Lower Leg and Ankle Flashcards
(117 cards)
1
Q
what are the most common injury in US collegiate sport (contribute to 15% of injuries reported)
A
lateral ankle sprain
2
Q
ankle injuries are most common in ?
A
competition (game time) over practice
3
Q
ankle injuries represent ? out of the reported 10000 exposures reported in US high school sport
A
5.23
4
Q
2 contributing factors to ankle injuries
A
types of playing surfaces and conditions
5
Q
neglecting injuries can result in
A
long term injuries
6
Q
what bone translates all the forces of the foot
A
the talus
7
Q
hyaline cartilage covering and no muscle attach to it (what bone)
A
the talus
8
Q
what are the 3 main lateral collateral ligaments of the foot and what 2 usually get hurt in conjunction with each other
A
posterior talofibular ligament
calcaneofibular ligament *
anterior talofibular ligament *
*= usually get hurt in conjunction with one another
9
Q
the deltoid ligament gives supports to what side of the ankle?
A
medial
10
Q
why is it good to ice muscles?
A
the muscular compartments can swell and out pressure on the fascia
11
Q
the ankle is what type of joint?
A
hinge joint
12
Q
medial and lateral displacement of the ankle is prevented by?
A
the malleoli
13
Q
what limits eversion and inversion at the subtalar joint
A
ligaments
14
Q
the square shape of the talus is good for what?
A
adds to stability of the ankle
Mortise stabilized by bony configuration, passive & active structures
15
Q
the ankle is most stable during? and least stable during?
A
dorsiflexion
plantar flexion
16
Q
how many degrees of motion of dorsiflexion does the ankle have and how many in plantar flexion
A
10 degrees
50 degrees
17
Q
normal gait requires what range of motion ?
A
10 degrees of dorsiflexion and 20 degrees of plantar flexion with the knee fully extended
18
Q
normal ankle function is dependent on what?
A
the action of the rear foot and the subtalar joint
19
Q
the ankle plays a critical link in what?
A
the kinetic chain
20
Q
5 preventative measures to take for ankle and lower leg injuries
A
- achilles tendon stretching
- strength training
- neuromuscular control training
- footwear
- preventative taping and orthosis
21
Q
2 types of special testing for ankle and lower legs injuries
A
- Percussion and compression tests for fracture
- Ottowa ankle rules
22
Q
a tight heal cord may limit what?
A
dorsiflexion leading to increase chance of injury
23
Q
Achilles tendon stretching techniques
A
- routinely stretch before and after practice
- stretching should be performed with knee extended and flexed 15-30 degrees (stretch the soleus when bent and gastroc when straight)
24
Q
strength training techniques for injury prevention of lower lag and ankle
A
- Static and dynamic joint stability is critical in preventing injury
- While maintaining normal ROM, muscles and tendons surrounding joint must be kept strong
25
neuromuscular control techniques for injury prevention of lower leg and ankle
- Can be enhanced by training in controlled activities
| - Uneven surfaces, BAPS boards, rocker boards, BOSU
26
injury prevention technique for footwear
shoes should not be worn in activities they are not made for
27
preventative taping and orthosis techniques for injury prevention of lower leg and ankle (4)
-Tape can provide some prophylactic protection
– Improperly applied tape can disrupt normal biomechanical function and cause injury
– Lace-up braces have even been found to be superior to taping relative to prevention
– Bracing can impact ankle & knee biomechanics
28
a blow to the tibia, fibula or heel to create vibratory force that resonates w/in fracture (pressing)
percussion test
29
involves compression of tibia and fibula either above or below site of concern (can flick the bone)
compression test
30
what can also be used to create vibration at the site of an injury
tuning forks
31
Used for determining need for radiograph
ottawa ankle rules
32
according to the ottawa ankle rules, X rays a required if: (4)
-Pain in malleolar or midfoot area (on the bone itself)
– Tenderness over inferior or posterior pole of either malleoli
– Inability to bear weight (4 steps taken independently, even if limping) at time of injury and/or evaluation
– Tenderness along base of 5th metatarsal or navicular bone
33
for functional testing, while weight bearing the following should be performed (6)
-Walk on toes (plantar flexion)
– Walk on heels (dorsiflexion)
– Walk on lateral borders of feet (inversion)
– Walk on medial borders of feet (eversion)
– Hops on injured ankle
– Passive, active and resistive movements should be manually applied to determine joint integrity and muscle function
34
what ligament is most likely to be injured in an inversion ankle sprain (injured with inversion PF and IR)
anterior talofibular ligament
35
if the anterior talofibular ligament ruptures it can create what kind of ankle instability
rotary
36
what ligaments are more rare to injure during an inversion ankle sprain but may be injured if there is great impact with an upward force
posterior talofibular ligament and calcaneo fibular ligament
37
a great upward force on the foot may do what?
avulse the lateral malleolus (rip a bit of bone)
38
- Occurs with inversion plantar flexion and adduction
| - Causes stretching of the ATF ligament
grade 1 inversion sprain
39
Mild pain and disability; weight bearing is minimally impaired; point tenderness over ligaments and no laxity (what grade of inversion sprain)
grade 1 inversion sprain
40
management of grade 1 sprains
-RICE for 1-2 days; limited weight bearing initially and then aggressive rehab
– Tape may provide some additional support – Return to activity in 7-10 days
41
Moderate inversion force; increased disability/ increased days off
– Pop or snap; moderate pain; difficult to WB; tenderness and edema
(what grade of inversion sprain)
grade 2
42
management of grade 2 sprains
-RICE for at least first 72 hours; X-ray exam to rule out frature; crutches 5- 10 days, progressing to weight bearing
– Begin ROM exercises early with tape/brace
– Long term disability
- chronic instability;
- increased re- injury
– Rehab required to prevent re-injury
43
Relatively uncommon but is extremely disabling
– Caused by significant force (inversion) resulting in spontaneous subluxation and reduction
– Causes damage to the ATF/PTF/CF & capsule
– Is possible to tear the talus out of the joint
grade 3 inversion sprain
44
grade 3 inversion sprain causes damage to?
ATF/PTF/CF ligaments , and possibly tear the talus out of joint
45
Severe pain, swelling, hemarthrosis, discoloration – Unable to bear weight
(what grade of inversion sprain)
grade 3
46
management of grade 3 sprains
-RICE, X-ray (physician may apply dorsiflexion splint for 3-6 weeks)
– Crutches are provided after cast removal
– Isometrics in cast; ROM, and balance/ proprioception exercise once out
– Surgery may be warranted to stabilize ankle due to increased laxity and instability
47
what type of ankle sprain accounts for only 5-10% of sprains
eversion
48
in an eversion sprain what gets damaged?
deltoid; possible fibular fracture
49
-Ligament may impinge & be contused with inversion sprains
– Increased chance of injury with pronated, hypermobile foot
– Tearing medial structures
– Possibility of avulsion
(what type of sprain)
eversion
50
an eversion sprain damages what side?
medial
51
inversion grade 1 sprain causes stretching of what ligament
ATF
52
increased pain; unable to bear weight; and pain with abduction and adduction (what type of sprain)
eversion
53
with a grade 2 or 3 eversion sprain the increased instability may cause weakness where? and result in what?
in the medial longitudinal arch resulting in increased pronation or fallen arch
54
how is eversion sprain tape job different than a inversion
just tape neutral, you don’t pull them inversion and you DON’T figure eight, you DO heel lock though
55
syndesmotic sprain results in damage to what joint? and what ligaments
the distal tibiofibular joint, anterior/posterior tibiofibular ligaments
56
syndesmotic sprain occurs from what?
increased dorsiflexion or excessive or forced external rotation or a driving force to the bottom of the foot
57
Closed position – full dorsiflexion – Intermalleolar distance increases 1.5mm
(what sprain? )
syndesmotic
58
-Can initially appear benign or assume ankle sprain
– Marked pain and tenderness over the anterior syndesmosis (anterolaterally)
-joint weakness
-inability to bear weight
syndesmotic sprain
59
with a syndesmotic sprain you will experience pain in?
dorsiflexion and eversion (active passive and resistive)
60
what type of sprain is also called a high ankle sprain
syndesmotic sprain
61
management of of syndesmotic sprain (whats different than normal sprain management?)
difficult to treat and may take longer, immobilization may also last longer
- surgury may be required
62
Number of mechanisms • Avulsion, bi-malleolar fractures
| - increased swelling and pain and possible deformity
ankle fracture
63
management of ankle fracture
RICE to edema & bleeding
– Walking cast or brace
– Immobilization lasting 6-8 weeks
64
snowboarders ankle is caused from what
fracture of the lateral talar process
65
greater odds of ankle injuries in what bone?
soft bone vs hard bone
66
persistant lateral ankle pain is a sign of what?
snowboarders ankle (lateral talar process fracture)
67
the achilles tendon is how long?
~ 15 cm
68
the achilles tendon inserts where?
calcaneal tuberosity
69
the achilles tendon spirals how many degrees? this results the gastroc fibers inserting ? and the soleal fibers inserting ?
- 90 degrees
- laterally
- medially
70
Common in sports and often occurs with sprains or excessive dorsiflexion
acute achilles strain
71
sometimes you dont feel this injury right away (might just feel like you got kicked there)
acute achilles strain
72
most severe achilles strain involves?
partial/complete avulsion or rupturing of the achilles
73
management of acute achilles strain (4)
-Pressure and RICE should be applied
– After hemorrhaging has subsided an elastic wrap should continue to be applied
– Conservative treatment should be used as Achilles problems generally become chronic
– A heel lift should be used and stretching and strengthening should begin soon
74
an inflammatory condition involving the tendon, sheath or paratenon
achilles tendinitis
75
achilles tendinitis is referred to as ?
tenosynovitis
76
Causes fibrosis and scaring that can restrict tendon motion in sheath
– May lead to tendinosis
achilles tendonitis
77
typically does not present with inflammation, area has lost normal appearance, with cell disorganization/scarring and degeneration
-Tendon is overloaded due to extensive stress • Presents with gradual onset and worsens with continued use • Decreased flexibility exacerbates condition
achilles tendonitis
78
a symptom of achilles tendonitis is generalized pain proximal to?
calcaneal insertion
79
-Warm and painful with palpation, also presents with thickening
– May limit strength
– May progress to morning stiffness
-Crepitus with active PF & passive DF (can sometimes hear it)
– Chronic inflammation may lead to thickening
achilles tendonitis
80
management of achilles tendonitis (4)
Resistant to quick resolution due to slow healing nature of tendon
– Must reduce stress on tendon, address structural faults (orthotics, mechanics, flexibility)
– Use anti-inflammatory modalities and medications
– Strengthening must progress slowly in order to not aggravate the tendon
81
Occurs w/ sudden stop and go; forceful plantar flexion w/ knee moving into full extension
-generally has a history of chronic inflammation
achilles tendon rupture
82
achilles tendon rupture is commonly seen in?
athletes >30 years old
83
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Sudden snap (kick in the leg) w/ immediate pain which rapidly subsides
– Point tenderness, swelling, discoloration; decreased ROM
```
achilles tendon rupture
84
obvious indentation and positive thompson test
achilles tendon rupture
85
an achilles tendon rupture occurs where?
2-6 cm proximal to the calcaneal insertion
86
achilles tendon rupture management (4)
Usual management involves surgical repair
– Non-operative treatment: RICE, NSAID’s, & a non-weight bearing cast for 6 weeks, followed up by a walking cast for 2 weeks (75-90% return to normal function)
– Will never have full ROM
– Rehabilitation lasts about 6 months and consists of ROM, and wearing a 2cm heel lift in both shoes
87
Susceptible to strain near musculotendinous attachment
– Caused by quick start or stop, jumping
– Muscular fatigues with fluid-electrolyte depletion & cramping
gastrocnemius strain
88
Depending on grade, variable amount of swelling, pain, muscle disability
– May feel like being “hit in leg with a stick”
– Swelling, point tenderness and functional loss of strength
gastrocnemius strain
89
management of gastrocnemius strain (3)
-RICE
– Grade 1 should apply gentle stretch after cooling
– Weight bearing as tolerated; use heel wedge to reduce calf stretching while walking
90
Occurs in sports with dynamic forces being applied to the ankle
fibularis tendon sublaxation
91
fibularis tendon sublaxation may be caused by a dramatic blow to the ? or moderate/severe ? ankle sprain resulting in tearing of ?
posterior lateral malleolus
inversion
fibularis retinaculum
92
Complain of snapping in & out of groove with activity
– Resisted eversion replicates subluxation
– Recurrent pain, snapping and instability
– Present with ecchymosis, edema, tenderness, and crepitus over the tendon
fibularis tendon sublaxation
93
management of fibularis tendon sublaxation (3)
-Compression with felt horseshoe
– RICE, NSAID’s and analgesics
– Rehab or surgery if conservative tx fail
94
shin contusion results from ? affecting?
direct blow, periosteum
95
Intense pain, rapidly forming hematoma w/ jelly like consistency
shin contusion
96
management of shin contusion (4)
-RICE, NSAID’s and analgesics as needed
– Maintaining compression for hematoma
– Fit with doughnut pad and hard shell for protection
– If not managed appropriately may develop into osteomyelitis (deterioration of bone)
97
muscle contusion of the lower leg is usually where ?
gastrocnemius
98
-Bruise may develop, pain, weakness and partial loss of limb function
– Palpation will reveal hard, rigid, inflexible area due to internal bleeding and muscle guarding
muscle contusion
99
management of muscle contusion
-Stretch to prevent spasm; apply cold compression and ice
| – Wrap or tape will help to stabilize the area
100
Occurs secondary to direct trauma • Medical emergency
acute compartment syndrome
101
Acute exertional compartment syndrome evolves from?
acute compartment syndrome with minimal to moderate activity
102
chronic compartment syndrome looks like?
symptoms arise consistently at certain point during activity
103
-Complain of deep aching pain & tightness due to pressure and swelling
– Often bilateral
– Reduced circulation and sensation of foot occurs
compartment syndrome
104
compartment syndrome often comes with reduced circulation and sensation of the?
foot
105
compartment syndrome symptoms are relieved with?
cessation of exercise
| activity related pain usually begins at a predictable time
106
management of compartment syndrome (3)
-If severe acute or chronic case, may present as medical emergency that requires surgery to reduce pressure or release fascia
– Fasciotomy may be necessary if conservative measures fail
– RICE, NSAIDs and analgesics as needed
107
pain in anterior portion of shin is a symptom of?
medial tibial stress syndrome
108
Catch all for stress fractures, muscle strains, chronic anterior compartment syndrome
medial tibial stress syndrome
109
medial tibial stress syndrome accounts for % of all running injuries, % of leg pain in athletes
10-15%, 60%
110
-Caused by repetitive microtrauma
– Weak muscles, improper footwear, training errors, tight heel cord, hypermobile or pronated feet & forefoot dysfunction can contribute
– May also involve, stress fractures or exertional compartment syndrom
medial tibial stress syndrome
111
4 grades of pain in MTSS (shin splints)
1) Pain after activity
2) Pain before and after activity and not affecting performance
3) Pain before, during and after activity, affecting performance
4) Pain so severe, performance is impossible
112
there is increased pain of MTSS with active?
plantarflexion
113
management of MTSS (shin splints) (6)
-Physician referral for X-rays and bone scan
– Activity modification
– Correction of abnormal biomechanics
– Ice massage to reduce pain and inflammation
– Flexibility program for gastroc-soleus complex
– Arch taping and or orthotics
114
-Common overuse condition, particularly in those with structural and biomechanical insufficiencies
– Runners tends to develop in lower third of lower leg (dancers middle third)
– Often occur in unconditioned, non-experienced individuals
– Often training errors are involved
– Component of female athlete triad
stress fracture of the leg
115
with a stress fracture of the leg, pain is more intense when?
after activity
116
Point tenderness; difficult to discern bone and soft tissue pain – Bone scan results (stress fracture vs. periostitis)
stress fracture of the leg
117
management of stress fracture of the leg (6)
-Discontinue stress inducing activity 14 days
– Use crutches for walking
– Weight bearing may return when pain subsides
– Cycling before running
– After pain free for 2 weeks patient can gradually return to running
– Biomechanics must be addressed
