AIPM III - ANKLE & FOOT

Acute ankle pain lasts

3-4 weeks

Subacute ankle pain lasts

<12 weeks

chronic ankle pain lasts

>3 months

what is the most common mechanism of ankle injury?

when the foot is plantarflexed, inverted, and adducted

What is the order of probable ankle ligamentous injury?

1. Anterior Talofibular Ligament

2. Anterolateral Capsule

3. Anterior Tibiofibular Ligament

What ligament is more likely to the sprained in a foot that suffered repeated ligament injury?

Anterior Tibiofibular Ligament

What is the most commonly sprained ligament in the ankle?

Anterior Talofibular Ligament

Why might Achilles tendinosis or paratendonitis arise?

Overuse or change in activity

Shin split pain is

diffuse

Shin fractures are

specific (pin point)

Ankle inversion sprain pain occurs

~GB40 & possibly medially d/t compression

Inability to bear weight, severe pain, and rapid swelling indicates

severe ankle injury (3rd degree?)

Ankle pain while walking

2d degree ankle sprain

Ankle pain while running

1st degree ankle sprain

Pain after activity suggests

Overuse

what can cause a flat arch?

medial hip rotation or trunk rotation toward the opposite hip

what can cause an elevated arch?

lateral hip rotation (not common)

swelling posterior to the lateral malleolus could indicate

peroneal retinaculum injury

What 2 arches exist in the foot?

Metatarsal & Longitudinal arches

If the achilles tendon curves out, this could indicate

fallen medial longitudinal arch

Difference between structurally and functionally flat feet?

Structural - life long; can be ID'd either way non-wt/wt-bearing

Functional - develop later in life w/a medial longitudinal arch when non-wt baring & a flat foot when wt-bearing

Pes Planus causes

trauma, ligament laxity, pronated food

Pes Cavus causes

congenital/genetic factor

Hallux Valgus?

medial deviation of the head of 1st metatarsal bone (bunion)

what could a callous between the 2nd and 3rd metatarsal heads on the ventral side of the foot indicate?

a fallen metatarsal arch

- Pt stands in a relaxed, standing position

- Palpate the head of the talus. Have the pt rotate their trunk right and left to move the tibia laterally/medially.

- Find a position where the talus does not bulge on either side.

Neutral Talus Position (Wt Baring)

- Pt is seated with knee flexed at 90*. Stabilize the lower leg against the table.

- Hold the pt's foot in 20* DORSIflexion and draw the talus foward.

- A dimple may appear over anterior talofibular ligament (GB40) if pain

Anterior Drawer Test of Ankle

Anterior Drawer Test of the Ankle ID's

Inversion Sprain

- Position the pt seated and knee flexed to 90*

- Passively dorsiflex and evert the pt's foot

External Rotation Test

Positive External Rotation Test

Tibiofibular ligament and/or interosseus membrane injury

- W/the pt supine, squeeze the metatarsal heads

Morton's Test

Positive Morton's Test

Pain/stress fracture of tarsal heads - or neuroma

What test ID's a high ankle / tibiofibular ligament sprain

Dorsiflexion Test

Shin Splint Tx

LIV3, LIV8, SP6, Tibialis Anterior IZ, Tibialis Posterior IZ

Inversion Sprain Tx

LIV4, GB40, ST41, BL62, Ashi GB34, IZ of tibialis ant/post/peroneus longus/brevis

High Ankle Sprain Tx

ST36, ST37, GB40, ST41, E-Stim 3hz 20-25 mins.

Morton's Neuroma Tx

Needle btwn metatarsals in a cross direction, ba feng

Fasciosis (Plantar Fasciitis) Key Sx

Pain of the medial heal or calcaneal attachment, worse on rising from bed and taking the first steps

Fasciosis (Plantar Fasciitis) Tx

Mu Guan, Gu Guan Contralaterally

Tarsal Tunnel Syndrome Key Sx

Pain, numbness, tingling, burning along the medial longitudinal arch from heat to great toe. Worse w/activity

Tarsal Tunnel Syndrome Tx

LIV4 SP6, SP7, Tibialis Poster IZ

Difference in cause btwn fasciosis and tarsal tunnel syndrome?

Fasciosis is d/t overuse. TTS is d/t trauma.

Difference in tissue effected by fasciosis and tarsal tunnel syndrome?

Fasciosis = fascia; TTS - nerve

What 3 tests need conducted when a pt reports "turned or sprained their ankle"

1. Ankle Drawer Test

2. Ankle External Rotation Test

3. Ankle Inversion Test

What does the Ankle Drawer Test ID?

Integrity of the Anterior TALOfibular ligament

What does the Ankle External Rotation Test ID?

Integrity of the Anterior TIBIO-Fibular ligament, High Ankle Sprain

What does the Ankle Inversion test ID?

Confirms Anterior TALO fibular ligament

What points would you needle for a rolled ankle on this AIPM exam?

ST37

Peroneal Longus IZ (1/3d distance GB34-Lateral Malleolus)

Peroneal Brevis IZ (2/3s distance GB34-Lateral Malleolus)

What tests should you do if your pt complins of pain in the bottom on their foot/toes?

1. Morton's Neuroma Test

2. Neutral Talus Test

3. Ankle Drawer Test

What does the Morton's Test ID?

Pain between the 3rd and 4th toes - nerve entrapment

What does the Neutral Talus Position test ID?

Over-pronation or supination of the foot

What does the Ankle Drawer Test ID?

Integrity of the Anterior TALOfibular ligament

Where would you need for plantar foot pain for this AIPM exam?

Plantar Fascia Needling x2

Morton's Neuroma x2 (btwn 3d-4th Metatarsals)