Exam 4- ankle/foot Flashcards
(130 cards)
1
Q
what is the most frequent injuries in the world of sports
A
ankle sprains
2
Q
what are RF for sprains in the ankle
A
previous ankle sprains
lack of external support
lack of warm up
lack of coordination training
3
Q
what is impaired DF due to
A
shortened gastroc
talar hypomobility
fibrotic capsule
4
Q
what can happen if pt has limited DF
A
excessively load on lateral foot due to TC jt not reaching CPP and staying in supination longer
5
Q
what is the cause of lateral ankle sprains
A
excessive PF and inv
6
Q
what structures are commonly injured with lateral ankle sprains
A
ATF
CF
PTF
7
Q
what subtalar lig can be affected with lateral ankle sprains
A
anterior interosseous
8
Q
what other structures can be damaged with lateral ankle sprains
A
avulsion of lat malleolus/5th MTP
medial malleolus fx
cuboid displacement
fibula ant subluxing on tibia
peroneal strain
9
Q
what would a pt report with lateral ankle sprains
A
sudden onset
ankle rolling in
lateral ankle pain/swelling
pain with WB
10
Q
what is in a SCAN for lateral ankle sprain
A
ob- swollen and bruising, painful asymmetric gait
CDR for fx
ROM- limited and painful PF and INV
RST- weak and painful EV
11
Q
what is in a BE for lateral ankle sprain
A
AM- hyper ant talar glides due to ATF lax
sp test- ant/reverse ant drawer, medial talar tilt, subtalar lateral
palpation- antlat talar, TTP
12
Q
what can cause medial ankle sprain
A
excessive eve
13
Q
what structures can be damaged with medial ankle sprain
A
deltoid lig
subtalar- posterior and medial
14
Q
what is the function of the deltoid lig
A
support medial arch
15
Q
which deltoid lig if torn can cause reinforcements to the medial arch to be compromised
A
tibiocalcaneal- calcaneus can over eve/pro and let medial arch collapse
16
Q
what other structures can be damaged during medial ankle sprain
A
avulsion of medial malleolus
post tib strain
lateral malleolus fx
17
Q
what are symptoms of medial ankle sprain
A
sudden onset
ankle rolling out
pain with WB
18
Q
whats in the SCAN for medial ankle sprain
A
ob- swelling and bruising, painful asymmetric gait
CDR fx
ROM- limited and painful with eve
RST- weak/painful inv
19
Q
what is in a BE for medial ankle sprain
A
AM- hypermobile calcaneal eve
sp test- ATF. deltoid, subtalar posterior and medial
palpation- TTP
20
Q
what can cause a high ankle sprain
A
primarily DF, excessive post glide with ER
21
Q
what is the order of lig structures most likely torn with a high ankle sprain
A
AITFL
interosseous membrane
PITFL
deltoid lig
22
Q
why is a talar or distal tib/fib fx likely with a high ankle sprain
A
CPP more bony congruency
23
Q
what are symptoms of a high ankle sprain
A
sudden onset
ankle bent up
anterior ankle pain/swelling
pain with WB
24
Q
what is in a SCAN for a high ankle sprain
A
ob- swelling and bruising, painful asymmetric gait
CDR fx
ROM- painful and limited DF and eve
RST- weak and painful
25
what is in the BE for high ankle sprain
AM- hypermobile post talar glide
sp test- inferior tibfib, medial, single hop test
TTP
26
what are RF for CAI
increased talar curvature
lack of external support
lack of coordination training
27
what can cause CAI
past severe recurrent sprain
28
what are S&S of CAI
no trauma
acute S&S if aggravated
decrease postural stability
altered m activation patterns
aberrant motion
fibula slightly more lateral than tibia
29
what is the PT rx for ankle sprains
POLICED
JM with MET
MET
STM
bracing/taping
pt edu
30
when does taping lose mechanical stability
after 30 minutes
31
what taping technique is indicated for high ankle sprains
distal tibfib
limits seperation and anterior distal fibular glide
32
what is the primary purpose of MET for acute ankle sprains
tissue proliferation
stabilization
33
what is the primary purpose for chronic ankle sprains
stabilization
34
what position/directional bias should we start with for a lateral ankle sprain
eve and DF
35
what position/directional bias should we start with for a medial ankle sprain
inv and PF
36
what position/directional bias should we start with for a high ankle sprain
PF and others that are nonprovoking
37
why do neuromuscular training for ankle sprains
prevent reoccurrence
improve balance and inversion jt position sense
38
what is the RTP for grade 1 sprain
1-2 weeks
39
what is the RTP for grade 2 sprain
2-6 weeks
40
what is the RTP for grade 3 sprain
> 6 weeks
41
what is the function of the lateral column of the foot
shock absorption from heel strike to just before heel off
42
what is the function of the medial column of the foot
propulsion just before heel off to toe off
43
what is the ROM for DF with knee flx during stairs
ascent- 15-25
descent- 20-35
44
what is the ROM for DF with knee ext during heel off/toe off
10-15
45
what is the functional ROM for PF
15-30
46
what ROM is needed for 1st MTP with toe off
65
47
what has the least support to arches
m provide limited support to arch
48
what is subtalar neutral
talus centered in talocrural and on calcaneus
49
what is eccentrically controlling heel strike in the ankle
ant tib
50
what is eccentrically controlling midstance/heel off in the ankle
post tib
51
what happens to the arches during midstance through heel off
maximally flatten to the ground
52
what is the potential energy structures within the foot
foot lig
middle and posterior lig
ankle pf
interosseous membrane
53
what carries the most load of the foot
1st ray
54
how is PE built during heel off to toe off
1st MTP ext causing maximally plantar fascia tightening
55
what happens in toe off to swing for the foot
great toes flexes
ankle pf and talus IR
knee flx and IR
hip flx and ER
56
what can cause excessive pronation
tibfib or TC hypermobility
impaired LE control
adjacent jt hypomobility
57
where could adjacent hypomobility be if we see excessive pronation
TC DF= mid/forefoot excessive EV and ABD
limited knee ext
58
what can happen if limited TC DF is found
excessive load on lateral footby staying in supination too long
59
what are RF/causes of achilles tendinopathy
reduced DF limiting PE of achilles
limited calf flexibility
weak calf
L4-S1 regional interdependence
male
older age
obesity
systemic inflammation
60
what is happening to the achilles during tendinopathy
repetitive lengthening and compression from limited DF or excessive EV
lack of PE due to limited DF
collagen disorganization
thickened tendon
61
what can be impacted with achilles tendinopathy
force transfer
impaired motor control
62
what are symptoms of achilles tendinopathy
gradual onset limits WB
localized pain and stiffness- more with inacitivity, less with mild activity, more with mod activity
63
what is in a SCAN for achilles tendinopathy
ob- thick tendon. impaired LE control
ROM- Pain/limited DF
RST- pain with PF and weak antigravity
64
what is in a BE for achilles tendinopathy
AM- hypo talar DF
sp test- arc sign, royal london, SL heel raise, SL hop test
m length- gastroc
palpation- TTP proximal of insertion, more medial= plantaris
65
what is the PT Rx for achilles tendinopathy
pt edu
POLICED
modalities
STM
JM
MET
bracing/taping
orthotics
66
what is the prognosis of achilles tendinopathy
2x wk for 6-12 weeks
67
what are MD rx for achilles tendinopathy
injections
debridement
remove plantaris
68
what causes Sever's disease
growth with high activity
69
what are RF for sever's disease
high sports activity
poor fitting shoes
training errors
shortened PF
foot dysfunction
70
what are symptoms of sever's disease
gradual onset of heel pain with overuse
bilateral more than unilateral
71
what is in a SCAN for sever's disease
ob- foot dysfunction, impaired LE control
ROM- limited DF
RST- weak and painful PF, weak DF
72
what is in a BE for sever's disease
sp test- squeeze heel, sever's sign (pain with heel raise)
m length- short gastroc
palpation- TTP over cap
73
what is the PT Rx for sever's disease
pt edu
POLICED
U shape foam
JM
orthotics
MET
74
what orthotic helps with sever's disease
heel lifts specifically gel heel cups
75
why should MET be performed for sever's disease
impaired LE control
76
what is the prognosis of sever's disease
75% resolved at 1 month
95% at 3 month
77
what are the clear RF for plantar fasciopathy
increased PF ROM = ankle instability and resulting excessive pronation
high BMI
running
impaired 1st MTP EXT
increased age
78
what are unclear RF for plantar fasciopathy
decreased DF= limits PE
excessive dynamic pronation
excessive standing calcaneal eve
79
how does plantar fascia assist gait
windlass effect that is PE developed by normal foot and ankle motion
80
what structures are involved with plantar fasciopathy
foot intrinsic= strains
heel pad thinning
achilles fibers connected
bone spur- plantar fascia thickening
81
what can cause plantar fasciopathy
fasciosis
neoplastic
inflammation
82
what are the symptoms of plantar fasciopathy
gradual onset of heel pain
medial more affected with first step in AM
worse with WB
83
what can we observe with plantar fasciopathy
thick plantar fascia
impaired LE control
excessive dynamic pronation
static calcaneal eve
84
what is in a SCAN for plantar fasciopathy
ROM- limited/painful DF and 1st MTP ext
RST- weak and painful toe flx
85
what is in a BE for plantar fasciopathy
sp test- plantar fascia taut
palpation- TTP over medial calcaneal arch
86
what is the PT Rx for plantar fasciopathy
Pt edu
POLICED
modalities
MT
MET
taping
orthotics
87
how can MT improve plantar fasciopathy
normalize mobility and m length for pain ROM and function
88
what joints should be focused on for MT for plantar fasciopathy
impaired DF and 1st MTP ext
89
how does stretching benefit plantar fasciopathy
calf and plantar fascia both improve pain
90
how can other joints affect plantar fasciopathy
knee limited ext causes tibia IR causing excessive pronation
hip/knee kinematics or impaired LE control can affect the foot and how it compensates
91
what passive treatment is better for a pt with plantar fasciopathy
orthotics
92
what MET is good for plantar fasciopathy
toe ext with achilles tendinopathy RX
post tib
hip antigravity
93
what structures can be involved with shin splints
post tib
ant tib
periosteum
94
what are risk factors for medial tibial stress syndrome
female
high BMI
running injury
excessive pronation
increased PF ROM
greater hip ER ROM
95
what causes medial tibial stress syndrome
increased load on post tib leading to subsequent tension and inflammation
96
what are the symptoms of medial tibial stress syndrome
gradual onset of medial shin pain
worse with exercise, NOT ADLs
no cramping, burning, or tingling
1/3 have co existing leg injuries
97
what is in the SCAN for medial tibial stress syndrome
ob- overstriding leading to greater heel strike, impaired LE control
RST- weak and painful PF and inv, limited hip ext/abd strength
98
what is in BE for medial tibial stress syndrome
pain with heel raises
palpation- TTP over post med border of distal 2 in tibia
99
what us the PT Rx for medial tibial stress syndrome
POLICED
Pt edu
taping/orthotics
MT- limited DF
MET
100
what movement patterns help with medial tibial stress syndrome
reduce LE IR
decrease hell strike- land soft
101
what MET should be done for medial tibial stress syndrome
improve hip antigravity
improve PF and INV
address spinal stabilization
102
what is the primary focus of MET for medial tibial stress syndrome
unload post tib and tibia
103
what is the difference between stress reaction and fx
stress reaction = periosteal inflammation
stress fx= cortical break
104
what area is most. common for bone stress injury in runners
tibia
105
what is the most common metatarsal for bone stress injury and AVN
5th
106
what zone of the 5th MTP is susceptible for AVN
zone 2
107
what are the RF for bone stress injuries
high forces
impaired LE control
longer stride
repetitive jumping
weak
lack of training
108
what is the pathology of bone stress injuries
increasing load and frequency without recovery
109
what are the symptoms of bone stress inuries
worse with ADLs and exercise
110
what is the PT Rx for bone stress injuries
diet= decreased BMD
111
when does BMD decrease and increase
decrease at growth spurt
increase 4 yrs after
112
how should PT be managed with adolescent bone stress injuries
cannot have pain
graded loading
113
when does BMD return to baseline for tibial stress fx
between 3-6 months post fx
114
what can cause compartment syndrome
blunt trauma
overuse
115
what is the pathology of compartment syndrome
increased swilling with limited fascia extensibility that compresses neurovascular structures in the ant leg compartment
116
what are symptoms of compartment syndrome
recent blunt trauma or overuse
primarily cramping, burning, tingling
lengthening DF adds compression
DF weakness
117
what are the 6 Ps for compartment syndrome
pain
palpation
paresthesia
paralysis
pallor
pulselessness
118
what is Pott's fx
bimalleolar- distal tibfib
trimalleolar- distal tibfib plus post tib rim
119
what is the most common tarsal fx
calcaneus
120
what is the most common region to have a fx below the knee
forefoot- 5th MTP
121
what can cause ARJC in the foot
longer 1st ray
trauma
genetics
122
what are symptoms of ARJC in the foot
gradual onset
AM stiffness
dorsal jt pain
painful asymmetric gait especially with inclines
123
what can we observe with a patient that has ARJC in the foot
hallux valgus
mallet toe
hammer toe
claw toe
124
what is in a SCAN for ARJC in the foot
ROM- great toe loss of EXT>ABD
CM- consistent block
ST- + compression
125
what accessory motion can be performed with ARJC in the foot
hypo 1st MTP ext (sup glide)
DF
sesamoid bones
126
what MET is good for ARJC in the foot
impaired LE control contributing to excessive pronation
127
what is morton's neuritis/oma
compression of interdigital nerves
128
what can cause morton's neuritis/oma
excessive pronation
small show box with/without heels
limited 1st MTP ext
129
what is tarsal tunnel
entrapment of tibial n at flexor retinaculum
130
what can cause tarsal tunnel
excessive pronation leading to excessive tension and compression of tibial n
