LAF Quizzes

Which of the following is true regarding Achilles tendinopathy?

- Increased tendon thickness

- Decreased vascularity

- Decreased neuronal growth

- Presence of inflammatory cells

Increased tendon thickness (remember: INCREASED vascularity & neuronal growth w/ ABSENCE of inflammatory cells)

A 14-year-old male cross-country runner presents to your clinic with heel pain. He describes the pain as point tenderness over the distal Achilles tendon insertion & pain w/ ankle DF. What is the MOST likely pathology?

Severs Disease

A 17-year-old female cross-country runner presents to your clinic w/ reports of diffuse pain along medial tibia that is exercise-induced. What anatomical finding is most likely?

Increased navicular drop value (based on the case, the MOST likely pathology is medial tibial stress syndrome -- associated w/ increased navicular drop value)

Your patient presents to your clinic w/ exercise-induced pain over the medial lower leg. Which structure is most likely involved?

Tibial periosteum

A 20-year-old basketball player reports bilateral exercise-induced anterior lower leg pain. He reports this pain begins 10 minutes into basketball practice. Which pathology is MOST likely?

Compartment syndrome (chronic exertional to be specific)

A patient presents to your clinic w/ gradual onset of medial foot pain w/ collapse of the MLA. What motion are they most likely to struggle with?

Single leg heel raise (based on the case, the MOST likely pathology is posterior tibialis tendon dysfunction — associated w/ difficulty PF)

A patient presents to your clinic w/ a minimally collapsed MLA w/ normal alignment of the hind foot. They are able to perform a heel raise. What stage of posterior tibial tendon dysfunction are they in?

Stage 1

In order to compensate during weight-bearing and gait, forefoot valgus requires midfoot _________

Supination

A patient presents to your clinic with 7/10 posterior ankle pain that started 8 weeks ago after increasing running duration. The pain is described as 4 cm proximal to calcaneus. Which special test would be useful?

Royal london hospital test (based on the case, we are hypothesizing Achilles tendinopathy)

A patient presents to your clinic w/ reports of ankle pain above the lateral malleolus due to an eversion ankle injury. The x-ray was negative. There is ongoing edema in lower leg/ankle w/ tenderness at the anterior tibiofibular joint. Which special test would be useful?

Squeeze test

To improve ankle DF STIFFNESS, what is the appropriate grade and mobilization @ proximal tibiofibular joint?

Grade III (or IV) anterior mob

A patient presents to you with recurrent ankle sprains, stiffness, and limited ankle DF. What is an appropriate mobilization?

Rear foot high-velocity, low-amplitude thrust manipulation

To improve eversion ROM @ subtalar joint, what is the appropriate grade and glide?

Grade IV (or III) medial glide

To improve symptoms associated w/ hallux rigidus, what is the appropriate grade and glide?

Grade IV (or III) dorsal glide

(remember: hallux rigidus is essentially OA of the big toe, which causes decreased extension ROM)

Plantar fasciopathy is associated w/ which of the following:

- Increased plantar fascia thickness

- Decreased vascularity

- Increased ankle DF

- Decreased neurogenesis

Increased plantar fascia thickness (remember: increased vascularity, decreased ankle DF, increased neurogenesis)

What is the STRONGEST contributor to disability in plantar fasciopathy?

Pain-related movements

What is the STRONGEST predictor of a (+) response w/ plantar heel pain?

Duration of symptoms

Burning b/w 1st & 2nd toes and inability to DF indicates compartment syndrome damage @ which area?

Anterior

(remember: the anterior compartment contains the deep fibular nerve, which provides sensory innervation b/w the 1st & 2nd toes as well as motor innervation to the dorsiflexors)

A patient presents w/ burning pain below medial malleolus + symptoms that are worse at night...which clinical finding would MOST LIKELY be accurate?

- (+) Windlass test

- Increased strength

- (-) Dorsiflexion-eversion test

- (+) Tinel's sign

(+) Tinel's sign

Note:

- (+) Windlass test correlates to plantar fasciopathy

- Strength would be impaired

- Nerve damage to the tibial nerve would result in a (+) dorsiflexion-eversion test

A patient presents w/ burning pain b/w 3rd & 4th MT head + sensation of stepping on a pebble...what is the MOST LIKELY pathology?

Interdigital nerve damage (Morton's neuroma)