ankle diff 2 Flashcards
(26 cards)
lateral ankle
- Inversion/lateral ankle sprain
- Chronic Ankle Instability
- Peroneal tendinopathy
- 5th metatarsal fracture – Review in Dutton
medial ankle
- Posterior Tibialis Tendon Dysfunction
- Tarsal Tunnel Syndrome
- Deltoid ligament sprain – Review in Dutton
LATERAL ANKLE SPRAIN
MOI
LATERAL ANKLE SPRAIN
Tissues
LATERAL ANKLE SPRAIN
Graded
LATERAL ANKLE SPRAIN
risk factors
LATERAL ANKLE SPRAIN
patient demo
LATERAL ANKLE SPRAIN
patient presentation
LATERAL ANKLE SPRAIN
objective
LATERAL ANKLE SPRAIN
Conservative Rehabilitation
*Most effective for Grade I and II
**Emphasis on following tissue healing timelines
- Phase I - Acute inflammatory phase
- Pain/edema control: compression, elevation, rest,
pain modulating modalities - Consider immobilization/external support
- Utilize crutches to allow NWB and decrease
repetitive stress to involved tissues - OKC AROM allowing patient to control
ROM/stress - Manual therapy for swelling reduction and pain
modulation - Distraction and TC posterior glides
Phase II – Fibroblastic repair phase
* Begin to allow more PWB, consider continued use
of external support/compression during transition
to FWB
* Manual therapy to TC,TF joint to maximize DF
* Low level balance training, bilateral or offloaded
(pool, total gym, etc.)
* Low level strengthening – OKC with bands, CKC
with functional WB’ing activities
Emphasis on following tissue healing timelines
Phase III – Remodeling Phase
* FWB
* Unilateral and loaded CKC activities
* Proprioceptive activities
* Isolated strengthening
* Progressing to activities in preparation for
running
* Phase IV – Maturation Phase
* Progressing from walk -> jog -> run ->
sport/activity specific
* Lateral movement focus
* Proprioceptive focus
* Co-contraction/timing of peroneals and
posterior tibilias during activity
LATERAL ANKLE SPRAIN
surgical
- Lateral Ankle Reconstruction
- Surgical reconstruction of torn ATFL and CFL
- Typically saved for persons with chronic/recurring ankle sprains
- May be necessary depending on severity of injury (Grade III)
and/or concomitant tissues compromised - Utilize surgeon protocol as well as tissue healing timeline to
work through post operative care
- It is estimated that 40% of Lateral Ankle
Sprains will become chronically unstable - This is more common in those who do not
seek treatment following injury - Definition: ”Patient’s being more than 12
months removed from the initial ankle
sprain and exhibiting a propensity for
recurrent ankle sprains, frequent episodes
of perceptions of the ankle giving way, and
persistent symptoms such as pain, swelling,
limited motion, weakness and diminished
self-reported function”
CHRONIC ANKLE INSTABILITY
CHRONIC ANKLE INSTABILITY
patient presentation
CHRONIC ANKLE INSTABILITY
objective
CHRONIC ANKLE INSTABILITY
Conservative Rehabilitation
Comprehensive physical exam
* Address ROM restrictions (often DF limitation)
* Address flexibility/isolated strength limitations and cocontraction
Primary focus: sensorimotor training, neuromuscular re-education
* Utilize changing BOS
* Bilateral to unilateral
* Stable to unstable surfaces
* Implement cognitive tasks during training for added variable and sensory input
Conservative Rehabilitation
PERONEAL TENDINOPATHY
physical exam
- Pes cavus
- Calcaneal varus
- Hypermobility/instability
- Pain at peroneal tendon
- Pain with resisted eversion
- Difficulty/pain in full WB’ing PF
- Examination of potential maltracking/subluxation during DF/PF movements
PERONEAL TENDINOPATHY
conservative treatment
- ID impairments and address possible
contributing factors (poor foot intrinsic
strength, poor evertor strength, poor
proprioception and training, etc. - Implement progressive strengthening and
proprioceptive training
PERONEAL TENDINOPATHY
surgical treatment for subluxation
- Repair retinaculum to guide tendon in sheath
during functional movements
PERONEAL TENDINOPATHY
Surgical Treatment for Tendinopathy
- Scope to the peroneal tendon, debridement of
inflamed tissue, fluid and scar - Repair of tendon if tear present
POSTERIOR TIBIALIS TENDON
DYSFUNCTION
patient presentation
- Medial ankle pain over tenosynovial sheath
- Common in activities requiring change of direction and repetitive plantarflexion (running sports)
- Pes planus, overweight presentation
- Swelling may be seen
- Female > Male – ages 20-50yrs old
POSTERIOR TIBIALIS TENDON
DYSFUNCTION
objective findings
- Limitation in DF
- Collapsed medial arch
- Pain with palpation
- Difficulty/pain with full plantar flexion
- Pain with resisted full plantarflexion then inversion
POSTERIOR TIBIALIS TENDON
DYSFUNCTION
treatment
- Consider orthotic/shoe wear for temporary offloading of tendon during function
- Pain modulation and progression towards isolated strengthening
- Maximize reduction of impairments resulting in
increased stress on posterior tibialis musculature
TARSAL TUNNEL SYNDROME
definition
- Entrapment of the tibial nerve as it passes through
retinaculum distal to medial malleolus - Posterior tibial nerve – splits into medial and lateral plantar nerve
TARSAL TUNNEL SYNDROME
patient presentation
- Pain with loading, often worsens with length of activity
- Poor/worn down footwear
- Sensory loss
