Podcast
Questions and Answers
During the observation portion of an ankle and foot osteopathic examination, which of the following findings would suggest a chronic rather than an acute condition?
During the observation portion of an ankle and foot osteopathic examination, which of the following findings would suggest a chronic rather than an acute condition?
- Presence of erythema around the ankle joint.
- Subtle malalignment observed during gait analysis. (correct)
- Significant bruising along the plantar fascia.
- Sudden onset of severe swelling.
When palpating the anterior compartment of the lower leg, differentiating between the tibialis anterior and extensor hallucis longus is crucial. Which technique provides the MOST specific isolation of the extensor hallucis longus?
When palpating the anterior compartment of the lower leg, differentiating between the tibialis anterior and extensor hallucis longus is crucial. Which technique provides the MOST specific isolation of the extensor hallucis longus?
- Palpating the muscle belly proximally while the patient plantarflexes the foot.
- Having the patient extend their second, third, fourth, and fifth toes against resistance.
- Activating extension of the great toe against resistance while palpating distally. (correct)
- Resisting ankle dorsiflexion while palpating the muscle belly.
A patient reports pain along the posterior medial aspect of their tibia. Palpation reveals tenderness deep to the superficial posterior compartment. Which muscle is MOST likely involved?
A patient reports pain along the posterior medial aspect of their tibia. Palpation reveals tenderness deep to the superficial posterior compartment. Which muscle is MOST likely involved?
- Tibialis Posterior (correct)
- Soleus
- Peroneus Longus
- Gastrocnemius
During an ankle examination, you suspect injury to the lateral ligament complex. To specifically assess the integrity of the calcaneofibular ligament, which maneuver is MOST appropriate?
During an ankle examination, you suspect injury to the lateral ligament complex. To specifically assess the integrity of the calcaneofibular ligament, which maneuver is MOST appropriate?
You are palpating the medial aspect of the ankle to assess the deltoid ligament. Which bony landmark is NOT directly connected to the medial malleolus by a portion of the deltoid ligament?
You are palpating the medial aspect of the ankle to assess the deltoid ligament. Which bony landmark is NOT directly connected to the medial malleolus by a portion of the deltoid ligament?
When palpating the plantar fascia, what specific finding would MOST strongly suggest the presence of plantar fasciitis?
When palpating the plantar fascia, what specific finding would MOST strongly suggest the presence of plantar fasciitis?
During assessment of the distal tibiofibular joint, you note restricted posterior glide of the lateral malleolus with ankle dorsiflexion. This finding indicates:
During assessment of the distal tibiofibular joint, you note restricted posterior glide of the lateral malleolus with ankle dorsiflexion. This finding indicates:
When assessing the talocrural joint, a restriction in posterior glide of the talus during dorsiflexion is identified. Which intervention is MOST appropriate to address this dysfunction?
When assessing the talocrural joint, a restriction in posterior glide of the talus during dorsiflexion is identified. Which intervention is MOST appropriate to address this dysfunction?
While evaluating subtalar joint motion, you observe limited eversion with a coupled lateral glide of the talus. This finding suggests:
While evaluating subtalar joint motion, you observe limited eversion with a coupled lateral glide of the talus. This finding suggests:
When assessing the midfoot, a patient presents with a navicular that is rigid and tender on the plantar surface. Considering the typical plantar glide dysfunctions of the midfoot bones, what associated motion is MOST likely present at the navicular?
When assessing the midfoot, a patient presents with a navicular that is rigid and tender on the plantar surface. Considering the typical plantar glide dysfunctions of the midfoot bones, what associated motion is MOST likely present at the navicular?
Flashcards
Ankle and Foot Observation
Ankle and Foot Observation
Observation includes gait analysis, squat test, active range of motion (dorsiflexion, eversion, plantar flexion, inversion), and looking for malalignment, trauma, bruising, erythema, and swelling.
Anterior Lower Leg Muscles
Anterior Lower Leg Muscles
Located in the anterior lower leg compartment, including extensor digitorum longus, tibialis anterior, and extensor hallucis longus.
Lower Leg Compartments
Lower Leg Compartments
Located in the superficial posterior compartment are gastrocnemius and soleus. The deep posterior compartment contains the posterior tibialis. Proneus longus and brevis comprise the lateral compartment.
Lateral Ligament Complex
Lateral Ligament Complex
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Deltoid Ligament
Deltoid Ligament
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Spring Ligament
Spring Ligament
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Distal Tibiofibular Joint Movement
Distal Tibiofibular Joint Movement
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Talocrural Joint Movement
Talocrural Joint Movement
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Subtalar Joint Movement
Subtalar Joint Movement
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Midfoot Bone Preference
Midfoot Bone Preference
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Study Notes
- Osteopathic diagnosis of the ankle and foot involves anatomical knowledge and examination techniques.
- The observation portion includes: gait analysis, squat test, active range of motion (dorsiflexion, eversion, plantar flexion, and inversion).
- Visual inspection for malalignment, signs of trauma, bruising, erythema, and swelling is also part of the observation.
Palpating Anterior Lower Leg Muscles
- Palpation starts with the anterior muscles of the lower leg, specifically in the anterior compartment.
- The most superficial muscles are the extensor digitorum and anterior tibialis.
- Deep to these lies the extensor hallucis.
- Activating extension of the big toe against resistance helps isolate the extensor hallucis.
- Activating extension of the other toes (second, third, fourth, and fifth) helps isolate the extensor digitorum.
Tibialis Anterior
- Function: (Not provided in text)
Palpating Posterior and Lateral Lower Leg Muscles
- The superficial posterior compartment contains the gastrocnemius and soleus.
- The deep posterior compartment contains the posterior tibialis, found on the posterior medial aspect of the tibia.
- The peroneus longus and brevis make up the lateral compartment.
- The peroneus longus is located near the fibular head, moving distally to the peroneus brevis in the distal half of the lateral compartment.
Tibialis Posterior
- Function: (Not provided in text)
- Origin: posterior surface of the tibia
- Insertion: tuberosity of the navicular bone
Ankle Ligaments
- Lateral ligaments: anterior talofibular, calcaneofibular, and posterior talofibular ligaments.
- Medial ligaments (Deltoid ligament): connects the medial malleolus to the talus, navicular, and calcaneus.
- Spring ligament (plantar calcaneonavicular ligament): runs from the calcaneus to the navicular.
Palpating Bones of the Foot
- The hindfoot includes the calcaneus and talus.
- The midfoot includes the cuboid, navicular, and three cuneiforms.
- Palpate each individual bone to assess their position.
- Following the metatarsals proximally can help locate the cuneiforms and cuboid.
- Palpate the plantar fascia superficially from the calcaneus to metatarsal heads, checking for tension, restriction, or hypertrophic musculature.
Distal Tibiofibular Joint
- Focus on the lateral malleolus (distal end of the fibula).
- During dorsiflexion, the lateral malleolus prefers posterior movement.
- During plantar flexion, it prefers anterior movement.
- A pincer grip is used to assess anterior and posterior motion of the lateral malleolus.
Talar Glide
- Assess the glide of the talus during plantar flexion and dorsiflexion at the talocrural joint.
- The talus glides posteriorly during dorsiflexion.
- The talus glides anteriorly during plantar flexion.
Subtalar Joint
- Most eversion and inversion occur here.
- Eversion involves major motion at the subtalar joint and medial glide of the talus at the talocrural joint.
- Inversion involves lateral glide of the talus.
- Hand placement: One hand on the calcaneus, the other monitoring the talus for motion during eversion and inversion.
Midfoot
- Assess for dorsal and plantar glides at the midfoot.
- Dorsal glide: translation towards the dorsum of the foot.
- Plantar glide: translation towards the plantar surface of the foot.
Midfoot Bone Preferences
- Cuboid: with plantar glide, the cuboid also Everts.
- Navicular: with plantar glide, the navicular also Inverts.
- Cuneiforms: Plantar glide goes straight with no eversion or inversion.
Tarsal Bone Dysfunction
- Tarsal bones commonly exhibit plantar glide dysfunction.
- Navicular: with plantar glide, it rotates slightly into inversion (supination).
- Cuboid: with plantar glide, it Everts (pronates).
- Cuneiforms: with plantar glide go straight.
Palpating Midfoot Bones
- Palpate each bone on the plantar surface.
- Plantar glide is more common, feeling prominent, rigid, and tender.
- Navicular is located on the medial aspect, distal to the talus, aligning with the first metatarsal.
- Cuboid aligns with the fourth and fifth metatarsals.
- Cuneiforms align with their respective metatarsals (first cuneiform with first metatarsal, etc.).
Assessing Cuboid Dysfunction
- One hand on the plantar surface thumb and fingers on the dorsal surface.
- Assess for dorsal and plantar glide.
- Move to each bone of midfoot using this technique to assses for glides.
- Gripping the dorsal and plantar aspect of a metatarsal and stabilizing the adjacent metatarsals is one method of isolating motion, assessing for preference of plantar and dorsal glides
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