Ankle and Foot Assessment Chapter 20 – page 401

Anatomy of the foot/ankle Bones of the ankle joint _________________ _________________ * Bones of the foot _________________ (14) _________________ (5) _________________ (3)

Anatomy of the foot/ankle Muscles Anterior- Lateral – What action? ______________ Tibialis anterior-What action? __________ Extensor digitorum- What action? _________ Peroneus longus Peroneus brevis – Insertion =_________ Peroneus tertius

Anatomy of the foot/ankle Muscles (cont.) Posterior- What action? ______________ Deep Posterior-What action? __________ Gastrocnemius Soleus Plantaris Flexor Hallicus Longus Flexor Digitorum Tibialis Posterior

Anatomy of the foot/ankle Arteries Nerves Tibial (ant.) Tibial (post. or deep) Peroneal (sup.) Peroneal (deep) Dorsal pedis Tibial = _______ Peroneal = _________

Anatomy of the foot/ankle Ligaments Deltoid (med.) Anterior talofibular (lat) – Abbrev: ______ Posterior talofibular (lat) – Abbrev: _____ Calcaneofibular (lat)- Abbrev: _________ Anterior Tibiofibular (ant) Posterior Tibiofibular (post) Spring Ligament (med) –Purpose: _____

Anatomy of the foot/ankle Joints Distal Tibiofibular Talofibular Calcaneofibular Talotibial Tarsal joints Metatarsal-tarsal Metatarsal phalangeal PIP = __________ DIP = __________

Anatomy of the foot/ankle Arches-How many are there? What would you name them?

History Acute vs. Chronic-What question? Mechanism-What question? Tear or fracture-What question? Location of injury-What question? History-What question? Age? Activity?

Observation Shoes Gait Foot position Callus Bunions Blisters Hot Spots Limp Arch What might each show/indicate?

Palpation Bony Tendons Medial Malleolus Lateral Malleolus Base of the 5th metatarsal Tendons Tibialis anterior Peroneus longus and brevis Achilles

Palpation Ligaments Anterior talofibular (ATF) Calcaneofibular (CF) Posterior talofibular (PTF) Spring Deltoid Anterior tibiofibular ligament Posterior tibiofibular ligament

Palpation Plantar fascia Retrocalcaneal bursa Dorsal pedal pulse

Special Tests Range of motion Remember! Dorsiflexion Plantar flexion Inversion Eversion Remember! Passive Active Resistive

Special Tests Test for the ATF: Anterior Drawer test _______________ Test for the PTF: Posterior Drawer test

Special Tests Test for the CF and deltoid ligaments: Talar tilt test _______________

Special Tests Tests for the tibiofibular ligaments: Side-to-side test, and squeeze test Ankle mortise _______________ Test for syndesmosis injury: Kleiger test

Special Tests Test for Achilles Tendon Rupture: Thompson test _______________ Test for heel fracture: Tap/Percussion test

Ankle/Foot injuries Fractures Dislocations Contusions Sprains Strains Compartment syndrome Overuse/inflammations Tendinitis Hematoma/Neuroma Abnormal arches/deformities

Fractures Tibia Fibula-a _________ bearing bone Dome of talus- Mechanism: _______________ Evaluate: Tib palpation, ___________ Care: Non-weight bearing, don’t move if displaced Fibula-a _________ bearing bone Dome of talus- Mech: inversion-dome hits _____________ or ____________ Metatarsals and phalanges

Jones Fracture Peroneus ________ pulls away from base of 5th breaking off part of bone=___________ Mechanism of injury- What do you think? ___________________________ Signs and symptoms: Swelling and tenderness over base of 5th Pain and weakness in eversion-Why? ______ Pain with walking-DUH!

Dislocations 1st Cuneiform (Lisfranc Fx) Talus-which part?_________ Fibular head

Sprains Affect Ligaments ONLY 1st degree (grade 1): __________________ 2nd degree (grade 2): 3rd degree (grade 3):

Inversion Sprain Over 80% of sprains are from inversion Ligaments damaged (in order of occurence): ________ and __________ and ________ Often accompanied by one or more of these: Talar dome fx, Subluxation of peroneal tendon, Jones Fracture Peroneal strain

Eversion Sprain Relatively uncommon Damage to deltoid ligament Sometimes tender over lateral malleolus and lateral surface of calcaneus-Why?

Strains Affects muscles and tendons ONLY Grading similar to sprains Mechanisms: overstretch or quick explosive contraction against significant resistance Most common: Peroneal group Gastrocnemius/Soleus Achilles tendon, Flexor Hallicus aka ___________________ Extensor digitorum

Tendinitis Inflammation of tendon Mechanism: Overuse Burning after warmup Tx: decrease inflammation, stretch, rest, support with taping or orthoses Look for it in: Achilles tendon, Tibialis Ant. tendon, Peroneal tendon, T ibialis Post. tendon

Rupture of Gastroc. Or Achilles Forced lengthening and contraction -what joints/positions? Feels like ____________ ____________________ “Hey! Who threw something at me?”

Contusions Common places: heel, tibia, gastrocnemius, tibialis anterior Range: mild bruise to serious injury Can lead to compartment syndrome: bleeding into compartment that compresses nerves and arteries Can be prevented in some cases with I & E of RICE

Hematoma Blood clot/pooling Under toenail = “Subungual hematoma” Danger of infection

Abnormal Arches Pes Cavus (High Arches) Absorbs shock poorly Often calluses on heel and ball of foot-Why? Pes Planus (Flat feet/low arches) From unsupportive shoes, ligament laxity, or overweight

Bunions aka “Hallux Valgus” Gradual because of poor footwear Often irritation on medial surface of 1st met head Tailor’s Bunion: varus 5th digit

Bursitis Inflammation of bursa Most commonly retro-calcaneal bursa Swelling and pain

Morton’s Neuroma Compressed nerve between 3rd and 4th metatarsal heads Causes pain, numbness and tingling

Ingrown toenail Recommendation: cut toenails straight across and not too short! Tx: Soak, prevent infection, lift toenail

Plantar Fasciitis Mechanisms Key symptom: first-step pain Acute: step on something, like a rock Chronic: walking without arch support Key symptom: first-step pain Pain on medial plantar calcaneus and in arch