ankle conditions

Question 1

retrocalcaneal bursitis

Answer 1

etiology: result from pressure rubbing on a heal, chronic condition

Pathology: inflammation of the bursa between Achilles tendon and calcaneous, may lead to exostosis (body outgrowth that protrudes from the surface of the bone) of posterior calcaneous

signs and symptoms: pain with palpation superior and anterior to achilles insertion, swelling on both sides of the heal cord

Question 2

exostosis (bone spur)

Answer 2

Etiology: overuse, trauma, excessive pressure, poorly fitting footwear that leads to undue pressure on the bone

Pathology: bony outgrowth or callus that protrudes from the surface of a bone and is usually capped by cartilage

Signs and symptoms: pain with palpation, formation of bony callus

Question 3

plantar fasciitis

Answer 3

etiology: increased tension and stress on fascia, change from rigid supportive footwear to flexible footwear, poor running technique, leg length discrepancy, excessive pronation, inflexible long, arch, high gastroc- soleus complex, etc.

pathology: inflammation of the plantar fascia

signs and symptoms: pain on anterior medial heel and along medial longitudinal arch, increased pain in morning loosens after first few steps, increased pain with forefoot dorsiflexion

Question 4

stress fracture (tibia and fibula)

Answer 4

etiology: repetitive micro-trauma, overload caused by muscle contraction, altered stress distribution in the bone accompanying muscle fatigue, change in ground reaction force, rhythmically repetitive stress

pathology: small, hairline-type fracture of the bone, runners tend to develop in lower third of leg

signs and symptoms: swelling, local tenderness, pain during activity but not during rest, pain becomes more constant and more intense at night, difficult to discern bone and soft tissue pain, stress fx won’t show up on regular x-ray

Question 5

calcaneal stress fracture

Answer 5

etiology: repetitive microtrauma

pathology: small, hairline-type fracture of the calcaneous

signs and symptoms: characterized by sudden onset of pain in plantar-calcaneal area, weight bearing causes pain (in heel strike), pain continuing after exercise, may require bone scan to see

Question 6

metatarsal stress fracture

Answer 6

etiology: excessive marching or running while wearing rigid footwear, change in running pattern or surface

pathology: small, hairline type fracture of the shaft of metatarsal, march fx= stress fx of the 2nd metatarsal, occasionally occurs at base of 5th metatarsal at insertion of peroneus brevis

signs and symptoms: weight bearing causes pain at injury site, pain relief in non weight bearing position, pain continues following exercise

Question 7

tarsal tunnel syndrome

Answer 7

etiology: may result from previous fracture, tenosynovitis, acute trauma or excessive pronation

pathology: any conditions that compromises tibialis posterior, flexor hallucinations longus, flexor digitorum, tibial nerve, artery or vein

signs and symptoms: pain and paresthesia along medial and planter aspect of foot, motor weakness and atrophy may result, increased pain at night with positive tinel’s sign

Question 8

achilles tendonitis

Answer 8

etiology: overuse injury, tendon is overloaded due to excessive tensile stresses during repetitive movements, uphill running usually exacerbates condition, decreased flexibility exacerbates condition

pathology: inflammatory condition involving achilles tendon and sheath, can lead to tendon rupture, chronic inflammatory may lead to thickening of synovial sheath

signs and symptoms: presents with gradual onset over a period of time, generalized pain and stiffness over the achilles tendon region, possible localized pain just proximal to the calcaneal insertion, may progress to morning stiffness, crepitus with active plantar flexion and passive dorsiflexion

Question 9

anterior tibialis tendinitis

Answer 9

etiology: exaggerated dorsiflexion or exaggerate heel strike, extensive down hill running

pathology: chronic inflammation of the anterior tibilalis tendon

signs and symptoms: point tenderness over anterior tibialis tendon

Question 10

posterior tibial tendonitis

Answer 10

etiology: common overuse condition is runners with hypermobility or pronated feet, repetitive microtrauama occurring during pronation while jumping, running or cutting

pathology: chronic inflammation of the posterior tibial tendon

signs and symptoms: pain and swelling in area of medial malleolus, edema and point tenderness behind medial malleolus, pain during resistive inversion and plantar flexion

Question 11

peroneal tendinitis (lateral malleolus)

Answer 11

etiology: not common, but can occur in athletes with pes cavus due to excessive supination placing stress on fibularis tendon

pathology: chronic inflammation of the peroneal/ fibularis tendon

signs and symptoms: pain behind lateral malleolus during push off or rising on ball of foot, pain along distolateral aspect of calcaneus and beneath the cuboid

Question 12

medial tibial stress syndrome (shin splints)

Answer 12

etiology: repetitive microtrauma, weak muscles, improper footwear, training errors, varus foot, thigh heel cord, hypermobile or pronated feet and forefoot supination, may also involve stress fractures or exertion compartment syndrome, may be caused by bad shoes and change in training surface

pathology: pain in the anterior part of the shin, stress fracture, muscle strain, chronic anterior compartment syndrome

signs and symptoms: pain in anterior portion of shin, four grades of pain: 1= after activity, 2= before and after activity not affecting performance, 3= pain before during and after activity affecting performance, pain so severe performance is impossible

Question 13

sesamoiditis

Answer 13

etiology: repetitive hyperextension of the great toe, most common in dancing and basketball

pathology: inflammation of the two sesamoids that lie within the flexor and adductor tendons of the great toe

signs and symptoms: pain under great toe especially during push off, palpable tenderness under first metatarsal head

Question 14

metatarsalgia

Answer 14

etiology: flattened transverse arch, depressing 2nd 3rd and 4th metatarsal bones, restricted extensibility of gastroc-soleus complex on toe off phase, fallen metatarsal arch, etc.

pathology: pain in the ball of foot (commonly under 2nd and 3rd metatarsal heads), heavy callus formation under the metatarsal heads

signs and symptoms: pain in ball of foot (2nd and 3rd metatarsal heads) with heavy callus development, cramping in the foot may also be present

Question 15

heel contusion

Answer 15

etiology: caused by sudden starts, stops or changes of direction

pathology: contusion (bruise) of calcaneous, contusion of the calcaneal fat pad

signs and symptoms: severe pain in heel and inability to withstand stress of weight bearing, often warmth and redness over the tender area, pain often on the lateral aspect due to heel strike pattern

Question 16

chronic exertional compartment syndrome

Answer 16

etiology: excessive exercise in an untrained individual, occurs most often in runners and sports that require excessive running

pathology: excessive swelling within the confines of a fascial compartment compressing muscles blood vessels and nerves, tissue fluid pressure increases too much and/or remains elevated after exercise stops producing ischemia (lack of blood supply) and pain

signs and symptoms: usually bilateral, pain in the anterolateral region of the leg during exercise, gradual pain after predictive manner, ache or sharp pain and pressure in the region of the anterior compartment, symptoms subside during rest, weakness in dorsiflexion and toe extension

Question 17

acute traumatic compartment syndrome

Answer 17

etiology: direct blow to the shin

pathology: excessive swelling within the confines of a fascial compartment compressing muscles blood vessels and nerves, tissue fluid pressure increases too much and/or remains elevated after exercise stops producing ischemia (lack of blood supply) and pain

signs and symptoms: heat, redness, ,pain and swelling in anterior shin, weakness in dorsiflexion and toe extension, numbness in the dorsal region of the foot

Question 18

apophysitis of the calcaneus

Answer 18

etiology: repeated avulsion of the achilles tendon at the calcaneus

pathology: inflammation of the apophysis, traction injury at apophysis of calcaneus where achilles tendon attaches, comparable to osgood-schlatter’s disease at the knees

signs and symptoms: pain occurring at posterior heel below achilles attachment in children and adolescent athletes, pain occurs during vigorous activity and goes away during rest

Question 19

achilles tendon rupture

Answer 19

etiology: sudden pushing off action of the forefoot with knee moving into full extension, common in athletes older than 30 yo (weekend warrior), usually occurs in an athlete with a history of chronic inflammation and gradual degeneration caused by micro tears

pathology: complete tear or rupture of tendon, usually occurring at 2-6 cm proximal to its insertion of the calcaneous

signs and symptoms: sudden snap with immediate pain which rapidly subsides, point tenderness swelling discoloration and decreased ROM, toe raising is impossible