Foot and Ankle Examination Quiz

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Questions and Answers

Which of the following is NOT considered a common bony deformity during a foot and ankle examination?

Pes planus

Hammer toe

Mallet toe

Plantar fasciitis (correct)

What is a potential sign of vascular insufficiency in the foot?

Thickened nails

Shiny skin (correct)

Increased hair growth

Redness in the skin

When assessing arch and calcaneus alignment, which position should be compared?

Active vs. passive

Sitting vs. standing

Weight-bearing vs. non-weight-bearing (correct)

Static vs. moving

Which of the following factors is least significant when assessing foot problems?

Favorite color Signup and view all the answers

What should the initial setup for palpation involve during a foot examination?

Patient in a supine or non-weight-bearing position Signup and view all the answers

Which aspect should NOT be included when discussing a patient's trauma history?

Duration of previous injuries Signup and view all the answers

What does a well-fitted orthotic aim to improve during foot assessment?

Comfort during weight-bearing activities Signup and view all the answers

Which symptom might indicate a radiculopathy related to foot sensation?

Numbness or paresthesias Signup and view all the answers

What bones comprise the hindfoot?

Calcaneus and talus Signup and view all the answers

Which component of the foot provides static support?

Plantar calcaneonavicular ligament Signup and view all the answers

What is the primary function of pronation at the subtalar joint?

To enhance impact absorption Signup and view all the answers

Which column of the forefoot is responsible for weight-bearing and push-off?

Medial column Signup and view all the answers

What injury is commonly associated with the fifth metatarsal?

Jones fracture Signup and view all the answers

During the foot examination, what should be noted during initial observation?

Disability, posture, and gait Signup and view all the answers

What should be observed when assessing the weight-bearing status of the foot?

The wear patterns on the shoes Signup and view all the answers

Which muscles provide dynamic support to the midfoot?

Tibialis posterior Signup and view all the answers

What condition may be indicated by tenderness and swelling between the metatarsals?

Morton's neuroma Signup and view all the answers

Where is the body of the talus primarily located?

Under the medial malleolus and distal tibia Signup and view all the answers

Which of the following is true about the plantar aponeurosis?

It helps support the medial longitudinal arch. Signup and view all the answers

Which structure becomes prominent with dorsiflexion and inversion?

Tibialis Anterior Tendon Signup and view all the answers

What is a characteristic of claw toes?

Hyperextension of the metatarsophalangeal joints Signup and view all the answers

Which toe condition occurs when the second toe is longer than the first metatarsal?

Morton's toe Signup and view all the answers

What is the location of the Dorsalis Pedis Pulse?

Lateral to the extensor hallucis longus and medial to the extensor digitorum longus Signup and view all the answers

What is the role of the Lateral Malleolus?

It helps with lateral stability of the ankle mortise Signup and view all the answers

What typically indicates the presence of plantar fasciitis?

Focal tenderness and nodules Signup and view all the answers

Which tendon becomes distinct during great toe extension?

Extensor Hallucis Longus Signup and view all the answers

What is a key feature of hammer toes?

Hyperextension of the metatarsophalangeal joint Signup and view all the answers

Where is the Peroneus Tubercle found?

Inferior and distal to the lateral malleolus Signup and view all the answers

Why is weight-bearing testing important?

It assesses muscle strength and endurance. Signup and view all the answers

Which of the following statements regarding normal toe alignment is false?

Morton's toe is a normal alignment. Signup and view all the answers

What is a characteristic of the Extensor Digitorum Longus Tendon?

Splits into four tendons for toes 2-5 Signup and view all the answers

What is a common feature of the cuboid bone?

It can become tender if displaced due to trauma Signup and view all the answers

What is the location of the medial malleolus?

Distal medial tibia Signup and view all the answers

What structure provides inferior support for the talus?

Sustentaculum tali Signup and view all the answers

Which ligament connects the medial malleolus to the navicular tubercle?

Deltoid ligament Signup and view all the answers

What could be a consequence of an eversion injury to the foot?

Avulsion fracture of the tibia Signup and view all the answers

Where is the posterior tibial artery located?

Between the tendons of flexor hallucis longus and flexor digitorum longus Signup and view all the answers

Which structure becomes distinct when the foot is inverted and plantarflexed?

Tibialis posterior Signup and view all the answers

What may the absence of the posterior tibial nerve signal?

Occlusive arterial disease Signup and view all the answers

What is a common condition affecting the first metatarsophalangeal joint?

Hallux valgus Signup and view all the answers

What is the initial patient position for assessing the dorsal and plantar glide of the first cuneiform-metatarsal joint?

Supine with the knee flexed to about 90 degrees Signup and view all the answers

During the traction of the first metatarsophalangeal joint, what position should the patient's knee be in?

Extended Signup and view all the answers

What does a positive Tinel's Sign indicate when testing for peroneal nerve compression?

Tingling sensation in the lateral leg and foot Signup and view all the answers

In the dorsal and plantar glide assessment, how should the clinician stabilize the metatarsal?

With the second and third fingers Signup and view all the answers

Which joint is affected during the longitudinal traction performed on the first proximal phalanx?

First metatarsophalangeal joint Signup and view all the answers

What does the dorsal and plantar glide assess in the metatarsals?

Mobility of the joints Signup and view all the answers

Which condition is assessed using Tinel's Sign below the medial malleolus?

Tarsal Tunnel Syndrome Signup and view all the answers

What is the purpose of gliding the metatarsal in both dorsal and plantar directions?

To assess joint play and limitations in motion Signup and view all the answers

Study Notes

Evaluation and Special Tests for Lower Limb Joints (Ankle and Foot)

Dr. Neah Al basha, a physical therapist specializing in rehabilitation for older adults, presented this material.
The presentation covers the anatomical structure, function, and examination of the ankle and foot.

Functional Anatomy of the Ankle

Anatomical Structure:
- The ankle joint is composed of three bones: tibia, fibula, and talus.
- It forms a bony mortise.
- Medially: bounded by the tibial malleolus.
- Laterally: bounded by the fibular malleolus (smaller, extending distally and posteriorly).
- The tibial plafond is the superior, flat surface.
- The transmalleolar axis is externally rotated 15 degrees relative to the coronal axis of the leg.
Ligament Support:
- The mortise is deepened by the anterior tibiofibular ligament.
- Supported posteriorly by the posterior tibiofibular ligament and the posterior malleolus of the tibia.
Talus Positioning:
- The talus sits within the mortise, articulating with the tibial plafond.
- The dome-shaped superior surface articulates with the plafond.
- The talus is wider anteriorly, causing it to wedge tightly during dorsiflexion, which increases joint stability.
Joint Movement:
- The ankle primarily permits flexion-extension, with limited anterior-posterior glide.
- Dorsiflexion enhances medial-lateral tension, aiding in assessing ligament integrity and subtalar joint mobility (inversion-eversion).
Weight-Bearing Function:
- The ankle transmits all weight-bearing forces between the body and the foot.
- Its high stability and limited range of motion give it notable resistance to degenerative changes.
Subtalar Joint:
- The talocalcaneal articulation complements the ankle and allows adaptation to ground surface variations and stress absorption.

Functional Anatomy of the Foot

Primary Functions:
- Provides a stable platform for support.
- Attenuates impact during locomotion.
- Assists in efficient forward propulsion of the body.
Foot Structure:
- Divided into three sections: hindfoot, midfoot, and forefoot.
- Contains 26 bones.
- Arches (longitudinal and transverse) absorb shock and adjust to varying surfaces.
Hindfoot:
- Comprised of calcaneus (heel bone) and talus (ankle bone).
- Supports the body and articulates with the tibia.
Midfoot:
- Contains navicular, three cuneiforms, and cuboid bones.
- Limited movement among these articulations.
Forefoot:
- Includes five metatarsals and 14 phalanges.
- Stability is ensured by ligaments and volar plates.
Soft-tissue support:
- Static support by ligaments (e.g., plantar calcaneonavicular ligament).
- Dynamic support by muscles (e.g., tibialis posterior).
- Pronation occurs at the subtalar joint, facilitating impact absorption and enhancing efficiency during midstance.
Columns of the Forefoot:
- Divided into three columns: medial (first and second digits), central (third digit), and lateral (fourth and fifth digits).
- Each column has a specific role in weight-bearing and propulsion.
- The fifth metatarsal base is a common site for fractures during ankle sprains.
- These fractures can be referred to as Jones fractures.

Foot and Ankle Examination Process

Initial Observation:
- Evaluate gait, posture, and any signs of discomfort.
- Assess weight-bearing status, and gait patterns (heel strike, push-off).
- Identify any assistive devices or gait deviations.
Weight-bearing and Non-weight-bearing Observations:
- Inspect the shoes for wear patterns.
- Examine bony and soft tissue contours of the foot and alignment after shoe removal.
Common Bony Deformities:
- Evaluate for conditions like pes cavus, pes planus, Morton's foot, splaying, mallet toe, hammer toe, claw toe, hallux valgus, hallux rigidus, tibial torsion, and bony bumps (e.g., pump bump).
- Check for calluses, corns, plantar warts, scars, sinuses, and edema.
Inspect Toenails: Look for abnormalities.
Signs of Vascular Insufficiency:
- Look for shiny skin, reduced hair growth, decreased temperature, and thickened toenails.
Arch and Calcaneus:
- Compare the medial arch in weight-bearing and non-weight-bearing positions.
- Observe for any abnormal inversion or eversion of the calcaneus.

Subjective Examination of the Ankle and Foot

Foot Vulnerability:
- The foot experiences high forces during the gait cycle, making it prone to injuries and deformities.
- Systemic diseases (e.g., diabetes, rheumatoid arthritis) can affect the foot.
Patient History:
- Inquire about systemic diseases and their impact on the foot.
- Assess functional limitations, swelling, and stiffness in the foot after rest.
- Inquire about activities, occupation, and abnormal stresses on the feet.

Activities and Sensation Issues

Activities: Can the patient stand on toes/heels or ascend/descend stairs?
Sensation Issues:
- Inquire about numbness, paresthesias, or altered sensation.
- These could indicate radiculopathy (injury to nerve roots) of L4, L5, S1, or S2.
Trauma History:
- Investigate injury mechanism, activity at the time, force direction, and type of footwear.
- Assess pain, swelling, and disability in the first 24 hours following the trauma.
- Check for a history of similar injuries.

Foot Examination Process: Palpation

Examination Techniques: Special Tests

Mobility Testing of Accessory Movements:
- Assess the non-physiological movements in the joints.
- Crucial for understanding joint laxity, stiffness, and how joints behave under load.
- The joint needs to be in a maximal loose-packed position.
- Assess glides of the fibula, and the talocrural joint
Neurological Tests: Assess sensory areas of the nerves and reflexes.
Tests for Nerve Compression:
- Peroneal Nerve Compression: Evaluate Tinel’s sign, which involves tapping the area lateral and inferior to the fibular head. A positive test results in tingling sensation down the lateral leg and dorsum of the foot, which could mean nerve involvement.
- Tarsal Tunnel Syndrome: Apply Tinel's sign test below the medial malleolus. A positive test indicates tibial nerve entrapment.
Tests for Upper Motor Neuron Involvement:
- Babinski's Response: The examiner scratches the plantar aspect of the foot from heel to upper lateral sole, then across the metatarsal heads. A positive response involves upward extension of the great toe with possible flexion of the foot, knee, and hip.
- Oppenheim's Test: The examiner runs a knuckle or fingernail along the anterior tibial surface while looking for dorsiflexion of the great toe, indicative of upper motor neuron involvement.
Special tests:
- Thompson Test for Achilles Tendon Rupture: assesses the continuity of the Achilles tendon.
- Anterior Drawer Sign: evaluates the integrity of the anterior talofibular ligament.
- Inversion Stress Test: assesses the lateral ligaments of the ankle (specifically calcaneofibular ligament).
- Stress Fracture Test: assesses for the presence of stress fractures in the metatarsals.
- Test for Morton's Neuroma: identifies Morton’s neuroma through metatarsal compression.
- Homan’s Sign: evaluates for deep vein thrombosis (DVT) by passively dorsiflexing the foot.
Tests for Alignment:
- Test for Flexible vs. Rigid Flat Foot: to differentiate between flexible and rigid flat foot.
- Test for Medial Longitudinal Arch (Feiss' Line): to assess the degree of flatfoot or arch collapse.
- Test for Leg-Heel Alignment: to determine if the hindfoot is in valgus (outward tilt) or varus (inward tilt)
- Test for Tibial Torsion: assesses rotational alignment of the tibia.

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Description

Test your knowledge on the assessment of foot and ankle conditions. This quiz covers common bony deformities, signs of vascular insufficiency, and key factors in foot examinations. Perfect for students and professionals in orthopedic and physical therapy fields.