| Question | Answer |
| dorsiflexion is in the ___ plane | sagittal |
| inversion is in the ____ plane | frontal |
| •ABD/ADD is in _____ plane | transverse |
| pronation is a combo of what 3 movements? | •DF/EVE/ABD |
| supination is a combo of what 3 movements? | •PF/INV/ADD |
| what makes up the talocrural joint? | •Distal tibia and fibula with talus |
| what motions occur at the talocrural joint | PF and DF |
| what ligaments is the talocrural joint supported by? | •Supported by deltoid ligament medially and anterior & posterior talofibular ligaments laterally |
| closed packed position of talocrural joint | DF |
| what makes up the subtalar joint | talus and calcaneus |
| what motions occur at subtalar joint | inversion and eversion |
| what ligaments support the subtalar joint? | •deltoid and lateral collateral ligaments |
| what ligament is most often involved in an ankle sprain | anterior talofibular ligament
(limits inversion) |
| is deltoid ligament frequently injured? | not injured very frequently
(limits eversion) |
| what is second most injured ankle ligament | calcaneofibular
(limits inversion) |
| what ligament in often only injured in severe ankle sprains or dislocations | posterior talofibular |
| Supination of the subtalar joint is caused by ______ rotation of tibia | lateral |
| Pronation of the subtalar joint is caused by _____ rotation of the tibia | medial |
| when during gait do we see supination? | at beginning and end during toe off |
| supination creates a ___ foot | rigid |
| during loading response: Heel strike in neutral or ____ | supination, |
| the LE rotates ____ during loading response | inward |
| during loading response the ____ conforms to ground contour and absorbs forces | foot |
| DF occurs as the ____ moves over the _____ | tibia, ankle |
| what occurs at the tibia during midstance? | ER |
| what occurs at the foot from midstance --> terminal stance | supination (closed pack) and windlass effect |
| *when do dorsiflexors fire in gait?* | - during heel strike to foot flat
- during swing phase |
| *when do plantar flexors fire in gait?* | - eccentrically early in stance to control forward mvmt of tiba
- Concentric to initiate push off |
| 2 keys for reducing fall risks | DF ROM and PF strength |
| Overuse (Repetitive Trauma) Syndromes | •Tendinitis/Tenosynovitis/Tendinosis |
| what can cause Achilles tendinitis | •Changes in footwear or poor footwear
•Changes in training
•Repetitive stresses such as jumping, running
**decreased DF ROM and posterior chain flexibility** |
| what position of the foot shortens the calf muscles | pronation
- ppl with limited DF often pronate to help advance tibia over talus |
| non operative tx for Achilles tendinitis in protection phase | •Rest
•Heel lift - not permanent, can help take load off for a short time
•Taping
•modalities
•Activity modification
•AROM, gentle stretching
•Isometrics |
| therex for Achilles controlled motion/return to function phase | progress stretching and strengthen
- Wall stretches, dynamic stretches
- Double calf→single→from stretched position
- Closed chain gastroc/soleus exercise, eccentrics
- Teach proper warm up
- Low impact activities, progress activity level |
| shin splints | •Anterior tib tendinitis or stress fx |
| shin splints can be a ____ syndrome | compartment |
| what causes shin splints | - Overuse of anterior tib is common, also weakness
- rigid foot
- tight gastroc/soleus complex
- inadequate shock absorption
- increase in training can precipitate |
| why is a rigid foot a cause of shin splints | rigid foot can't absorb shock properly so it is directed up the chain |
| symptoms of shin splints | - pain with active DF
- pain when stretched into PF |
| what mm are involved in Medial/Posterior Shin Splints (Medial tibial stress syndrome) | •Inflamed Posterior tibialis
•Soleus and flexor digitorum longus/hallucis longus involved
•Can also be medial gastroc |
| what can cause Medial/Posterior Shin Splints | •May be overpronator
•Difficulty with deceleration of entire chain
•Poor footwear
•Tight gastroc-soleus |
| symptoms of Medial/Posterior Shin Splints | •Pain with passive pronation at end range or with overpressure |
| protection phase of shin splint tx | rest, taping, modalities, activity modification, AROM and gentle stretching, Isometrics |
| a ___ may help with shin splints | orthotic - but it cannot be soft |
| shin splints Controlled Motion Return to Function Phase | Progress stretching and strengthening
- Wall stretches
- Dynamic stretches
- Dorsiflexion exercises
- Hip exercises to decelerate IR/Pronation
- Teach proper warm up
- Teach proper warm up
- Low impact activities, progress activity level |
| plantar fasciitis | - Pain at medial tubercle of calcaneus |
| what causes plantar fasciitis | - Tight gastroc/soleus complex
- Hyperpronation |
| what can develop in plantar fascitis? | heel spur |
| symptoms of plantar fasciitis | Pain in a.m. upon arising or after long periods of sitting |
| plantar fasciitis protection phase | Rest, taping, modalities, activity modification, AROM, gentle stretching, isometrics, night splint, OTS orthotics |
| controlled motion/ return to function phase for plantar fasciitis | Progress stretching and strengthening, wall stretches, dynamic stretches, - Double calf→single→progress to a stretched position, foot intrinsic strengthening, Closed chain gastroc/soleus exercise, eccentrics, Low Impact Activities, teach proper warm up |
| what ligaments are involved in inversion ankle sprain | - Anterior talofibular ligament primary involvement
- Posterior talofibular torn with massive inversion stress |
| - Instability of mortise joint if ____ torn | tibiofibular ligaments |
| what motion at tibia causes inversion ankle sprain | forced DF and ER (tibial) |
| therex in ankle ligamentous injury protected motion phase | - RICE
- grade 1 mobs
- PROM, AROM
- assistive devices
- bracing or taping (horseshoe or kinesiotape- pic 23) |
| therex in controlled motion phase of ankle ligamentous injury | - Friction massage
- Grade II Mobilization
- AROM
- Gentle Stretching gastroc/soleus
- Isometrics
- Light PREs
- Bicycle
- Balance Board in sitting, progress to PWB, FWB |
| therex in return to function phase of ankle ligamentous injury | - progress PRE
- proprioceptive exercise
- CKC
- toe raise progression
- return to sport activities |
| general considerations for ankle injuries | - address swelling: circulation can be poor
-joint mobs grade 1 and 2
- braces: be careful, injury can still occur
- shoe or no shoe |
| what should you generally start with for treating ankle injuries | - start with ROM and progress |
| - Long periods of immobilization can be followed by _____pain when WB is begun | plantar surface foot |
| when should a pt wear their shoes during tx? | - if they can't control foot motions
- if they have orthotics |
| indications for Total ankle arthroplasty | •Severe arthritis that has failed conservative treatment
•Post traumatic arthritis
•RA
•Avascular necrosis of the talus |
| TAA May be accompanied by lengthening procedure of ____ if decreased DF | Achilles |
| TAA May be accompanied by ____ fusion if significant hindfoot deformity | subtalar |
| max protection phase for TAA | •WB may be restricted from 3-6 weeks
•Progression of WB will start in a boot or some type of immobilizer
•Work ROM
- begin mm setting |
| what motion is no longer available after hindfoot fusion | inversion and eversion |
| TAA post op guidelines | - Progress ROM especially for DF and PF
•Progress strengthening, particularly mm endurance
•Begin balance/proprioceptive activities |
| how long does non weight bearing last after TAA | varies - generally 12-16 weeks |
| •**NO _____ FOR TRIPLE ARTHRODESIS—PF/DF ONLY | INV/EVE |
| you may not see a TAA pt until ___ weeks | 6
- start from ground zero/ max protection phase |
| thompson test is for the ___ | Achilles tendon |
| anterior drawer test is for ____ | ACL |
| talar tilt test is for ___ | calcaneal fibular ligament |
