Deck 19: The Ankle and Lower Leg

Question 1

Please check all of the muscles that invert the foot.

A) Peroneus tertius
B) Tibialis anterior
C) Soleus
D) Tibialis posterior
E) Flexor hallicus longus
F) Gastrocnemius
G) Extensor digitorum longus

Answer 1

Tibialis anterior
Tibialis posterior
Flexor hallicus longus

Question 2

Please check all of the statements that appropriately apply to the Ottowa ankle rules when determining the need of a radiograph.

A) Inability to bear weight (4 steps taken independently, even if limping) at time of injury and time of evaluation
B) Tenderness over superior or anterior pole of either malleolus
C) Inability to bear weight for 4 steps (2 on each foot) at the time of injury and time of evaluation
D) Tenderness along the base of the 1^st metatarsal or navicular bone
E) Tenderness over the inferior or posterior pole of either malleolus, including the distal 6 cm

Answer 2

Inability to bear weight (4 steps taken independently, even if limping) at time of injury and time of evaluation
Inability to bear weight for 4 steps (2 on each foot) at the time of injury and time of evaluation
Tenderness over the inferior or posterior pole of either malleolus, including the distal 6 cm

Question 3

Why is the lower third of this bone the most common site for fractures of the leg?

A) It is does not have any muscular coverage and is vulnerable to outside trauma.
B) It is the most pronounced change in structure, producing an anatomical weakness.
C) It is common insertion point for the lower leg muscles predisposing it to stress fractures.
D) It is a common point of origin for the lower leg muscles predisposing it to stress fractures.
E) It is where the interosseous membrane is the weakest.

Answer 3

It is the most pronounced change in structure, producing an anatomical weakness.

Question 4

What is the name of the joint that is formed with the distal portions of the tibia and fibula?

A) Ginglymus
B) Synovium
C) Syndesmotic
D) Diarthrodial
E) Interosseous

Question 5

What are the correct movements that occur at the talocrural joint?

A) Inversion and eversion
B) Flexion and extension
C) Supination and pronation
D) Accessory motions
E) Plantar flexion and dorsiflexion

Question 6

Which ligament is the primary resistance to foot eversion?

A) Deltoid ligament
B) Calcaneofibular ligament
C) Lateral collateral ligament
D) Syndesmosis
E) Anterior tibiofibular ligament

Question 7

What is the primary function of the calcaneofibular ligament?

A) Restrains the anterior displacement of the talus
B) Restrains inversion of calcaneus
C) Restrains the posterior displacement of the talus
D) Prevents abduction and eversion of ankle and subtalar joint
E) Prevents eversion, pronation, and anterior displacement of the talus

Question 8

What structures help prevent medial or lateral displacement of the talus?

A) Ligaments
B) Tarsals
C) Tendons
D) Malleoli
E) Capsules

Question 9

In order to prevent injury to the Achilles tendon, it is recommended to stretch with both the knee extended and with it flexed 15-30 degrees. Why?

A) The knee needs to be extended and bent to allow the superficial and deep aspect of the Achilles tendon to be stretched.
B) The knee needs to be extended and bent to allow the superficial and deep compartments of the lower leg to be stretched.
C) The knee needs to be extended and bent to allow both static and dynamic stretching of the involved muscle groups.
D) The knee needs to be extended and bent to allow full dorsiflexion at the ankle.
E) The knee needs to be extended and bent to allow stretching of both the gastrocnemius and the soleus.

Question 10

From the following, which one would be considered an inappropriate approach in the prevention of ankle sprains?

A) Stretching of the tibialis anterior muscle
B) Strengthening key muscles
C) Wearing proper footwear
D) Taping when appropriate
E) Obtaining proprioceptive training

Question 11

What would be considered a key element to address with patients who have chronic ankle instabilities?

A) Orthotics
B) Prophylactic bracing
C) Neuromuscular control
D) Increasing range of motion
E) Introduction of therapeutic modalities

Question 12

In the history section of an ankle assessment, what would be considered an inappropriate question to ask the patient?

A) Have you ever hurt your ankle before?
B) How disabling was the injury?
C) Do you think your age contributes to your chronic ankle sprains?
D) What first aid and therapy, if any, were given for this, or previous injuries?
E) Was there immediate swelling, or was it gradual, or none at all?

Question 13

In the observation section of an ankle assessment, what would be considered an inappropriate action to perform?

A) Assessing foot alignment
B) Assessing the width of the hips
C) Assessing if there is crepitus or abnormal sounds in the ankle joint
D) Assessing if patient is in obvious pain
E) Assessing for deformity, swelling, or discoloration

Question 14

If weight-bearing for the patient were tolerable, which of the following would be an inappropriate patient position when observing for structural deformities of the ankle / lower leg?

A) Supine
B) Prone
C) Running
D) Standing
E) Walking

Question 15

Which of the following would be unable to be discovered during the palpation section of an ankle assessment?

A) Retinaculum tear
B) Pain
C) Muscle soreness
D) Fractures
E) Structural deformities

Question 16

What is known as a bimalleolar fracture?

A) Posey fracture
B) Masionneuve fracture
C) Ottawa fracture
D) Potts fracture
E) Avulsion fracture

Question 17

Of the varying ankle sprains that can occur, which one has an etiology of moderate force on the ankle while it is in a position of inversion, plantar flexion, and/or adduction?

A) Grade 1 ligament sprain
B) Grade 2 ligament sprain
C) Grade 3 ligament sprain
D) Eversion ankle sprain
E) Syndesmosis (high ankle) sprain

Question 18

Of the varying ankle sprains that can occur, which one has an etiology of increased external rotation or forced dorsiflexion?

A) Grade 1 ligament sprain
B) Grade 2 ligament sprain
C) Grade 3 ligament sprain
D) Eversion ankle sprain
E) Syndesmosis (high ankle) sprain

Question 19

Avulsion fractures are common in which of the following?

A) Grade 2 inversion ankle sprain
B) Grade 2 eversion ankle sprain
C) Grade 3 inversion ankle sprain
D) Grade 3 eversion ankle sprain
E) Grade 2 & 3 inversion or eversion ankle sprains

Question 20

If a person is suffering from posterior tibialis tendinitis, where would they be point tender?

A) The calcaneous
B) The dorsum of the foot
C) The base of the fifth metatarsal
D) Behind the medial malleolus
E) At the navicular

Question 21

What is the pain purpose of the pad in this picture?

A) Provide support to the lateral ankle
B) Create a focal compression
C) Provide stability for a bone fracture
D) Prevent syndesmotic ankle sprains
E) Provide support to the medial ankle

Question 22

An athlete is suffering from medial tibial stress syndrome, complaining of pain before and after activity, but it does not affect performance. What grade of pain would the patient be assigned?

A) Grade 1
B) Grade 2
C) Grade 3
D) Grade 4
E) Grade 5

Question 23

Which of the following diagnostic techniques would be the MOST APPROPRIATE for diagnosis of a tibial stress fracture?

A) MRI
B) X-ray
C) Echocardiogram
D) Bone scan
E) Sonogram

Question 24

Which of the following forms a link between the lower leg and the foot?

A) The malleolus
B) The tibia
C) The talus
D) The calcaneus
E) The fibula

Question 25

Which of the following refers to the talocrural joint formed by the tibia, fibula, and talus?

A) Extensor retinacula
B) Medial condyle
C) Intercondylar eminence
D) Medial malleolus
E) Ankle mortise

Question 26

Which of the following is the main function of the fibula?

A) To provide for the attachment of muscles
B) To form a link between the lower leg and the foot
C) To serve as the principal weight-bearing bone of the leg
D) To extend greater joint stability to the medial aspect of the ankle than to the lateral aspect
E) To form the heel and attach to the Achilles tendon

Question 27

Which of the following statements is true of the special tests to assess injury to the ankle ligaments?

A) They are used as a last resort when there are no visible signs of an injury.
B) They require the use of a tuning fork to determine whether there is a rupture of the Achilles tendon.
C) Their diagnostic accuracy is higher at five days following injury than at two days.
D) They are most diagnostically accurate when performed after joint effusion has occurred.
E) They require suspected fractures to be tested by squeezing the calf muscle while the leg is extended.

Question 28

Which of the following statements is true of ankle injuries?

A) The grade 2 ligament sprain is the most common type of sprain.
B) Females are at a higher risk of suffering from ankle sprain than males.
C) Generalized joint laxity and anatomical foot type are risk factors for ankle sprains.
D) Patients who have suffered a previous sprain to the ankle have an increased risk of reinjury if a brace is worn.
E) Limb dominance is the number one predictor of sustaining a recurrent ankle injury.

Question 29

Which of the following statements is true of a grade 2 ligament sprain?

A) It causes a subluxation of the ankle.
B) It has a high incidence among active individuals.
C) It is the most common type of sprain.
D) It is characterized by complete impairment of weight-bearing ability.
E) It provides a negative talar tilt test.

Question 30

Which of the following statements is true of a syndesmotic sprain?

A) It is the most common type of sprain.
B) It delays the return to functional activities for a shorter period of time than inversion sprains.
C) Its treatment requires a shorter period of immobilization than the treatment for medial sprains.
D) It is the easiest type of sprain to treat.
E) It is characterized by a loss of function in the ankle region.

Question 31

Which of the following statements is true of posterior tibialis tendinitis?

A) It is characterized by a numb sensation in the area of the medial malleolus.
B) It is managed using a weight-bearing cast on the leg.
C) It is a problem that affects individuals if they have a pes cavus.
D) It is a common overuse condition among runners with pronated feet.
E) It is most likely to affect individuals who run downhill for an extended period of time.

Question 32

Which of the following is a symptom of a shin contusion?

A) A hematoma forms rapidly and tends to exhibit a jellylike consistency.
B) The area of the medial malleolus begins to swell.
C) A point tenderness is felt over the anterior tibialis tendon.
D) The lateral aspect of the ankle shows ecchymoses, edema, and tenderness.
E) Toe raising becomes impossible.