Ankle, AT & foot pain CPG Flashcards Preview

OCS Ciccarello > Ankle, AT & foot pain CPG > Flashcards

Flashcards in Ankle, AT & foot pain CPG Deck (15):
1

Grade I

  • no loss of function
  • no ligamentous laxity (- anterior drawer / talar tilt tests)
  • little or no hemorrhaging,
  • no point tenderness
  • decreased total ankle motion of 5° or less
  • swelling of 0.5 cm or less.

2

Grade II

  • some loss of function

  • + anterior drawer test (ATFL)

  • - talar tilt test (no CFL)

  • hemorrhaging

  • point tenderness

  • decreased total ankle motion > 5° ,<10°,

  • swelling greater >0.5 cm <2.0 cm.

3

Grade III

  • near total loss of function
  • + anterior drawer / talar tilt tests
  • hemorrhaging
  • extreme point tenderness
  • decreased total ankle motion > 10°
  • swelling greater than 2.0 cm

Stress radiographs

  • <3.0mm Grade IIIA
  • >3.0mm Grade IIIB

 

4

ankle & foot outcome measures

  • Ankle Sprain
    • FAAM (ADLs 8,Sport 9)
    • LEFS (MCID 9)
  • achilles tendinopathy
    • VISA-A
    • FAAM
  • Plantar foot pain
    • foot function index
    • foot health status questionaire
    • FAAM
    • LEFS

5

Ankle interventions

(acute phase)

  • external supports & bracing for more severe (STRONG)
  • manual therapy AP (Moderate)
  • physical agents
    • cryotherapy (STRONG)
    • diathermy (weak)
    • electrotherapy / laser (conflicting)
    • NOT ultrasound (STRONG)
  • Therex (STRONG)

6

ankle sprain interventions

(progressive loading / sensorimotor phase)

  • manual therapy (STRONG)
  • therex (weak)
  • sport-related (weak)

7

Ankle sprain risk factors

  • hx ankle sprain

  • do not

    • use an external support

    • warm up (static stretching / dynamic mvmt)

    • have WNL ankle DF ROM

    • participate in a balance/ proprioceptive prevention program if history previous injury

8

Achilles tendinopathy risk factors

  • Intrinsic
    • abnormal DF ROM

    • abnormal subtalar joint ROM

    • decreased PF strength

    • increased foot pronation

    • abnormal tendon structure

  • Extrinsic

    • training errors, environmental factors, faulty equipment

  • Medical

    •  obesity

    • hypertension

    • hyperlipidemia

    • diabetes

9

Achilles tendinopathy signs/symptoms

  • Achilles tendon tenderness,
  • positive arc sign (palpated swelling moves

    w/ DF & PF)

  • + Royal London Hospital test

    • TTP 3cm proximal to insertion with slight PF, decreases with ankle DF

10

Achilles tendinopathy interventions

  • Strong
    • eccentric loading
  • Moderate
    • low-level laser
    • iontophoresis
  • Weak
    • stretching
    • foot orthoses
    • NOT night splint
  • Expert opinion
    • manual therapy
    • taping
  • Conflicting
    • heel lift

11

orthotics and...

  • LBP: prevention=equivocal; tx = neg
  • pain: negative
  • plantar fasciiitis
    • 3mo dec in pain, no long term >1 yr benefit
    • custom no better than COTS
    • chronic (>20 mo) = short term relief w/ custom
  • hallux valgus
    • custom orthotics = surgery @ 6 mo
    • surgery > orthotics @ 12 mo
  • pes cavus
    • no benefit

12

Plantar heel pain

risk factors

  • limited DF ROM
  • high BMI (non-athletic pop)
  • running
  • work-related WB actitivities

13

Plantar heel pain

  • plantar medial heel pain: most noticeable with initial steps after period of inactivity; also worse with prolonged WB
  • heel pain worse with recent increase in WB
  • pain with palpation of prox insertion of the plantar fascia
  • +windlass test
  • - tarsal tunnel
  • limited AROM/PROM TCJ DF
  • abnormal FPI
  • high BMI

14

Plantar heel pain outcomes

  • FAAM
  • FHSQ
    • MCID pain 13; function 7; footwear 7
  • FFI
  • LEFS
    • MCID 8 (100)

15

Plantar heel pain interventions

  • STRONG
    • MT (joint/STM)
    • Stretching
    • anti-pronation & elastic therapeutic taping
    • Foot orthoses (if +taping)
    • night splints (1-3 months)
  • Weak
    • low-level laser
    • phonophoresis
    • NOT ultrasound
  • Conflicting
    • ionto
  • Foundational/expert
    • weight loss
    • therex
    • NOT TDN