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ORTHO 560 > ankle pathologies > Flashcards

ankle pathologies Flashcards

1
Q

what is a primary consequency of hallux valgus?

A

hypermobility of the 1st MT

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2
Q

what is the main cause of hallux valgus?

A

hyperpronation during propulsive phases of gait

shoes too narrow which compress the feet

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3
Q

what can hallux valgus be identified clinically?

A

1st MT is adducted on medial cuneiform relative to midline

1st phalynx is abducted on MT relative to midline

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4
Q

how can hallux valgus be treated

A

correct for the hyperpronation w/ strenghtening of the intrinsic muscles and posture or orthosis
taping for temporary pain relief

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5
Q

what is plantar fasciopathy?

A

histological degeneration and deterioration of collagen fibers, increased secretion of ground substance proteins and fibroblast in areas of proliferation

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6
Q

what clientele is affected by plantar fasciopathy?

A
  • very active people

- people w/ a shigh standing workload

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7
Q

what causes plantar fasciopathy?

A

degenerative causes due to excessive and repeated loading
low arches: increase the stress in order to stabilize the arch
high arches: inability to pronate foot and thus decreased shock absorption and thus increase stress on foot
-poor MTP extension = poor windlass mechanism = increased stress on plantar fascia
-tightness of myofascial structure = increased pronation or increased tension on fascia

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8
Q

what is the most common MOI(s) for plantar fasciopathy?

A

overuse injury (insidious)
WB activivity s/a running
activities w/ excessive mvmt, foot pronation or stressing/stretching of plantar fascia (MTP in full extension, foot hyperpronated or foot hypersupinated)

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9
Q

what is the pain site for plantar fasciopathy?

A

medial tuiberosity of calcaneus and extends along the medial border of the plantar fascia

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10
Q

what is the pain pattern for plantar fasciopathy?

A

pain worse in am or post activity in WB
if more severe: pain w/ NWB
pain increases w/ mvmt stretching/stressing of the plantar fascia

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11
Q

hwta can be noticed in gait in a foot w/ plantar fasciopathy?

A

hypersupination or hyperpronation

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12
Q

what is the effect of having a foot hypersupinated

A

poor motion of tbhe bones thus excessive load on the fascia

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13
Q

what is the effec of foot hyperpronated?

A

hypermobility

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14
Q

how is the ROM in a foot w/ plantar fasciopathy?

A

MTPs full extension might be painful and stiff

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15
Q

how is palpation for plantar fasciopathy?

A

pain on medial tubercle of calcaneuse

might have a heel sput; which is generally painless

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16
Q

what results from flexibility testing for plantar fasciopathy

A

stiffness

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17
Q

what test can be used to test flexibility in plantar fasciopathy? explain the test?

A

windlass test
pt in WB is asked to bring hallux into full extension, the arch should rise
might be painful
if nothing happens or is delayed –> weakness
if needs lots of force before being initiated –> stiffness of the fascia

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18
Q

can imaging be used for plantar fasciopathy?

A

only is conservative Rx is uneffective it is used to detect changes in the facia or heel spurs

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19
Q

how can we decrease pain in plantar fasciopathy

A
  • avoid aggravationlload reduction
  • ice and NSAIDs to reduce inflmmation
  • taping to elevated fascia
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20
Q

when is stretching used as a tx option for plantar fascipathy? what stretches cn be done

A

when the plantar fascia is stiff w/ windlass test
-PROM MTP exrtension, full ankle DF
STT, self massage

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21
Q

what grading techniques ares used for mobilization of 1st MTP in extension?

A

grade 3 and 4

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22
Q

what strenghtning is suggested for plantar fasciopathy?

A
  • hyperpronated foot: STR of intrinsic muscles of the foot

- might want to STR tibialis post and hip ABD/ER

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23
Q

exercise prescribed for plantar fasciopathy?

A
  • pt raises the medial arch of the foot and asked to keep edge in contact w. groun and 1st MTP w/ toe resting normally on floor.
    goa: 10 reps of 10s hold 4-5x per day
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24
Q

how can the biomechanics be corrected in the case of plantar fasciopathy?

A
  • taping: only temorary while strengthening intrinsic muscles
  • orthodics or new footwear
  • othoses
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25
Q

what other Rx options are availible if consevrative Rx doesnt work for plantar fasciopathy?>

A

-corticosteroid injections for 4-6 weeks
high load STR exercise: HSR protocol
extracorporeal shockwave therapy
-surgery

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26
Q

what can be used to rule out ankle fx?

A

ottawa ankle rules

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27
Q

what is a grade 1 sprain?

A

-local tenderness
-microtear or overstretched
-minimal or no swelling
-lig stress test: no grap, normal EF, painful
POP over ligament

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28
Q

what is a grade 2 sprain?

A

macroscopic tear
marked POP over ligament
localized swelling/ bruised
lig stress test: gap, firm EF, pain

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29
Q

what is a grade 3 sprain?

A

complete rupture of ligament
+/- pain
swelling common, no tenmse effusion, fluid can circulate
lig stress test: gap ++, soft EF, may or may not have pain

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30
Q

which b/w MCL and LCL is more commonly ruptured?

A

LCL of the ankle since MCL is stronger, however rupture of MCL will take longer to heal

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31
Q

which ligament of the LCL of the anle is most commonly sprained?

A

ATFL since lease elastic component of the LCL

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32
Q

what is the sequence of ankle ligement sprain w/ inversion injury

A

ATFL > anterior capsule > distal anterior tibiofibular ligament > CFL > PTFL

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33
Q

how do LCL strains generally occur (MOI)

A

-inversion mechanis

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34
Q

what is the pain site of LCL sprain?

A

lateral aspect of the ankle/foot

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35
Q

what is the pain pattern of LCL sprain?

A

pain w/ inversion –> stretching of the ligament

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36
Q

what observations (swelling) can be observed in LCL sprains

A

2 patterns of swelling can be observed

  1. distal to lat malleoli: egg shaped occurs immediately after injury and generally associated w/ ATFL involvement
  2. swelling may spread to the foot when capsuleis torn of int. tibfib ligment is affected –> sandwhich like foot
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37
Q

what functional tests can be performed in a LCL sprain?

A

anatalig gait patterns/NWB

torsion test painful w/inversion

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38
Q

how is ROM of a foot w/ LCL sprain?

A

inversion and PF are painful

hypermobility due to ligament laxity

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39
Q

how is risom w/ LCL sprain?

A

depends on aaffected structure and pain level

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40
Q

how is proprioception w/ LCL sprain?>

A

decreased

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41
Q

what are possible Rx for LCL sprain to decrease pain and swelling

A

-PRICE/PEACE AND LOVE
-avoid heat
electrotherapy
-drainage/massage/ effleurage from distal to proximal
-light mobilizations; grade 1 and 2

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42
Q

what are possible Rx for LCL sprain to restore ROM

A

-NWB for the first 24h
-PWB until normal heel-toe pattern is obervsed
-AROM as soon as pain permits
DF in WB
-grade 3 and 4 mobilizations

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43
Q

what are possible Rx for LCL sprain to for STR

A

str in all directions

isometric then isotonic

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44
Q

what are possible Rx for LCL sprain to improve proprioception

A 
5-10 moin/day 5x/week for 8-10 weeks
unilateral
eo --> ec
stable to unstable surface
double task
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45
Q

what are possible Rx for LCL sprain to return to functional exercise and activities

A

once pain free, full ROM and adequate str aand proprioception; ju,ps,. hops, figure of 8, stop and go

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46
Q

what is an anterolateral impingement generally secondary to?

A

an acute or recurrent ankle sprain in pf and inversion

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47
Q

where does anterolateral impingement generally occur?

A

ant. inf. tibiofibular lig
ATFL
anterior capsule

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48
Q

where is the pain site for anterolateral impingement

A

anterolateral side of the ankle

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49
Q

what is the pain type of anterolateral impingement

A

intermittent catching sensation

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50
Q

what is the pain pattern for anterolateral impingement

A
  • pain present even once sprain has heeled

- pain increases w/ mvmt arom/prom for DF

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51
Q

how is ROM impacted in anterolateral impingement?

A

decreased DF in WB

catching sensation but no lig instability

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52
Q

can imaging be used for anterolateral impingement?

A

most reliable is MRI but not commonly used

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53
Q

how to treat anterolateral impingement?

A

conservative Rx
rest 4 weeks
use cast of splint to limit ankle ROM
ICE & NSAIDs for pain

54
Q

what are the two locations for AT tendinopathy?

A

mid portion

insertional

55
Q

what may be causes of midportion tendinopathy?

A
  • weak plantar flexion
  • increased df
  • hypersupinated foot
  • dec. knee flexor strenght
  • poor tendon structure
56
Q

how can weak PFs lead to mid portion AT tendinopathy?

A

failure to attenuater load = increased stress on tendon

57
Q

how can increased DF rom lead to mid portion AT tendinopathy

A

increased loading periods thus more stress on tendon

58
Q

how can hypersupination/ decreased DF rom lead to mid portion AT tendinopathy

A

shorter loading periods and as such same force distributed over shorter time thus decreased ability of tendon to absorb load

59
Q

how can reduced knee flexor str lead to mid portion AT tendinopathy

A

gastroc may compensate and lead to over activation and thus increased stress on AT

60
Q

how can Poor tendon structure lead to mid portion AT tendinopathy

A

less capacity to tolerate and absorb load

61
Q

what type of organ is the insertional AT said to be?

A

enthesis organ

62
Q

what may cause for insetional AT tendinopathy? what does this result in?

A

excessive DF w/ high tendile loads
compression/irrittation of the tendon and bursae leads to increased FC of tendon leading to assicifaction; haglund’s deformity

63
Q

what are other pathologies associated w/ insertional AT tendinopathy?

A

retrocalcaneal bursitis

64
Q

who is more at risk of insertional AT tendinopathy?

A

hypersupinated/ high rched feet
runners w/ important ms stiffness
pts w/ haglund’s deformity

65
Q

what is important differential diagnosuis of insertional AT tendinopathy?

A
  • achilles bursitis

- rheumatic conditions

66
Q

how is the pain pattern in insertional AT tendinopathy?

A

pain w/ resistance of PF and DF stretch

67
Q

how can a midportion AT be identified on observation?

A

if in reactive on degenerative phase; swollen, red, warm and thickened tendon
degenerative: thickening nodule

68
Q

how can a insertional AT be identified on observation?

A

bursitis at the level of calcanues
haglunds deformity at calcneus
foot hypersupinated

69
Q

how is the ROM for AT tendinopathy?

A

pain w/ AROM POF and EOR DF

pain w/ PROM DF EOR

70
Q

when may pain be present w/ risom for AT tendinopathy?

A

w/ PF

71
Q

how is the flexibility of gastroc and soleus w/ AT tendinopathy?

A

stiff and possibly painful

72
Q

what tests (functional) can be done for assessing AT tendinopathy?

A

heel raise in WB

hopping

73
Q

what may be a specific plapation associed w/ midpoint AT tendinopathy?

A

pain/thickening of fibers +/- nodules 2-6 cm above calcaneus

pinch test = +

74
Q

what may be a specific plapation associed w/ insertional AT tendinopathy?

A

pain from bursitis of haglunds deformity

pain at calcaneus

75
Q

whatb questionnaire is specific for AT

A

VISA A

76
Q

is imaging needed to assess AT tendinopathy?

A

not needed but can be used to assess quality of tendon and bursae or info on bone (deformity)

77
Q

what is the 4 stage program of Rx for midpoint tendinopathy

A
  1. isometric exercises
  2. isotonic of HSR exercises
  3. speed and energy storage exercises
  4. energy storage and release of sports specific exercises
78
Q

what exercises are performed in stage 1 midpoint AT?

A

Seated w/ heel raises
Standing BW hold SLS vs DLS
Weight in standing heel raise machine

79
Q

when can we progress to stage 2 for midpoint AT

A

when reactive pain has progressed

80
Q

what protocol is used eccentric training in AT tendinopathy?

A

alfredson painful heel drop

81
Q

how to train eccentric midportion AT?

A

begin on 2 legs and then go up- on unaffected side and then down on affected side
repeat 15 x leg straight, 15 x leg bent

82
Q

how to train eccentric insertional AT?

A

ensure to stop mvmt at neutral DF

unaffected leg up, affected leg down

83
Q

how to treat eccentrically if pain is bilateral

A

use a step to elevate one leg, the go on tippy toe of other and descend, process is to be repeated with other leg

84
Q

how to treat AT tendinopathy using HSR

A

go from PF to neutral, only go lower in people who need STR in these angles

85
Q

what should be trained before going to stage 3 for AT tendinopathy?

A

endurance

86
Q

what stage should be continued lifelong 2x/week for AT tendinopathy?

A

stage 2

87
Q

is additional loads added in stage 3 of AT tendinopathy?

A

no

88
Q

how often is stage 3 for AT tendiopathy performed?>

A

EOD and on days it isnt performed, stage 2 exercises are performed

89
Q

how does stage 4 for AT tendinopathy compare to stage 3?

A

exercises are done faster

90
Q

how is pain monitored during exercises in rehab for AT tendinopathy?

A

use daily tests to assess pain levels
low load: SL heel raise
high load: hop

91
Q

what happens if the isolated Rx for insertional AT is ineffective?

A

need to consider entire enthesis organ

92
Q

how to treat for insertional AT tendinopathy

A

conservative Rx

  • alfredson modified protocol w/ neutral DF
  • heel raised 3-5 cm to reduce compressive loads
  • avoid stretching
93
Q

what are the presentations of a complete rupture of AT

A 
macrotrauma
rupture at midsection
reports of snap/sound
sudden pain
feeling of being kicked at the back of the leg
swelling
limping
generally cannot rise on toes (WB PF
94
Q

where is pain felt in ruptured AT

A

at the AT

95
Q

what should be looked out for in ruptured AT

A
  • swelling/bruising
  • antalgic gait pattern
  • when in prone does the foot hang straight down off the edge of the bed
96
Q

how is the strenght in ruptured AT

A

weakness of ankle in PF

97
Q

what can be felt w/ palpation of a ruptured AT

A

gap of ~3-6cm

98
Q

what test can be performed to assess for AT rupture

A

thompson’s test which involves squeezing the calf muscle and looking for sligh PF of the foot

99
Q

is MRI/US used to diagnose ruptured AT

A

not all the time but can help confirm diagnosis

100
Q

how can ruputred AT be treated

A

conservatively vs surgery

101
Q

which procedure conservative vs surgery optimizes the STR of AT post rupture

A

surgical

102
Q

which procedure conservative vs surgery has the risk of future rupture of ?

A

conservative

103
Q

which procedure conservative vs surgery increases complications AT post rupture

A

surgery due to risk of infection

104
Q

which procedure conservative vs surgery is generally done in which population

A

conservative generally done in older population

105
Q

how to usse conservative Rx to treat ruptured AT tendon

A

cast or functional brace w/ crutches for 6-8 weeks

initially ankle in in max PF and then angle of PF decreases gradually

106
Q

which b/w cast or functional brace seems to haver better results for conservative Rx of ruputred AT

A

functional brace

107
Q

what mvmts may be permitted to pt using functional brace Rx for AT ruputre?

A

ROM on toes
light isometric PF
ankle ROM if brace allows

108
Q

what is the protocol of Sx for AT rupture?

A 
rehab begins ~6-8 weeks 
exercise in bracer, similar to conservative
earliest mobilization possible
WBAT
ice, massages, US 
ROM: knee bent, restrict DF for ~6 wks
STR: progressive
stretching: only w/ ok from surgeon
109
Q

what is the MOI for tibialis posterior tendinopathy?

A

overuse especially w/ subtalar overpronation

110
Q

what is the painsite for tibialis posterior tendinopathy?

A

along the path of tib post. 3-4 cm before medial malleoli

111
Q

when is pain w/ mvmt felt in tib post tendinopathy?

A

pain w/ AROM: PF and Inversion

pain w/ PROM for DF and eversion

112
Q

how to treat tib post tendinopathy conservativedlu

A

-healing based on the stage of the teninopathy
initial progressive unloading then progressive loading exercises usingb the 4 stage program
STT as needed and mobiliation of TC of STjoints

113
Q

MOI for tib ant tendinopathy?

A

overuse syndrome involving excessive DF or aassocied w/ footover pronation and stiffness of the TC or ST joint

114
Q

pain site in tib anterior tendinopathy

A

along path of tib ant tendon

115
Q

what can generally be observed in pts w/ tib ant tendinopathy?

A

hyperpronated foot

116
Q

when is pain felt w/ mvmt in tib ant tendinopathy?

A

pain felt w/ arom in DF and inversion
PROM:
PF and eversion

117
Q

how to treat conservatively tib ant tendinopathy?

A

same fashion as tib post tendinopathy

118
Q

what is the MOI for gastroc ms strain?

A

microtrauma

max tension on gastroc when in lengthened position nd ms contracts

119
Q

where is pain felt in gastroc ms strain?

A

medial belly

MTjunction

120
Q

how to describe pain for gastroc ms strain?

A

acute, stabbing, tearing

121
Q

how is pain w/ mvmt in gastroc strain?

A

arom: pain w/ PF and DF at EOR
PROM: pain w/ DF
note that low grades might not be painful

122
Q

how is risom in gastroc strain?

A

pain w/ PF and extended knee

may be weak

123
Q

what may be noticed w/ palpation of a acute gastroc strain?

A

warm if in substrate phase
pain at MT junction
may feel palpable defect –> grades 3

124
Q

how to stretch gastroc?

soleus?

A

gaastroc: df w/ knee extended
soleus: df w/ knee flexed

125
Q

what is a possible complication of gastroc strain?

A

DVT

126
Q

what test is used to detect DVT

A

omen’s test

127
Q

how to treat gastroc strain in the inflammatory phase

A
  • police to decrease pain and swelling
    -NWB
    heel rise orthosis
128
Q

how to treat gastroc strain in the proliferative

A 
begin ankle and knee ROM exercise
gentle gastroc stretch
pain-free isometric exercises
if pain free being str
When pain free WB start proprioception
129
Q

how to treat gastroc strain in the remodeling phase

A

gastroc stretch for flexibility
STR progression
functional exercises
DTF and STT as needed

130
Q

when is Surgical Rx needed for gastroc Ms strain?

A

in cases of large ms disruption of failed conservative Rx after 6 months

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