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MSK II > Foot and Ankle 1 (test 4) > Flashcards

Foot and Ankle 1 (test 4) Flashcards

(73 cards)

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1
Q

Functional questionaires for ankle sprains

A

cumberland ankle instability tool

foot and ankle ability measure

LE functional scale

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2
Q

incidence/prevalence of ankle sprain

A

very frequent in sports

up to 1/4 people are unable to attend work for >1 wk

persistent symptoms in 30-72%

80% reinjury rate following inversion sprain

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3
Q

risk factors for ankle sprain

A

previous sprain

lack of external support

lack of warm up

lack of coordination training

impaired DF

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4
Q

what may cause impaired dorsiflexion

A

shortened triceps surae

talar hypomobility (decreased posterior glide or ER)

fibrosed capsule (universal hypo; limited distx compared to other side and all glides limited)

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5
Q

limited DF may cause escessive load where

A

lateral foot bc talocrural jt NOT reaching CPP and staying in supination longer before pronating

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6
Q

common etiology of ankle sprains

A

PF > inversion

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7
Q

most commonly torn ankle ligament

A

anterior talofibular

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8
Q

when is the calcaneofibular ligament often torn

A

primarily with pure IV

on slack with PF so not torn then

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9
Q

what are the 3 lateral talocrural ligaments

A

Anterior talofibular (ATF)
Calcaneofibular (CF)
Posterior talofibular (PTF)

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10
Q

what are the subtalar or talocalcaneal ligaments involved in lateral sprains

A

intraarticular = anterior interosseous

extraarticular = lateral attaches and runs parallel to CF ligament so they will likely be damaged together

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11
Q

what mechanism may strain the calcaneifibular ligament and the lateral talocalcaneal ligament (LCL)

A

Inversion and DF

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12
Q

what mechanism may strain the anterior talocalcaneal ligament

A

inversion and plantar flexion

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13
Q

how might the bone be involved with a lateral ankle sprain (and mechanism)

A

avulsion fx or lateral malleolus (ligament attachment)

avulsion fx of 5th MT (excess action of peroneus brevis)

medial malleolus fx (excess IV)

cuboid displacement (excessive action peroneus long.)

ant. subluxed fibula on tibia (reversed m action of peroneals)

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14
Q

what muscles/tendins may be involved with a lateral ankle sprain

A

possible peroneal strain and/or sublux if retinaculum is torn

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15
Q

symptoms of a lateral ankle sprain

A

sudden onset with trauma by “rolling ankle” and foot turning inward

lateral ankle P!/swelling

limited and painful ROM especially with pointing foot inward

difficulat and painful WBing

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16
Q

observation with a lateral ankle sprain

A

swelling with possible ecchymosis

antalgic/asymmetrical gait

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17
Q

what is the purpose of the Ottawa and Bernese ankle clinical decision rules

A

determine the need for a radiograph

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18
Q

ROM findings with a lateral ankle sprian

A

primarily limited in PF and IV

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19
Q

resisted test findings for a lateral ankle sprain

A

weak and painful EV

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20
Q

acessory motion findings for lateral sprain

A

likely hypermobile anterior talar glides due to ATF laxity

possibly hypomobile cuboid from sublux

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21
Q

special tests for a lateral ankle sprain

A

anterior and reverse anterior drawer

ATF = anterior lateral drawer and reverse anterior lateral drawer and anterior lateral talar palpation

CF = medial talar tilt

PTF

subtalar = anterior interosseous and lateral interosseous

TTP over involved structures

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22
Q

etiology of medial ankle sprains

A

excessive EV

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23
Q

structures that may be involved with a medial ankle sprain

A

deltoid lig (connect tibia to talus, calcaneus, and navicular + medial arch reinforcement)

dubtalar or talocalcaneal ligaments (intraarticular = post interosseous and extra = medial)

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24
Q

non-ligamentous structures that may also be involved with medial sprains

A

bone = avulsion fx of medial malleolus

epiphyseal plate of medial malleolus

possible post tib strain and/or sublux if flexor retinaculum is torn

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25
symptoms of a medial ankle sprain
sudden onset with trauma + ankle turning out medial ankle pain/swelling limited/painful ROM, especially turning out pain with WBing
26
what could you observe with a medial ankle sprain
swelling possible ecchymosis antalgic/asymmetrical gait
27
ROM and MMT findings with medial ankle sprain
ROM = primarily pain/limits with EV MMT = possible weak/painful IV
28
accessory motion findings for medial sprain
potentially hypermobile calcaneal EV glides
29
special tests for a medial ankle sprain
talocrural -general = anterior and reverse anterior drawer -specific = medial lig tests for deltoid ligs subtalar -general = medial calcaneal glide -specific = post interosseous and medial lig tests
30
what is a syndesmotic sprain
high ankle sprain
31
etiology of a syndesmotic sprain
primarily DF (bc talus is wider anterior than posterior) excessive talar posterior glide with ER aka peeling mechanism possibly EV
32
what ligaments are involved with a syndesmotic in order
1st = Anterior inferior tibio fibular ligament 2nd = interosseous membrane or syndesmosis 3rd = posterior inferior tibio fibular ligament 4th = deltoid ligaments
33
what bones may be involved with a high ankle sprain
talar or distal tib/fib fx
34
symptoms of syndesmotic sprain
sudden onset with trauma with ankle bent up often anterior ankle pain or swelling limited and painful ROM, especially with DF pain with WBing
35
observation of a syndesmotic sprain
swelling possible ecchymosis antalgic/asymmetrical gait
36
ROM and MMT findings for high ankle sprain
ROM = limited and painful with DF and possibly EV MMT = weak and painful; no specific direction
37
accessory motion findings for syndesmotic sprain
likely hypermobile post talar glides
38
special tests for syndesmotic sprain
inferior tib/fib lig -general = reverse post drawer -specific = fibular ant/post translation possibly same as medial ankle sprain single leg hop test (inability is most sensitive test for syndesmotic test)
39
what is chronic ankle instability
CAI presence of functional or mechanical instability
40
risk factors for CAI
increased talar curvature lack of external support lack of cordination training following prior sprain
41
etiology of chronic ankle instability
past severe and or recurrent sprains 80% re-injury rate following IV sprain
42
S&S of CAI
acute S&S if aggravated; otherwise may be asymptomatic S&S of hypermobility/instability plus: -decreased postural stability and plantar sensation -altered muscle activation patterns -aberrant joint motion -fibula is significantly more lateral from tibia
43
PT rx for sprains outside of MET/MT
90% success brief immobilization period modalities modtly conflicting evidence; cryotherapy good for pain/swelling/gait; US should NOT be used with acute bracing/taping for protection/function -bracing = reduced risk and frequency -talar technique to limit anterior glide -distal tib/fib technique for high ankle sprains; limits separation and anterior distal fibular glide
44
MT for sprains
STM including lymphatic drainage for swelling JM with MET -ROM/proprioception/tissue tolerance -AP talar JM -hypo analgesic effect and subsequent increased ROM
45
MET for sprains
goal = tissue proliferation and stabilization positional/directional biases? balance and neuromuscular training -prevents reoccurance -improved balance and inversion jt position sense and greater motor neuron excitability
46
prognosis for return to activity for grade I sprain
1-2 weeks avg 7.2 days with track and field athletes
47
prognosis for return to activity for grade II sprain
2-6 weeks avg 15 days with track and field athletes
48
prognosis for return to activity for grade IIIsprain
> 6 weeks avg 30-55 days with track and field athletes
49
what is the MD Rx for CAI
CAI sx; "christman-snook procedure for mechanical ankle instability drill holes in fibula and calcaneus split portion of peroneus brevis tendon tendon is inserted into drill holes and attached into itself
50
outcomes of CAI sx for sprains
no one procedure is better than another early functional rehab appears superior to 6 weeks immobilization in restoring early function
51
what makes up the forefoot
metatarsals and phalanges
52
what makes up the midfoot
navicular, cuboid, and cuneiforms 2nd MT is a keystone in between the medial and lateral cuneiforms
53
what makes up the rearfoot
talus and calcaneus
54
what makes up the lateral foot or column and what is its functional purpose
4th and 5th rays and cuboid and calcaneus functions more for shokc absorption from heel strike to just before heel off strong ligaments are a storehouse of potential energy on the lateral longitudinal arch
55
what makes up the medial foot/column and its functional purpose
1dt ray thru the 3rd rays and the cuneiforms and talus functions more for propulsion just before heel off to toe off less ligament support vs lateral foot
56
how much DF occurs with knee extension and flexion and when does it occur in the gait cycle
knee extended = during heel/toe off; 10-15 deg knee flex = during stairs; 15-25 during ascent; 20-35 during descent
57
how much PF is needed for stairs
15-30 deg for walking and stairs
58
how much MTP hyperext is needed at the first MTP
at least 65 deg at heel/toe off
59
what structures help maintain the arches of the foot
ligaments and aponeurosis = most support shape of the bones and their relation to each other muscles = only 15-25% of support so minimal ability to "strengthen" any abnormal arch flattening
60
what is subtalar neutral
talus is centered in talocrural andn on calcaneus aka position talus should be in
61
best measurement of medial longitudinal arch
standing position = not predictable of dynamic fxn measuring from video or 3D analysis is more reliable
62
how does the foot move during the gait cycle from heel strike to foot flat
supination with heel strike (PF, IV and ADD) PF eccentrically controlled by tibialis anterior
63
how does the foot move from foot flat through heel off
DF, EV, ABD eversion primary control is tibialis posterior max ankle DF and talar ER with ABD of foot
64
how does the foot move from mid stance to heel off
all arches are maximally flattened when all MT heads contact the ground knee ER and hip IR while both maximally extend/hyperextend (up to 10 deg)
65
how is potential energy built in the foot
foot ligaments middle and posterior ankle ligaments ankle PFs interosseous membrane as tib/fib seperates with DF knee and hip structures per prior lecture
66
what happens from heel off to toe off in terms of load bearing and potential energy
1st ray bears most of the load of the foot 1st MTP maximally hyperextends and PE is built through the plantar fascia tightening
67
what happens when PE is releases from toe off to swing
opposing motions occur for propulsion great toe flexion ankle PF and talus IR knee flexes and IR hip flexes and ER
68
what is excessive pronation
earlier, extended, and or excessive combo of DF, EV, and ABD
69
most common reason of excessive pronation related to hypermobility/instability
tib fib or talocrural hypermobility/instability (more common) or impaired LE control (top down influence)
70
less common mechanism for hypermobility related excessive pronation
subtalar or medial knee hypermobility
71
how can adj joint hypomobility cause excessive foot pronation
limited talocrural DF may lead to midfoot and forefoot excessive EV and ABD limited knee ext may lead to excessive DF hip wont compensate bc hip is IR where knee and talus are ER
72
what might limited DF lead to
excessive loading on lateral foot and staying in supination longer = more common for lateral sprains compensatory/excess knee ext
73
LQ conditions associated with limited DF
1st MTP DJD mortons tarsal tunnel plantar fascitis 5th MT stress fx lateral ankle sprain achilles tendinopathy severs MTSS

MSK II (18 decks)

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