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Musculoskeletal Pathophysiology > Ankle and Foo > Flashcards

Flashcards in Ankle and Foo Deck (91):
1

What is Talipes Equinovarus?

Clubfoot

2

What is the position of the calcaneus with clubfoot?

varus

3

What is the forefoot position in clubfoot?

adduction

4

What is the position of the midtarsal in clubfoot?

Supination

5

What happens to the joint capsule in clubfoot?

thickened

6

Who gets clubfoot more often?

Males 2:1

7

How many cases of clubfoot are bilateral?

1/3-1/2

8

What is the management of eqinovarus?

weekly casting (6 wks)
splints (8 wks)
AFO or corrective boot (until walking)
Night splint (1 more year)
Straight lace shoes (2 years)

9

What % of those with equinovarus respond in the first 3-4 months?

40%

10

What % of those with equinovarus need soft tissue surgery?

60%, usually a muscle release

11

If the pt is not treated for equinovarus by 5 years what will they need?

arthrodesis, usually wait until they are > 10 years old

12

What is pes cavus?

Structural high medial and lateral arch resulting in a rigid foot

13

What can pes cavus be associated with?

May be associated with a neurological disorder

14

Is pes cavus familial?

yes

15

What is an associated pathology with pes cavus?

Claw toes

16

What is the Rx for pes cavus?

adaptive shoes
specialized arch supports

17

What is pes planus?

flat feet, congenital or acquired. If you dont have adequate dorsiflexion you will pronate prematurely.

18

A congenital pes planus is more or less common? more or less rigid?

less common. More rigid

19

How is pes planus acquired?

compensation for other bony abnormalities, weakness or neuromuscular problems

20

What is Hallux limitys?

1st MTP restriction usually due to OA or Jt capsule.

21

How much MTP extension do you need for push off?

65 degrees

22

What is the Rx for Hallux limitus?

adaptive shoues (rocker sole shoes), joint mobs (if capsular)

23

What is Hallux rigidus?

complete bony ankylosis, may require resection arthroplasty

24

What is hallux (abducto)valgus?

1st toe laterally angulated at MTP joint associated with bunion formation

25

Who gets hallux (abducto)valgus more?

Females>males, usually assocated with poorly fit shoes

26

What is a Keller operation?

Resection of proximal half of the proximal phalanx and excision of prominent medial portion of met head

27

What is a hammer toe?

MTP extended, PIP flexed,

28

How are hammer toes caused?

Intrinsic weakness or imbalances
fallen transverse arch
poor shoe fit

29

What is a claw toe?

MTP extended, PIP flexed, DIP extended

30

What is a mallet toe?

Flexed DIP, usually due to poor shoes

31

What is a mortons toe?

Long 2nd metatarsal or short 1st metatarsal elading to excessive pressure under 2nd met head

32

What do you see sometimes with a mortons toe?

abnormal pronation

33

What is Mortons neuroma?

Nerve inflammation usually between 3rd and 4th metatarsals

34

Who gets mortons neuroma more?

Females>males

35

What are the symptoms of mortons Neuroma?

burning pain, toe numbness

36

What is the Rx for Mortons neuroma?

Roomier shoes (limit heels)
Corticosteroid injection
Orthosis
Excision if conservative failure

37

What are the most common type of ankle sprain?

Lateral (inversion sprain)

38

What is a medial sprain?

eversion sprain

39

What is a high ankle sprain?

syndesmotic sprain. excessive ankle dorsi-flexion and external rotation of the shin

40

What are the signs/sxs of an ankle sprain

Edema
eccyhmois
painful gait
tender to palpation
laxity

41

What is a grade 1 sprain?

mild-stable. single ligament stretch or minor tear, usually ATFL

42

What is a grade 2 sprain?

moderate, some instability. Full ATFL tear or partial of ATFL and CFL

43

What is a grade 3 sprain?

Severe, unstable. Complete tear of ATFL, CFL and ant. capsule. may need operative repair

44

1st degree high ankle sprain?

only a few ligament fibers are damaged within the interosseous membrane

45

2nd degree high ankle sprian?

more extensive damage to the interosseous membrane with some widening of the T-F joint

46

3rd degree high ankle sprain?

complete rupture of the interosseous ligament with gross widening of the T-F joint and possible joint dislocation

47

PT considerations post ankle sprain?

protect from eversion/inversion
restore active motion painfree
restore timing and coordination and strength

48

What is the mechanism of an Achilles tendon rupture?

violent contraction of gastroc, usually 1-2 inches above insertion into calcaneus (if complete)

49

What are the signs/sxs of an Achilles tendon rupture?

Edema, ecchymosis, PF grossly impaired
+ thompson test

50

What is the Rx of a total Achilles rupture?

surgical repair then casted in PF for 4-6 weeks (LLC 2 wks then SLC for 3-6 wks)

51

What is Achilles tendinitis usually 2ndary to?

training errors
uphill running
rigid shoes
tight gastrocs

52

Rx for Achilles tendinitis?

RICE, heel lift, check for abnormal foot position, length of muscle

53

What is Retrocalcaneal Bursitis? What is it assocaiated with?

Inflammation of bursa anterior to gastroc tendon but posterior to talus and calcaneus. excessive pronation, poor shoe fit or padding in heel area

54

What is plantar fascitis?

inflammation of plantar apeneurosis

55

How do you get plantar fascitis?

repetitive mecrotrauma associated with rigid or excessively mobile foot AND/OR excessive pronation

56

What is associated with plantar fascitis?

May have heel spur at medial calcaneal tubercle

57

What are the signs/sxs of plantar fascitis?

plantar foot pain on arising in AM or after sitting for a while
may have crepitus in soft tissues of the facia

58

What is the Rx for plantar fascitis?

treat inflammation, night splints in DF, foot orthosis to correct biomechanical faults

59

What is MTSS?

Medial tibial stress syndrome. Periosteal irritation or stress reaction of medial border of tibia along post. Tib or Soleus origin

60

What can cause MTSS?

excessive pronation, tight muscles

61

What are the signs/sxs of MTSS?

painful gait, tender along medial/posteriomedial shin

62

What do you need to differentiate MTSS from?

tibial stress fx via bone scan

63

What are some sxs of Tibial stress fx?

Night pain
Specific spot pain
Sensitive to US

64

What causes a Tibila stress fx?

Overuse injury often with poor mechanics

65

Acute Compartment syndrome cause?

direct blow

66

Acute Compartment syndrome length of symptoms?

hours to days

67

Acute Compartment syndrome area of involvement?

any muscle group

68

Acute Compartment syndrome method of diagnosis?

clinical symptoms or compartmental pressures

69

Acute Compartment syndrome treatment?

EMERGENCY FASCIOTOMY

70

Chronic Compartment syndrome type of injury?

usually no trauma

71

Chronic Compartment syndrome length of symptoms?

weeks to months

72

Chronic Compartment syndrome area of involvement?

usually anterior or lateral compartment of lower leg

73

Chronic Compartment syndrome method of diagnosis?

compartmental pressures or stress thallium testing

74

Chronic Compartment syndrome treatment?

RICE or possible elective fasciotomy if no response to conservative therapy

75

What muscle is usually the culprit in anterior compartment syndrome?

Anterior tib, 2ndary irritation and swelling of muscle causing ischemia and compression of neurovascular strutures

76

What is the timeframe for return for a fasciotomy?

return to exercise after 3 weeks

77

What is tarsal tunnel syndrome?

A compression of the tarsal tunnel in the foot

78

What are the symptoms of tarssal tunnel?

pain burning, paresthesiae to medial and plantar surface of foot

79

How is tarsal tunnel aggravated?

eversion, DF and excessive pronation

80

What is a distal Tib-Fib fx usually secondary to?

MVA

81

Why does the lower 1/3 shaft of a the distal fib heals slower?

poor vascularity

82

How is a distal Tib-fib fx treated?

Closed reduction if stable; ORIF with intramedullary nail if unstable

83

What is a type A ankle fx on the Denis-Weber Classification scale?

fx below the ankle joint

84

What is a Type B ankle fx on the Denis-Weber Classification scale?

Fx at the level of the joint, with tib-fib ligaments usually intact

85

What is a Type C ankle fx on the Denis-Weber Classification scale?

Fx above the joint level which tears the anterior and posterior syndesmotic ligaments

86

How would you fx the medial malleolus?`

adduction (inversion) injury. With or without lateral ligaments

87

How would you fx the lateral malleolus?

Abduction and ER (with or without medial ligaments)

88

What is a tibial pilon Fx?

Verticle compression fx of distal tibia

89

How would you treat a severe Tibial pilon fx?

ORIF or arthrodesis

90

What are talar injuries usually 2ndary to?

high impact

91

What can lead to avascular necrosis of the talar dome?

3rd degree talar neck fx