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517 Ortho > Ankle/Foot > Flashcards

Ankle/Foot Flashcards

(80 cards)

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1
Q

How many bones in the ankle/foot? How many articulations?

A

28 bones, 55 articulations

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2
Q

Forces through ankle joint while walking and running

A

walking: 120% BW
running: 275% BW

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3
Q

weight distribution in foot while walking, %

A

60% rearfoot
28% met heads

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4
Q

rearfoot bones

A

tib/fib, talus, calcaneus

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5
Q

midfoot bones

A

cuboid, cuneiforms, navicular

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6
Q

forefoot bones

A

metatarsals, toe bones

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7
Q

hypermobility vs instability

A

hypermobile has more motion than is typical due to laxity in ligaments; it is not always pathological
instabillity means the joint moves off its axis, issue with supporting tissues; “clunk”

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8
Q

ankle sprain - most common type?

A

85% are lateral ankle sprains
most commonly ATFL involved 60-70%
then CFL then PTFL

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9
Q

What directions tension each lateral ligament?

A

CFL: DF/neutral + inv
ATFL: PF/inv
PTFL: DF

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10
Q

grades of ankle sprain

A

1: less than 25%, painful, microtears, stable, some swelling
2: 25-75%, laxity and pain with movement
3: 75% to full tear, no pain with movement

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10
Q

high ankle sprain involved structures and MOA
Recovery?

A

syndesmosis torn as well as AITFL, PITFL, transverse
often in high contact sports
caused in DF/inv, dome of talus separates tib/fib
recovery takes twice as long!

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11
Q

medial ankle sprain MOI

A

excess ev/DF
strong ligament, so less common

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12
Q

ottawa ankle/foot rules

A

bony tenderness at lat malleolus
bony tenderness at med malleolus
bony tenderness at navicular
bony tenderness at base of 5th metatarsals
inability to weight bear

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13
Q

significance of ottawa ankle/foot

A

pt needs xray if they are showing any of the ottawa findings
pt safety, PT liability to prevent displacing a potential Fx

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14
Q

Treatment of ankle sprain: acute phase

A

1-3 days; protection!
reduced swelling, early pain free motion, supported WBAT, prevent reinjury
RICE
ankle pumps

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15
Q

Treatment of ankle sprain: subacute stage

A

4-14 days post
dynamic balance
proprioceptive ther ex
open chain resistance
bike

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16
Q

treatment of ankle sprain: advanced healing

A

restore normal AROM, normalize gait w/o AD
FWB in fxal activity
enhance proprioception

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17
Q

phases of ankle sprain treatment

A

1: protect, immobilize/stabilzie, NWM, RICE
2: low level strength/balance, PWB
3: advanced balance, SL, walking
4: jog, sport specific training

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18
Q

What obj/subj signs differentiate Grade 1 vs 2 ankle sprains?

A

edema - increased in 2
ligament integrity - decreased on special tests in 2
WB status - 2 will be PWB/NWB
location of tenderness

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19
Q

Which ligament is often damaged first in an inversion ankle sprain?

A

ATFL
stretched in inv/PF

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20
Q

Chronic ankle instability (CAI)

A

frequent ankle sprains, chronic ankle weakness and giving out over 12+ months
presents as pain, instability, swelling, decreased function
tenderness, + ant. drawer

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21
Q

CAI treatment

A

conservative - PT, splints
balance and strength training
surgical repair or reconstruction

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22
Q

What % of ankle sprains become chronic?

A

30%

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23
Q

CAI diagnostic criteria

A

Hx of 1+ traumatic ankle sprain
Hx of ankle instability, recurrent ankle sprains
- confirmed with validated questionnaire
impaired level of disability

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24
osteochondritis dissecans of the talus | MOI, symptoms
injury of the anterolateral/posteromedial talus due to torsional stress/impact twisting injury to the ankle causing a talar Fx clinical tenderness, diffuse swelling, persistant pain/stiffness
25
regression of osteochondritis dissecans
area has lack of blood flow at articular cartilage, repeated stress degrades area over time subchondral impaction -> partly detached fragment -> non displaced free fragment -> fragment with 180 shift
26
osteochondritis dissecans treatment
nondisplaced: rest, cast to immobilize displaced: arthroscopic removal/drilling
27
posterior tibialis tendonitis
pain at: distal to medial malleolus over navicular; proximal to medial malleolus; at origin/insertion findings: swelling tenderness around med malleolus flattened medial arch heel valgus painful PF/inv
28
Posterior tibialis tendonitis management
xray/MRI tenosynovitis - rest/NSAIDs, short walking boot/orthotic, steroid injection, synovectomy incomplete tear - repair/augmentation complete tear - repair w possible fixation of hindfoot
29
peroneal tenosynovitis
pain behind lateral malleolus, worse with activity and better with rest diagnose w xray to exclude FX, MRI, tenderness/tendon subluxation more common in high arches due to increased excursion
30
peroneal tenosynovitis treatment
conservative - rest, walking boot, lateral heel wedge, NDAIDs, cortisone, PT surgical - tenosynovectomy, repair, stabilize dislocating tendon by deepening groove, retinaculum reconstruction
31
Achilles tendinitis/osis
insertional at calcaneus or non insertional superior to insertion most common in 30s-40s and runners gradual onset worse w activity pain stiffness worse in morning/start of activity and improves obj: tenderness/warmth decreased DF antalgic gait, early heel off, leg in ER
32
tendonitis vs tendinosis
osis - clinical inflammation, lack of cellular inflammation itis.- peritendinous inflammation
33
Achilles tendinitis treatment
conservative: rest, ice, NSAIDs, orthotics, 12 wk eccentric calf strengthening, correct LE asymmetries, stretching surgical: decompression/debridement, not a guarantee of symptom cure
34
types of Achilles tendinitis/severity
1: pain after activity - reduce activity 25% 2: pain during/after activity not affecting performance - reduce activity 50% 3: pain during/after activity affecting performance - discontinue running temp.
35
Should insertional Achilles tendinitis complete full range or floor level eccentrics?
floor level, to reduce stress on insertion as compared to dropping heel off step
36
timeline of achilles tendinopathy
3-6 mo for significant improvement with first symptom improvement with morning stiffness
37
Acceptable pain levels when working with tendinitis
<4/10 during activity subjective, alter number as needed for low-mod pain levels
38
Where will a pt report tenderness w posterior tibialis tendinits
distal to med malleolus over navicular proximal to med malleolus at origin/medial shin splints or insertion in foot
39
Achilles tendon rupture
MOI: DF + knee extension, microtrauma, eccentric loading increased risk w/ gout, hyperparathyroidism, steroid injections timeline: 6-8 mo
40
thompson's test
achilles tendon integrity pt in prone, leg over edge of table, squeeze calf +: absence of slight PF
41
achilles tendon rupture treatment
non operative - minimally displaced ruptures or older pts would not get surgery serial casting 10-12 weeks surgical - younger pt, displaced rupture
42
complications of achilles tendon rupture repair
wound healing sural nerve injury DVT
43
success of achilles tendon treatment
non operative - lower return to prev activity level, lower satisfaction, and higher reinjury surgical - 83% return to activity level, 93% satisfaction, 2-3% re rupture
44
general progression of post op Achilles tendon rupture
0-4 weeks: NWB, crutches compression, splint, boot 4 weeks: TTWB to WBAT, walking boot/CAM to limit DF, immobilize addt 2-4 weeks 6-8 weeks: allow DF beyonf neutral, AROM exercise in brace, FWB w/ brace, transition to heel lift 12+ weeks: discontinue brace, FWB w/o lift
45
Evidence for interventions for Achilles tendon rupture
mechanical loading/exercise/eccentrics iontophoresis to decrease pain and increase function some evidence for stretching PFs
46
plantar fasciitis
heel pain, worst upon waking subj: Hx of pain on medial arch, worse with activity obj: tenderness along medial fascia, origin at calcaneous firm pressure
47
causes of plantar fasciitis
obesity excess walking sports tight plantar fascia flattened arch excess pronation
48
plantar fasciitis treatment
orthotic, injection, NSAIDs, surgical release (poor outcomes) PT: foot intrinsics, support arch w towel in exercise, stretching PFs/DFs, balance, resisted ankle AROM
49
plantar fascia prognosis
90% who do conservative treatment improve in 12 mo
50
evidence for interventions - plantar fasciitis
A - manual therapy, stretching, taping, foot orthoses, night splints B - diagnosis/assessment
51
retrocalcaneal bursitis
aka haglund's deformity tenderness/enlarged calcaneal lump due to inflammation
52
causes of retrocalcaneal bursitis
repetitive trauma - shoes and sports gout, RA, ankylosing spondyloarthopathy bursal impingement w achilles tendon
53
treatment for retrocalcaneal bursitis
conservative: shoe wear, injection (risky) PT: achilles tendon stretching, reduce inflam surgery: resect deformity, excise bursa, debride tendon insertion
54
Hallux valgus
bunions - lateral deviation of great toe causing bony growth on 1st metatarsal MTP joint angle > 20 degrees painful callus on 2nd toe lack DF
55
causes of hallux valgus
familial inappropriate shoes flat feet - abducts toes long first ray MTP joint surface incongruous metatarsus primus varus - 1st ray rotated away from 2nd RA
56
hallux valgus treatment
conservative: low heel/stiff shoes w wide toe box splints, toe spacers bunion pad to reduce pressure rest/heat/analgesics surgical: only for severe deformity or pain bunionectomy
57
progression of post op bunionectomy protocol
0-2: NWB w crutches, safe ADLs w AD, hip/knee AROM, rest/elevate 2-6: ankle/toe AROM, boot on except exercises, heel WB short distances 6-10: full WB w boot, ankle ROM, hip/knee strength, scar massage, joint mob unfused joints
58
pes planus
flat foot - 99% flexible, 1% rigid medial arch disappears in weight bearing, reappears when non weightbearing
59
jack test
hallux hyperextension should create medial arch in flexible pes planus, won't in rigid
60
heel rise
pt raises heel, flexible pes planus heel will move into varus
61
rigid pes planus cause/symptoms
congenital vertical talus, no subtalar motion, stays pronates bc bone/scar tissue/fusion foot pain, hard to walk on uneven surface, fatigue, peroneal spasm
62
rigid pes planus treatment
control symptoms immobilization 4-6 weeks once irritated surgical treatment
63
metatarsal stress Fx
overuse, cyclical submaximal loading caused by shoes, hard surface, increase in running distance most often 2nd/3rd MT pain/swelling in WB, Hx of change in activity/shoes/surface ecchymosis
64
Will stress Fxs show up on xrays?
Not while acute, too hairline to detect they will show up as healing area of more white bone on subsequent xrays
65
Morton's neuroma
nerve entrapment of interdigital nerve caused by trauma, ischemia, entrapment shooting/constant pain w WB, rest/no shoes help female > men most common btwn 3rd/4th
66
metatarsal squeeze test
+ tenderness/click on squeeze of MTPs
67
Morton's neuroma treatment
conservative - metatarsal pad, orthotic, injection, excision wide toe box/no heels surgical - dorsal or plantar approach
68
dorsal vs plantar approch morton's neuroma
dorsal allows immediate WB, sutures removed after 2 weeks plantar delays WB 2 weeks, transition to normal shoe 3-4 weeks, return to sport 4-6 weeks
69
Tarsal Tunnel
tibial nerve entrapment in flexor retinaculum and medial malleolus burning/pain/paresthesia medial plantar surfacce of foot worse after activity + tinel's sign painful DF/ev decreased 2 pt discrim plantar aspect heel varus/valgus weak foot intrinsics
70
tarsal tunnel treatment
injections, orthotics, foot intrinsic exercises to restore medial arch
71
turf toe
sprain of 1st MTP hyperextension, varus/valgus stress on MTP 1st MTP inflammation, tender, limp, unable to run, Hx or DF injury or great toe injury need at least 70 degrees DF at 1st toe to avoid overstretching
72
grades of turf toe injury
sprain grades 1: minor stretch, little swelling/pain/disability, return as symptoms improve 2: partial tear, mod pain/bruising/disability, 3-14 days rest 3: complete tear of plantar plate w severe swelling/pain/bruising, unable to WB, 6 weeks rest, crutches
73
turf toe treatment
RICE, NSAIDs, tape to limit toe DF return to sport when toe can DF 90 1: tape toe to 2nd, stiff shoes 2: brace/boot, weeks of rest 3: surgery if Fx, cartilage damage, tendon tear, excess joint movement causing subluxation
74
cuboid syndrome
disrupts congruence of calcaneal/cuboid joint uncommon w lateral ankle sprain lacks valid/reliable tests ligament injury poor function of the cuboid reduces mechanical advantage of the peroneals
75
s/s of cuboid syndrome
persistnet local pain over cuboid following lateral ankle sprain painful toe off painful plyometrics medial arch/4th metatarsal pain palpable prominence limited/painful DF/inv/ev at joint painful mobs of cuboid - ligament
76
cuboid syndrome treatment
cuboid whip (grade 5) cuboid squeeze mobs w movement retrain foot intrinsics and kinetic chain as applicable NM/proprioceptive control peroneal/gastroc stretching
77
3 feet types and shoe types
flat: stability shoes normal: neutral high arch: cushion
78
Lateral Ankle Sprain CPG Components
A: prevention/bracing those at risk/those who have had 1st ankle sprain; AD and immobilization for acute sprain; PT/HEP; should NOT use ultrasound; manual therapy like drainage, MWM, STM, joint mob, to reduce pain/swelling B: brace usage for return to work schedule and activity. limitation C: preventative balance training for those w/o LAS; ice; diathermy; low level laser; NSAIDs D: mode of HEP mixed evidence (paper/app/etc); electrotherapy; accupuncture
79
CAI CPG Components
A: NRED/proprioceptive to retrain postural stability; manual to improve DF B: bracing alone should not be used, supplement; combined treatment C: dry needling E: motivational interviewing/psych

517 Ortho (11 decks)

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