Foot/Ankle Potential Pathologies Flashcards Preview

PT 515 Musculo > Foot/Ankle Potential Pathologies > Flashcards

Flashcards in Foot/Ankle Potential Pathologies Deck (69):
1

Foot/Ankle Potential Pathologies

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

2

Foot fractures common sites

5 Met
Stress fx of the mets
Calcaneus

3

Foot fx common MOI

overuse or trauma

4

Stress fx symptoms

swelling
tenderness
gait change
reproduction of cc by performing activity

5

Special tests stress fx

Metatarsal compression test
Tuning fork

6

Ottawa Ankle Rule Ankle X-Ray required if

-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

7

Ottawa Ankle Rule Foot X-Ray required if

-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

8

Metatarsal Compression Test

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

9

Tuning Fork

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

10

Achilles Tendon Rupture

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

11

Thompson Test

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

12

Deep Vein Thrombosis

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

13

Homan's Sign

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

14

Calf Swelling

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

15

Well's Clinical Prediction Rule for DVT

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

16

Ligamentous Injuries

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

17

Acute Lateral Ankle Sprain

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

18

Kissing Lesion

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

19

Grade I Acute Ankle Sprain

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

20

Grade II Acute Ankle Sprain

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

21

Grade III Acute Ankle Sprain

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

22

Chronic Ankle Sprains

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

23

Anterior Drawer Ankle

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

24

Longitudinal fibularis tendonitis/subluxation

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

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