ankle 2 - injury Flashcards
(116 cards)
1
Q
what does pes clavus mean
A
high arch
the rearfoot is stuck in inversion and cannot get eversion to pronate
2
Q
is pes clavus more supinated or pronated
A
supinated
the foot is rigid - poor shock absorbing foot
3
Q
what is pes planus
A
flattened arch
4
Q
what range of motion deficits do we expect for a patient with pes planus
A
limited DF
5
Q
is pes planus more rigid or flexiable
A
flexiable - weak supinator muscles
or
rigid - bony structure abdnormality
6
Q
what muscle creates the supination motion
A
tib post
7
Q
what is the result of abnormal pronation
A
pronation that is in excessive in range
or when the foot should be supinated
8
Q
what causes abnormal pronation
A
all 3 -planes are involved
frontal, transverse, sagittal plane
9
Q
what is occuring the frontal plane to cause excessive pronation of the foot
A
tibial varus
subtalar varus
forefoot varus
10
Q
what is occuring the transverse plane to cause excessive pronation of the foot
A
hip anteversion
internal femoral rotation
internal fibilar rotation
11
Q
what is occuring the sagittal plane to cause excessive pronation of the foot
A
leg length
equinas
limited knee and or hip extension
12
Q
what are the effects of abnormal pronation
A
callus/pain under the 2-4 met heads and plantar medial 1st MTP joint
hallux rigidus (stiff big toe)
mortons neuroma
plantar fascitis
metarsal stress fracture
13
Q
what is mortons neuroma
A
the thinkening of tissue around one of the nerves leaving to your toe
14
Q
what is result of abnormal supination
A
supination that is excessive motion in range or occurs when the foot should be pronating
15
Q
with supination what do we see in the forefoot
A
valgus
16
Q
first ray and supinated foot
A
plantar felxed
17
Q
what other factors can cause supination in the foot
A
equinas = where the heel cannot reach the ground
leg length - the shorter side
18
Q
what are some foot injuries that you see with abnormal supination
A
callus/pain under the 1st - 5th MT heads
seasomoiditis and/or stress fracture 5th met head
hammer toe
haglund’s deformity
chronic lateral ankle strain
19
Q
what is a hammer toe
A
the toe is bent at the middle joint
20
Q
what is haglund’s deformity
A
boney enlargement on the back of the heel
this can irritate soft tissue around the achilles tendon
21
Q
what is the most common ankle sprain
A
inversion sprain
22
Q
grade 1 ankle sprain
A
mild over stretching
no tearing
no functional instability
short recovery time
23
Q
grade 2 ankle sprain
A
partial tear of the ligament
increased functional loss
swelling, effusion, and tenderness
recovery 10 - 30 days
24
Q
grade 3 ankle sprain
A
complete rupture
restricst
25
what is the most common type of ankle sprain
inversion
26
what mechanisms are involved with inversion
talocural PF
subtalr inversion
27
what are inversion sprain
tenderness to palpation
28
what is equinas
when the ankle lacks DF flexibility
tightness in the calf muscles
in some patients this tightness is congenital
can be in one or both ankles
29
what are the upper chain issues seen with abnormal pronation
achilles tendinitis
anterior or medial knee pain
30
what are the upper chain issues seen with abnormal supination
achilles tendinitis
lateral knee or hip pain
31
what is a rigid plantar flexed 1st ray associated with
excessive supination
limited ST joint motion
32
what can rigid plantar flexed 1st ray lead to
lateral instability of the ankle
callus under the first and 5th met
33
what can we do for a rigid plantar flexed 1st ray
accomadated orthotic cut out for the 1st ray
34
what is the first ray
1st met and the medial cuneiform
35
what is the mechanism of an inversion ankle sprain
talocural PF
subtalar inv
36
which ligament is involved with a inversion ankle sprain
anterior talofibular ligament
talo-fibular ligament
37
what ligament is sometimes involved in severe inversion ankle sprain issues
post talo-fib
38
what are intrinsic risk factors to an inversion ankle sprain
limited DF ROM
decreased balance
decreased ankle proprioception
39
what are extrinsics risk factors to an inversion ankle sprain
sport type
40
what are some associated injuries with inversion strains
peroneal tendon injury
peroneal nerve issue
fracture of the dital tib fib, lateral malleolus, medial mallelus , base of the fifth met
sinus tarsi syndrome
41
what are the signs and sym of a inversion sprain
tenderness to palpation of the lateral collateral ligaments
swelling and discoloration of the lateral ankle region
painful limitation of the PF./inv
possible - pain and weakness to resisted ev
anatalgic gait
42
what tests will be positive for an inversion sprain
anterior drawer
medial talar tilt test
43
why do we see an antalgic gait with an inversion sprain
pain and decreased weight bearing
44
what are the ottowa ankle rule
pain in the malleolar or mid foot
either
cannot walk immediately after the incident or four steps in the ED
or
infer tibfib, inf medial and lateral malleolus
bone tenderness in the navicular or the base of the 5th met
45
would you perform manuel therapy for those with inversion sprain
yes
increase ROM and decrease pain
46
what should be the progression of exercises for those with inversion ankle sprains
isometrics
thera band
PRE - progressive resistance exercises
weight bearing exercises
(most of the emphasis is place of the ankle everters)
47
what are PRE
Gradually adding load and overload to the
48
what is chronic ankle instability
recurrent ankle sprains or giving away that last for more then 6 months
49
what is FAI
functional ankle instablity
50
what is FAI caused by
distrubted ankle properioception
51
how do you treat FAI
balance
SLS
return to position
52
what kind of laxity do we see with chronic AI
anterior and inversion laxity
53
what is sinus tarsi syndrome
chronic pain and inflammation of the lateral aspect of the subtalar joint
54
where is the sinus tarsi
the lateral portion of the foot
between the talus and calcaneus
55
what is sinus tarsi normally a secondary condition of
chronic ankle instability
in patients who hyperpronate
tthe STJ ligaments are lax
56
what happens to the talus with hyperpronation
the talus is displaced into the sinus tarsi and this results in irritation
57
what is sinus tarsi syndrome a result of
results from instability of the subtalar joint.
58
what are the signs and symptoms of sinus tarsi syndrome
point tenderness - ant and inf to the lateral mall
patient is an over pronator
pain with amb that goes away with rest
59
how do we treat sinus tarsi syndrome
low dye taping
or
orthotics
sertiod injections
60
what is the purpose of low -dye taping
unloading the plantar fasciatis and providing medial ankle support
61
eversion sprains - MOI
forced ...
excessive pronation of the foot
excessive abd of a planted foot
62
what ligament is normally implicated with a eversion sprain
the deltoid ligament
may also involve the distal tib-fib interosseous membrane
63
what may be involved with a sever ankle eversion sprain
avulsion fracture of the calcaneal insertion of the deltoid ligament
64
what is more common ankle inversion or eversion sprains
inversion
the distal tibfibextends below the joint line, and this provides more medial stability
65
what are the signs and symptoms of an eversion sprain
tenderness of the deloitd ligament also maybe the tibiofibular ligament and interosseus membrane
swelling and possible discoloration
painful limitation in df/ev
possible - painful and weak inverters
antalgic gait
66
what test could be positive for an eversion sprain
anterior drawer test
ER test
talar tilt
67
for eversion sprain what muscle are we focus on strengthening
the invertors
68
what ligamanents are involved with high ankle sprain
ant distal tibfib
distal interosseous membrane
69
what is the MOI for high ankle sprains
forced ER of the foot
IR of the leg
70
gait of someone with a high ankle sprain
patient will avoid dull DF in gait to min the stress on the distal tibfib joint
steppage gait
71
what are the signs and sym of a high ankle sprain
TTP distal tibfib
mim swelling sometimes
patient will avoid dull DF in gait to min the stress on the distal tibfib joint
passive DF my reproduce sym
72
what happens to the distal ant tibfib joint when we move into DF
the the distal tib fib to open up
73
what is a steppage gait
the inability to lift the foot while walking due to weakness of the muscle that cause DF
foot drop during gait
could also be due to equinas
74
what tests will be positive for a high ankle sprain
ER test
distal tibfib test
75
what is a non-op treatment for a high ankle sprain
prolonged protected weight bearing - 4 weeks
delay functional advanced retraining until 8 weeks
external ankle support or brace is used for retraining
76
what is the average recovery time for a high ankle sprain
>6months
77
are thrust mobs okay after an acute ankle injury
yes
78
evidence based practice for PT after acute ankle sprain
manual therapy
thrusts and non-thrust mobilization
exercise therapy
balance and proprioceptive exercises
79
what are some contraindications for manual therapy and ankle sprains
acute with sig pain
grade 3 sprains
injury of syndesmosis or fracture
history of surgery or fracture
80
what is a syndesmosis
a fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments
81
what is plantar fasciitis
inflammation fo the plantar fasciitis
82
what are the feature of plantar fasciitis
tenderness at the medial tubercle of the fasciitis
worst witht he first few steps in the morning or after a long time sitting
pain with combined DF and great toe extension
slight PF aids relief of symptoms
83
what is the mechanism Plant fas
excessive foot pronation
pes clavus foot
limited DF ankle
limted DF of the MTP joints
84
where does the plantar fasciatis insert
the phalanges
85
what is a another word for high arch
pes clavus
86
what is a another word for low arch
pes planus
87
excessive pronation and - plant fac
this will over stretch the plantar fascia
results in irritation
88
pes clavus - plant fas
there is limited pronation during gait and this result in a rigid foot that is not able to absorb shock
therefore the plant fas is absorbing a lot of the shock
89
limited ankle Df - plant fas
this may lead to more PF needed from the MTP joint and this will place more tension on the plantar fas
90
limted MTP DF
this will place excessive tension on the plant fas during gait
91
what are the signs and symptoms of Plant fas
pain wil palpation - calcaneal insertion
complain of severe pain on WB after period of rest - this may resolve as the patient walks and will reappear with increased activity
limited passive ankle DF and/or MTP Df
pronators - pes cavus deformity or RF/FF deformity
92
how can you reproduce plant fas
palpate
passive extension of MTPs or resisted flexion
93
what is the windlass effect
this is the mechanism that lift the medial long arch during toe off
94
what happend to the plant fas during the windless mechanism
as the toe extends the plant fas lengthens and increases tension on the medial long arch
the increased tension pulls the are togethere and raises it to stablize the foot during toe off
95
what is the purpose of windlass testing
the presence of fascial impairments in the foot
96
what is the procedure for the windlass testing - sitting
stablize the ankle in neutral with one hand just proximal to the met-tarsal head
extend the proximal phalangy
97
what is the procedure for the windlass testing - standing
pt on a stool with metarsal just off of the stool
98
what is a positive test
pt pain is reproduced
99
what is the treatment for plant fas
stretch PF, toe flexor, plantar fas
strengthing of toe flexor and intrinsics of the foot
deep friction massage the plant fas
orthotics to correction mechnical deficts
resting DF night split
100
fat pad syndrome - location
plantar heel
non-isertional point of fascia on the medial calcaneal tubercle
101
fat pad syndrome - related to
age related changes
fat pad degeneration
102
fat pad syndrome - can result from
fall on heel
rep landing
training errors
103
what are some treatment consideration for fat pad syndrome
activity modification
heel pads- cups
shoes with increased cushioning
orthotics with a heel pad
104
tarsal tunnel syndrome - what is the mechanism that is occuring
entrapment neuropathy of the tibia nerve as it passes through the tarsal tunnel
105
what can cause tarsal tunnel syndrome
edema or space occupying lesion in the tarsal tunnel
tendonitis of the muscles in the tarsal tunnel
fracture callous
gout crystals
deep varicose veins
tumors
excessive pronation -
106
what are the signs and sym of tarsal tunnel syndrome
shooting and burning pain on the plantar aspect of the foot and heel
para or impaired sensation on the plantar aspect of the heel
stress with max DF/EV and MTP/IP extension for 10 sec
107
would a tinel sign be positive for tarsal tunnel syndrome
possible
108
what is a test that we can perform for tarsal tunnel syndrome
stress present with max DF/EV and MTP/IP extension held for 10 secs
tinel sign
109
what are some treatment options for tarsal tunnel syndrome
activity mod
treat the inflammation if tendonitis is a contributing factor
orthotic if the patient is an over pronator
110
what is a non conservative approach to tarsal tunnel syndrome
surgical release of the tarsal tunnel
111
what is the MOI of achilles tendionpathy
chronic overuse syndrome
imbalance between recovery and use
112
what pop do we normally see achilles tendionpathy
runners
30 - 50
increased activity
113
what is the general presentation of achilles tendionpathy
pain is isolated to the tendon or its insertion
morning stiffness
warm up effect
decrease sport perfromance
reports of increase in training
114
what is warm up effect
the pain will start to go away with the warm up
115
what are the test for achilles tendionpathy
palpation
royal london hosiptal test
arc sign
116
