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ankle and foot pain Flashcards

1
Q

an achillles tendinopathy can occur at two locations, which two locations?

A
  1. insertional: at calcaneus
  2. non-insertional: occurs 4-5 cm proximal to calcaneus
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2
Q

what are s&s of Achilles tendinopathy?

A

pain in achilles
pain worse with activity
squeeking of ankle during plantarflexion
walking is more comfortable in high heels or open back shoes
ttp: achilles tendon
non-insertional: possible thickening of the tendon of palpation
insertional: possible bony protuberance on calcaneus
non-insertional: possible swelling of tendon

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3
Q

what is the treatment for achilles tendinopathy?

A

NSAIDs
gentle achilles stretching
foot and ankle mobilisation
ultrasound
myofascial release
immobilise
! injection is not indicated because corticosteroids might increase the risk for a tendon rupture!

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4
Q

what are s&s of an achilles rupture?

A

sudden, severe pain in the achilles
bruising and swelling in posterior calf to calcaneus
unable to bear weight
palpable defect in achilles tendon
+ve thompson (calf squeeze) test

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5
Q

what is a dancer’s/Jones fracture of the foot?

A

fracture of 5th metatarsal styloid process (peroneus tertius attachment)

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6
Q

what is a bedroom fracture of the foot?

A

fracture of the 5th proximal phalanx shaft

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7
Q

what is the mechanism of injury in a calcaneal fracture?

A

compression on loading through heel (ef fall from ladder onto heels)
high probability of associated Tx or Lx compression fracture

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8
Q

what is the most common site for stress fractures in the foot?

A

2nd and 3 rd metatarsals

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9
Q

what is the most common fracture in running athletes and what are the s&s?

A

navicular fracture
- pain on forefoot which may come on during or after activity

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10
Q

what is the cause of gout/pseudogout?

A

build up of uric acid crystals within the joint space

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11
Q

which joint is most commonly affected in gout?

A

1st MTP (great toe)

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12
Q

what are s&s of gout?

A

sudden onset
joint red hot and swollen
no systemic symptoms

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13
Q

what are risk factors for gout?

A

alcoholism
diuretics
poor hydration
high purine diet

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14
Q

what is hallux valgus deformity of the foot?

A

lateral displacement of the great toe (may predispose bunion formation) often caused by poor fitting shoes

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15
Q

what other condition can be associated with hallux valgus deformity?

A

pes planus (hyperpronation)
poor intrinsic muscle activation

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16
Q

what is metatarsalgia?

A

refers to pain and tenderness over the plantar head of the metarsals

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17
Q

what is morton’s neuroma?

A

a benign swelling of a nerve in the foot due to a degenerative process

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18
Q

what are the possible causes of morton’s neuroma?

A

prolonged compression (irritation causes oedema)
poor fitting shoes
pregnancy
trauma
RA
hyper pronation
prolonged crouched position
conditions alternating normal weight bearing in the foot

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19
Q

who is most at risk to develop morton’s neuroma?

A

female
<50

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20
Q

what are s&s of morton’s neuroma?

A

severe, burning pain between the 2nd and 4th toes (MC 3rd and 4th)
worse with weightbearing on hard surfaces, wearing tight shoes and activities causing toe extension
relieved by taking shoes of or massaging
localised tenderness over MT head
+ve morton’s neuroma test

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21
Q

what is the management for morton’s neuroma?

A

correctly fitting shoes
calf stretching exercises
orthotic pads
steroid injection or surgical decompression if no relief with conservative care

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22
Q

what is the most common site in the foot for OA to occur?

A

1st metatarsal phalangeal (big toe)

23
Q

what are s&s of 1st MTP OA?

A

gradually increasing discomfort
reduced ROM (dorsiflexion)
shortened stride lenght

24
Q

what is the management for 1st MTP OA?

A

roomy protective foot wear
relative stress
SMT of affected joint
home exercises (stretching to into plantarflexion)

25
Q

what is the most common location for osteochondritis dissecans in the foot?

A

the lateral talar dome

26
Q

what are s&s of osteochondritis dissecans of the talus?

A

commonly asymptomatic and incidental finding
intermittend weight bearing pain (especially when running)
symptoms may onset if the osteochondral fragment is detached eg after ankle sprain
joint pain, swelling and locking
instability

27
Q

what is the mechanism of injury in plantar fasciitis/fasciosis?

A

disorganisation of local collagen fibres with an increase in fibroblasts numbers + minimal inflammation

28
Q

what are s&s of plantar fasciitis?

A

mostly UL heel pain (if BL consider spondylonegative arthropathy)
pain on the plantar aspect of the heel
typically increased across the course of the day
worse with standing and walking after sitting, getting out of bed
relieved with walking around for a little bit after standing up
tenderness over the medial calcaneal tuberosity
+ve windlass test
tight achilles
hyper pronation of foot
crepitus

29
Q

which imaging would you refer to for plantar fasciitis?

A

US

30
Q

who is most at risk to develop plantar fasciitis?

A

obese
>40

31
Q

what is the management plan for plantar fasciitis?

A

correct mechanical changes in LL
stretching and massaging achilles and calf
orthotic prescription

32
Q

what is sinus tarsi?

A

injury to the anatomical tunnel between the tarsal and calcaneus (lateral foot)

33
Q

what are the possible causes of sinus tarsi?

A

ankle inversion sprain
repetitive load on a hyper-pronated ankle

34
Q

what are s&s of sinus tarsi?

A

pain anterior to lateral malleolus
feeling of instability within the ankle
trouble walking on uneven surfaces

35
Q

in which conditions is bilateral heel pain common?

A

ankylosing spondylitis
reiter’s syndrome
reactive arthritis
psoriatic arthritis
enteropathic arthropathy

36
Q

what is the most commonly sprained ligament in the ankle?

A

anterior talo-fibular ligament (ATFL) (calcaneofibular ligament CFL and then posterior talo-fibular ligament)
due to plantar flexion-inversion

37
Q

what is the mechanism of injury in a deltoid ligament sprain?

A

forced eversion

38
Q

what is the mechanism of injury for a high ankle sprain (distal tib-fib syndesmosis)?

A

forced external rotation (particularly in dorsiflexion)

39
Q

what are s&s of an ankle sprain?

A

pain, bruising and swelling over the area of ligament
inability to weightbear
ttp over ligament and muscular attachment points (eg fibular head)
+ve ligament laxity tests
+ve syndesmosis stress test

40
Q

which muscle may cause ATFL pain post-ligament healing time?

A

fibularis/peroneal brevis

41
Q

what are the characteristics of a grade 1 ankle sprain?

A

stretch of ligament
pain, stiffness
little to no swelling
no bruising
-ve anterior draw test
-ve talar tilt test (inversion stress)
return to play in 1-10 days

42
Q

what are the characteristics of a grade 2 ankle sprain?

A

partial tear
moderate swelling and tenderness
some bruising
severe difficulty walking
anterior draw test: increased laxity
-ve talar tilt test
return to play 2-4 weeks

43
Q

what are the characteristics of a grade 3 ankle sprain?

A

ruptured ligament
severe swelling and tenderness
substantial bruising
unable to support weight
+ve anterior draw test
+ve talar tilt test
return to play: 5-8 weeks (with optimal rehab)

44
Q

what is the stage 1 (onset of weight-bearing 0-2 weeks) management for an ankle sprain?

A

RICE and NSAIDs
treat myofascial distortion
taping, bracing to allow weight bearing but early introduction of dynamic ROM
gentle ankle adjustments

45
Q

what is the stage 2 (begins when patient can weight bear, 2-4 weeks) management for ankle sprain?

A

begin exercises to increase peroneal dorsiflexion strength
achilles stretches
continue until full ROM and 80% normal ankle strength

46
Q

what is stage 3 (reduce risk or restrains, 4-6 weeks) for ankle sprain?

A

ankle proprioception training
progressive plyometric training

47
Q

what are s&s of a high ankle sprain or distal tibiofibular syndesmosis?

A

pain and tenderness proximal to lateral malleolus
inability to weight bear
+ve syndesmosis stress test

48
Q

what is the imaging of choice for a suspected distal tibiofibular syndesmosis?

A

arthroscopy

49
Q

what are the s&s of tendinopathy in the ankle?

A

pain and swelling around the insertion of the tendon
decreased ROM
tendons may also feel more prominent

50
Q

what is the treatment of choice for tendinopathy in the ankle?

A

NSAIDs
partial immobilisation
cross-friction massage
ultrasound

51
Q

what are common s&s for peroneus tendinitis/dislocation?

A

pain in PROM in inversion
pain on RROM in eversion
(common in athletes and ballet dancers)

52
Q

what are s&s for tibialis posterior tendinitis?

A

pain on PROM in eversion
RROM in inversion and plantar flexion
common in middle aged females, ballet dancers and those with pes planus

53
Q

what are the s&s of a tibialis posterior tendon rupture?

A

occurs post inflammation, degeneration or trauma
causes medial arch collapse –> flat foot + gross eversion of the foot
too many toe signs
+ve single heel raise test
often does not cause any pain

54
Q

what is the most common cause of a tibialis anterior tendinitis?

A

downhill running

conditions (29 decks)

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