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PT 515 Musculo > Foot/Ankle Potential Pathologies > Flashcards

Foot/Ankle Potential Pathologies Flashcards

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1
Q

Foot/Ankle Potential Pathologies

A 
Fx
Achilles Tendon Rupture
DVT
Sprains
Instability
Strains
Plantar Fasciitis
Osteochondral Injuries
OA
Capsular Restrictions
Peripheral Nerve injuries
Diabetic Foot
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2
Q

Foot fractures common sites

A

5 Met
Stress fx of the mets
Calcaneus

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3
Q

Foot fx common MOI

A

overuse or trauma

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4
Q

Stress fx symptoms

A

swelling
tenderness
gait change
reproduction of cc by performing activity

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5
Q

Special tests stress fx

A

Metatarsal compression test

Tuning fork

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6
Q

Ottawa Ankle Rule Ankle X-Ray required if

A
  • Pain in anterior aspect of medial or lateral malleoli and anterior talar dome area
  • Bone tenderness at posterior medial malleolus
  • Bone tenderness at lateral malleolus
  • Inability to bear weight on the limb immediately after the injury and in the ER
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7
Q

Ottawa Ankle Rule Foot X-Ray required if

A
  • Pain in dorsal medial and lateral aspect of the midfoot
  • Bone tenderness at the base of the 5th metatarsal
  • Bone tenderness at navicular
  • Inability to bear weight on limb immediately after the injury and in the ER
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8
Q

Metatarsal Compression Test

A

Morten’s Test
Positive pain with metatarsal fx or neuroma
False positive in pt with metatarsalgia
Unclear evidence to support this

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9
Q

Tuning Fork

A

For fibular fx
Pt supine, stethoscope is placed on fibular head, hit a tuning fork on lateral malleolus
Positive if there is a different sound in bilateral comparison
Minimal evidence to support it

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10
Q

Achilles Tendon Rupture

A

MOI: trauma jumping or landing, prolonged steroid use?
Symptoms: “Hit” in the back of the anke, “pop”, weak
Special tests:
-Bilateral Toe Raise
-Thompsons test

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11
Q

Thompson Test

A

Squeeze gastroc w/ patient in supine, foot should PF
Positive test if nonresponsive ankle PF during test
Unclear evidence to support this

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12
Q

Deep Vein Thrombosis

A 
MOI: Insidious, after recent surgery or immobilization
Signs/symptoms
-calf pain, ankle swelling
-Antalgic gait
Special Tests:
-Homan's sign
-Calf Swelling
-Well's CPR for DVT
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13
Q

Homan’s Sign

A

Positive test is popliteal and/or calf pain
Many presentations may lead to false positive
Minimal evidence to support this

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14
Q

Calf Swelling

A

Positive test if bilateral comparison is difference of 15 mm for men or 12 mm for women
Minimal evidence to support this

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15
Q

Well’s Clinical Prediction Rule for DVT

A

Asking questions regarding recent events
Positive test related to score on the test
Strongly supported by evidence
Great for screening and ruling out an ER trip

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16
Q

Ligamentous Injuries

A

Inversion/Supination: Lateral ligaments
Eversion/Pronation: Deltoid ligaments
Syndesmosis Injuries

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17
Q

Acute Lateral Ankle Sprain

A 
MOI: Trauma Inv/PF
Symptoms:
-Difficulty in activity
-Lateral ankle pain
-Medial ankle pain: Kissing lesion
-Swelling
-Ecchymosis
-Painful WB and ROM
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18
Q

Kissing Lesion

A

Medial aspect compromised because of medial malleolus and talus contact during inversion

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19
Q

Grade I Acute Ankle Sprain

A

Mild (2 weeks rehab)
-Mild effusion, no hemmorrhage
-Negative anterior drawar, negative varus laxity
-Pain with inversion and PF
Little to no limp, but trouble with hopping

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20
Q

Grade II Acute Ankle Sprain

A

More swelling, hemmorrhage likely present
Positive anterior drawer, no varus laxity at neutral
Limping with walking, unable to raise on toes/hop/run

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21
Q

Grade III Acute Ankle Sprain

A 
Immobilization 1-10 days, 8-10 weeks of rehab
Diffuse swelling, hemmorrhage
Significant instability
Complete tears of ATFL and CFL
Unable to FWB
Decreased ROM
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22
Q

Chronic Ankle Sprains

A

Patient reports giving way with no pain in between inversion episodes
Leads to chronic instability
If ll. are lengthened beyond patients control then surgery is necessary

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23
Q

Anterior Drawer Ankle

A

Positive test if pain reproduced laterally or excessive gapping betwen the distal lateral malleolus and calcaneous

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24
Q

Longitudinal fibularis tendonitis/subluxation

A

-Swollen, tender, painful posterior to lateral malleolus
-Pain with AROM eversion
-Minimal response to PT intervention
May seem like lateral ankle sprain

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25
OCD/Loose bodies within joint
Effusion Crepitus felt when palpating medial/lateral talus "catch" "lock" "give way" Can look like lateral ankle sprain
26
Anteriorlateral synovitis or impingement
``` No swelling Point tenderness at anteriolateral junction of tib/fib Pain with DF, Increased activity, stairs May look like lateral ankle sprain Use Forced DF test to rule in or out ```
27
Talar Tilt
- Positive if pain is reproduced or excessive gapping between the distal lateral malleolus and calcaneous - DF to bias PTFL, Neutral for CFL, PF for ATFL
28
Posterior Drawer Test
Positive test if pain is reproduced or excessive gapping between distal lateral malleolus and calcaneus
29
Eversion Stress Test
- Positive test if pain is reproduced medially over deltoid ligament or excessive compression at lateral aspect between distal lateral malleolus and calcaneus - For acute medial ankle sprain
30
Syndesmosis Injuries
``` MOI: Leg rotation with immobile foot S/S: Pain in anterior distal shin; difficulty ambulating and decreased ROM (DF>PF) Special Tests: -Fibular translation test -Crossed Leg test -Kleiger test ```
31
Fibular Translation test
Positive if pain produced with fibular translation and more displacement compared to contralateral side -Tests for syndesmosis injury
32
Crossed Leg Test
Positive test if pain produced is chief complaint Therapist assists by applying gradual pressure w/ test -Tests for syndesmosis injury
33
Kleiger Test (ER stress test)
Positive if pain produced is cc. Unclear evidence to support this test, it may also test medial ligaments. -Tests for syndesmosis injury
34
Musculotendinous Injury
MOI: Poor footwear; Tight muscles; Overuse Imbalance | S/S: Pain with active contraction and passive lengthening
35
Posterior heel Musculotendinous injury
Achilles tendonitis (Insertional v. Non-insertional) Acute Rupture Chronic Rupture
36
Medial Foot musculotendinous injury
Posterior tibialis tendon insufficiency
37
Non-Insertional Achilles Tendonitis
Above insertion of achilles tendon MOI: Overuse; increased running intensity; shoe change Types: -Paratendonitis -Tendonosis -Paratendonitis with tendonosis S/S: -may improve w/ mild activity -Mild ache in posterior leg post activity -more pain after prolonged activity or stairs -Tenderness or stiffness, especially in am -bulbous area mid-tendon
38
Insertional Achilles Tendonitis
At insertion onto calcaneus MOI: Overuse, increased running intensity, shoe change Types: -Haglund's Deformity -Pretendon Bursitis -Retrocalcaneal Bursitis S/S: -may improve w/ mild activity -Mild ache in posterior leg post activity -more pain after prolonged activity or stairs -Tenderness or stiffness, especially in am -Active inflammation -Tenderness, swelling over insertion
39
Paratendonitis
Inflammation of the lining around the tendon
40
Tendonosis
Noninflammatory, age related degeneration of the tendon itself
41
Paratendonitis with tendonosis
Paratendon inflammation with infratendinous degeneration
42
Haglund's deformity
Enlargement on the back of the heel
43
Pretendon bursitis
located anterior to the tendon
44
Retrocalcaneal bursitis
located posterior to the tendon
45
Achilles Tendonitis special tests
SLS (single leg stance) heel raises Thompson test Foot/ankle biomechanical exam
46
Achilles Tendon Rupture
``` Age: Typically 30-40 Weekend warrors; explosive activities Medications -Antibiotics -Systemic corticosteroids Palpable defect; severe loss of function ```
47
Surgical vs Non surgical Achilles Tendon Rupture
Less risk of re-rupture with non-surgical repair Non-surgical: -Immobilized in 20 degrees PF for at least 4 weeks w/ progressive WBAT Surgical: -Standard vs accelerated program -Initially NWB w/ immobilization 4-6 weeks -Slowly increased WB in CAM boot with DF ROM neutral at 6 weeks -Accelerated protocol may be earlier WB and Earlier DF Neutral
48
Posterior Tibialis Tendon Dysfunction/Insufficiency
``` MOI: Inflammation and degeneration of the tendon progresses to lengthening and mechanical insufficiency S/S: -Acute or gradual onset -pain in medial long arch -secondary pain in lateral hindfoot -pain/weak MMT -hindfoot valgus -medial talar bulge Special Tests: Too many toes sign, No inversion w/ heel raise ```
49
PTTI Stage I
S/S: Pain with inversion | Rx: Rest tendon, modalities, walking brace
50
PTTI Stage II
S/S: History of pain 2-3 years, no rearfoot inversion during unilateral heel raise Rx: Walking brace 4 weeks and orthotics (6 months)
51
PTTI Stage III
S/S: Fixed hindfoot deformity (Valgus) with a compensated forefoot, arthrosis of STJ Rx: Triple arthrodesis (fusion), heel cord lengthening
52
Plantar Fasciitis
MOI: Direct repetitive microtrauma, pes planus or cavus, increased BMI, prolonged standing, reduced DF ROM S/S: -Pain/stiffness in AM and after prolonged sitting -Recent change in intensity of running -worse walking barefoot -point tenderness over medial calcaneal tubercle
53
Plantar Fasciitis differential diagnosis and treatment
Achilles tendonitis vs peripheral nerve entrapment Acute -85% of patients will get better within 10 months -NSAIDs, DF, night splints, OTC insoles Chronic -Repetitive partial tear and chronic irritation -Patients with symptoms past 10 months need to consider different diagnosis and r/o entrapment symptoms
54
NWB examination
PROM IR/ER Hip Tibial Torsion Subtalar Neutral Forefoot to rearfoot position
55
Weight bearing examination
``` Tibial varum Rearfoot valgus/varus Navicular drop test Forefoot adduction/abduction Bilateral comparison of navicular height (Feiss line) ```
56
Osteochondral Injuries
``` MOI: OCD s/p traumatic ankle sprain Most common in the talus S/S: Pain during terminal stance, decreased standing tolerance, aching during rest Special Tests: -Blind stance ability vs FTPO -Treadmill tolerance test -Step-up tolerance test -Step-down tolerance test -unilateral toe raise tolerance test -balance tests ```
57
Non-surgical intervention osteochondral injuries
Period of immobilization and NWB to allow for cartilage to heal
58
Surgical Invterventions osteochondral injuries
Debridement Fixation of the injured fragment Microfraxture or drilling of the lesion Transfer or grafting of bone and cartilage
59
Rheumatoid Arthritis
Inflammation of the joint capsule | Will often affect the metatarsals and digits
60
Gout
Excessive amounts of uric acid | Often affects the great toe
61
Osteoarthritis
Degenerative - Redness, inflammation, swelling - Pain and stiffness particularly in the morning or after rest - OA progresses more rapidly due to previous joint injury
62
Osteoarthritis Criteria for diagnosis
``` Age >50 Stiffness >30 minutes Crepitus Bony tenderness Bony enlargement No palpable warmth ```
63
Capsular Restriction
``` MOI: Post ankle immobilization, develops over time Presentation -Capsular pattern during AROM/PROM TC pattern PF>DF 1st MTP pattern DF>PF ```
64
Tarsal Tunnel Syndrome
``` MOI: Insidious, RA S/S: -Difficulty localizing pain, diffuse burning, worse at night Special tests: -Tinel's sign at the tarsal tunnel ```
65
Distal Tarsal Tunnel Syndrome
``` Baxter's nerve: lateral plantar nerve Population 40-50 y/o MOI: >9 month hx of plantar fascia type pain, long distance runners S/S -Pain at medial calcaneal tubercle -Decreased sensation at lateral heel -Unable to abduct 5th digit ```
66
Diabetic Peripheral neuropathy
Neuropathic Ulcers
67
Diabetic Charcot neuropathy
Osteomyelitis | Charcot Neuropathic Fractures and dislocations
68
Diabetic Foot
Prevention is the best treatment - Daily foot inspections - Appropriate footwear - Custom diabetic inserts
69
SLR Nerve biases
Tibial nerve bias: DF, eversion Fibular nerve bias: PF Inversion Sural nerve bias: DF, Inversion

PT 515 Musculo (18 decks)

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