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ocs prep > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

What is the biggest contributor to disability with foot and ankle problems?

A

Pain related fear avoidance

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2
Q

True or False: Heel Spurs are the number one predictor for plantar fasciitis pain

A

False, evidence of heel spurs is not correlated to plantar fasciitis

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3
Q

True or False: Prognosis of plantar heel pain is good overall

A

True, 80% of patients will get relief of symptoms in one year

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4
Q

Which populations are most at risk for plantar heel pain?

A

long distance runners, obese patients, and those who work on their feet all day

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5
Q

What subjective findings are most correlated to the diagnosis of plantar fasciitis?

What objective findings?

A

-presence of symptoms in medial heel with pain mostly during the first few steps in the morning or after long bouts of inactivity or with prolonged weight bearing
-recent increase in weight bearing activity
-non-athlete with high BMI

Objective Findings
-pain with palpation of plantar fascia at proximal insertion
(+) Windlass
(-) Tarsal Tunnel Tests
abnormal foot posture position during testing

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6
Q

What position is best to perform Windlass test?

A

Standing

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7
Q

What is the best test for detecting tarsal tunnel syndrome?

A

The dorsiflexion/eversion test

examiner maximally dorsiflexes and then everts the foot while fully extending the toes and holds this position for 5-10 seconds while tapping the tarsal tunnel

positive if this recreates the patient’s familiar symptoms or if tenderness in tarsal tunnel and numbness in the foot

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8
Q

How is the foot posture index scored?

A

6 criteria rated from -2 to +2 with negative values correlated to supinated foot posture and positive values correlated to pronated posture (0=neutral)

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9
Q

What outcome measures are recommended to use in the plantar heel pain CPG?

A

A level evidence for the use of foot and ankle mobility measure, foot health status questionnaire, and foot function index or computer LEFS

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10
Q

What interventions have been given A level recommendation in the plantar heel pain CPG?

A

-Manual therapy focusing on STM and joint mobs with stretching
-stretching
-anti-pronation taping
-foot orthoses (custom OR prefabricated) for short or long term use
-night splints

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11
Q

What interventions have a C level recommendation in the plantar heel pain CPG?

What is the only recommendation AGAINST the use of?

A

-low level laser
-phonophoresis
-rocker bottom shoe

C level recommendation AGAINST ultrasound

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12
Q

What level of evidence does the use of electrical modalities in the CPG for plantar heel pain?

What level was given for exercise and movement training to control pronation?

Dry needling?

Education and counseling for weight loss?

A

D level for Electrical modalities
F level for exercise and movement training to control pronation
F level for dry needling
E level for education and counseling for weight loss

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13
Q

What anatomic changes are caused by mid portion achilles tendinopathy?

What happens to the tendon size and strength?
How does this effect load transfer?
What drives progression of this disease?

A

tenocyte formation, fat deposition, and tissue sheering
-tendon tens to thicken but get weaker
-lessens load transfer and resistance
-tissue changes drive progression of disease not inflammation

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14
Q

What populations are mostly linked with achilles tendinopathy?

What risk factors are associated with achilles tendinopathy?

A

athletes and age ranges between 30-50

-old age
-obesity
-diabetics
-HTN/hyperlipidemia
-genetics
-abnormal foot mechanics
-poor plantarflexion strength
-poor glute strength
-rigid insoles
-athletes

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15
Q

What is the prognosis for achilles tendinopathy?

What is the median time to recover for runner?

A

long term recover rate is usually very good especially those who are heavily loaded

81 days for athletes but ranges from 21-140 days

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16
Q

What 4 components for diagnosing achilles tendinopathy received a C level recommendation?

A

-gradual onset of pain 2-6cm proximal to insertion of achilles
-TTP at achilles tendon
-(+) Arc sign (palpable swollen area of achilles that moves with the tendon in DF and PF)
-(+) Royal london hospital test (examiner finds most tender spot on achilles and patient dorsiflexes their foot, if less pain in area after dorsiflexion this is a positive)

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17
Q

What is Severe’s Disease?

A

A condition affecting the calcaneal growth plater in obese or extremely active youth between 8-15 years old

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18
Q

What type of imaging is recommended to diagnosis tendinopathy?

A

ultrasound or MRI

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19
Q

What is the Victoria Institute Sport Assessment (VISA A) used to assess?

How is it scored?

A

Severity of symptoms

Graded 0-100

score of 80=good recovery
score of 100=full recovery

20
Q

What is the Foot and Ankle Ability measure used to assess?

A

Function

21
Q

What intervention received an A level evidence grade for achilles tendinopathy?

What B level recommended interventions are there?

C?

E?

F?

A

A-mechanical loading to decrease pain and improve function (eccentric or slow concentric 2x/wk)

B-patient education encouraging chronic pain patients to continue sport activity as long as pain is below 5/10
B-Iontophoresis with dexamethasone for acute tendinopathy

C-PF stretching

E-counseling patients on how PT intervention can help

F-Manual mobilization and rigid taping as well as FDN

22
Q

What interventions have recommendations AGAINST being used according to the achilles tendinopathy CPG?

A

C level AGAINST night splints
F level AGAINST elastic taping

23
Q

Should PRP injections be used to treat achilles tendinopathy?

What about corticosteroid injections?

How effective is extra-corporeal shockwave therapy?

A

No, they are not recommended and should not be used

there is short term benefit but long term affects are not great, however high volume injections with eccentric exercise has been shown to be beneficial

has no use in isolation but when combined with eccentric exercise it can help with CHRONIC symptoms

24
Q

Patients with an acute and irritable achilles tendinopathy usually present with what symptoms?

How should treatment look like for these patients?

A

There will be redness/warmth/swelling in the tendon that has been present for 3 months or shorter and pain limits low level activity such as walking

If patient has pain and inflammation use iontophoresis with dexamethasone
If there is loss of ROM stretch the joint or perform soft tissue manual therapy
Educate the patient on being active if pain is lower than a 5/10

25
Q

If a patient presents with non-acute achilles tendinopathy how will they usually present?

How should treatment look for these patients?

A

Patient will lack redness/warmth/swelling and have symptoms that have lasted over 3 months where their pain is higher after activities

If there is TTP, load them heavily with exercise
If there is loss of ROM, stretch
Educate to stay active

26
Q

What is the most common foot and ankle impairment for medical screening?

What conditions make this impairment more likely?

A

Lateral Ankle Sprain

more frequent with indoor sports compared to outdoor, high school more than college, and females more than males

27
Q

What are common side effects with ankle sprains?

A

-bone bruise
-ankle effusion (remember more swelling does not equal fracture)
-ankle impingement
-fibularis muscle/tendon injury
-nerve pathologies

28
Q

How long is typical time frame for return to activity participation following a lateral ankle sprain?

A

1 day-3 weeks but full recovery can take months to a year and is not guaranteed

high number of people who have an ankle sprain will develop chronic symptoms such as instability

29
Q

What percentage of first time ankle sprain patients will develop chronic ankle instability?

A

40%

30
Q

What factors help diagnose an acute lateral ankle sprain?

A

-history of acute inversion ankle injury
-(-) Ottawa ankle rules
-(+) Reverse anterior drawer
-(+) anterior drawer test (100% specificity)
-(+) anterolateral talar palpation test (same as anterior drawer test but examiner is palpating talar dome to measure amount of translation)

31
Q

What diagnostic cluster received a B level recommendation on the lateral ankle sprain CPG?

A

anterior drawer
anterolateral talar test
reverse anterior drawer

all along with history and physical

32
Q

What are the Ottawa Ankle Rules?

A

If there is a ‘yes’ for any of the following, patient should be sent for radiographs

-inability to bear weight and take 4 steps after injury or in ER
-TTP along posterior tip of medial or lateral malleoli
-TTP to navicular
-TTP at the base of the 5th met

33
Q

How do high ankle sprains typically occur?

where is the location of pain?

What is the best diagnostic test?

A

a hyper DF and ER of the foot

location of pain 1 cm higher than distal fibula and talus

best test is the squeeze test (squeeze distal tib-fib above malleoli, if painful this is a positive finding)

34
Q

What outcome measures were recommended to use in the Lateral ankle sprain CPG?

A

A level evidence for the FAAM and LEFS
A level evidence to assess and document ankle ROM and swelling and talar translation as well as inversion (use STAR excursion)

C level evidence for measuring for psychological issues

35
Q

What is primary injury prevention for lateral ankle sprains?

What are the two recommendations the CPG gave for primary prevention?

A

Reducing the risk of first time sprains

A level recommendation for prophylactic bracing for lateral ankle sprain
C level recommendation for balance training exercise

36
Q

What is secondary injury prevention for lateral ankle sprains?

What recommendation did the CPG give for secondary prevention?

A

reducing risk of a second or chronic sprains

A level recommendation for bracing AND use of proprioceptive and balance exercise programming

37
Q

According to the lateral ankle sprain CPG, what A level recommendations were given for interventions treating a lateral ankle sprain?

A

-Early progressive weight bearing
-Bracing and possibly the use of an AD in severe cases
-If it is a severe injury, have a short (up to 10 days) immobilization program to protect injury
-structure there-ex programming
-manual therapy to reduce pain and improve dorsiflexion ROM with exercise

38
Q

According to the lateral ankle sprain CPG, there is a B level recommendation to implement a return to sport/work timeline and program schedule, what should this look like for sports population, vs sedentary work vs active work environments?

What about following surgery?

A

Mild injury-2 weeks for sedentary and 3 weeks for high activity

Moderate injury such as tear or rupture- 3-6 weeks for sedentary and 6-8 weeks for high demand work/sport

Post-operative
2 weeks of NWB
3-6 weeks of WBAT and can resume sedentary work
at week 6 replace cast or boot with a brace
16 weeks return to high demand work and sport

39
Q

According to the lateral ankle sprain CPG, what intervention receive a C level recommendation?

What interventions received D level recommendation?

A

-cryotherapy in acute cases ONLY and should be used alongside ther-ex
-pulsating short wave diathermy for acute sprains
-low level laser in initial phase
-NSAIDs to reduce pain and swelling

D Level
-acupuncture
-electrotherapy for acute pain

40
Q

According to the lateral ankle sprain CPG, what is the only intervention to receive a recommendation AGAINST?

A

Ultrasound

41
Q

True or False: bracing, taping, and insoles should not be used as a stand alone treatment for chronic ankle instability.

A

True, there is B level evidence to support this

42
Q

According to the lateral ankle sprain CPG, for chronic ankle instability, what two intervention received A level research recommendation?

A

there-ex to improve stability with proprioceptive and neuromuscular exercise

Manual therapy

43
Q

According to the lateral ankle sprain CPG, should dry needling be performed for chronic ankle instability?

What recommendation does it give for maximizing self-efficacy in patients with chronic ankle instability?

A

There is C level evidence that dry needling the fibularis muscle alongside exercise may be helpful

E level evidence for the use of psychologically informed techniques to maximize self-efficacy

44
Q

What is Kleiger’s Test and what is it used to help diagnose?

A

A special test for high ankle sprains which determines rotator damage to the deltoid ligament or the distal tibiofibular syndesmosis

Performed by having the knee flexed by 90 degrees with the ankle in neutral position and appyling an external rotational force to the affected foot and ankle.

(+) test: Pain in the anterolateral ankle. An indicator of deltoid ligament damage would be if there is a displacement of the talus away from the medial malleolus

45
Q

What is Cotton’s Test and what is it used to help diagnose?

A

a special test used to assess for syndesmosis instability with diastasis for high ankle sprains

Performed: steadying the distal leg with one hand while grasping the plantar heel with the opposite hand and moving the heel directly from side to side

(+) test: Any lateral translation would indicate syndesmotic instability

46
Q

How can you differentiate between medial tibial stress syndrome and exercise induced compartment syndrome or tibial fracture?

A

Medial Tibial stress syndrome-Vague, diffuse pain along middle-distal tibia, worse at beginning of exercise, that decreases during training

Compartment syndrome: Symptoms begin 10min into exercise and resolve 30min after exercise, sensory or motor loss, elevated anterior compartment pressures

Fracture: Pain with running, point tenderness over fracture site, “dreaded black line” on lateral x-ray

ocs prep (11 decks)

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