DPT 691 - MSK II > Practical #2 Ankle > Flashcards

Practical #2 Ankle Flashcards

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1
Q

Closed Chain Ankle ROM

Tests & Measure

A

Closed Chain Ankle ROM:

  • Toes in tandem stance with lead foot toes against the wall.
  • Elbows flexed to 90d with fist against the wall. Bend back knee as far as possible without the heel lifting off.
  • Back knee should clear the lead leg malleous if the ankle has 40d DF.

  • 35-40d is normative number

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2
Q

Navicular Drop Test

Tests & Measure

A

Navicular Drop Test

  • Bunion
  • Posterior Tib Issue
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3
Q

Ankle Anterior Drawer Test

Tests & Measure

A

Ankle Anterior Drawer Test: Anterior talofibular ligament

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4
Q

Reverse Anterior Drawer Test

Tests & Measure

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5
Q

Talar Tilt Test

Tests & Measure

A

Talar Tilt Test:

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6
Q

Cotton Test

Tests & Measure

A

Cotton Test: Special tests for syndesmotic ankle sprain.

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7
Q

External Rotation Test

Tests & Measure

A

External Rotation Test: Special tests for syndesmotic sprain.

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8
Q

Syndesmotic Squeeze Test

Tests & Measure

A

Syndesmotic Squeeze Test: Special tests for syndesmotic sprain.

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9
Q

Forced Dorsiflexion Impingement Test

Tests & Measure

A

Forced Dorsiflexion Impingement Test: Ankle impingement special test.

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10
Q

Hyper Plantar Flexion Thrust Test

Tests & Measure

A

Hyper Plantar Flexion Thrust Test: Ankle impingement special test.

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11
Q

Royal London Hospital Test

Tests & Measure

A

Royal London Hospital Test: Positive test if the painful spot moves w/ plantarflexion and no pain is felt dorsiflexing.

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12
Q

Thompson Test

Tests & Measure

A

Thompson Test: Achilles Rupture

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13
Q

Heel Raise Test

Tests & Measure

A

Heel Raise Test: Achilles Tendinopathy

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14
Q

Windless Test

Tests & Measure

A

Windless Test: Test for PF.

  • Stand with the toe over the edge of the table.
  • Extend the big toe
  • (+) Reproduction of pain in the insertion of the plantar fascia
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15
Q

Dorsiflexion Eversion Test

Tests & Measure

A

Dorsiflexion Eversion Test: Tarsal tunnel syndrome special test (Posterior tibial nerve).

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16
Q

Triple Compression Test

Tests & Measure

A

Triple Compression Test: Tarsal tunnel syndrome special test.

  • Nerve glides w/ external rotation = pt. has compression
  • Neutral nerve glides = pt. has tension

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17
Q

Foot Squeeze Test

Tests & Measure

A

Foot Squeeze Test: Morton’s Neuroma

  • Morton’s neuroma, also known as Morton metatarsalgia, is a benign condition that occurs when the intermetatarsal plantar nerve becomes trapped.

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18
Q

Webspace Tenderness

Tests & Measure

A

Webspace Tenderness: Morton’s Neuroma

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19
Q

Functional Hallux Limitus Test

Tests & Measure

A

Functional Hallux Limitus Test:

  • Patient is NWB
  • Examiners uses one hand to maintain the subtalar joint in neutral while maintaining first ray in DF.
  • Moving hand DF’s proximal phalanx.
  • (+) Test = Limited movement at the toe. Immediate PF of the first ray with DF of the proximal phalanx

Grade:

  • Grade 0: 40-60 deg. of DF
  • Grade I: 30-40 deg. of DF
  • Grade II: 10-30 deg. of DF
  • Grade III: 0-10 deg. of DF

  • Functional hallux limitus is a loss of metatarsophalangeal joint extension during the second half of the single-support phase, when the weightbearing foot is in maximal dorsiflexion

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20
Q

Promote Ankle Dorsiflexion

Therapeutic Exercise

A
  • Rocker Board
  • Banded Self A-P Ankle Mobilization for restoring DF
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21
Q

Promote Basic Ankle Balance activities

Therapeutic Exercise

A
  • Floor - SL
  • AIREX - SL
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22
Q

Promote Advanced Ankle Balance/Proprioception Activities

Therapeutic Exercise

A
  • Add specific activity to SL balance
  • SL balance on Aerex w/ opposite leg, band resisted hip flexion
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23
Q

Promote Higher Level Eccentric Gastroc / Soleus Strength

Therapeutic Exercise

A
  • Two-up / One-down loaded eccentric heel raise

  • Insertional stops at floor

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24
Q

Promote Plantar Fascia specific heel raises/lowering

Therapeutic Exercise

A
  • Heel raise w/ great toe extension (use towel)

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25
Promote Basic Foot intrinsic strengthening ## Footnote *Therapeutic Exercise*
* Doming * " " w/ mini band resistance * Toe Yoga
26
Promote Abductor digiti minimi & Abductor Hallucis strengthening ## Footnote *Therapeutic Exercise*
* Toe spreading with pencils
27
Promote Advanced short foot strengthening ## Footnote *Therapeutic Exercise*
* Tripod reinforcing band challenge for short foot * Planter flexed Dome w/ mini-band march * Planter flexed Dome w/ iso-hold
28
Promote Ankle Dorsiflexion Eccentric Strengthening ## Footnote *Therapeutic Exercise*
**Tibialis Anterior Strengthening**: * Ecc. Tib raise on slant board * Ecc. toe raise w/ band or KB
29
Standing Lunge for ankle Dorsiflexion mobility ## Footnote *Therapeutic Exercise*
Standing Lunge for ankle Dorsiflexion mobility: * 3x30 sec.
30
Promote Ankle Pronation and supination ## Footnote *Therapeutic Exercise*
* Chops & Lifts for the Foot & Ankle w/ MB, Band, Cable ## Footnote * [FMS](https://www.youtube.com/watch?v=z3kheToAses) Chops & Lifts Video
31
Promote Ankle Eversion Strengthening ## Footnote *Therapeutic Exercise*
* [Band resisted eversion](https://www.youtube.com/watch?v=QFgPY6oJWcA)
32
Promote Posterior Tibialis Strengthening ## Footnote *Therapeutic Exercise*
* [Heel raise w/ball squeeze](https://www.youtube.com/watch?v=IjoSXiL-dO0) * [Band resisted ankle adduction](https://www.youtube.com/watch?v=XBvfk3zwiiE)
33
Triplanar Dynamic Calf Stretching ## Footnote *Therapeutic Exercise*
**1**) Sagital = Front & Back **2**) Frontal = Chest to hands on wall **3**) Transverse = Rotation / Shoulder to outside of knee ## Footnote * [Video](https://www.youtube.com/watch?v=F19tzGnpfpU)
34
Promote Advanced Gastroc Soleus Strengthening for insertional Achilles tendonitis ## Footnote *Therapeutic Exercise*
* Seated - heal raise with DB/KB's on knees * Standing - heal raise with DB/KB's on knees ## Footnote * Iso → Ecc → Concentric → Landing
35
Advanced Ankle/Foot motor control exercises involving the entire LE/Trunk ## Footnote *Therapeutic Exercise*
* Y-Balance * Lunge matrix * Rotation w/ KB
36
[Peroneus Longus](https://www.kenhub.com/en/library/anatomy/peroneus-longus-muscle) Strengthening on slant board ## Footnote *Therapeutic Exercise*
**-** TheraBand strengthening: **-** **Slant Board** neuromuscular re-education: SL Balance 3x30-45 sec **-** Reactive Neuromuscular Reeducation: ## Footnote Board & Arch up
37
Basic Ankle AROM exercises ## Footnote *Therapeutic Exercise*
* Ankle Pumps * Ankle "A,B,C's" * Banded 4-way ankle
38
Bosu Therex progression ## Footnote *Therapeutic Exercise*
**Beginner**: * DL Balance - 3x30 sec. * "" w/ eyes closed * "" w/ eye closed and head rotations
39
Return to sport agility drills for ankle ## Footnote *Therapeutic Exercise*
* Sports cord resisted jogging with multiple leg movement challenges. * Single leg lateral hops lower level
40
Low level Gastroc / Soleus strengthening ## Footnote *Therapeutic Exercise*
* Seated DL Heel Raise - 3x12-15 (RPE 8) * Standing DL Heel Raise - 3x12-15 (RPE 8)
41
Mobilization for Increased Ankle Dorsiflexion (Grade III)
[**Mobilization for Increased Ankle Dorsiflexion**](https://www.youtube.com/watch?v=LtzP-OEwlQA) (**Grade III**): * Hold dorsiflexion w/hip
42
Mobilization with movement for Increased Ankle Dorsiflexion (Grade III)
[**Mobilization w/ movement for Increased Ankle Dorsiflexion**](https://app.clinicalpattern.com/ortho/p8157/#main) (**Grade III**): * Place a mobilization belt around the posterior inferior tibia and fibula. * Anchor the belt around therapist at hip level. * Place the web space of the therapists hand on the anterior talus. * Have the patient squat (if performed in standing) or move anteriorly over the foot (if in tall kneeling). * A posterior glide is applied to the talus during the motion of the patient. ## Footnote * Progress from NWB to weight bearing.
43
Mobilization for Increased Ankle Plantar Flexion (Grade IV)
[**Talocrural Anterior Glide**](https://app.clinicalpattern.com/ortho/p1145/#main) **of Talus**: Apply an anterior force through the calcaneus driving the talus in an anterior direction. **-** **Indications**: * Limited Talocrural mobility (plantarflexion)
44
Mobilization for Increased Ankle Eversion (Grade IV)
[**Lateral Subtalar Glide**](https://app.clinicalpattern.com/ortho/p1139/): **-** **Indications**: * Hypomobility of the subtalar joint, limited pronation / eversion of the foot and ankle. ## Footnote * If ankle Talocrural ROM is limited assess the subtalar join
45
Rearfoot Distraction manipulation (Grade V)
[**Rearfoot Distraction manipulation**](https://app.clinicalpattern.com/ortho/p1147/#main) (**Grade V**) **-** **Indications**: Overall decrease in ROM in the Talocrural joint **-** **Possible conditions**: * Ankle Sprain * Impingement syndrome * Plantar Fasciitis **-** **Impairments**: * Decreased PF & DF * Decreased Closed Chain DF Test
46
Plantar fascia Manual Release
[**Soft tissue mobilization plantar fascia**](https://app.clinicalpattern.com/ortho/p1199/#main) ## Footnote * [PhysioU](https://app.clinicalpattern.com/ex_patt/p295/#overview) Plantar Fascia : Forefoot Eversion Stretchin - Video
47
Distal tibiofibular posterior mobilization
**[Distal Tibiofibular Posterior](https://app.clinicalpattern.com/ortho/p1125/#main) Mobilization**: Posterior glide of the tibiofibular joint. * Use thenar eminence of hand to apply pressure to the distal tibiofibular joint **-** **Indications**: * Ankle sprains (**NOT** Syndesmotic) * Difficulty with dorsiflexion, inversion, and eversion.
48
Cuboid Whip manipulation
**Cuboid Whip manipulation**: ## Footnote [PhysioU](https://app.clinicalpattern.com/ortho/p1121/#main) Video
49
Cross Friction to the Achilles
**Cross Friction to the Achilles**:
50
Medial glide to the calcaneous
[**Medial glide to the calcaneous**](https://app.clinicalpattern.com/ortho/p1141/): Apply a glide of the calcaneus into the medial direction. **-** **Indications**: * Limited Talocrural joint mobility * Limitations in **Inversion** & **supination**. ## Footnote * Realize this looks just like the lateral glide but the difference is if you are working on the top leg or the bottom leg.
51
Pin and stretch to the Gastroc/Soleus
Pin and Stretch to the Gastroc/Soleus:
52
First Toe Mobilization to promote MTP Extension
[**First Toe Mobilization to promote MTP Extension**](https://app.clinicalpattern.com/ortho/1197/1197-7/685/p1110/): First toe mobilizations for limited mobility * AP glides * Medial-Lateral Glides **-** **Traction glides**: * Hallux rigidus * Hallux valgus ## Footnote * [1st MTP Extension Stretching](https://app.clinicalpattern.com/ex_patt/p296/) * **Hallux rigidus**, also known as stiff big toe, is a degenerative arthritis that causes stiffness in the joint at the base of the big toe. * **Hallux valgus**, also known as a bunion, is a deformity that occurs when the base joint of the big toe develops sideways, causing the big toe to bend towards the other toes.
53
Pin and Stretch to the Peroneals
**Pin and Stretch to the Peroneals**: ## Footnote * [Video](https://app.clinicalpattern.com/rom_mmt/p7080/#main)
54
Lateral Glide to the Calcaneous
**[Lateral Glide](https://www.youtube.com/shorts/Ds9dXXIdEJc) to the Calcaneous**: * To improve ankle ***eversion*** * Cross the involved leg over the uninvolved leg * Apply a lateral force through the calcaneus with a distraction force
55
Intertarsal mobilizations
**Intertarsal Mobilizations in the Midfoot** * Piano key up and down the metatarsals. * Assess for hypomobility and treat * Re-test the patient for changes in pain and range of motion ## Footnote * [Physiotutors](https://www.youtube.com/watch?v=js4BWkxcUV0) Video
56
# ROM * DF = **?** * PF = **?** * Inversion = **?** * Eversion = **?** * Great Toe Ext = **?**
**ROM**: * DF = **0-20** deg. [Video](https://app.clinicalpattern.com/rom_mmt/p7142/#main) * PF = **0-50** deg. [Video](https://www.youtube.com/watch?v=5yZ-YSr_V_E) * Inversion = **0-35** deg. [Video](https://app.clinicalpattern.com/rom_mmt/p7146/#main) * Eversion = **0-20** deg. [Video](https://app.clinicalpattern.com/rom_mmt/p7147/#main) * Great Toe Ext = **70** deg. [Video](https://www.youtube.com/watch?v=dx6Eq5bE7HU)
57
# What am I = **?** * ↓ great toe - dorsiflexion * ↓ great toe - extension
**Functional Hallux Limits**: * ↓ great toe - dorsiflexion * ↓ great toe - extension **-** **Tests**: * Functional hallux limitus test * 1st Ray mobility
58
# What am I = **?** * Pain - posterior heel * Pain - worse with activity * Abnormal dorsiflexion * ↑ Foot pronation
**Achillies Tendinosis** / **Tendonitis**: * Pain - posterior heel, worse with activity, and after sleeping. * Popping heard * Abnormal dorsiflexion (hyper/hypo) * ↓ PF strength * ↑ Foot pronation **-** **Test** * Palpation test * Royal london hospital test * Thompson test * Heel raise test
59
# What am I = **?** * Female * Pain - Worse 1st thing in the morning * Abnormal arch
**Plantar Fascitis**: * Pain - over inferior heel and plantar surface. * Pain - Worse 1st thing in the morning, and with activity. * ↓ Cross-sectional area * Females * Abnormal arch * Posterior chain tightness **-** **Tests**: * Windless test * Palpation of proximal plantar fascia * Heel pain with first step
60
# What am I = **?** * Pain - Anterior, lateral ankle * ↓ Proprioceptive awareness * Played soccer
**Chronic Ankle Instability**: * Episodes of instability * Pain - Anterior, lateral ankle * ↓ Proprioceptive awareness * History of previous ankle sprains * Sports - w/ end-range of motion, twisting and pivoting **-** **Impairment** = * Path - mechanical * Sensory - percepual * Motor - behavior **-** **Tests**: * No specific * Reverse anterior drawer
61
# What am I = **?** * Pain - Lateral ankle w/ trauna * Popping * ↓ ROM
**Lateral Ankle Sprain**: * Pain - Lateral ankle w/ trauna * Popping * Forced plantar flexion and inversion * Males * Swelling, bruising * ↓ ROM **-** **Tests** * Anterior drawer * Reverse anterior drawer * Talar Tilt
62
# What am I = **?** * Medial side tenderness * Difficulty WB * MOI = ER, hyper dorsiflexion, axial load
**Syndesmotic Ankle Sprain**: * Pain - Anterior lateral ankle, proximal to AITFL * Medial side tenderness * Difficulty WB * MOI = ER, hyper dorsiflexion, axial load * Football, rugby, westling **-** **Tests**: * Syndesmotic squeeze * Cotton * ER
63
# What am I = **?** * Pain - Anterior jamming restriction in motion * Dorsal/Posterior "Block" * Previous ankle injuries/fractures
**Ankle Impingement**: * Pain - Anterior and posterior with jamming restriction in motion * Dorsal/Posterior "Block" * Post. impingement may look like achilles tendonopthy * Previous ankle injuries/fractures * High impact/high stress athletic events (dance, ballet, soccer) * Hypermobility in ankle **-** **Tests**: * Forced dorsiflexion impingement tests * Hyper plantar flexion is common in eliciting factor for posterior impingement
64
# What am I = **?** * Gradual onset * patient demonstrates over-pronation * Numbness in toes and foot
**Tarsal Tunnel**: * Gradual onset * Could be due to over pronation * Smells like nerves (pain and numbness in toes and foot) **-** **Tests**: * Tinel's sign * Dorsiflexion eversion test * Triple compression
65
# What am I = **?** * Medial sided foot and ankle pain * Middle aged to older adults * Gastroc/Soleus tightness
**Posterior Tibial Tendonopathy**: * Medial sided foot and ankle pain * Floot foot and over pronation * Middle aged to older adults * Difficulty doing HR * Gastroc/Soleus tightness **-** **Tests**: * HR Test
66
# What am I = **?** * Runners * Medial shin pain * Poor running mechanics
**Medial Tibial Stress Fracture**: * Runners * Medial shin pain * Poor running mechanics * Over & rapid pronation * ↑ mileage **-** **Tests**: * HR is hard * Poor running mechanics
DPT 691 - MSK II
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