Ankle and Foot

complaint, mechanism, weight bear, description, claudication, neurologic, occupation, recreational, skin temperature, vascular

history should include chief _____, _____ of injury, ability to _____ following injury, pain _____ (cramping/aching may accompany _____, numbness/tingling may indicate _____), _____ and _____ activities, change in _____ (potential _____)

swelling, discoloration, nail, condition, callus, posture, height, alignment, deformities, weight bearing, footwear, wear

observation should include _____, skin _____, _____ and skin _____, _____ formation, foot _____ and arch _____, toe _____ or _____, _____ status, _____ with _____ pattern

hammer toe

PIP flexion, MTP and DIP hyperextension

mallet toe

DIP flexion

claw toe

PIP and DIP flexion, MTP hyperextension

hallux valgus

proximal phalanx deviates laterally, first metatarsal drifts medially, increased prominence of first metatarsal head

laterally, progressive, deformities, overlapping

hallux valgus will cause WB to shift _____, may contribute to _____ gait deviations and further toe _____ (_____ toes)

morton’s toe

longer second toe

metatarsus adductus

metatarsal bones deviated inward

dynamic, double, single, squats, gait, jumping, landing, running

movement analysis allows _____ assessment, may include _____/_____ leg _____, strength/ROM, _____ examination, _____ and _____ mechanics, and _____

lateral ankle sprain

most common foot/ankle injury, most common sports injury

inversion, plantarflexion, anterior tibiofibular ligament, plantarflexion, inversion, calcaneofibular ligament, dorsiflexion, inversion, posterior tibiofibular ligament

lateral ankle sprain MOI is _____ usually with _____, sequence of injury is _____ (_____ and _____) then _____ (_____ and _____), and _____

bruising, proprioceptive, ROM, impingement, chronic ankle instability, fracture, osteochondral, altered, cartilage, osteoarthritis

lateral ankle sprain secondary complications include bone _____, _____/_____ deficits, ankle _____, _____ (CAI), _____, _____ defect, _____ kinematics causing _____ stress causing _____

lateral ankle sprain, women, dorsiflexion, hip abductor, extensor, asymmetry, functional, court, prophylactic bracing

lateral ankle sprain risk factors include history of _____, more _____, limited _____, decreased _____/_____ strength, _____ or poor performance on _____ outcome measures, participating in _____ sports without _____

grading, extent, number, presentation, functional

no universal _____ system on ankle sprain severity, may be based on _____ of damage to single ligament, _____ of ligaments injured, _____ and _____ impairments

stretched, ATFL, mild, tenderness, limited, no, full, normal, little

West Point ankle sprain grading system grade I is _____ ligament (_____), _____ point _____, _____ dysfunction, _____ laxity, _____ WB, _____ gait, _____ edema

partially torn, ATFL/CFL, diffuse, tenderness, moderate, slight, painful, antalgic, moderate local

West Point ankle sprain grading system grade II is _____ ligament (_____), _____ and point _____, _____ dysfunction, _____ laxity, _____ WB, _____ gait, _____ edema

substantially torn, ATFL/CFL/PTFL, diffuse, tenderness, significant, definite, severe pain, AD, significant diffuse

West Point ankle sprain grading system grade III is _____ ligament (_____), _____ and point _____, _____ dysfunction, _____ laxity, _____ WB, needs _____, _____ edema

trauma, malleolar zone pain, posterior lateral malleolus tenderness, posterior medial malleolus tenderness, inability to weight bear immediately and in ED

ottawa ankle rule radiograph ordered after _____ with _____ and _____/_____/_____

trauma, midfoot zone pain, metatarsal base tenderness, navicular bone tenderness, inability to weight bear immediately and in ED

ottawa foot rule radiograph ordered after _____ with _____ and _____/_____/_____

figure 8 edema measurement, anterior drawer, medial talar tilt, weight bearing lunge

lateral ankle sprain special tests (4)

sensorimotor, ROM, strength, fibularis, reaction time, dorsiflexion, plantarflexion, mobility

lateral ankle sprain presents with _____ and _____ deficits including decreased leg/ankle _____, decreased _____ muscle _____, decreased _____/_____, increased forefoot and midfoot _____

movement, ankle, knee, hip, both, balance, gait, jumping

lateral ankle sprain presents with altered _____ strategies, in _____/_____/_____, in _____ extremities, occur during _____/_____/_____

pain, edema, POLICE, external support, gait, sagittal, AROM, pain free, isometrics, low, joint mobilizations, estim

lateral ankle sprain acute phase protection interventions should control _____ and _____, use _____, _____ as needed, _____ training, gentle _____ plane _____ in _____ range, gentle _____, _____ grade _____, _____ as needed

brace, gait, mobilizations, resistance, intensity

lateral ankle sprain subacute phase controlled motion interventions include _____ to provide stability, _____ training, joint _____, progress therex _____ and _____

strengthening, neuro reed, external support, functional

lateral ankle sprain chronic phase return to function interventions should progress _____ and _____, no _____ during training, use _____ movement patterns

running, surface, plyometrics, sport specific, prophylactic bracing

lateral ankle sprain return to sport interventions include _____ progression considering _____, _____, _____ training, use _____ and appropriate footwear

chronic ankle instability

long term complication of lateral ankle sprain

one year, giving way, pain, weakness, ROM, self reported function, ankle sprains

CAI symptoms persist for more than _____ after initial injury, repetitive episodes of ankle _____, ongoing _____/_____/reduced _____, diminished _____, recurrent _____

single leg drop landing, double leg drop landing to vertical jump, dynamic control, SEBT, ADL

predictors of CAI is 2 weeks is inability to complete _____ and _____, 6 months poor _____ of hip/knee/ankle with _____ in posteromedial and posterolateral directions and lower scores on _____ subscale of FAAM

primary tissue injury, pathomechanical, sensory perceptual, motor behavioral, personal, environmental, outcome, CAI, coper

components of CAI include _____ (ankle sprain), _____ impairments, _____ impairments, _____ impairments, _____ and _____ factors, leading to continuum of _____ from _____ to _____

both, muscle activation, strength, force, proprioception, dorsiflexion, motion, spinal, reflex, supraspinal corticomotor, movement

CAI sensorimotor findings in _____ limbs include abnormal timing of _____, decreased _____, impaired _____ and _____, decreased ankle _____, increased subtalar/midfoot _____, impaired _____ level control and _____ inhibition, abnormalities of _____, affects _____ system

strength, dynamic balance, postural stability, joint mobilizations, dry needling, fibularis

CAI interventions include neuro reed and therex to improve _____/_____/_____, manual therapy including _____, and _____ to _____ muscle group

5, 24, 11

CAI patient report outcome cut offs include ankle instability instrument yes to at least _____ questions, cumberland ankle instability tool score equal to of less than _____, identification of functional ankle instability score of equal to or greater than _____

hop, lift, balance, sls, posteromedial, SEBT, barefoot, correlate

CAI functional outcome measures include _____ tests, foot _____/time in _____/_____ of BESS, _____ of _____, all tests performed _____, _____ with other symptoms

high ankle sprain/syndesmotic injury

injury to distal tibiofibular joint or syndesmosis

interosseous membrane, anterior inferior tibiofibular ligament, fracture, widening

high ankle sprain injury may include _____ and _____, may have concurrent _____, excessive _____ between tibia and fibula during dorsiflexion

external rotation, dorsiflexion

high ankle sprain MOI is excessive _____ with possible _____

anterolateral pain, AITFL, weight bear, swelling, bruising

high ankle sprain presents with _____ proximal to _____, difficulty/inability to _____, less _____ and _____ than lateral ankle sprain

dorsiflexion external rotation, syndesmosis squeeze

high ankle sprain special tests (2)

NWB, pain free, brace, external rotation, lateral ankle sprain, delayed

high ankle sprain interventions include _____ in cast for 2-3 weeks, delayed WB until _____, use _____ that limits _____, similar treatment to _____ but _____

deltoid ligament, rare, fracture, excessive eversion, lateral talar tilt

medial ankle sprain is sprain of _____, very _____, usually with ankle _____, MOI is _____, special test is _____

overuse, eccentric

achilles tendinopathy is most common _____ syndrome of the leg from extreme/rapid/repetitive _____ loading

midportion, insertion

achilles tendinopathy may occur at _____ (more common) or at tendon _____

age, anatomic, systemic, collagen, extrinsic, fluoroquinolone

tendinopathy risk factors include _____ related, _____ causes, _____ disease, (decrease _____ quality) and _____ factors such as _____ use

biomechanical, pronation, lateral, concentric/eccentric, gait, propulsion

achilles tendinopathy risk factors include _____ causes such as excessive _____, more pressure on _____ side during running, rapid alternating _____, altered _____ with decreased _____

eccentric, plantarflexion, weakness, motor control, cold, alcohol, obesity, footwear, age, men, genetics, fluoroquinolone, tendinopathy, fracture

other risk factors for achilles tendinopathy include decreased _____ and _____ strength, proximal muscle _____/_____, training during _____ weather, moderate _____ use, _____, _____ with rigid insoles, increasing _____, _____ sex, _____, _____ use, prior LE _____/_____

gradual, stiffness, inactivity, loading, tenderness on palpation, thickening, crepitus

achilles tendinopathy has _____ onset, _____ following _____, pain provoked with _____, _____ with possible tendon _____ and _____

arc sign, royal london hospital, thompson

achilles special tests (3)

dorsiflexion, plantarflexion, arch height, alignment, weight bearing

other considerations for achilles tendinopathy include _____ ROM, _____ strength/endurance, static _____, forefoot _____, _____ testing

education, modification, risk factors, complete rest, stretch plantarflexors, motor control

achilles tendinopathy treatment includes patient _____ for activity _____ or modifiable _____, _____ not recommended, follow tendinopathy progression, _____ if DF ROM is limited, neuro reed for _____

manual, dry needling, heel lift, taping, iontophoresis, not

achilles tendinopathy treatment may include _____ therapy and _____, temporary _____, _____ if patient prefers, and _____ if acute, night splints _____ recommended

fibularis longus, fibularis brevis, avascular zones, lateral malleolus, cuboid

peroneal tendinopathy is acute or chronic overuse to _____/_____, _____ are contributing factor (tendons run around _____/curve around _____)

direction change, jumping, training, footwear, growth, tightness, CAI, subluxing tendons, varus, forefoot

fibularis tendinopathy risk factors include sports with frequent _____/_____, abrupt change in _____, inappropriate _____, recent _____ spurt, _____ in gastrocnemius/soleus, history of _____ or _____, excessive hindfoot _____, _____ strike pattern

gradual, tendon sheath, mechanical, subluxation, eversion, plantarflexion, stretch, rest

fibularis tendinopathy presents with _____ onset, fluid may be palpable in _____, may report _____ symptoms, _____ may occur in eversion, pain/weakness with resisted _____/_____, pain exacerbated with _____, running/cutting/uneven surface, activity after _____

palpation, MMT, pain, subluxation, anterior drawer, swelling, posture

fibularis tendinopathy testing includes _____ and _____ of fibularis longus and brevis for _____ or _____, _____ for CAI concerns, _____ assessment, and foot _____ in weight bearing

tendinopathy, motor control, manual, restrictions, education, training, footwear

tendinopathy treatment follows _____ progression, _____ for biomechanical issues, _____ for soft tissue _____, and patient _____ for _____/_____ modifications

posterior, tibia, fibula, interosseous membrane, tarsal tunnel, navicular tuberosity, supinate, plantarflex, stabilize, medial longitudinal arch, concentric, eccentric

tibialis posterior is in _____ compartment, origin is proximal/posterior _____/_____/_____, passes through _____, inserts on _____, acts to _____/_____, functions to _____ foot/ankle, support _____, _____ (supination)/_____ (control pronation) during gait

microtrauma, overuse, medial malleolus, vascularity, tarsal tunnel, direction, friction

tibialis posterior tendinopathy is from chronic repetitive _____ from _____, pain posterior/slightly proximal to _____, decreased _____ in this region, in _____, change in tendon _____ causes increased _____

>50, men, systemic, medial ankle trauma, steroid injections, pronation, repetitive

tibialis posterior tendinopathy risk factors include age _____, _____ sex, _____ disease, history of _____, local _____, biomechanical factors including excessive _____, _____ loading

gradual, insidious, lateral, impingement, loading, plantarflexion, inversion, on toes, tenderness on palpation

tibialis posterior has _____ and _____ onset, _____ ankle pain possible with _____ later, pain worse with _____ (WB, resisted _____/_____, difficulty standing _____), _____

swelling, pronation, too many toes, pain, plantarflexion, everted

tibialis posterior tendinopathy inspection may include _____, excessive _____, and _____ sign, gait may have _____ with _____, and an _____ foot

single leg heel raise, maximum height, inability to perform, pain reproduction

tibialis posterior special test is _____ compare _____ to uninvolved side or NWB, positive is _____ or _____

intrinsics, proximal, orthoses, motor control, nsaids

tibialis posterior tendinopathy treatment follows tendinopathy progression, also strengthen _____ and _____ muscles, may use _____ to support medial arch and reduce tendon stretch, address faulty _____, use _____

tibial nerve, medial malleolus, talus/calcaneus, flexor retinaculum, FDL, FHL

tarsal tunnel syndrome is entrapment of _____, tarsal tunnel is formed by _____/_____/_____, passes between _____/_____ and then divides

footwear, trauma, sprain, biomechanical, scar, systemic, edema

tarsal tunnel syndrome extrinsic risk factors include poorly fitting _____, _____ (ankle _____), _____ faults, _____ tissue, _____ disease, generalized _____

tendinopathy, osteo, retinaculum, masses, arterial

tarsal tunnel syndrome intrinsic risk factors include _____, _____phytes, hypertrophic _____, any _____, _____ insufficiency

sharp, numbness, tingling, plantar, light touch, radiation, paresthesia, eversion, dorsiflexion, night, pronation, tenderness on palpation, gait, motor

tarsal tunnel syndrome presents with ____ pain, _____/_____/burning on _____ surface, diminished _____, _____ of pain and _____ along distribution, symptoms worsen at extreme _____/_____, with activity, or at _____, increased _____, _____, _____ abnormalities, and _____ symptoms if chronic

tinel’s sign, dorsiflexion eversion

tarsal tunnel syndrome special tests (2)

strengthening, tibialis posterior, stretching, nerve glides, manual, motor control, modalities

tarsal tunnel syndrome treatment includes therex (_____ of _____, _____, and _____), _____ therapy, neuro reed for _____, _____ for pain relief

medial tibial stress syndrome, fascial insertion, medial soleus, tibia, periosteum inflammation, bone overload

_____ AKA shin splints occur at _____ of _____ on _____ due to _____ and _____

runners, military, women, BMI, smaller, pronation, plantarflexion, external rotation, training, uneven, overuse, weakness, vitamin D

medial tibial stress syndrome risk factors include _____ and _____ recruits, _____ sex, greater _____, _____ q angle, excessive _____, increased ankle _____ and hip _____ ROM, sudden increase in _____, training on _____ ground, _____/_____ of tibialis anterior/EDL/EDB, _____ deficiency

exercise, aching, tibia, palpation, 5 cm, tendinopathy

medial tibial stress syndrome presents with _____ induced _____ pain on _____, produced by _____ over length of _____, follows _____ pain behaviors

pain, 5 cm, absence

medial tibial stress syndrome is diagnosed with _____ with palpation over _____ length and _____ of other findings

reducing, gradual, 9-12 months, low impact, graded, manual, motor control

medial tibial stress syndrome treatment includes education on _____ training and _____ return up to _____, _____ stretching/_____ strengthening, _____ therapy, neuro reed _____

plantar, medial heel, fascia insertion, calcaneus, heel spur, healthcare, chronic

plantar fasciitis causes _____/_____ pain at _____ on ____ with/without _____, often _____ workers, becomes _____ prior to treatment

dorsiflexion, BMI, running, prolonged standing, noncompliant, footwear, hamstring, leg length

plantar fasciitis risk factors include limited _____, high _____, _____ athletes, work related _____ especially on _____ surface, _____ worn, _____ tightness, _____ discrepancy (longer)

plantar medial heel, initial steps, NWB, prolonged, increase, tenderness on palpation

plantar fasciitis presents with pain in _____ region, worst with _____ after period of _____ or _____ WB, or recent _____ in activity, _____

windlass test

plantar fasciitis special test is _____

DF ROM, tenderness on palpation, posture, hamstring, length, gait

plantar fasciitis can also be tested using _____ and _____, foot _____ index, _____ muscle _____, and _____ assessment

heel center, progressively worse, barefoot, bilateral, night

heel fat pad syndrome presents with pain at _____, _____ pain, worse pain when _____, more likely to be _____ or at _____ pain

loads, footwear, BMI, stretching, strengthening, kinetic chain, manual

plantar fasciitis treatment includes education on modifying _____, _____ recommendations, maintaining optimal _____, therex for gastrocnemius/soleus _____, foot/ankle _____, any _____ deficits with neuro reed, _____ therapy

antipronation taping, are, orthoses, ultrasound

plantar fasciitis treatment may include _____, night splints _____ recommended, dry needling, foot _____, no _____ with biophysical agents

metatarsal heads, plantar, description

metatarsalgia is pain under _____ on _____ foot surface, _____ of symptoms rater than true diagnosis

anatomic, first ray, second metatarsal, plantarflexion

primary metatarsalgia is due to _____ abnormalities such as _____ insufficiency, long _____, or excessive metatarsal _____

indirect overloading, trauma, metabolic

secondary metatarsalgia is due to _____ such as _____, _____ disorders, or other syndromes

training, fat pad, tightness, arch, deformities, hyper, dorsiflexion, footwear, shorter, inflammatory, metabolic

metatarsalgia risk factors include over_____, submetatarsal _____ atrophy, _____ in toe extensors, _____ posture, toe _____, _____mobile first ray, limited _____, _____ worn, leg length discrepancy _____ leg, _____/_____ disorders

weight bearing, terminal stance, callous, pressure

metatarsalgia pain worsens with _____ especially in _____, _____ formation is possible with pain and _____ sensitivity

ROM, palpation, posture, gait

metatarsalgia special tests include thoroughly examining _____, _____, foot ____ in NWB/WB, and _____ analysis

orthotics, footwear, dorsiflexion, plantarflexor, kinetic chain, motor control

metatarsalgia treatments include foot _____, education on _____, therex for _____ ROM and _____ stretching, strengthen weakness from _____, neuro reed for _____

compressive, interdigital, third and fourth, narrow, thicker

morton’s neuroma is _____ neuropathy of _____ nerve, specifically between _____ metatarsals (space is more _____ and nerve is _____)

unknown, microtrauma, compression, ligament, soft tissue, bursa, ischemia

morton’s neuroma etiology is _____, possibly chronic _____, _____ between _____/_____ or _____, _____

women, middle, footwear, trauma, deviation, bursitis, impact, MTP, thickening

morton’s neuroma risk factors include _____ sex especially _____ age, _____ worn, history of _____, _____ of toes, intermetatarsal _____, high _____ sports, _____ pathology, _____ of ligament

between, burning, tingling, weight bearing, radiate

morton’s neuroma presents with pain _____ metatarsal heads, _____/_____ sensation, aggravated in _____, pain may _____

web space tenderness, squeeze

morton’s neuroma special tests (2)

orthotics, activity, footwear, biomechanical, pain

morton’s neuroma treatment includes foot _____, education on _____/_____ modification, correction of _____ faults and _____ management

degenerative arthritis, limited dorsiflexion, first MTP

hallux limitus/rigidus is progressive _____ resulting in _____ of _____

tenderness on palpation, lost joint space, osteophytes, gait

hallux limitus/rigidus causes _____, radiographs demonstrate _____ with _____, alters _____ mechanics

footwear, NSAIDs, corticosteroids, joint mobilizations, mobility

hallux limitus/rigidus conservative interventions include _____ modifications to limit DF, _____/_____ for pain, _____, ROM/stretching/strengthening to maintain _____

cheilectomy, dorsal metatarsal head, articular cartilage, moberg, proximal phalanx

hallux limitus/rigidus surgical interventions include _____ (excision of _____ to remove osteophytes, improve DF ROM, preserves _____) or _____ procedure (dorsiflexion osteotomy of _____ to improve DF ROM)