CCEP Lower Extremity Treatment 5 — Questions and Answers
Question 1: Which of the following best describes the mechanism of Morton's neuroma?
- Avascular necrosis of the metatarsal head
- Perineural fibrosis of the common digital nerve, most often in the 3rd interspace (Correct answer)
- Stress fracture of the 4th metatarsal shaft
- Bursitis between the 2nd and 3rd metatarsal heads
Correct answer: Perineural fibrosis of the common digital nerve, most often in the 3rd interspace
Morton's neuroma is a perineural fibrosis of the common plantar digital nerve, classically in the 3rd intermetatarsal space.
Question 2: A positive Ober test finding (thigh does not adduct to the table from the abducted side-lying position) indicates tightness of the:
- Hip adductors
- Iliotibial band and tensor fasciae latae complex (Correct answer)
- Quadriceps muscle group
- Piriformis muscle
Correct answer: Iliotibial band and tensor fasciae latae complex
The Ober test stretches the ITB/TFL; inability to adduct indicates contracture or tightness of this lateral hip and thigh complex.
Question 3: Which taping technique is used to offload the Achilles tendon by reducing tensile load during rehabilitation?
- Low-dye taping
- Heel lift with calcaneal taping in mild plantarflexion (Correct answer)
- Gibney basketweave taping
- Dorsal blocking tape
Correct answer: Heel lift with calcaneal taping in mild plantarflexion
A calcaneal lift tape in slight plantarflexion reduces Achilles tensile stress by shortening the functional length of the tendon unit.
Question 4: After an inversion ankle sprain, which proprioceptive rehabilitation sequence is most appropriate?
- Static balance → dynamic balance → sport-specific tasks (Correct answer)
- Strengthening before any balance training
- Sport-specific tasks immediately to stimulate healing
- Passive range of motion only for 6 weeks
Correct answer: Static balance → dynamic balance → sport-specific tasks
Progressive proprioceptive rehab moves from static (single-leg stance) to dynamic (perturbation) to sport-specific challenges to restore neuromuscular control.
Question 5: A patient with patellofemoral pain syndrome shows a J-sign on knee extension. This indicates:
- Medial subluxation of the patella
- Lateral tracking and sudden medial movement as the knee reaches full extension (Correct answer)
- Posterior patellar impingement
- Chondromalacia patellae grade IV
Correct answer: Lateral tracking and sudden medial movement as the knee reaches full extension
The J-sign describes lateral patellar tracking that abruptly shifts medially near full extension, suggesting VMO weakness and lateral retinacular tightness.
Question 6: The squeeze test (compression of the tibia and fibula at mid-calf) is used to detect:
- Compartment syndrome
- High ankle sprain (syndesmotic injury) (Correct answer)
- Stress fracture of the fibula shaft
- Peroneal tendon subluxation
Correct answer: High ankle sprain (syndesmotic injury)
The squeeze test transmits force through the interosseous membrane to stress the anterior inferior tibiofibular ligament (syndesmosis); pain indicates high ankle sprain.
Question 7: Which clinical finding most strongly suggests a complete Achilles tendon rupture rather than a severe Achilles tendinopathy?
- Severe pain with passive dorsiflexion
- Palpable gap in the tendon and positive Thompson test (Correct answer)
- Crepitus along the tendon sheath with motion
- Significant swelling at the calcaneal insertion
Correct answer: Palpable gap in the tendon and positive Thompson test
A palpable defect combined with a positive Thompson test (no plantarflexion with calf squeeze) confirms complete Achilles rupture.
CCEP Lower Extremity Treatment 5
Which of the following best describes the mechanism of Morton's neuroma?