CCEP Lower Extremity Treatment 2 — Questions and Answers
Question 1: Which manipulation technique is most appropriate for a hypomobile subtalar joint with calcaneal varus positioning?
- High-velocity low-amplitude thrust into eversion (Correct answer)
- Soft tissue mobilization only
- Joint distraction in the neutral position
- Long-axis traction of the first MTP joint
Correct answer: High-velocity low-amplitude thrust into eversion
A calcaneal varus with subtalar hypomobility responds best to an HVLA thrust directed into eversion to restore pronation motion.
Question 2: A patient presents with pain at the posterior heel worsening with the first steps in the morning. The most likely diagnosis is:
- Achilles tendinopathy
- Plantar fasciitis (Correct answer)
- Retrocalcaneal bursitis
- Tarsal tunnel syndrome
Correct answer: Plantar fasciitis
Morning post-static dyskinesia (pain with first steps after rest) is the hallmark presentation of plantar fasciitis.
Question 3: The Windlass mechanism directly loads which structure during toe extension?
- Achilles tendon
- Peroneus longus
- Plantar fascia (Correct answer)
- Spring ligament
Correct answer: Plantar fascia
Dorsiflexion of the toes winds the plantar fascia around the metatarsal heads, tensioning it and raising the medial longitudinal arch.
Question 4: Which Grade of mobilization (Maitland) is most appropriate for an acutely painful ankle joint where motion is limited by pain before resistance?
- Grade I (Correct answer)
- Grade III
- Grade IV
- Grade V
Correct answer: Grade I
Grade I (small amplitude at the beginning of range) is used for acute, pain-dominant presentations to avoid provocating guarding.
Question 5: During gait analysis, excessive pronation through midstance is best addressed initially by:
- Strengthening hip abductors and foot intrinsics (Correct answer)
- Cortisone injection at the subtalar joint
- Surgical correction of pes planus
- Taping the knee into varus
Correct answer: Strengthening hip abductors and foot intrinsics
Hip abductor weakness allows femoral internal rotation that drives subtalar pronation; foot intrinsic strengthening restores dynamic arch support.
Question 6: An anterior drawer test of the ankle assesses the integrity of which ligament?
- Deltoid ligament
- Anterior talofibular ligament (ATFL) (Correct answer)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL)
Correct answer: Anterior talofibular ligament (ATFL)
The anterior drawer test stresses the ATFL by translating the talus anteriorly on the tibia/fibula.
Question 7: When performing a chiropractic adjustment to the cuboid using a prone whip technique, the intended joint motion is:
- Plantarflexion and inversion of the cuboid
- Dorsal to plantar glide restoring plantar flexion
- Plantar to dorsal glide restoring dorsiflexion (Correct answer)
- Lateral distraction of the calcaneocuboid joint
Correct answer: Plantar to dorsal glide restoring dorsiflexion
The cuboid whip/prone technique applies a quick plantar-to-dorsal force to restore dorsal glide and relieve cuboid syndrome.
CCEP Lower Extremity Treatment 2
Which manipulation technique is most appropriate for a hypomobile subtalar joint with calcaneal varus positioning?