I like the way this is going...feel free to continue with this type of content OR Q&A. - Eric

  1) Ah ha moment from Lindsay- When identifying Tibialis posterior (Tom), Flexor Digitorum longus (Dick), and Flexor Hallucis longus (Harry), always start by finding tibialis posterior by resisting inversion. I found it is the easiest to find (most pronounced), then move to resisted flexion of the big toe to find flexor Hallucis longus (the most posterior of the three) and finally resist flexion of the digits to find flexor digitorum longus (in the middle)

2) Did You Know Factoid...

     The sinus tarsi, a seemingly unimportant space used for landmarking purposes, is very important in the event of an injury. This space can fill with fluid during swelling unless the foot and ankle are put into dorsiflexion prior to being immobilized. The tarsal bone must slide into this area to prevent fluid accumulation.     - Brodie

3) When performing the Kleiger's Test or the Squeeze Test, one of the symptoms is Syndesmosis.  Syndesmosis is a 'high ankle sprain' (i.e. tibiofibular), and represents a small percentage of ankle sprains.  It has accounted close to 10% of all ankle sprains and 18% in professional football players (Strakey & Ryan).  Syndesmosis sprains result in a longer recovery time compared to other types of ankle sprains, and may require immobilization.  Pain is generally located on the anterior aspect of the ankle and proximally along the interosseous membrane and is intensified during forced dorsiflexion, or the two tests named above. -Jared

4) When asked to palpate the peroneus longus and brevis tendons the first action one might consider resisting is eversion, as both of these tendons will become visible. In order to distinguish between the two, restrict plantarflexion as peroneus longus becomes even more visible. Also, keep in mind the insertion of the peroneus brevis tendon, onto the styloid process of the 5th metetarsal. -Lucy

5) When asked to palpate the extensor digitorum longus and extensor digitorum brevis resist extension of the digits.  This will make the tendons of the longus very prominant as they head to each of the digits.  While still resisting extension of the phalanges the muscle belly of the extensor will be very prominant on the dorsal, lateral side  of the foot. - Caitlin

6)  Ingrown Toenails....what causes them and other than the pain associated with them, why should we care?

Ingrown toenails most often occur on the big toe.  The common causes include:

              1.  cutting nail too short, allowing the nail to re-grow deep into the skin around the nail bed

              2.  genetic predisposition

      Infections are very common for ingrown toenails, as many people try to fix the problem themselves.  This is important because the bone is so near the surface at the toe and can also become infected.  This can be hard to treat, resulting in surgery and if severe, the removal of part of the foot or toe. -Sarah

7) For any one insteresting, I found this fun pneumonic about how to treat a sprained ankle, DR ICE:

• D is for diagnosis. It is important to get the correct diagnosis from the start. If other factors such as an avulsion sprain (where a bone fragment is pulled away from the bone) are suspected then treatment may be different.
• R is for rest. It is important to rest the injury to reduce pain and prevent further damage. If you need crutches then use them! People with crutches get more sympathy! Many therapists advocate partial weight bearing as soon as pain will allow. This is thought to accelerate rehabilitation.
• I is for ICE or cold therapy. Applying ice and compression can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow (when used later).
• C is for compression - This reduces bleeding and helps reduce swelling.
• E is for Elevation - Uses gravity to reduce bleeding and reduces swelling by allowing fluids to flow away from the site of injury. So put your feet up and get someone else to wait on you.

          *go to our del.icio.us site and find Sports Injury Clinic link for a whole lotta info about sprains.

    Remember, the most common ligament damaged during ankle sprain is the talofibular ligament and second to be damaged is the calcaneofibular ligament. When the posterio talofibular ligament is damaged as well that means the injury is very severe. Since these ligaments themselves are not readily palpable remember to find their position and apply pressure looking for signs of pain and inflamation. - Tony

8) QUESTION: Order the ankle ligaments (Deltoid, ATF, CF, and PTF) from highest to lowest likelihood of sprain and explain. 

ANSWER: ATF, CF, PTF, Deltoid.  Because the ankle is more stable in eversion than inversion, the Deltoid is the least likely to be strained.  The ATF has the highest likelihood because it becomes tense first during supination followed by the CF which is most likely to sprain in a neutral position.  Much more force is required to strain the PTF.  -Ian

9)  When testing a patient for deep vein thrombosis, a special test commonly used is Homan's Sign.  Deep Vein Thrombosis (DVT) is a blood clot that develops most commonly in the lower leg but can also be found in the arms or thigh region.  Patients will complain of pain usually in the calf accompanied with swelling.  DVT has an increase in risk on long flights due to the immobilization of the extremities, most importantly the legs.  This is extremely important, and if diagnosed, the patient should be immediately referred to a doctor, because if not treated properly this condition can be fatal.  I recently found out that one can get a better result with the Homan's sign by squeezing the calf while passively dorsiflexing the foot.  This will be able to get a better result then just placing an open hand on the tibia, and the patients symptoms will become more apparent.  -Lauren

10)   Special Test! When conducting a Special Test (Active, Passive, Resistive, to the Break Test) be sure to remember it is key to reach and maintain a close End Feel. Also creating a small rocking motion once End Feel is reached. When studying with many fellow classmates (and myself during the exam), the majority would bring a respective ROM too far away from the point of End Feel, giving a false reading.  -Ryan

11) What is pes planus, and when should people (or parents) start to worry if their child is starting to develop it? ANSWER: Flat foot (feet). Typically the arch of the foot begins to develop in early infancy and into childhood. Six years old is the age at which children should have developed an arch in their foot. Wikipedia states that parents can facilitate arch building through foot exercises such as gymnastics or walking on terrain without shoes. The best way to look for pes planus is to measure for a navivular drop. -Stephanie

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