MSK: Lab 8 - Ankle Flashcards by Chavez Girls

Subjective questions for foot and ankle

MOI? did you hear a pop? which way did your foot land?
recently change mileage or training or surface
What type of shoes do you use during the day/training
does your ankle “give out”?
AM stiffness?
surgeries or bracing?

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Observations for ankle/foot

arch height
decreased push off
dec WB
pro/supinated
knee position

calcaneus position, malleoli, toe curling? (trying to stabilize)

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what position should the foot be in during a quat (pronation or supination?)

should be neutral/slight supination, knee absorbs all the force

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What functional movements do you need to observe?

gait
squat
SL stance
SLS squat

watch for sup/pro of foot - do they have stability?

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overpronation during squat may cause what motion at the knee

valgus

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foot posture index scoring

0-5 normal
negative supination
positive pronation

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know your palpation! he is big on palpation. when do you palpate?

after joint play

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sinus tarsi to sustentaculum is what

orientation of subtalar joint

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ROM ankle/foot

DF/PF, Inv/Ev, great toe lab

DF knee bent and straight!

DF - OKC and CKC if possible

knee motion

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When measuring ROM, do we assess in WB or NWB first?

NWB 1st then WB as tolerated

DF against wall - knee touches wall, heel stays down, measure distance from wall

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Normal Talocrural DF

20 degrees

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Normal Talocrural PF

50 degrees

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TC Supination ROM

45-60

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TC Pronation ROM

15-30

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Subtalar Inversion ROM

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Subtalar Eversion ROM

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MTP Extension

Great Toe: 70
2-5 toes: 40

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MTP Flexion

Great Toe: 45
2-5 toes: 40

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review your Goni & MMT Landmarks & positions

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MMT foot ankle

gastroc
soleos
TA - DF INV
TP - PF INV
Fib long/brevis - PF EV
Big toe Flex/Ext
Other toes Flex/Ext
Foot intrinsic - knuckle test
Abductor/Adductor hallucis

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During knee flexion, the fibula moves _____
During knee extension, the fibula moves _____

Posterior

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In DF, the proximal Fibula moves __ and ___

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ER and superiorly

distal tibfib joint joint play

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DF: push posterior medially (AP), supine

PF: prone (PA) anterolateral push

a PA glide for the Talocrural joint (patient in prone), helps test/improve ____ motion

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PF = anterior glide because TC is convex on concave

an AP glide at the Talocrural joint with the patient supine helps test/improve ____ motion

DF DF = posterior glide

When we perform a **medial** glide at the **subtalar** joint, we are checking ____ motion

Eversion so lateral side of foot is up, pushing heel medially

When we perform a **lateral** glide at the **subtalar** joint, we are checking _____ motion

Inversion medial side of foot is up, pushing heel out

cuboid joint play cuboid has more ____ movement

stabilize calcaneous, pink cuboid and move dorsally and laterally supine, leg straight more translational

navicular joint play navicular has more ___ movement

supine, knee bent, stabilize talus, other hand wraps around to inside of foot to rotate more pro/sup movement

When we perform a dorsal glide at the MTP and IP joints, we are testing _____ motion

extension

When we perform a plantar glide at the MTP and IP joints, we are testing _____ motion

Flexion

Which 3 special tests are for a syndesmotic ankle sprain?

1. Fibular Translation Test 2. External Rotation Test 3. Syndesmosis squeeze

Fibular translation test

(syndesmotic sprain) AP or PA force through fibula at level of syndesmosis (+) ROS or increased displacement

For the External Rotation test, the patient's knee is flexed to ____ degrees and the ankle is in ____ position. Then what

90 degrees Neutral PT stabilize ankle and ER ankle (+) ROS or excessive movement

Sydnesmosis squeeze test

squeeze tibia and fibula together starting proximally, then mid, then distal (+) ROS

Tests for lateral ligamentous injury

Anterior drawer (anterior talus displacement) - ATFL reverse anterior drawer - ATFL medial talar tilt stress test - ANY 3 WITH POSITIONING

Anterior talus displacement (anterior drawer)

OKC supine, heel off bed, stabilize tibia and pull calcaneus straight up (+) with excessive translation

reverse anterior drawer

simulates CKC, supine, leg bent with foot on table like regular reverse anterior drawer (push mortise/fibula back) (+) excessive translation

MEDIAL TALAR TILT STRESS TEST

supine stabilize mallleoli while medial mobilizing force at calcaneus (pushing into inversion) PF = ATFL neutral = CFL DF = PTFL (+) excessive laxity

Achilles tendon integrity tests

thompson royal london hospital

royal london hospital test

prone with feet off bed palpate Achilles for pain then pt actively DF while PT re-palpates (+) decrease in pain during active DF why? bc tendinopathy hurts with contraction, this is stretching the tendon not activating

Ankle impingement test

supine, knee bent stabilize distal tibia, forcefully DF (+) ROS fibula on talus

Anterior ankle impingement CPR

AL ankle joint tenderness AL ankle joint swelling pain with forced DF pain with SL squat pain with activities absence of ankle instability 5/6 (+)

tarsal tunnel test

sidelying on involved side, forced DF and eversion (stretching retinaculum) (+) ROS

tarsal tunnel tinels

tap it (+) ROS of tingling

Tx for a hypomobile fibula (stuck back) - what would cue you to use?

decreased knee flexion, DF, and lateral knee pain proximal tibiofibular manip wedge MTP of hand behind fibular head, slight pronation of hand ER tibia at ankle add knee flexion to take of slack quick knee flexion

distal tibiofibular mobs - when to use and how to

hypomobile joint play, decreased DF* (or PF) PA - (PF) AP (DF) stabilize tibia and push on fibula (use thenar eminence

When would you use TC gapping manip

decrease pain, restore general mobility general distraction technique, so if they limitations everywhere and pain? perform 3-5 times

TC joint mobs

AP - pushing talus posterior, improve DF PA - pushing calcaneus (talus) anterior, improve PF

Subtalar mobs how and what would cue you?

medial mob - improve eversion, lateral side up lateral mob - improving inversion, medial side up stiffness pain in tow off - lateral mob for inversion (supination) stiffness pain in midstance - medial mob for eversion - pronation control hypomobility in joint play

For the Cuboid Whip or Squeeze, what is the foot position

Plantar flexion, inversion, adduction

MTP mobs

TC mob - AP with progressive DF

MWM put foot on thigh, move into end range DF then do mob or mob then increase DF, repeating PILLOW UNDER FOOT

MWM facilitating DF - whats the PROPER WAY

if we want to simulate CKC DF, have pt lunging on table, strap around back of ankle pulling tibia anteriorly can have them rock forward into DF

MSK: Lab 8 - Ankle Flashcards

(54 cards)