Foot & Ankle Overuse Flashcards
(44 cards)
What is involved in a LE exam?
- Hx w/ mech of injury
- Observation
- Palpation
- ROM
- Neurovascular
- Provocative Testing
What does Anterior Talofibular ligament do?
Prevents forward displacement (Drawer sign)
What does Posterior Talofibular Ligament do?
Prevents backward displacement
What does Calcaneofibular ligament do?
Prevents inversion (Talar Tilt)
What are the Classifications of Sprains/Strains?
- Grade I: Gen. intact tensile strength (no gapping), TTP.
- Grade II: In between, with pain and slight gapping upon stress
- Grade III: Complete disruption with no tensile strength, sloppy end-feel with gapping/indentation.
Inversion Stress testing classification
- Grade I: No gapping
- Grade II: Slight gapping
- Grade III: Major gapping (correlate w/ xray & anterior drawer)
Grade I (1st degree) Lateral ankle sprain
- Ligament integrity
- Conservative care, wt. bearing w/ brace immediately
- Minimal swelling
Grade II (2nd degree) Lateral Ankle Sprain
- Partial tearing (slight laxity)
- “Goose egg” swelling*
- Lateral stabilizing ankle brace & protected wt bearing
- Early rehab
Grade III (3rd degree) Lateral Ankle Sprain
- Complete rupture
- Immediate diffuse swelling, heard “pop” (classic history)*
- Immobilize 3-4 wks., rehab, and (rarely) surgery
What is the MC type of ankle sprain?
Inversion (80%)
What are the Ottawa rules for X-ray?
- Tenderness over inferior or posterior pole of either malleolus
- Inability to bear weight (4 steps taken independently, even if limping)
- Tenderness along base of 5th metatarsal or navicular bone
- Pediatric population <18yo
What is the most critical finding on the Anterior Drawer test?
Increased laxity→ Grade III ATF tear
What are the Classifications of overuse
- Grade I: Pain after activity only
- Grade II: Pain w/ activity, but does not significantly restrict performance
- Grade III: Pain w/ activity w/ significant performance restriction
- Grade IV: Pain with activity & rest
What causes Stress fractures?
Occur when damage from cyclical loading of a bone overwhelms its physiologic repair capacity
Can lead to gross fx
Who are Stress Fractures common in?
Young active adults involved in vigorous (excessive) exercise w/ no single acute event
What are the MC stress fracture sites in runners??
Metatarsals (2nd or 3rd) or calcaneus
What are the clinical findings in a stress fracture?
Pain at rest accentuated w/ walking, can have swelling & usually point tenderness
What imaging is needed w/ a stress fracture?
Xray if suspect (may be neg. initially), bone scan, CT or MRI for definitive diagnosis
What is the tx for a stress fracture?
- Rest until healing occurs
- Resolution of tenderness/ walk w/o pain
- Signs of healing on Xray
- Continuous activity can lead to complete fracture
What is the tx for Achilles Tendonitis?
- Heel lift (1/4”)
- Decrease (stop) running/jumping
- Stretching exercises
- Arch supports or Custom orthotic if due to hyperpronation
- NSAIDS/ice
- No steroid injections!
- Surgery (excise areas of fibrosis or calcium from tendon, or some bone) seldom needed
What is the cause of Peroneal Tendonitis?
- Inflammation from acute trauma
- Repetitive motion (recurrent rubbing of peroneal tendons on distal end of fibula)
- Inflammatory arthropathy
What are the clinical findings of Peroneal tendonitis?
- Lateral ankle pain
- Made worse w/ activity
- Improved w/ rest/NSAIDS
- Tenderness along peroneal tendons
- Pain/weakness w/ resisted eversion
What is the tx for Peroneal Tendonits?
- RICE
- NSAIDS
- Cast for 4-6 weeks if severe
- Surgery (rare)-inflamed synovium removed
Who gets Posterior Tibial Syndrome?
Runners w/ hyperpronation
