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Theory :lower extremity > Lower leg, foot and ankle > Flashcards

Lower leg, foot and ankle Flashcards

1
Q

What are painful syndromes found at the ankle, foot and leg?

A 
Ankle sprains
Ankle fracture & dislocation
Excessive pronation and supination
Stress fractures 
Plantar fascitis
Compartment syndrome
Achilles tendonitis
Achilles rupture
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2
Q

What is the most common ankle sprain?

A

Inversion sprain

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3
Q

What ligaments are injured in an inversion ankle sprain?

A

Lateral ligaments

  • ATFL (weakest and most likely injured)
  • PTFL (rarely injured)
  • CFL (injured with greater inversion motion)
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4
Q

What is also essential to take into consideration with an ankle sprain?

A

fracture

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5
Q

What ligaments are damaged with a eversion sprain?

A

Deltoid ligament

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6
Q

Rather than an eversion sprain what is more likely to happen?

A

An avulsion of the tibia before the deltoid tears

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7
Q

Which sprain is worse eversion or inversion? which takes more recovery time?

A

Eversion more severe and longer recovery

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8
Q

What is considered a high ankle sprain?

A

Syndesmotic sprain

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9
Q

What ligaments are involved in a high ankle sprain?

A

Anterior and posterior tibiofibular ligaments

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10
Q

Do high ankle sprain have a long or short recovery period?

A

longest

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11
Q

What rehab do you do in the acute phase for an ankle sprains?

A

PRICE
injured ligaments must be held in a stable position to allow healing
NWB or PWB
PWB–> reduces muscle atrophy and improves circulation, prevents loss of proprioception, inhibits contracture development

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12
Q

What does a ligament need to heel properly?

A
  • stress
  • early, limited stress AFTER the initial inflammatory response may promote faster healing and stronger healing
  • facilitates proper collagen orientation
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13
Q

During the acute phase of rehab strengthening should also be initiated at?

A

thigh, buttocks core strengthening and cardiorespiratory fitness

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14
Q

What should be done in the early phase (acute) of ankle rehab?

A

ROM

  • dorsiflexion and plantarflexion
    * AAROM
    * Stretching
  • Minimize eversion and inversion
    * As pain decreases–> initiate inversion and eversion exercises
    * BAPS or similar device to regain neuro control
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15
Q

When can isometrics be initiated with ankle sprains?

A

Early- pain free, avoid compensation with tibial rotation

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16
Q

Should dorsiflexion and plantar flexion be initiated before inversion and eversion isometrics?

A

yes, dorsiflexion and plantar flexion should be first

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17
Q

What is the progression of strengthening in ankle sprains?

A

Weight bearing
-progress seated to standing
-balance
Activity specific

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18
Q

What is tendinopathy?

A

Tendon injury that happens when the tendon becomes painful or torn

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19
Q

What causes tendinopathy of the tibialis posterior and tibialis anterior?

A

Foot mechanics
Footwear
Changes in training

Requires complete lower extremity evaluation

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20
Q

How long does it take acute tendinopathy to resolve?

A

about 2 weeks

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21
Q

How long does it take to resolve chronic tendinopathy?

A

May take months

Tendon thickens and remodeling must occur

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22
Q

What type of exercise progression for tendinopathy?

A

Pain free strengthening
Pain that does not resolve 24-48 hrs
-tast was too aggressive

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23
Q

Ankle fractures and dislocations have a similar MOI to?

A

Ankle sprains

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24
Q

Are dislocations common?

A

No, they are rare

usually require surgical intervention

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25
Q

Medial malleoli fractures may be accompanied by?

A

lateral ligament sprain

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26
Q

Lateral malleoli fractures may be accompanied by?

A

medial ligament sprain

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27
Q

What is a non displaced fracture?

A

nothing is out of place

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28
Q

How do you rehab a nondisplaced fracture?

A

PRICE

Subacute–AAROM, AROM, isometrics, stretching, OKC

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29
Q

How to rehab a nondisplaced fracture in the repair phase?

A

CKC, balance exercise

return to exercise activites

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30
Q

What is a displaced fracture?

A

Something is out of place

Requires open reduction and internal fixation (surgical fixation and realignment)

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31
Q

Rehabilitation for displaced fractures?

A

NWB initially (follow surgical preferences)
-surgical healing about 6 weeks
Initiate stretching, AAROM, AROM (pain free)
Proximal strengthening and endurance
Progress to CKC, balance

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32
Q

When does excessive supination or pronation occur?

A

May occur as a compensation for an existing structural deformity

 - subtalar or calcaneal varus
   - excessive pronation to put foot on the ground
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33
Q

Forefoot varus is?

A

excessive pronation

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34
Q

Forefoot valgus is?

A

excessive supination

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35
Q

Excessive, delayed or prolonged pronation may cause?

A

Major cause of stress injuries during running
Compensatory STJ motion
-MTJ remains unlocked
-increased tibial rotation excursion
-will not allow foot to supinate in time to act as a rigid lever for push off (less power and efficiency)

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36
Q

Problems with excessive pronation?

A

Bunions
Stress fractures of 2nd MT
Tendonitis—->achilles, peroneal, tibialis post., ITB

37
Q

Excessive supination at heel strike?

A

STJ will not allow MTJ to unlock

- foot remains too rigid
     - can not absorb shock efficiently, limits tibial IR
38
Q

Excessive supination injuries?

A 
Tibial stress syndrome
MT stress fractures
Tendinitis-achilies, peroneal, ITB
Greater trochanteric bursitis
inversion ankle sprain
39
Q

The cause of excessive foot pronation and supination is always the foot? (T/F)

A

FALSE

but in order for the body to put the foot on the ground, excessive pronation or supination may occur

40
Q

Genu varum

A

subtalar pronation to get the foot on the ground

41
Q

Genu Valgus

A

subtalar pronation is forced because knee position

42
Q

Ankle Joint Equinus

A

Loss of talocrural joint motion (loss of DF)
Compensation at MTJ
-increased pronation
-forefoot pain
-more often seen in folks with high arches

43
Q

What is forefoot varus?

A

Medial MT heads inverted relative to the plane of the calcaneus

  • -cause excessive pronation
  • -In stance, foot must get to the floor, compensated with talus rolling down the calcaneus everting
44
Q

What is forefoot valgus?

A

Lateral MT heads everted relation to the plane of the calcaneus

45
Q

What is calcaneal varus?

A

STJ must pronate

46
Q

First ray mobility resting postion?

A

Neutral or PF is most common

47
Q

Is you lack great toe extension how do you compensate?

A 
Forefoot abduction and ER at the hip (inefficient push off)
Short strides (reduced DF, early knee flexion, decreased hip extension)
48
Q

Can you correct the faulty biomechanics that are due to the structural deformity?

A

Not necessarily

  • orthodics
  • appropriate footwear
  • pt treatment
  • educate
49
Q

What is chronic exertional compartment sydrome?

A

Aching or burning pain in the affected limb (ant)

  • usually the leg
  • may have numbness or tingling
  • weakness—anterior compartment will have drop foot
50
Q

When does chronic exertional compartment syndrome start?

A

Begins at start of exercising

  • worsens as exercise continues
  • stops shortly after exercise stops
51
Q

What causes chronic exertional compartment syndrome?

A

Inefficient or excessive exercise

Pressure builds and occludes blood flow and nerve signals

52
Q

What occurs with chronic exertional compartment syndrome?

A

Tissues naturally swell with exercise or mild injury

  • excess swelling due to overuse
  • fascia can not explain to accommodate the volume
53
Q

What is acute compartment syndrome?

A

Medical emergency
develops within hours of a reverse injury
-leg or forearm

54
Q

How is a stress fracture to the navicular caused?

A
  • Excessive pronation during running

- Compensated calcaneal or forefoot varus (or both)

55
Q

How is a stress fracture to the 2st MT caused?

A
  • Excessive pronation (calcaneal varus or forefoot varus or both
  • Training errors
  • Inappropriate shoes
56
Q

How is a stress fracture to the 5th MT caused?

A
  • Overuse
  • Acute inversion
  • High velocity rotation (forefoot valgus or rigid, plantar flexion big toe)
57
Q

How do you rehab stress fractures?

A

-Determine the precipitating cause and alleviating them

58
Q

How do you rehab navicular and 5th MT fractures?

A

-May require NWB

59
Q

How do you rehab 2nd MT fractures?

A
  • Modified rest and WE TE’s
  • Transition to full impact WB exercises
  • pool running ->elliptical-> treadmill running-> overground running
60
Q

What can heel pain be caused by?

A
  • Spurs
  • Plantar fascia irritation
  • Bursitis
61
Q

What does pain in the proximal arch and heel indicate?

A

-possible plantar fasciitis problem

62
Q

What can cause plantar fasciitis?

A
  • Subtalar joint pronation
  • Lack of flexibility of arch
  • Gastroc-soleus restrictions
  • Shoe wear
  • Over striding
63
Q

Explain plantar fasciitis?

A
  • Tension on the fascia

- pronated foot more prone to problems

64
Q

How do you rehab plantar fasciitis?

A
  • Orthotics
  • Proper footwear
  • Taping
  • Modalities
  • Appropriate PT (flexibility and strengthening)
65
Q

How is the success rate for total ankle replacement?

A

Very fucking low

66
Q

What is arthrodesis?

A
  • fusion of the tibiotalar joint
  • used in severe OA
  • fused at 0 deg DF
67
Q

Who is achillies rupture common in?

A

younger than 50 active people

68
Q

What do you do if you rupture the achillies tendon?

A

surgical intervention needed for higher level functioning

69
Q

How do you know if someone is an over pronator based on their shoes?

A

they wear our the front under the 2nd MT head

70
Q

How do you know if someone is a normal rear foot striker based on their shoes?

A

wear lateral edge of the heel

71
Q

Is the runner placing exceptional torsion on the shoe through the midfoot? how do you know?

A
  • put shoe on flat surface and push down on the toe box

- veers medially or laterally indicated torsion with running

72
Q

How do you fix torsion?

A

-may need a more stable shoe or orthotic

73
Q

How do you know if someone needs new shoes?

A
  • bend shoe in half
  • if you can touch toe to heel, no longer has good structural integrity
  • cushion property broken down
74
Q

How do you check the structural stability of the shoe?

A
  • bend shoe in figure 8 pattern

- if it bends a lot the structural integrity is broken down

75
Q

If someone pronates what type of shoes should they get?

A
  • firmer shoe

- rearfoot control

76
Q

If someone supinates what type of shoes should they get?

A

adequate cushion and flexibility

77
Q

What position does the foot function most efficiently in?

A

subtalar joint neutral

78
Q

What do orthotics do?

A
  • provide support so the foot does not move abnormally

- create a biomechanically balanced kinetic chain

79
Q

Describe biomechanical orthosis?

A

-hard or semi flexible capable of controlling movement related pathology by attemping to guide the foot into functiong at or near subtler joint neutral

80
Q

Describe accommodative orthosis?

A
  • allows foot to compensate (malformations)

- medial or lateral wedge to accommodate deformity

81
Q

How do you correct bad technique or compensation?

A
  • what are they doing wrong?
  • what do you want them to do?
  • what needs to be done to correct what they are doing? (take pictures, new instructions, give them new pics)
82
Q

What do you look specifically for the form of a patient?

A
  • stabilization appropriate
  • position of patient is appropriate
  • resistance occurring in proper plane of motion
  • change the resistance?
83
Q

how do you document?

A
  • what did the you or the patient do?
  • how did you do it
  • how many reps
  • patient position
  • equipment used
84
Q

what is the purpose of self stretching?

A

to improve ROM

85
Q

Techniques of self stretching?

A
  • techniques (static or dynamic)
  • position (supine, sidelying, standing)
  • device (wall, cane, table)
  • Dose (no convention or standard established in the literature)
  • make sure you document
86
Q

What is the purpose of isometric exercises?

A
  • loss of strength occurs rapidly with disuse, immobilization, surgery
  • minimize atrophy when movement is not possible
  • dynamic strengthening not possible
  • facilitate muscle firing
  • require endurance (postural or joint stability)
  • post-op surgical
  • improve volitional muscle activation
87
Q

Ways to strengthen the stupid foot?

A
  • weights (cuff and elgin)
  • therabands
  • OKC
  • CKC
88
Q

what can you do for balance and proprioceptive training?

A
  • firm
  • foam
  • BOSU
  • rockerboard
  • rollerboard
89
Q

what do you do if a patient is doing an exercise with a theraband and they are doing it in the wrong plane?

A

you change the resistance

Theory :lower extremity (3 decks)

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