ATH301.txt

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itzlinds
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241281
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ATH301.txt
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2013-11-13 20:52:36
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Foot toe pathologies
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foot and toe pathologies
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  1. what are the 2 fxns of the foot and toes:

    During which phase of gait does each fxn occur:
    • provide a rigid platform/support for the body
    • (ability) to remold itself to adapt to uneven terrain.

    • pre-swing phase: rigid lever
    • initial contact/loading response: shock absorber
  2. list the 5 weight bearing portions of the phases of gait:
    • inital contact
    • loading response
    • mid stance
    • termial stance
    • pre-swing
  3. list the 3 non-weight bearing portions of the phases of gait:


    • initial swing
    • mid swing
    • terminal swing
  4. how many structural and sesamoid bones can be found in the foot?

    list the 3 regions the foot can be divided into and its associated structures:
    26 structural and sesamoid bones

    • rearfoot/hindfoot: talus and calcaneus
    • midfoot: 3 cuneiform, the navicular and the cuboid
    • forefoot: 5 metatarsals, 14 phalanges, and 2 sesamoid bones
  5. list the bone structures that make up the tarsals:
    metatarsals:
    list the strcutres that make up the toes:
    list the structures of the great toe:
    • tarsals: calcaneus, talus, navicular, cuboid, 3 cunieforms
    • metatarsals: 5
    • toes: 3 plalanges (proximal, middle, distal)
    • great toe: proximal and distal phalnges
  6. list the fxn of the rearfoot/hindfoot:
    list the 3 prominate features of the calcaneus:
    list the 5 articulations of the talus:
    fxn: provides stability, shock absorption, lever arm for the achilles tendon during plantarflexion

    • prominate features of the calcaneus
    • calcaneal tubercle: powerfull lever, increases muscular force by triceps surae group
    • sustentaculum tali: helps support talus, "shelf"
    • peroneal tubercle: stability and alignment of peroneal tendons

    • articulations of the talus
    • no muscular attachments
    • superiorly with distal tibia
    • medially with medial malleolus
    • laterally with lateral malleolus
    • inferiorly with calcaneus
    • anteriorly with navicular
  7. the articulation formed by the distal articular sruface of the tibia and its medial malleolus. the fibula's lateral malleolus, and the talus is called:


    ankle mortis

    • fxn: produce ROM needed for walking and runing
    • the lateral malleolus is longer; stabilizes by not allowing movement; hard stop of eversion
    • medial malleolus sits higher than lateral, allows for more movement
  8. what is the fxn of the midfoot?
    what is the prominate feature of the navicular:
    what are the 2 prominate features of the cuboid:
    name the 3 cuboids:
    • fxn: shock absorbing segment of the foot
    • prominate feature navicular: navicular tuberosity; primary insertion for the tibialis posterior

    • prominate features of cuboid
    •  sulcus
    • cuboid tuberosity

    • cuboids: medial (1st) intermediate (2nd), lateral (3rd)
    • .
  9. what are the 3 joints that can be found in the midfoot? 

    what are the ligaments that articulate at each joint:
    • talocalcaneonavicular joint (TCN)
    • plantar calcaneonavicular "spring" ligament

    • calcaneocuboid joint (CC)
    • calcaneocuboid ligaments (plantar and dorsal)
    • long plantar ligament
    • plantar fascia

    • midtarsal joints
    • allows the foot to adapt to uneven terrain
  10. what are the 4 joints and ligament articulations of the forefoot?
    • tarsometatarsal joint
    • 5 Metatarsal's form gliding articulations with the bones of the midfoot

    • intermetatarsal joints
    • movements: slight dorsal and plantar glide
    • deep transverse ligament
    • interosseous ligament

    • metatrasophalangeal joint (MTP)
    • movement: flexion, extension, ABDuction, ADDuction
    • reinforeced by plantar fascia, plantar ligament, collateral ligaments
    • joint capsules

    • interphalangeal joints (IP)
    • movement: flexion, extension
    • reinforced by plantar and dorsal joint capsules, and collateral ligaments
  11. list the 3 arches of the foot:
    • medial longitudinal arch
    • lateral longitudinal arch
    • transverse metatarsal arch
  12. describe the meidal longitudinal arch:
    dynamic support is obtained through the tibialis anterior, tibialias posterior, and flexor hallucis longus

    the spring ligament is assist by the plantar fascia and intrinsic foot muscles in bowing the arch

    extends from the calcaneus to the big toe
  13. describe the attachments of the plantar fascia and its motions aids the medial longitudinal arch:
    the central slip attaches to the each of the five toes

    extending the toes tightens the fascia, increasing the curvature of the medial longitudinal arch
  14. describe the windlass effect on the plantar fascia on the medial longitudinal arch of the R foot:
    • the height of the medial arch when the foot is fully weight bearing

    extending the toes causes the plantar fascia to tighten, results in an increase in the height of the arch
  15. which of the 3 arches is rarely the site of injury?
    lateral longitudinal arch
  16. describe the transverse metatarsal arch:
    • formed by the lengths of the metatarsals and tarsals (cuboid,  lateral cuniform, middle cuneiform, medial cuneiform)
    • shaped concave features along the inferior surface of the metatarsals
  17. list the where the dorsal structures of the foot receive their blood supply:
    • dorsalis pedis artery
    • lateral tarsal artery
    • arcurate artery
    • 1st dorsal metatarsal artery
  18. list the blood supply of the plantar structures:
    • posterior tibial artery
    • medial tibial artery
    • deep plantar artery
    • plantar arch
  19. list the veins of the dorsal and plantar network in the foot:
    • medial marginal vein
    • great saphenous vein
    • lateral marginal vein
    • small saphenous vein
  20. during the history portion of a foot examination, an acute onset of symptoms should lead the examiner to suspect:
    bony or soft tissue trauma
  21. during the history portion of a foot examination, insidious (gradual) pain may be caused from:
    • soft tissue degeneration
    • inflammation
    • stress fracture ( HS leve; open growth plate; increased risk for stress fxs)
  22. rheumatoid arthritis, reactive arthritis, psoratic arthritis, or inflammatory bowel disease can produce swelling in the foot and ankle are conditions called:
    seronnegative spondyoarthropathies
  23. a form of arthritis marked by inflammation and pain in the distal joints is called:
    gout

    • -found in the big toe typically; but could be any toe
    • -assosicated with a build up of uric acid
  24. describe how diabetes warrants consideration for potential causative factors:
    • peripheral aterial diease
    • peripheral neuropathy

    • -carefull of foot care
    • -blood supply to the foot has an increased risk for compromise
    • -example: blister, ingrown toe nail.... if thing go wrong, could lead to an amputation
  25. a cancerous tumor that forms in the shaft of the long bones, or less frequently, in soft tissue and is most prevalent in children and teenagers is called:
    ewing's sarcoma

    chronic heel pain that does not have discernible orgin could be indicative of this
  26. a common heel injury in kids, due to inflammation (swelling) of the growth plate in the heel is called:
    sever's disease
  27. what muscle causes the downward pull on the 1st metatarsal?
    flexor halluces brevis
  28. what bone is supported by the sustentaculum tali?
    the talus
  29. what ligament partially inserts on the medial talar tubercle?
    • anterior tibulartalar
    • group of deltoid ligaments
  30. besides its primary action of flexing the great toe, what other accessory motion does the flexor hallucis longus preform?
    inversion and plantarflexion of the foot
  31. what muscle inserts at the base of the 5th metatarsal:
    peroneus brevis
  32. The peroneal tubercule marks the point of diversion of the peroneus longus and brevis. which tendon passes superior to the tubercle:
    fibularis (peroneus) longus
  33. what two actions does the tibialis anterior perform:
    • dorsiflexion
    • inversion
  34. what structures keep the long dorsal extensor tendons in close proximity to the dorsum of the ankle and foot?
    superior and inferior retinaculum
  35. in what tendon do the sesamiod bones lie?
    flexor hallucis brevis
  36. which of the following produces the windlass effect?

    A. flexion of the toes causes the calcaneus to come forward
    B. flexion of the toes causes the navicular to drop down
    C. extension of the toes causes the navicular to drop down
    D. extension of the toes causes the calcaneus to come forward
    D. extension of the toes causes the calcaneus to come forward
    (this multiple choice question has been scrambled)
  37. Which bone in the foot has no muscular attachment?

    A. Calcaneus
    B. cuboid
    C. First metatarsal
    D. Talus
    D. Talus
    (this multiple choice question has been scrambled)
  38. Which vascular structure is found behind the medial malleolus?

    A. First dorsal metatarsal artery
    B. Arcuate artery
    C. Medial tibial artery
    D. posterior tibial artery
    D. posterior tibial artery
    (this multiple choice question has been scrambled)
  39. An athlete presents in The athletic training room with redness, swelling, and pain in the great toe with no mechanism of injury. Evaluation reveals pain on palpation, but pain does not increase with toe extension. Which of the following injuries is correct with these signs and symptoms.

    A. Gout
    B. first degree sprain of the great toe
    C. bunion
    D. ingrown toe nail
    A. gout
    (this multiple choice question has been scrambled)
  40. retrocalcaneal (posterior aspect of calcaneus) pain may result from:
    • inflamation of retrocalcaneal bursa
    • inflammation
    • degeneration of the achilles tendon
  41. heel pain may result from:
    • plantar fasciitis
    • heel spur
    • lumbar nerve roots (if not MOI)
  42. medial arch pain may result from:
    • tarsal tunnel syndrom
    • a midfoot sprain
    • plantar fasciitis
    • navicular fx
    • tibialis posterior tendinopathy
  43. metatarsal pain may result from:
    • stress fx
    • impingment of the nerve
  44. great toe pain may result from:
    • hallux rigidus
    • hallux valgus
    • seasmoid fx
    • sesamoiditis
    • gout
    • ingrown toenail
  45. lateral arch pain may result from:
    • compression of posterior tibial nerve
    • fx of 5th MT or cuboid
    • peroneal tendon pathology
  46. how does the playing surface, distance and duration, and shoes effect the insidious (gradual) on set of pain:
    • playing surface: moving to a harder surfaces increases load on structures, softer/rubberized surface increases eccentric demand
    • distance and duration: increased stress, muscles providing support become fatigued, altered biomechanics
    • shoes: can redistribute the forces of the foot, new shoes-blisters, old- lifetime of certain distance, look at bottoms of sole, is one side more worn out than the other, heat blisters (turf surface can get HOT)
  47. describe how WB status is important to the inspection of the foot
    • inspect NWB and compare to WB and during gait
    • NWB foot assumes natural alignment
    • WB relveals how it compensates for structural abnormailities
    • inspect shoes for irregular wear patternes (soles)
  48. list and describe the 3 classifications of foot type:
    • cavus foot: high medial longitudinal arch, adducted forefoot, inverted rearfoot
    • planus foot: low, bulging medial longitudinal arch, ABDucted forefoot, and everted rearfoot
    • neutral: neither cavus or planus
  49. skin conditions can provide evidence to the nature of pain or alteration in gait, describe:

    calluses
    blisters
    teina pedis
    hard corn
    soft corn
    plantar warts
    • calluses:  result of long-term pressures
    • blisters: indicate area of friction, irritation
    • teina pedis: athlete's foot, fungi,
    • hard corn: (heloma dura) area recvs excessive pressure, hard central core, defined margin, form on toes & PIP joints
    • soft corns: (heloma molle) form b/w toes, dampness keeps it soft
    • plantar warts: (verruca plantaris) cause pain during WB, disrupts gait, "stepping on a pebble", easily spread in common showers, blackhead on bottom of foot
  50. describe the inspection of the toes:

    morton's alignment:
    claw toe:
    hammer toe:
    hallux valgus:
    bunion:
    ingrown toenail:
    subungual hematoma:
    • morton's alignment: 2nd toe is longer than the 1st toe;greater force transmitted to 2nd ray during push off
    • claw toe: callus found on dorsal portion of PIP joint; rubs on top of shoes
    • hammer toe: long toe extensors/long toe flexors substitue for weakness of primary dorsiflexors/plantarflexors
    • hallux valgus: abducted 1st ray
    • bunion: inflammed medial aspect of 1st MTP joint
    • ingrown toenail: great toe, nail grows into nailbed; considered an open would, special caution for diabetics, cut a "v" in the middle of the nail, cotton underneath the nail
    • subungual hematoma: hematoma beneath the nail, great toe, blood turns nail dark purple, pressure on nerve endings, secondary to fx of distal phalanx
  51. inspection of the posterior structures should include:

    achilles tendon:
    calcaneus:
    • achilles tendon: normally aligned with tibia, bowing of tendon indicates pes planus
    • calcaneus: retrocalcaneal exostosis, calcification, hagland's deformity, pump bumps
  52. active range of motion of 1st MTP joint:

    Flexion:
    Extension:
    • Flexion: 35-45 degrees
    • extension: 75-85 degrees

    ROM decreases with each subsequent joint from the 1st MTP joint to the 5th
  53. stress tests are used to isolate stresses to the ligaments stablilizing the toes, MTP and IP joints:

    Joint capsule:
    Valgus:
    Varus:
    • Joint capsule: passive overpressure in flexion and extension (if hypermobil- moves alot, if hypomobil- moves a little)
    • Valgus: stresses the medial collateral ligaments (MCL)
    • Varus: stresses the lateral collateral ligaments (LCL)
  54. describe the following for a joint play intermetatarsal glide assesment:

    evaluative procedure:
    positive test:
    implications:
    • evaluative procedure
    • stabilize on of the MT heads while moving the other in plantar and dorsal direction
    • procedure is repeated by moving to the lateral MT heads until all 4 intermetatarsal joints have been evaluated

    postitive test: pain or increased glide or decreased glide compared to opposite exteremity

    • implications
    • traum to the deep transverse metataral ligament, interosseous ligament or both
    • pain w/o the presence of laxity may indicate the presence of neuorma
  55. describe the following of a joint play tarsometatarsal joint play assesment:

    evaluative procedure:
    positive test:
    implications:
    • evaluative procedure: the MT is glided dorsally on the tarsal and then glided plantarly on the tarsal. repeat for each joint
    • positive test: pain associated with movement

    • implications
    • increased glide: ligamentous laxity
    • decreased glide: joint adhesions, articular change causing coalition of the joint
  56. describe the following of a joint play midtarsal joint play assesment:

    evaluative procedure:
    positive test:
    implications:
    • evaluative procedure: one tarsal is glided dorsally and then plantarly on the stabilized adjacent tarsal. repeat for each tarsal
    • positive test: pain associated with movement, increased or decreased glide relative to the opposite foot

    • implications
    • increased glide: ligamentous laxity
    • decreased glide: joint adhesions, articlar changes causing coalition of the joint
  57. what are the nerve roots that supply the foot and toes:

    list 4 neurological symptoms:

    which tests are used to identifity nerve root pathologies:
    nerver roots: L4- S2

    • neurological symptoms
    • numbness
    • muscle weakness
    • hypereflexia
    • hyporeflexia

    identifity nerve root patho: lower quater neurologic screen
  58. identify 3 ways to check for pulse on the foot:
    • posterior tibial pulse: postier to med. malleolus
    • dorsalis pedis pulse: extensor hallicus longus
    • capillary refill: nail beds, skin on dorsum of the foot
  59. the condition characterized by the lowering of the medial longitudinal arch, giving this condition is colloquial name, "flat feet" is called:

    how does the lowered arch affect the...
    talas:
    navicular:
    the condition characterized by the lowering of the medial longitudinal arch, giving this condition is colloquial name, "flat feet" is called: pes planus

    • lowered arch affects the talus: tilt medially
    • lowered arch affects the navicular: displace inferiorly, making the talus more prominent (talar beaking)
  60. a congential foot deformity appearing as a high medial longitudinal arch is called:

    which fxn is impaired with this condition:
    treatment:
    • a congential foot deformity appearing as a high medial longitudinal arch is called: pes cavus
    • impaired fxn: ability to absorb ground contact forces
    • treatment: soft orthotics, shoes with soft midsoles to maximize mtions and to dissipate forces
  61. many cases of plantar fasica pathologies are not inflammatory, but rather a degenerative process that is better described as:
    many cases of plantar fasica pathologies are not inflammatory, but rather a degenerative process that is better described as: planatar fasciosis
  62. what are the signs and symptoms of plantar fascitits:
    • pain on the medial calcaneal tubercle
    • pain when stepping out of bed in the morning
    • pain in heel after activity
  63. what is the MOI for a plantar fascia rupture:

    what are the signs and symptoms of a plantar fasica rupture:
    MOI: forced ankle dorsiflexion and toe extension exerts a tensile force on the plantar fascia

    • signs and symptoms
    • immeidate difficulty weight bearing
    • a "tearing" sensation
    • swelling around the medial cancaneal tubercle
    • acute hammer toe
  64. describe the evaluative procedure in a special test of the supple Pes Planus - Windlass Test for plantar fascitis:

    what does a positive test look like:
    • evaluative procedure
    • A. with the patient in NWB position, note the presence of a medial longitudinal arch
    • B. instruct the pt. to stand so weight is evenly distributed
    • C. instruct the pt. to perform a toe raise

    positive test: pain is noted when the patient performs a toe raise
  65. a hooked shape boney outgrowth (exotosis) located on the medial calcaneal tubercle is called:

    is the onset of this condition gradual or acute:
    what is the most common chief complaint of this condition:
    treatment:
    • a hooked shape boney outgrowth (exotosis) located on the medial calcaneal tubercle is called: heel spur
    • onset: gradual
    • chief complaint: pain with heel strike

    • treatment
    • conservative
    • stretching
    • changes in footware
  66. a boney, fibrous, or cartilaginous union between two or more tarsal bones is called:

    how is this condition differentiated from other foot pathologies:
    • a boney, fibrous, or cartilaginous union between two or more tarsal bones is called: tarsal coalition
    • differentiated from other pathos: limitiation in subtalar motion
    • tarsal beaking: the navicular overrides the talus
    • tarsal bones breakdown; shift
  67. the entrapment of the posterior tibial nerve or one of its medial or lateral branches as it passes is called:

    what are the signs and symptoms of this condition:
    the entrapment of the posterior tibial nerve or one of its medial or lateral branches as it passes (through the tarsal tunnel) is called: tarsal tunnle syndrome

    • signs and symptoms
    • diffuse pain
    • burning
    • parestheia
    • numbness along the plantar and medial apsect
    • symptoms increase with activity; decrease with rest
  68. list and describe the 2 special tests for tarsal tunnle syndrome

    evaluative procedure:
    positive test:
    • dorisflexion-eversion test
    • evaluative procedure: passively evert the heel (calcaneus and talas) while passively dorsiflexing the foot and toes
    • positive test: provocation of pain and/or paresthesia radiating into the foot

    • tinel's sign
    • tapping over the path of the posterior tibial nerve causes radiating symptoms into the foot and toes
  69. list the 3 possible fx that could possibly occur to the proximal 5th MT:

    list 3 signs and symptoms of an acute fx:
    • avulsion fx
    • involves the styloid process

    • jones fx
    • occurs 1 cm distal to the proximal diaphysis

    • stress fx
    • occur distal to the proximal diaphysis

    • sigsn and symptoms
    • obvious deformity
    • presence of a false joint over fx site
    • limited ROM of joints above and below fx site
  70. describe the evaulative procedure for a long bone compression test of the metatrasals:

    what does a positive test look like:
    • evaulative procedure: a longitudinal force is placed along the shaft of the bone
    • positive test: the compression of the two fragments results in pain and possibly the presence of a "false joint"
  71. sprains, dislocations, fxs, or fx dislocations throught the tarsometatarsal joints are called:

    list some MOI for this injury:
    sprains, dislocations, fxs, or fx dislocations throught the tarsometatarsal joints are called: lisfranc injuries

    • MOI
    • axial loading that forces the toes into extension and the foot and ankle into dorsiflexion (e.g., landing from a jump)
    • rotational loading from a fixed forefoot
    • crushing forces
    • pronation or supination while distal segment of foot is fixed (or being stepped on)
  72. what types of forces are phalangeal fx the result of:

    list the signs and symptoms of a phalangeal fx:
    forces: longitudinal forces, crushing force

    • signs and symptoms
    • deformity
    • pain during toe-off (running/walking)
    • crepitus
    • antalgic gait: limp or unnatural walking pattern
  73. an entrapment of a nerve between two MT heads is called:

    list 4 dispositions to this condition:
    an entrapment of a nerve between two MT heads is called: intermetatarsal neuromas

    • dispostitions
    • excessive motions
    • thicken and shortened transverse intermetatarsal ligaments
    • excessive pronation
    • activities that increase WB pressure or compressive pressure in forefoot
  74. entrapment of a nerve between the 3rd and 4th MT is called:
    entrapment of a nerve between the 3rd and 4th MT is called: mortons neuorma

    • over time demyelination of the nerve occurs
    • loss of a nerve's fatty lining
  75. what is the name of the speical test for intermetatarsal neuroma or mortons neuroma:

    evaluative procedure:
    positive test:
    special test: mulder sign

    • evaluative procedure
    • position one hand along the distal 5th MT and the opposite hand along the distal 1st MT
    • apply pressure to compress the transverse arch
    • using the thumb and forefinger to apply pressure over the symptomatic interspace b/w the MTs

    positive test: a click, pain, or reproduction of symptoms
  76. for which problem would one recommend proper bathing, regularly changing socks, and keeping the area dry to help prevent the bulid up of fungi?

    A. verruca plantaris
    B. molluscum contagiosum
    C. tinea pedis
    D. hard corns
    C. tinea pedis
    (this multiple choice question has been scrambled)
  77. what injury results in an abducted first ray at the MTP joint?

    A. hallux maximus
    B. hallux internus
    C. hallux rigidus
    D. hallux valgus
    D. hallux valgus
    (this multiple choice question has been scrambled)
  78. an athlete presents in the AT room wiht callus under each of the metatarsal heads. what problem does this athlete have?

    A. fallen lateral longitudinal arch
    B. fallen medial longitudinal arch
    C. fallen metatarsal arch
    D. fallen transverse arch
    C. fallen metatarsal arch
    (this multiple choice question has been scrambled)
  79. an athlete presents in the AT room with a bump on the back of the heel. it is red, swollen, and painful to the touch.  The athlete states that it has been there awhile, but the new shoes he is wearing have irritated it. what does this athlete have?

    A. plantarcalcaneal exostosis
    B. achilles tendonitis
    C. retrocalcaneal exostosis
    D. os trigonum
    C. retrocalcaneal exotosis
    (this multiple choice question has been scrambled)
  80. which of the following is the best position for the ankle when assessing PROM in the great toe:

    A. 50 of plantar flexion
    B. anatomical neurtral (900)
    C. 250 of plantar flexion
    D. 150 of plantar flexion
    A. 15 of plantar flexion
    (this multiple choice question has been scrambled)
  81. which nerve roots supply the foot and toes:

    A. L4-S2
    B. L4-S1
    C. L3-S2
    D. L5-S2
    A. L4-S2
    (this multiple choice question has been scrambled)
  82. morton's nueroma is used to describe entrapment between which two metatarsal heads?

    A. fourth and fifth
    B. thrid and fourth
    C. second and thrid
    D. first and second
    B. third and fourth
    (this multiple choice question has been scrambled)

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