64. etiology of piriformis
    -sciatic nerve passes deep

    -entrapment results in sensory changes along lateral and posterior portion of the leg and dorsal/plantar surface of the foot

    -progressive weakness in hamstring, portion of the adductor magnus and other muscles of the leg and foot can develop
  65. common impairment/problems with piriformis syndrome
    -exacerbated with sitting

    -complain of deep buttock pain, radiating pain down leg

    -often confused with radiating pain from a lumbar problem; when x-rays, MRI's are negative patient is dismissed as all in youre head
  66. management of piriformis (acute)
    rest, ice, and other anti-inflam treatments
  67. management of piriformis (subacute/chronic)

    -soft tissue mobilization to piriformis

    • -stretching of piriformis
    • stretch as many times a day
    • piriformis is an ext, abd, ER until 90d then changes to IR

    • -stretch/strengthen may be muscle imbalance due to
    • tight ITB, hamstrings, weak adductors
  68. knee joint is _______ (size)
  69. what type of joint is the knee?
    modified hinge
  70. femoral condyles are ________concave/convex?
  71. medial tibial plateau is _______concave/convex?
    concave (slightly)
  72. lateral tibial plateau is _______concave/convex?
    concave in the front

    convex in the sagittal
  73. does the medial or lateral condyle project more anteriorly?
    lateral to prevent subluxing
  74. normal Q angle for men? for women?
    men 13d

    women 18d
  75. how many facets does the patella have? name them!

    lateral, medial, odd (medial side of patella)
  76. lateral and medial facets are sub divided into proximal, middle and distal pairs for a total of how many facets?
  77. name quad muscles:
    rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
  78. what is the function of the VMO?
    pull patella medially to prevent from subluxing laterally
  79. what muscles is affected first with knee joint effusion?
  80. name the hamstrings muscles:
    biceps femoris, semitendinosus, semimembranosus
  81. name the hamstrings muscles that are lateral? that are medial?
    lateral-biceps femoris

    medial-semitendinosus, semimembranosus
  82. what makes up the pes anserine? where is it?
    sartorious, gracilis, semitendinosus

    located on medial aspect of tibia

    has bursae that is commonly irritated
  83. popliteus muscle-where is it? what does it do?
    crosses behind knee, lateral aspect of femur to medial tibia

    helps with the screw home mechanism
  84. what does the gastroc do?
    flexes the knee in open chain
  85. describe the medial meniscus
    C shaped, thicker posteriorly,

    large and skinny
  86. describe the lateral meniscus
    O shaped, same thickness throughout

    short and fat
  87. how are the menisci attached to the tibia?
    by coronary ligaments
  88. how much motion does the lateral meniscus have?
    10 mm
  89. how much motion does the medial meniscus have?
    2 mm
  90. meniscus moves ______with knee flexion

    meniscus moves _______with knee extension
    posterior (flexion)

    anterior (extension)
  91. what is the medial meniscus attached too?
    MCL, semimembranosus, ACL
  92. what is the lateral meniscus attached to?
    popliteus tendon and PCL
  93. what is the function of the menisci?
    shock absorption, depress weight, make joint surfaces more congruent
  94. Collateral ligament facts
    tight in extension, loose in flexion

    tight in ER of tibia
  95. MCL resists _____forces
  96. LCL resists _____forces
  97. MCL connects to....?
    medial meniscus and semimembranosus
  98. LCL connects to....?
    biceps femoris
  99. attachments of ACL
    starts posterior/lateral on femur

    courses anterior/medial to attach on tibia
  100. when is ACL most taut?
    throughout entire knee motion
  101. has how many bands? name them!
    3 bands



  102. When is the anteromedial portion of the ACL tight?
    during knee flexion, somewhat in extension too
  103. when is posterolateral portion of ACL tight?
    knee extension
  104. when is the ACL at its "loosest"?
  105. is it vascularized and innervated?
  106. ACL tigthens in MR/LR?
  107. PCL attachments
    starts anterior/medial on femur and attaches posterior/lateral on tibia
  108. is the PCL vascularized and innervated?
  109. Arcuate ligament complex...what does it do? what is it?
    -strengthens the posterior lateral capsule

    -Y shaped band of deep capsular fibers that attach distally to the fibular head, fanning proximally over the posterior capsule and a portion of the popliteal tendon
  110. Posterior oblique popliteal ligament--what does it do? what is it? what does it limit?
    -supports the posterior-medial capsule

    -an expansion of the semimembranosus tendon

    -limits anterior-medial instability
  111. Joint capsule- what is it? where does it go? what does it contain?
    -like a cylinder with a posterior invagination

    -courses around the ACL/PCL

    -has up to 3 folds called plicas
  112. patellar tendon.....is it a tendon or a ligament?
  113. patella alta
    patellar tendon too high, more than 20% longer , more likely to have problems with instability
  114. patella baja
    patellar tendon too low, 80% or less length of patella, some say more likely to have compressive disorders
  115. Iliotibial tract...what is it? what does it attach to?
    -fascia lata of the thigh that arises from the TFL and tendon of glute max

    -attaches to lateral condyle of tibia, and vastus lateralis and lateral patellar retinaculum
  116. Screw-home mechanism with flexion
    tibia IR and femur ER
  117. screw home mechanism with extension
    tibia ER and femur IR
  118. screw home mechanism with extension (incorporating menisci)
    tibia moves anterior, menisci move anterior too
  119. screw home mechanism with flexion (incorporating menisci)
    tibia moves posterior, menisci move posterior too
  120. which way does the medial meniscus go when the femur IR on the tibia
    with IR of the femur on the tibia the medial meniscus goes POSTERIOR
  121. which way does the lateral meniscus goe when the femur IR on the tibia
    with IR of the femur on the tibia the lateral meniscus goes ANTERIOR
  122. during flexion/extension menisci travel with ______
  123. during rotation menisci travle with _______
  124. ER tightens which ligaments?
  125. IR tightens which ligaments?
  126. Resting/loose pack of the knee
    25d flexion
  127. Closed pack position of the knee
    full extension, LR of the tibia
  128. capsular pattern of the knee
    flexion then extension
  129. hyperextension stretches out which ligament?
  130. isolated medial rotation of the tibia results in what?
    ACL tear
  131. dashboard affects which ligament?
  132. Valgus, anterior forces of the tibia and forced ER of the tibia affects what and is called what?
    MCL, ACL, medial meniscus

    Terrible Triad
  133. hyperflexion results in what?
    meniscal injury
  134. if you hear clicking what does that suggest?
    patellofemoral issue
  135. "pop" at the time of accident suggests
    ACL tear
  136. theatre sign
    pain with prolonged sitting with knee flexed

    suggest patellofemoral problems
  137. joint locking suggests
    meniscal tear
  138. Osgood- Schlatters
    enlarged tibial tuberosity
  139. knee flexion ROM
  140. knee extension ROM
  141. MR of the tibia on the femur (knee flexed to 90) ROM
  142. LR of the tibia on the femur (knee flexed to 90d) ROM
  143. end feels:
    MR of tibia
    LR of tibia
    patellar movements
    • flexion=tissue approximation
    • extension=tissue stretch
    • MR of the tibia=tissue stretch
    • LR of the tibia=tissue stretch
    • patellar movements=tissue stretch all directions, should not translate laterally more than 1/2 of its body width without tilting or rotating
  144. who do you do a ligament screen on?
  145. valgus stress test at 0d extension 30d flexion =
  146. varus stress test at 0d extension and 30d flexion =
  147. Lachman's/ Anterior Drawers =
  148. Posterior drawer
  149. one plane medial tests which ligament?
  150. one plane lateral tests which ligament?
  151. one plane anterior tests which ligament?
  152. one plane posterior tests which ligament?
  153. Anteromedial rotary tests which ligaments?
    MCL first than ACL
  154. Anterolateral rotary tests which ligaments?
    ACL, LCL
  155. Posteromedial rotary tests which ligaments?
    PCL, MCL
  156. Posterolateral rotary tests which ligaments?
    LCL, PCL
  157. anteromedial rotary tests is called?
  158. anterolateral rotary test is called?
    pivot shift
  159. posteromedial rotary test is called?
    hughston's posteromedial drawer
  160. posterolateral rotary test is called?
    external rotation

  161. describe the posterior drawer test
    patients lies supine knee bent to 90d

    thumbs on jt line

    push posterior on tibia

    looking for increase in posterior motion
  162. describe the lachman's test
    anterior drawer in 15-30d flexion

    patient sitting c leg rest on examiners knee

    examiner stabilizes with hand and forearm
  163. describe the slocum test
    15d of lateral rotation

    do anterior drawer test

    motion occurs mostly on medial side showing anterior medial instability
  164. describe the lateral pivot shift
    knee extended or slightly flexed, medial rotation of tibia

    apply valgus/forward pressure at the proximal tibia then flex the knee
  165. clunk from lateral pivot shift is what?
    reduction of tibia (tibia going back in place)

    occurs at 30d of flexion
  166. reduction from lateral pivot shift is what?
    occurs because at 30d of flexion ITB drops below the center of rotation of the knee and then jerks the tibia posteriorly back in place
  167. describe hughston's posteriomedial drawer test
    tibia slightly medial rotated

    push tibia posterior

    if there is a lot of movement it suggests PCL,MCL,ACL tears
  168. describe external recurvatum test
    patient lies with legs extended

    grasp big toes and lift legs

    if knee hyperextends and tibia rotates laterally suggests LCL PCL tears
  169. describe anterior drawer test
    junk test

    one plane anterior

    suggest ACL but can be false due to help from collaterals
  170. describe the McMurray test for medial meniscus
    knee in full flexion, ER tibia, valgus pressure at knee extend knee
  171. describe the McMurray test for the lateral meniscus
    knee in full flexion, IR of tibia, varus pressure at knee then extend knee
  172. swelling within 1-2 hours suggests?
    think blood which suggests ligament tear, osteochondral fracture or peripheral meniscus tear, doughy feel, hot joint
  173. swelling within 8-24 hours suggests?
    think synovial fluid, suggest joint irritation, fluctuating or boggy feeling
  174. describe plica syndrome
    irritated soft tissue medial to knee


    presents like patellofemoral issue

    occurs from repetitive motions
  175. describe the brush test
    start medial to inferior patella, brush up 2-3 times, then start lateral and brush down lateral aspect

    positive sign is a wave of fluid going back to medial area
  176. describe the McConnell Test
    isometric contraction of quads at 0, 30, 60, d 10 secs each

    -compare pain level to same contraction with slight medially directed pressure on the lateral edge of the patella

    -if less pain, patellar tracking problem (lateral) indicated
  177. what is the Q angle?
    measure by ASIS thru midpoint of patella and tibial tubercle through midpoint of patella
  178. describe the apprehension test
    knee at 30d flexion, examiner pushes patella laterally

    quad will fire and patient will be apprehensive for tendency of patella to dislocated laterally
  179. describe the noble compression test
    supine, flex knee to 90d

    pressure applied to lateral femoral condyle or 1-2 cm proximal to it, thumb and knee passively extended

    -at 30d short of full extension, patient will complain of pain
  180. you palpate the jt line for what kind of injury?
    meniscal tears
  181. palpating patella facet
    relaxed quads, push patella medially and laterally to check for tenderness
  182. palpating suprapatellar pouch
    proximal to base of patella

    lift skin with thumb and finger

    feel for thickness, tenderness or nodule
  183. palpating MCL
    medial to tibiofemoral joint, feel for tenderness
  184. palpating pes anserinus
    medial and distal to tibial tuberosity, check for tenderness
  185. etiology of symptoms of Anterior knee pain (patellofemoral issue)
    -direct trauma

    -imbalance of soft tissues aligning the patella in the trochlear groove and influencing patellar tracking

    -increasing Q angle

    -insufficient VMO muscle
  186. common impairments/problems with anterior knee pain
    1. weakness, inhibition or poor recruitment or timing of VMO

    2. outstretched medial retinaculum

    3.tight lateral retinaculum, IT band, or facial structures around the patella

    4. decreased medial glide or medial tipping of the patella

    5. pronated foot

    6. pain on palpation

    7. tight gastroc, hamstring, or rectus femoris

    8. irritated patellar tendon or subpatellar fat pad

    9. pain with long term sitting (theatre sign)
  187. Management of anterior knee pain (acute)
    -modalities, rest, protection, gentle submax multi angle isometrics
  188. management of anterior knee pain (subacute)
    mobile the patella

    friction massage

    medial tipping of the patella

    patellar taping

    stretch of IT band

    strengthen VMO
  189. what does taping of the patella allow for?
    more vigorous exercise

    pain relief so you can exercise them
  190. what are the exercises that strengthen the VMO
    -quad sets



    -weight bearing terminal knee ext


  191. management of anterior knee pain (remodeling stage)
    functional activities

    increase resistance

    activity specific drills
  192. mechanisms of injury of meniscal tears
    -medial more commonly injured

    -often foot fixed on ground and femur is IR or ER
  193. common impairments/problems of meniscal tears
    joint locking

    pain along joint line

    knee effusion/swelling
  194. describe a bucket handle tear

    loose, not attached to tibial plateau so you can pick it up like a bucket handle
  195. describe a radial meniscal tear
    perpendicular to edge
  196. non-operative management of meniscal tears
    - reduction of loose body

    -general open and closed chain exercises to improve strength of leg musculature

    -weight bearing may be limited for some time to aid in healing of meniscus
  197. non-operative management of MCL/LCL strains
    general open and closed chain exercises to improve strength of leg musculature

    limit medial and lateral stress/rotational stress

    avoid varus/valgus functional activities
  198. post-operative management of an ACL tear
    often in slight flexion

    sometimes none at all
  199. how strong is the ACL? before you tear it...
    tear comes from 652 lbs or more

    graft is equal or better
  200. what weight do you pull out the ACL?
    230lbs- bone tendon bone

    this is your worry initially

    6 weeks bone plug healed
  201. what makes the tibia not slide forward?


    meniscus/joint geometry

    weight bearing
  202. maximum protection phase of ACL: (5)
    1. RICE

    2. gentle isometric contraction of quads and hams

    3. patellar glides

    4. ambulation weight bearing varies some full

    5. ROM
  203. moderate and minimal protection phase of the ACL
    -advancement and vigorousness of ROM and strengthening exercise, increasing intensity of closed chain rehab
  204. precautions of ACL tears
    -terminal knee extension in open chain will cause anterior translation of tibia

    -closed chain provides more stability via joint compression and firing of hamstrings

    -graft is at its weakest at approx 6 wks
  205. what % of the population have foot complaints?
  206. general functions of the foot (4)
    -acts as a support base with minimal muscular effort

    -mechanism for rotation of the tibia/fibula during stance

    -flexibility to adapt to uneven terrain, and shock absorption

    -acts as a lever at push off
  207. rearfoot/ hindfoot bones in foot
    talus and calcaneus
  208. forefoot bones of the foot
    navicular, cuboid, 3 cuneiforms
  209. talocrural joint (ankle joint) characteristics
    -uniaxial, modified hinge, synovial joint

    -talus, medial and lateral malleolus

    -much more mobile while in PF
  210. medial ligament in foot:

    -medial collateral ligament
  211. superficial medial ligaments in foot: what are they and what do they do?


    posterior tibiotalar

    **resist talar abduction
  212. deep medial ligaments in the foot: what do they do? what are they?
    anterior tibiotalar

    **resist lateral translation and lateral rotation of the talus
  213. anterior talofibular ligament: medial/lateral? what does it do?

    resists excessive inversion

    often sprained 1st
  214. posterior talofibular ligament: medial/lateral? what does it do?

    resists DF,adduction, MR and medial translation of the talus
  215. calcaneofibular ligament: medial/lateral? what does it do?

    resists inversion

    sprained 2nd
  216. subtalar joint
    articulation between the talus and calcaneous
  217. midtarsal joint
    combination of 2 joints: calcaneo-cuboid and the talo navicular
  218. talocrural joint resting pack, closed pack, capsular pattern
    resting/loose pack: 10d PF, neutral inversion/eversion

    closed packed: maximum DF

    capsular pattern: PF, DF
  219. normal transmalleolar angle
  220. normal toe out angle
    5d as a child

    12-18d as an adult
  221. foot loading during gait: walking, running, jumping
    walking- 1.2 x body weight

    running- 2 x body weight

    jumping- (2 feet) 5 x body weight
  222. arches of the foot maintained by:
    -wedging of the interlocking tarsal and metatarsal bones

    -tightening of ligaments of the plantar aspect of the foot and plantar fascia

    -instrinsic and extrinsic muscles and tendons of the foot
  223. medial arch is made up of:
    calcaneus, the talus, the navicular, the three cuneiforms, and the 1, 2, 3, metatarsals
  224. lateral longitudinal arch is made up of:
    calcaneus, the cuboid, and the 4, 5 metatarsals
  225. transverse arch is made up of
    cuneiforms, the cuboid, and the five metatarsal bases.
  226. line of Feiss is made up of what?
    medial malleolus, navicular, 1st metatarsal head should be in line with weight bearing
  227. Anterior tarsal tunnel contents
    -deep peroneal nerve passes under the extensor retinaculum

    -motor loss-extensor digitorum brevis

    sensory-small triangular area between the first and second toes
  228. tarsal tunnel contents:
    medial malleolus, calcaneus, and talus on one side and the deltoid ligament on the other

    -tibial nerve passes through

    -pain and paresthesia into the sole of the foot
  229. biomechanics of the foot: heel strike

    name foot position and ankle postions
    foot: supination-->pronation

    ankle: moving into PF
  230. biomechanics of the foot: flat foot

    name foot position and ankle position
    foot: pronation

    ankle: PF to DF
  231. biomechanics of the foot: midstance

    name foot positon and ankle positon
    foot: neutral

    ankle: 3d DF
  232. biomechanics of the foot: heel off

    name foot position and ankle position
    foot: supination

    ankle: 15d DF
  233. biomechanics of the foot: toe off

    name the foot position and ankle position
    foot: supination

    ankle: 20d PF
  234. where do sprains most generally occur?
    in PF inverted and adducted
  235. high heeled shoes contribute to what condition?
    heel cord tightening
  236. swelling above lateral malleolus suggests?
    fibular fracture or disruption of syndesmosis
  237. swelling posterior to lateral malleolus suggests?
    peroneal retinacula injury
  238. swelling distal lateral malleolus suggests?
    inversion ankle sprain
  239. asymmetrical calf bulk could suggest?
    peripheral nerve or nerve root involvement
  240. what is a pump bump and what does it suggest?
    build up of bone and callus on posterior calcaneus

    results from pressure on heel
  241. lateral malleoulus extends farther ______

    medial malleolus extends farther _______

  242. what are bone spurs? how do you get them? where do they commonly occur?
    abnormal bone growth

    get them from irritative lesion, overuse, trauma or excessive pressure

    occur at the dorsal aspect of the tarsometarsal joint, head of the 5th metatarsal, calcaneus, insertion of plantar fascia, superior aspect of navicular bone
  243. hallux valgus: what is it?
    -medial deviation of the head of the first metatarsal bone in relation to the center of the body and lateral deviation of the head in relation to the center of the foot

    -as metatarsal bones move medially, the base of the proximal phalanx is carried with it

    -phalanx pivots around the adductor hallucis muscle

    -bunion-combination of callus, thickened bursa and exostosis
  244. hallux rigidus is what?
    extension of big toe is limited

    causes: OA of the 1st MTP joint, abnormally long 1st metatarsal bone, pronation of the forefoot or trauma
  245. describe claw toe:
    hyperextension of the MTP and flexion of the proximal and distal IP
  246. describe hammer toe:
    extension of the MTP and flexion of the proximal IP, distal can vary
  247. describe mallet toe:
    flexion of the distal IP
  248. ROM for PF
  249. ROM for DF
  250. ROM for inversion
  251. ROM for eversion
  252. how many degrees of DF does it take to DESCEND stairs?
    20d DF
  253. what does walking require of the foot?
    10d DF

    20-25d PF
  254. describe the test for tibial torsion
    supine, align femoral condyles parallel with floor and have patient contract quad to hold

    -look at angle formed from malleoli and floor

    norms can be 12-30d
  255. describe the anterior drawer sign of the foot
    patient lies supine, examiner stabilizes the tibia and fibula, holds the patients foot in 20d of PF and draws the talus forward in the ankle mortise
  256. describe Thompson's test
    patient prone, with feet over edge of table

    squeeze calf muscle and foot should PF if the Achilles Tendon is intact
  257. describe Tinel's test of the foot:
    tap the front of the ankle (joint line) for the anterior tibial branch of the deep fibular nerve

    -posterior tib nerve may be impinged as it passes behind the medial malleolus
  258. if there is extracapsular edema what does that suggest?
    on one side of the Achilles tendon
  259. if there is intracapsular edema what does that suggest?
    on both sides of the Achilles tendon
  260. where is the anterior talofibular ligament?
    horizontal, small palpate very close to anterior aspect of lateral malleolus
  261. where is the calcaneal fibular ligament?
    tip of laterally malleolus down and back at approximately 45d stress with calcaneal inversion
  262. inversion/lateral ankle sprain characteristics
    95% of all ankle sprains are lateral

    most common ligament is the anterior talofibular ligament

    next most common is calcaneal fibular ligament
  263. eversion/medial ankle sprains
    greater likelihood of avulsion or fracture of medial malleolus with severe eversion stress
  264. grade 1 ankle sprain
    microscopic tearing of the ligament with no loss of function
  265. grade 2 ankle sprain
    partial disruption or stretching of the ligament with some loss of function
  266. grade 3 ankle sprain
    complete tearing of the ligament with complete loss of function
  267. acute management of ankle sprains

    crutches and splint if severe

    submax multi angle isometrics

    cross friction massage
  268. subacute management of ankle sprains
    cross friction massage to affected ligaments

    grade 2 mobilization for pain relief and to maintain motion

    gentle AROM and PROM
  269. chronic management of ankle sprains
    isometric to isotonic progression of lower extremity musculature

    proprioceptive and balance training

    endurance and activity specific exercise

    may need to protect joint during vigorous activity
  270. plantar fascitis general info
    pain usually along the plantar aspect of the heel where plantar fascia inserts on the medial tubercle of the calcaneus

    excessive pronation of the subtalar joint predisposes the foot to abnormal forces and irritation of the plantar fascia
  271. common symptoms of plantar fascitis
    severe pain on plantar surface of the foot, near calcaneus that is especially severe in AM upon waking

    activities that cause stress to the plantar fascia will reproduce pain
  272. management of plantar fascitis

    cross friction to plantar fascia


    stretching of gastroc

    management of pronation
  273. etiology of tarsal tunnel syndrome (what nerve is entrapped?)
    posterior tibial nerve or one of its branches (medial or lateral plantar nerve) trapped within the tunnel posterior to medial malleolus
  274. what are the structures passing through the tarsal tunnel?
    long flexor tendons and their sheaths, posterior tibialis tendon, and tibial nerve artery and vein
  275. causes of tarsal tunnel?
    chronic tendinitis, old fractures, anatomic anomalies in the area, excessive pronation
  276. what does over pronation do to tarsal tunnel syndrome?
    causes stress to the musculature and cause an inflammatory process that decreases space in tunnel
  277. common symptoms/findings of tarsal tunnel
    sensory changes to plantar surface of the foot and toes and dorsum of distal phalanges

    pain on plantar surface of foot, palpation negative

    weakness and postural changes of the foot may occur

    positive tinnel over tunnel
  278. management of tarsal tunnel
    therapy is effective if cause is inflammation

    use anti-inflams

    gradually progress to stretching, isometric to isotonic

    manage pronation
  279. describe shin splints
    junk term for any pain posteromedial, anteromedial, or medial lower leg pain
  280. what can cause shin splints?
    myositis, periositis, inflammation of the interosseous membrane or tendinitis
  281. Medial Tibial Stress Syndrome and its general info
    most common form of shin splints

    tibial periostitis at the fleshy origin of the posterior tibialis muscle or medial aspect of the soleus

    tender to the medial tibial border above the ankle

    resisted foot inversion/plantar flexion is painful

    often hyperpronators
  282. managements of MTSS (acute)
    cross friction massage

    sub max, multi angle iso

    AROM in pain free range

    protect joint

    control improper biomechanics as needed
  283. management of MTSS (subacute/chronic)
    correct abnormal foot alignment

    stretch tight structures, often gastroc

    progress isometric to isotonics and fxnal exercises

    increase endurance

    stress proper warm up, cool down and gradual increase of offending activity
  284. general info of a tibial fracture
    failed adaptation to stress on the bone

    accelerated osteoclastic remodeling progressing to a complete fracture
  285. signs and symptoms of a tibial fracture
    pain during weightbearing activity that slowly resolves with rest--progresses to severe pain with weightbearing activity that does not totally dissipate with rest

    -night pain common

    callus forms=positive X ray

    bone scan most useful- look for increased uptake

    US over site painful

    pain with vibratory fork
  286. treatment of tibial fractures
    modified rest pool exercise cycling or other decreased weight bearing exercise

    educate on appropriate training technique and foot wear
  287. how long does the average tibial stress fracture take to heal?
    8-12 weeks
  288. what is exertional compartment syndrome?
    raised pressure within a closed osteofacial compartment that compromises the circulation and function of tissues within the compartment
  289. what are common causes of exertional compartment syndrome?

    acute/chronic overuse

    anti-coagulants worsen this
  290. what are the 5 P's of exertional compartment syndrome?




  291. hallmark findings of exertional compartment syndrome
    persistent progressive pain beyond what would be expected from a strain or contusion

    swollen, tense compartment

    pain with muscular stretch


    decrease muscle action

    increase compartment pressure
  292. if you have pressure of over 70 mmHg that suggests what?
    lower extremity compartment syndrome
  293. if pressure difference is 30 mmHg from DIASTOLIC BP that suggests what?
    acute compartment syndrome
  294. Anterior compartment
    lateral surface of tibia

    anterior intermuscular septum

    interosseous membrane

    most common compartment affected, 45% of syndromes
  295. Lateral compartment
    between anterior and posterior intermusclar septum

    anterior surface of fibula

  296. posterior compartment

    interosseous membrane


    posterior intermuscular septum

    40% deep, 5% superficial
  297. muscles in anterior compartment and nerve that innervates them
    tibialis anterior

    extensor hallucis longus

    extensor digitorum longus

    fibularis tertius

    deep fibular nerve innervates
  298. muscles in the lateral compartment and the nerve that innervates them
    fibularis longus

    fibularis brevis

    superficial fibular nerve
  299. muscles in the superficial posterior compartment and the nerve that innervates them



    tibial nerve innervates them
  300. muscles in the deep posterior compartment and the nerve that innervates them
    tibialis posterior


    flexor digitorum longus

    flexor hallucis longus

    tibal nerve innervates them
  301. severe pain increases with activity and then decreases with rest (20min or so) describes what condition?
    exertional compartment syndrome
  302. no pain at rest: stress fractures will do what?
    continue to hurt
  303. pain with warm up: shin splints will often have ______ pain with warm up
  304. exertional compartment syndrome is often confused with MTSS...how is MTSS different?
    MTSS has tenderness to posterior medial tibia, not common in compartment syndrome
  305. no pain with vibratory testing so what condition has a positive sign of this?
    stress fracture
  306. management of overuse injuries (acute)
    protect...decrease activity

    anti-inflam (ice, iontophoresis)

    RIE do not use compression

    control of biomechanic faults
  307. management of overuse injuries (once symptoms have evolved)
    stretching of involved musculature

    sub-max, multi-angle isometrics, progressed to isotonic

    gradual return to activity
  308. describe subtalar neutral
    not pronated or supinated

    point of positon that the head of the talus cannot be palpated or is felt to extend equally at the medial and lateral borders of the talonavicular joint
  309. closed chain PRONATION of the subtalar joint
    calcaneus everts

    talus rotates down and in

    IR of tibia

    knee flexion

    floppy foot
  310. closed chain SUPINATION of the subtalar joint
    calcaneus inverts

    talus rotates up and out

    ER of tibia

    knee extension

    rigid foot
  311. 7 criteria for normal foot function during latter part of the mid stance gait
    • 1-metatarsals lie in the transverse plane
    • 2-plantar surface of the calcaneus is in the transvere plain
    • 3-subtalar joint is neutral
    • 4-midtarsal joint is locked in its maximum position of pronation
    • 5-subtalar joint, ankle joint and knee joint lie in transverse plane
    • 6-significant rotational or torsional influences are present
    • 7-distal 1/3 of the leg is in sagittal plane
  312. during rearfoot varus what happens?
    pronate more
  313. during forefoot varus what happens?
    big toe in air, talus, navicular twisted, pronate late and over pronate
  314. during rearfoot varus and forefoot varus what happens?
    flat feet, look like they walk on medial malleolus
  315. during forefoot valgus (rigid)/ rigid plantarflexed 1st ray what happens?
    big toe down, really high arch, forces into supination
  316. posting deformities
    arch was NOT meant to be a weightbearing structure

    generally post 40-60% of the deformity

    rigid to semi-rigid

    4-6d varus deformity norm
Card Set