Lower Leg, Ankle and Foot Injuries Flashcards Preview

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Flashcards in Lower Leg, Ankle and Foot Injuries Deck (53)
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1

"Shin Splints"

An umbrella term for a variety of lower leg pain.
Tibial Contusion
Medial Tibial Stress Syndrome
Tibial Periostitis
Tibial Stress Fracture

2

Tibial Contusion

Results from a direct contact with the tibia.
- Presentation
- Pain tenderness to palpation
- Local area of swelling
- Area of eccymosis
- Gait Disturbances

X-Ray to R/O (rule out) a fracture.
Treat conservatively with RICE

3

Medial Tibial Stress Syndrome

Medial Tibial Stress Syndrome (MTSS) is a general term used to describe a number of disorders including tendonitis in the following muscles:
- Tibialis Posterior
- Flexor Hallucis Longus
- Flexor Digitorum

Presentation:
-Pain and tenderness to palpation
- Local are of swelling
- Gait disturbances

4

MTSS Treament

Initially treat MTSS symptomatically
Address etiology
If symptoms persist R/O stress fracture.

5

Tibial Periostitis

Irritation of the periosteum of the tibia
Diagnosis is based on palpation
"Periostitis" is actual inflammation along the lining of the bone.

Presentation:
-Pain and tenderness to palpation
- Local area of swelling
- Gait disturbances

Treat initially symptomatically as well as with a reduction in weight bearing activity.

Graded return to activity.

6

Tibial Stress Fracture

Microscopic fractures in the bone
Results from repeated microtrauma
Presentation:
-Pain and tenderness to palpation
- Local are of swelling
- Gait disturbances (especially with activity)

7

Stress Fracture: Diagnosis (x-ray and bone scan)

Plain x-rays are often inconclusive
- Low sensitivity (doesn't always pick up fractures)
- High specificity (you know its a fracture)

Bone Scan
- High sensitivity (high metabolism or actual fracture)
- Low Specificity

8

Stress Fracture: Diagnosis (ct scan and MRI)

CT Scan:
- Useful in differential diagnosis
- Assists in identification of osteoid osteoma or osteomyolitis

MRI
- High sensitivity
- High specificity
- Expensive

9

Tibial Stress Fracture

Tibial Shaft is the most common site for stress factures

Careful history and evaluation necessary for differential diagnosis.

10

Tibial Stress Fracture: Treatment

RICE
NSAID's
Activity Reduction
Address contributing factors
- Biomechanical causes
- Decreases in bone density
- Menstrual/hormonal disturbances

11

Compartment Syndrome Types

Acute Compartment Syndrome

Exert Ional (Chronic) Compartment Syndrome

12

Acute Compartment Syndrome

Traumatic Injury
Caused by:
- Direct Trauma
- Complication after surgery
- Inappropriate immobilization

13

Acute Compartment Syndrome Signs and Symptoms

Inappropriate complaints of pain
C/O dysthesia
Muscle may feel "tight of full"
Paralysis
A medical emergency

14

Exert Ional Compartment Syndrome (ECS)

CC of lower leg pain and dysthesia (aching or cramping pain) during or immediately following activity.

Diagnosed with measurement of intramuscular pressure
- 80% involve the anterior and the deep posterior compartment

Treatment
Conservative management includes edema reduction and assessment of biomechanical causes
Surgical intervention: Fasciotomy.

15

"Return to Play Criteria"

Non-tender to palpation
Full and painless range of motion
Equal strength bilaterally with both flexion and extension
Successful completion of functional performance Testing

16

Deep Venous Trombosis

A term used to describe a clot formation in the deep veins of the leg.

Considered a serious condition because of the treat of an embolism (esp. pulmonary embolism)

Risk Factors
Age
Obesity
Surgery
Trauma
Immobilization/Bed Rest

17

DVT Presentation and Treatment

Presentation
-Diffuse swelling throughout the lower leg
-Diffuse Discoloration (Redness)
-Generalized complaints of pain

Treatment
-Edema Reduction (elevation)
-Immediate Medical Referral*
-Anticoagulant medication

Return to play requires clearance from a physician.

Homan's Sign is a DVT test (DON'T DO)

18

Fibular Fracture

MOI: Typically traumatic in nature

Presentation
-Local pain and tenderness along the lateral lower leg
-Local area of edema
-Deformity (maybe)
-Positive compression test/heel tap test

19

Ankle Sprain

Presentation
-local pain and tenderness along the lateral lower leg (could be medial if inversion vs. eversion)
-local area of edema (especially near the lateral malleolus
-Gait disturbances

Clinical Evaluation
-Anterior Drawer
-Talar Tilt Test.

20

Ankle Sprain Treatment

Conservative Management
-Rice
-Activity Restriction
-Graded return to activity

21

Syndesmotic Sprain

Injury tothe distal tibiofibular ligament
MOI: Similar to "inversion sprain"

Clinical Evaluation
-Overpressure with end range dorsiflexion
External rotation Test
Squeeze Test

Prognosis: Extended rehab timeline.

22

Pott's Fracture

Avulsion fracture of the medial malleolus of the tibia with rupture of internal lateral ligaments

MOI: Displacement of the lower leg laterally and posteriorly while the foot is fixed.

23

Achillies Tendonitis/Tenosynovitis

Inflammation of the achillies tendon.

Typically an "overuse" injury.

Presentation
-Pain and tenderness in Achillies Tendon
-Increased complaints with weight bearing

Gait Deviations
Crepitus with AROM

24

Achillies Tendonitis/Tenosynovitis

RICE
Activity Reduction
Prophylactic Taping
Graded return to activity

25

Sever's Disease

Apophysitis of the Achillies Tendon

Affects the Calcanue-s in growing children ( years)

Associated with running and jumping activities.

self Limiting disorder.

Treated with activity reduction and bracing.

26

Achillies Tendon Rupture (Risk Factors and MOI)

Risk Factors
-Poor conditioning/flexibility
-Advanced age
-Over-exertion

MOI: Sudden eccentric Force.

27

Treatment and Presentation for Achillies Rupture

Presentation:
HPI: "Sudden pop"
"severe" comlaints of pain.
Significant gait disturbances
Palpable defect
Inability to plantar flex the foot

Clinical Evaluation
Tompson Test

Surgical Repair is required.

28

Heel Contusion

MOI: Blunt trauma to the plantar surface.

Presentation
-Tenderness o palpation
-eccymosis
-Gait Disturbances

R/O Fracture

Treatment:
RICE
Padding

29

Plantar Fasciitis

Inflammaroty condition of the plantar fascia

Irritation at the insertion to the medial calcaneal tuberosity

Number of biomechanical risk factors such as:
-leg length discrepancy
-excessive pronation
-"tightness" in triceps surae muscle group.

30

Plantar Faciitis Presentation

Pain and tenderness over the medial calcaneal tuberosity.
Gait disturbances
"Movie Goer's Sign"