Lower Eval 3

The normal active range of motion (ROM) for ankle plantar flexion is which of the following?

0-50 degrees

Average cadence during walking gait is

100 to 131 steps per minute

During walking, the vertical ground reaction force averages what percent of body weight?

100% to 140%

To allow for proper gait, the talocrural joint must provide ____ degrees of dorsiflexion during walking and ____ degrees during running as the opposite limb goes from the stance to the swing phase.

10; 15

Scoliosis is defined as a curvature of more than

10°

Which is the best position for the ankle when assessing passive range of motion for extension of the great toe?

15 degrees plantar flexion

Rearfoot inversion and eversion ROM allows ____ degrees of inversion from the neutral position and ____ degrees of eversion from neutral.

20; 5

How many structural bones form the three regions of the foot?

26

Joint stability tests (stress testing and special tests) are most accurate when they are performed how many days following injury?

4-7 days

Olympic-caliber cadence during short distance sprints is

5 steps per second

A 50-year-old male client presents to your clinic after being immobilized in a cast for 6 weeks. While walking from the waiting room to the table in flip-flops, he feels a sharp pain in his heel. The client reports that he felt like he had been kicked in the posterior ankle and could no longer push off of that foot. What is the most likely diagnosis?

Achilles rupture

Walking gait kinetics Rockers are the anatomical pivot points during crucial phases of the walking gait cycle. The second rocker is also termed the ________ rocker.

Ankle

Which ligament is assessed using the anterior drawer test of the ankle?

Anterior talofibular

Which ligament is more commonly injured during supination of the ankle?

Anterior talofibular ligament

Which single special test has the best diagnostic accuracy to rule in Achilles tendinopathy?

Arc test

Which term is used for a walking gait characterized by a wide base of support and by the hands being held out to the sides?

Ataxic gait

A 75-year-old female arrives at your clinic for evaluation of falls risk. She states that she is fairly active and walks in the park with her husband three times per week. She reports that she is concerned about her balance and would like to learn some exercises to perform at home in addition to her walking program. Based on her current level of function, what is the most appropriate balance screen to use for this patient in order to get a thorough interpretation of her falls risk?

BESS

An 80-year-old client presents at your clinic with a prescription to evaluate and treat balance because she has fallen twice while walking in the last 4 months. She reports that she doesn't leave her apartment much but lives alone and does not have any help. She scores at the top of the scale for the Tinetti test. What is a more challenging test that you can use with this patient?

Berg

All of the ligaments in the ankle are actually thickenings of the joint capsule with the exception of one. Which of the following is an extracapsular ankle ligament?

Calcaneofibular

Which deformities involves the progressive contracture of the interosseous or lumbrical muscles?

Claw toe

Which structures can be palpated just posterior to the fibular head?

Common peroneal nerve

A 70-year-old female with a medical history of diabetes mellitus, hypertension, hypothyroidism, and long-standing smoking arrives at your clinic with acute-onset mid-thoracic back pain. She reports that the pain developed when she was picking up her grandchild from the floor. The pain was immediate and severe. She reports that she cannot find a comfortable position and that the pain does not change much. Based on the history alone, what is the most likely diagnosis?

Compression fracture

Which mechanism of injury is more likely to result in an injury to the lateral malleolus?

Compressive force from eversion

The most lateral bone of the midfoot is which?

Cuboid

Which is not one of the five bones that form the medial longitudinal arch?

Cuboid

The tibial nerve is located in which of the four leg compartments?

Deep posterior compartment

Which is the most common mechanism of injury for the distal tibiofibular syndesmosis?

Dorsiflexion and/or external rotation of the talus

Which of the below is least statistically acceptable of a test to assess balance in an older patient?

Dynamic Gait Index

Which of the following is a common contributing factor to iliotibial band (ITB) syndrome?

Excessive hip adduction

Which produces the windlass effect?

Extension of the toes causes the calcaneus to come forward

T/F Clinical studies have identified muscle mass gain as an effective strategy for pain control throughout the age spectrum.

False

T/F Running gait requires a wider base of support than does walking gait.

False

What is the normal end-feel for plantar flexion?

Firm

During static weight bearing, in which of the following foot postures does the forefoot compensate by abducting and everting, resulting in a more planus foot?

Forefoot varus

A backward lean during walking is commonly due to weakness of the ________ muscle.

Gluteus maximus

A male 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 indicated by these signs and symptoms?

Gout

What injury results in an abducted first ray at the metatarsophalangeal (MTP) joint?

Hallux valgus

Which is described as a contracture of the associated toe extensors and flexors accompanied by an inability of the interosseous muscles to hold the proximal phalanx in the neutral position?

Hammer toe

An ultimate player comes into the clinic after rolling her ankle yesterday. She can walk a few steps but has some loss of function, a positive anterior drawer test, some hemorrhaging, and decreased ankle ROM. According to the textbook, what grade of ankle sprain does this client have?

II

Which is not a sign/symptom of anterior compartment syndrome?

Increased dorsiflexion strength

Which motion is not a result of closed-chain supination of the ankle?

Internal rotation at the hip

Which is not a function of the fibula?

It provides medial stability to the ankle mortise

A ballerina presents to your clinic with difficulty in pushing off of her toes. She reports that she was practicing a dance routine when another dancer stepped on her forefoot as she was pirouetting. On evaluation, you notice minimal swelling around the midfoot, as well as plantar ecchymosis. What is the most likely diagnosis?

Lisfranc injury

​​Which position is the closed-packed position of the ankle?

Maximal dorsiflexion

Typically, where is pain centralized when someone has plantar fasciitis?

Medial calcaneal tubercle

Which deformity is formed by the first metatarsal being shorter than the second?

Morton's toe

The primary insertion for the tibialis posterior is on what bone?

Navicular

You are examining a child who reports pain in her knee, ankle, and hip that has lasted about 5 months. You are suspicious about possible juvenile idiopathic arthritis (JIA) and refer the child to a rheumatologist. The diagnosis of JIA is confirmed. Based on the child's presentation, she likely has which type of JIA?

Oligoarthritis

What is the difference between traumatic compartment syndrome and chronic exertional compartment syndrome?

Onset of the injury

According to current research, what is suggested for early management of ankle sprains?

Pain-free range-of-motion (ROM) exercises

Which is not contained in the anterior compartment?

Peroneus longus

Which structures is not located in the deep posterior compartment?

Peroneus longus

Which is NOT a factor that can predispose someone to hallux valgus?

Pes cavus

Which nerve is inflamed when someone is suffering from intermetatarsal neuroma?

Plantar

Which ligament is also referred to as the "spring" ligament?

Plantar calcaneonavicular

A flight attendant presents to your clinic with a 1-year history of pain in his heel. The client reports that the first few steps out of bed in the morning are usually most painful right under his heel. Your examination reveals that the client has 5° of dorsiflexion on that side as well as a positive windlass test. What is the most likely diagnosis?

Plantar fascitis

The ankle must be in what position in order to palpate the dome of the talus?

Plantar flexion

The anterior talofibular ligament limits anterior translation of the talus on the tibia and tightens to provide support during what motion?

Plantar flexion

Which vascular structure is found behind the medial malleolus?

Posterior tibial artery

Which describes correct patient positioning for the Thompson Test?

Prone with the foot off the table

During the braking phase in running, which two muscle groups work eccentrically to control excessive transverse plane motion at the knee and ankle?

Quadriceps and gastroc-soleus complex

An athlete presents in the athletic training 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 for a while, but the new skates he is wearing have irritated it. What does this athlete have?

Retrocalcaneal exostosis

What bone(s) of the foot is (are) responsible for assisting in absorbing and redirecting weight-bearing forces, reducing friction, and protecting the tendon?

Sesamoids

Six determinants of walking gait have been identified as required for an efficient motor pattern. Which of the following is one of the six?

Shift of 1 inch to 2 inches (2.5 to 5 cm) toward the stance limb

Which disappears with an ankle sprain?

Sinus tarsi

Correct hand positioning for the anterior drawer test includes one hand stabilizing the leg while the other hand cups the calcaneus with the forearm supporting the foot in what position?

Slight plantar flexion (10-20 degrees)

An os trigonum injury forms when separates from the __________.

Stieda's process, talus

What bony structure can be palpated approximately one finger's width inferior from the medial malleolus and serves as an attachment site for the spring ligament?

Sustentaculum tali

Which bony landmarks are located on the calcaneus?

Sustentaculum tali, peroneal tubercle, lateral cuboid articulation

What joint is better known as the Lisfranc joint?

Tarsometatarsal

This phase of walking gait requires 10° of dorsiflexion.

Terminal stance

If a child's body mass index is in the 87th percentile, how is this fact properly interpreted?

The child is overweight.

In order for stress tests to achieve a high reliability, they require attention to detail when performing the test. Which of the following is the appropriate way to determine a Kleiger test?

The foot and talus are externally rotated while the examiner maintains a stable leg

After completing a Muscle Function Scale on a 6-month-old baby, you give the baby a score of 3 for left head righting. Which of the following interpretations is correct?

The head is held above the horizontal line, less than 45°

A 16-year-old boy is referred to an outpatient orthopedic clinic for "kyphosis." He has had no other assessments of his posture. You measure the kyphosis to be 52°. Which of the following would NOT be an appropriate clinical consideration?

This kyphosis will likely improve to a normal adult value with a home exercise program of anterior chest stretching.

Which trauma or pathology is indicative of bony pain located anteriorly?

Tibial stress fracture

Which muscle of the deep posterior compartment is responsible for controlling pronation?

Tibialis posterior

Which two ligaments of the collective deltoid ligament tighten during dorsiflexion of the ankle?

Tibiocalcaneal and posterior tibiotalar

A recommendation of proper bathing, regularly changing socks, and keeping the area dry to help prevent the buildup of fungi is appropriate for which condition?

Tinea pedis

T/F A physical exam offers better diagnostic value when performed 5 days after an ankle sprain than when performed 48 hours after the incident.

True

T/F Double support during walking gait occurs during initial contact, loading response, and pre-swing.

True

T/F Inactivity is the most common reason for declined functional capabilities in an older client.

True

T/F Inadequate dorsiflexion causes a deficiency in the attribute of foot clearance in swing.

True

T/F One of the concerns about balance assessments is the ceiling effect because the test may NOT have sufficient range to identify all of those who are still at risk for falls.

True

T/F Studies have shown that clients with less than normal ROM can preserve the functional ROM necessary to complete ADLs.

True

A client presents to your clinic after rolling her ankle. On further questioning, she indicates that she was pivoting on her right foot in a soccer match when an opponent fell on her foot. On evaluation, the patient is tender over her AITFL and PITFL. What diagnostic imaging is highly sensitive for ruling out this pathology?

US

Which condition does not result in retrocalcaneal pain?

Weakness of the gastrocnemius

A 68-year-old sedentary man with a BMI of 34 arrives at your clinic with a diagnosis of osteoarthritis in his right knee. He has a medical history of hypertension, congestive heart failure, atrial fibrillation, and COPD. What is the most likely influential risk factor for the development of his painful osteoarthritis?

Weight

You are treating a person who is the parent of a 3-year-old and who inquires about the child's flat feet. Which of the following is an appropriate response?

You should certainly ask your pediatrician if you are concerned, but I can tell you that flat feet in children is considered a normal finding in children up to age 6.

One of the differences between Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) is that

cardiac failure is usually the cause of death in BMD

Common bone-related tissue changes that lead to osteoporosis include

decreased osteoblast activity, unchanged level of osteoclast activity, and decreased calcium levels

The use of a tuning fork for a fibular fracture, while using a stethoscope over the fibular head, is better at

helping to rule in a potential fracture than helping to rule it out

The Ottawa Foot Rules are equally capable of

helping to rule in and helping to rule out a potential fracture

A 12-year-old with a history of a brachial plexus injury (BPI) is referred to an outpatient orthopedic clinic for "strengthening." The only medical information that you have about this child is that the type of BPI is called "Erb's palsy." Which type of clinical presentation would you expect?

impaired proximal strength with preserved distal strength

The support phase of running can be subdivided into two phases: braking and propulsion. The propulsion phase is defined as the

point when the body moves in front of the stance leg

Which set of conditions, diseases, and medications may cause or contribute to the diagnosis of osteoporosis and increase the risk of fracture?

premature menopause, smoking, and diabetes mellitus

Little League elbow results from

repetitive valgus stress at the elbow

A 13-year-old boy presents at a physical therapy clinic with reports of groin pain. Upon examination, you find that the child is obese and prefers to keep his leg externally rotated. You are concerned that this child may have a

slipped capital femoral epiphysis

Which of the following is NOT a typical finding in early Duchenne muscular dystrophy?

subtle speech difficulties

The lateral arch is composed of all of the following bones except the

talus

The most common fracture in the pediatric lower extremity occurs in the

tibia

n clients with osteoporosis, a distance of _________ between the inferior margin of the ribs and the superior surface of the pelvis has been suggested as indicating the presence of vertebral compression fracture.

two finger breadths (or widths)