MSK foot and ankle Flashcards
(258 cards)
1
Q
how many bones are in the foot and ankle?
A
28
2
Q
what is the shank?
A
the tibia and fibula
medially rotated the rearfoot with pronation
syndesmotic joint
3
Q
how much of body weight goes through the tibia?
A
70-90%
4
Q
what is the mortise?
A
space created by tibia and fibula where talus articulates
very important for stability
5
Q
open chain DF vs closed chain DF glides at the mortise
A
open chain: talus glides posterior on a fixed tibia
used post glide
closed chain: tibia glides anterior on a fixed talus
use ant glide
6
Q
describe the talocrural joint
A
artic of the talus and mortise
primary function is PF and DF
wedge shape
greater stability in DF
7
Q
what muscles attach on the talus?
A
none
8
Q
what does the interosseous ligament do?
A
transfers some WB force to the fibula
injured with rotation
9
Q
what do the tibiofibular ligaments do?
A
prevent excessive displacement of the fibula
10
Q
what is the deltoid ligament for?
A
restrains eversion
11
Q
what are the ant/post talofibular and calcaneofibular ligaments for?
A
restrain inversion
12
Q
describe the subtalar joint
A
artic of talus and calcaneus
“bridge between the foot and ankle”
mobile yet stable
mvmts of supination and pronation
13
Q
what is the sinus tarsi?
A
area of nerves for proprioception
between the two artics of the subtalar joint
14
Q
what are the two subtalar joint axis?
A
superior view: 23 deg +/- 11 (towards big toe)
medial view: 41 deg +/- 9 (anterior is up)
15
Q
midtarsal joint
A
chopart joint
talonavicular is more mobile
calcaneocuboid
mvmts of eversion/inversion and PF/DF
16
Q
tarsometatarsal joint
A
lisfranc joint
cuneiforms and MT 1-3, cuboid and MT 4-5
very little motion in 1-3 (like the hand)
lisfranc injury most common at 3 MT
17
Q
where is the lisfranc ligament?
A
medial cuneiform to 2 MT
18
Q
1st MTP joint
A
transmits lots of force
80% during walking
200% during athletic activities
800% during jumping
19
Q
where are the two sesamoids of the foot?
A
near 1st MTP
20
Q
how much mobility is needed at 1st MTP?
A
60-75 deg
21
Q
describe the plantar fascia
A
type I collagen
prevents collapse of longitudinal arch
22
Q
when is tension in plantar fascia highest?
A
between initial contact and loading response
23
Q
what are some potential causes of heel pain?
A
subcutaneous calcaneal bursa - tight shoes
retrocalcaneal bursa - between achilles/calc
calcaneal fat pad - 2nd leading cause
24
Q
what are the muscles of the anterior compartment?
A
anterior tibialis:
primary DF/inverter in OC
stab talocrural and midfoot in CC
extensor hallucis longus:
extends great toe and stab midfoot
extensor digitorum longus:
extends 2-5 and stab midfoot
peroneus tertius:
assists in DF/eversion
synergist with per brevis
25
what is the innervation of the anterior compartment?
deep peroneal nerve
26
what is the extensor retinaculum for?
hold tendons close to join so they cant get away because there is not a straight line of pull
superior and inferior
27
what muscles are part of the superficial posterior compartment?
gastroc
soleus
plantaris
innervated by tibial nerve
PF, stab foot through plantar fascia
28
what muscles are part of the deep posterior compartment?
tibialis posterior - PF, inv, stab arch
flexor digitorum longus
flexor hallucis longus
innervated by tibial nerve
FDL/FHL stab foot and provide proprio
29
what is the windlass mechanism?
plantar fascia attaches to MT, phal, flexor tendons
passive extension at 1st MTP tenses plantar fascia to move foot from pronation into supination and provide a rigid lever for push off
30
describe the flexor retinaculum
from med mall to calc
roof of the tarsal tunnel
contributes to tarsal tunnel syndrome
prevents tendons form rolling over the mall
31
what is housed in the tarsal tunnel?
post tib
FDL
FHL
post tib vein/artery
tibial nerve
32
what are the muscles in the lateral compartment?
fibularis peroneus:
distal attachment to medial cuneiform and base of 1st MT
imp for proprio
PF and ever
stabilized medial foot
fibularis brevis:
primary evertor of rearfoot
resists inversion
33
fibular retinaculum
prevents sublux of tendons
vulnerable during inversions strains
inferior is continuation of extensor ret
34
what nerve innervated the foot intrinsics?
plantar: med and lat plantar nerves
dorsal: deep fibular
35
what do the foot intrinsics do?
support longitudinal and transverse arches
36
describe the tibial nerve
motor and sensory
branches into med and lat plantar nerves
PF and flex toes
MPN: abd hall, FDB, FHB, first lumbrical
LPN: QP, FDM, add hall, lat lumbricals, interossei, abd DM
37
interdigital (morton's) neuroma
plantar branches irritated
between 2&3 or 3&4
38
describe the fibular nerve and branches
superficial:
PL, PB - lateral muscles
deep: ant tib, EHL, EDL, dorsal foot intrinsics
anterior muscles
lisfrac area
sural nerve:
sensory for lat heel, foot and ankle
entrapment
39
foot and ankle ability measure
21 ADL and 8 sports items
MCID = 8
less opportunity for ceiling effect
40
is the pain pattern of ankle reliable?
very
41
which nerve entrapment site is commonly misdiagnosed as plantar fascitis?
baxter's nerve entrapment
one medial foot
42
what is the foot posture index 6 for?
to determine if foot is pronated (>4) or supinated (<0)
43
symptoms of compartment syndrome?
95% in ant or lat compartments
cramping, burning, numbness
has a predictable pattern
44
ottawa ankle rules
ANKLE: pain in malleolar zone plus one of following
- tenderness of lat mall
- tenderness of med mall
- inability to bear weight for 4 steps immediately after injury and at time of eval
FOOT: pain in midfoot plus one of following
- tender base of 5th MT
- tenderness of navicular
- inability to bear weight for 4 steps immediately after injury and at time of eval
45
tuning fork exam
TESTING FOR: bone injury (fracture)
place vibrating tuning fork on area of suspected fracture
test BILATERALLY
+ if symptoms reproduced
46
thompson test
TESTING FOR: achilles rupture
pt prone
squeeze calf muscle
+ ankle remains still or only minimal PF occurs
47
how can you clear the lumbar spine and hip?
quadrant test
MRS
neurodynamics
ROM with overpressure
48
what % of referral pain goes past the knee?
10%
49
neurodynamics: TED
tibial nerve bias
perform straight leg raise
evert and DF the foot
50
neurodynamics: SID
sural nerve bias
perform SLR
invert and DF to foot
51
how to measure closed chain ankle dorsiflexion
touch knee to wall by aiming straight forward
10cm is normal
35-40 deg is normal
52
how does the fibula rotate in DF and PF?
DF: 3-5 deg ER, widens syndesmosis
PF: 3-5 deg IR, narrows syn
53
what motion are talocrural ant and post glides for?
ant: PF
post: DF
54
figure 8 hop test
2 cones, 5 meters apart
hop on foot around cones
best of 2
compare bilateral
55
single leg heel raise test
testing for: achilles
+ pain during concentric or eccentric
56
royal london hospital test
testing for: achilles
pt prone
actively DF and PF
+ no tenderness on palpation in DF
57
arc test
testing for: achilles
prone
watch area of swelling in active DF and PF
+ area of swelling moves
58
anterior drawer test
testing for: anterior talofibular ligament integrity
supine
slight PF, anteriorly glide calc on talus
+ excessive ant translation or reproduction of symptoms
59
sinus tarsi syndrome
after lateral ankle sprains
occurs in pronated feet
anterolateral pain with standing
no specific test
60
talar tilt varus stress test
testing for: lateral ligaments
supine
quick lateral tilt to subtalar joint
(force in)
+ gross laxity
61
talar tilt valgus stress test
testing for: medial ligaments
supine
quick medial tilt to subtalar joint
(force out)
= excessive laxity
62
syndesmosis squeeze test
testing for: high ankle sprain
supine
squeeze middle 1/3 of lower leg
+ pain reproduced
63
lateral rotation (kleiger's) test
testing for: syndesmosis, medial ankle sprain
seated with feet over edge
with ankle in neutral, evert and DF the foot
+ higher pain - syndes, medial pain - medial sprain
64
force dorsiflexion test
testing for: ankle impingement
long sitting
palpate anterolateral talus
passively DF with purpose
+ symp reproduction
65
tibial torsion
supine with femurs neutral
measure the angle of the two malleoli
norms: 0-20 at birth
30 + may lead to patellar sublux
measure when someone walks with toes out
66
forefoot varus/valgus
prone with foot off edge
palpate talus and 5th MT
move into inversion/eversion until neutral
DF to keep in place
measure angle with stationary arm parallel to calc and moving in line with MT heads
norm: 6-8 varus
rapid pronation in loading response
67
subtalar joint neutral in WB
standing
palpate talus
twist leg in and out
find where most congruent
68
navicular drop
find subtalar neutral
find navicular
measure from floor
have pt relax foot
remeasure navi
+ 1+ cm difference
69
tinel's
testing for: nervy shit
side lying
tapping force to post-med ankle
+ repro of numbness/tingling
70
dorsiflexion and eversion test
testing for: tarsal tunnel
sitting
passively DF, evert and extend toes
hold for 5-10 while tappin tarsal tunnel
+ tender or numb over nerve or numb/pain over nerve distribution
71
interdigital (morton's) neuroma squeeze
testing for: neuroma
supine or sitting
squeeze forefoot on affected side
+ sym repro in MT 2/3 or 3/4
72
calcaneal squeeze test
testing for: calc apop (sever's)
supine or sitting
squeeze calc with thenar eminences
+ sym repro
73
shin palpation test
testing for: medial tibial stress syndrome
supine with knee flexed
squeeze distal 2/3 of post-med leg with force to squeeze out a wet sponge
+ 5+ cm of continuous tenderness
74
windlass test
testing for: plantar fasciitis
non WB then WB
passively extned 1st MTP through full ROM
+ sym repro
75
figure 8 girth
testing for: swelling
lat mall
navi
5th MT
med mall
achilles
back to start
76
STM
plantar fascia - ankel neutral, toes ext
post tib - lying on affected side
77
ischemic compression on gastroc
higher pressure - 30 sec
lower pressure - 90 sec
until 50% reduction in referred pain
78
general guidelines for mobilizations
2-4x 45sec or until tissue change
79
distal tibfib mobs
for inversion sprain
push on fibula
supine for posterior
prone for anterior
80
talocrural mobs
make sure you are off tibia - on talus
distraction
anterior
posterior
WB posterior
81
WB posterior talocrural mob
one foot on step
have them push into DF
pull prox tibia to you
push back on talus
82
subtalar mob - distraction
for general mobility
supine
grab calc ad lean back
83
subtalar mob - medial
for inversion
side lying, affected up
push down on calc
84
subtalar mob - lateral
for eversion
side lying, on affected
push down on calc
85
intermetatarsal mob
stab on MT and mob the next
dorsal or plantar
86
1st MTP mob
general mobility - distraction
extension - dorsal glide
87
taping techniques
for hypermobility or lack of control
goal is to reduce strain
88
distal tibiofibular stabilization
holds foot in eversion and DF
anchor tape anteriorly to fibula
apply posterolateral glide and warp tape around back of lower leg ending 2 inches above where you started
89
modified low dye for anti-pronation
lateral calc to dorsal 1st MTP joint
lateral calc medially and anteriorly over navi
dorsal 1/2 interspace medially and plantarly
90
ankle AROM
ankle pumps
ankle circles
ankle alphabet
for sprain
high reps: 20-30, full time through alphabet
91
ankle and rearfoot self mob
dorsiflexion - foot on step
plantarflexion - quadruped
lateral glide - push down on heel
for lack of ROM
45 sec, 2-4x
92
hallux self-mob
distraction
dorsal glide - up to increase extension
abduction stretch - band around both
93
rolling and splaying
rolling - roll out arch
splaying - big toes
for plantar fasciitis
94
inversion/eversion
keep heel on ground
towel under the foot
make sure the forefoot is moving
hard for a supinated foot
95
theraband ankle 4 way
DF - hold one in PF and DF the other
PF
eversion - hold with one and evert other
inversion - cross legs and hold, invert other
96
soleus strengthening progression
bent knees while laying
progress to bridge
sitting in chair
wall sitting
decel tibia over talus in stance
97
heel raises with post tib bias
squeeze ball between heels
band around shins
can also do single leg but bilateral better
decels pronation in loading response
98
heel raises with fibularis bias
band around one leg pulling into inversion
needed for push off
dont roll on outside toes
99
gastroc/soleus strengthening
both up and down
both up, one down
single up and down
on step
g: straight
s: bent
100
peroneal press
push down only through big toe
rest of foot off ground
101
short foot/tripod
have 1st, 5th and calc on ground
scrunch arch
102
short foot progression
sitting banded
standing
squatting
in lunge
103
toe yoga
toe spreading
alternating up and down
the wave
2 min for motor control
good for improving windlass
104
towel scrunches and marble pickups
most beneficial to do one foot at a time
105
banded hallux flexor stretching
in ext of big toe
flex against band
keep baby toes in neutral
106
single leg stance with pallof and diagonals
pall: hold it straight out
diag: move the weight diagonally
keep balance while moving weight
107
inward/outward pivots
out: start at 12:00 and move to 7:00
in: start at 7:00 and move to 12:00
108
boards
maze
strong - spring one, so many things
BAPS - ROM
109
hallux limitus angle
< 40 deg
110
hallux rigidus angle
< 10 deg
111
what are the three components of supination?
inversion
PF
forefoot add or tibial ER
112
what are the three components of pronation?
eversion
DF
forefoot abd or tibial IR
113
overview of lateral ankle sprain
ATF most affected, but not only one
40% develop ankle instability
inversion force
114
pain pattern with lateral ankle sprain
lateral ankle pain, stiffness
tender at syndesmosis, ATF, CF, PTF
115
risk factors for lateral ankle sprain
female
younger
sports
possible genetics
116
observation for lateral ankle sprain
acute: antalgic
chronic ankle instability: wide BOS
117
exam for lateral ankle sprain
+ anterior drawer, talar tilt
anterior positional fault of distal fibula
decreased DF ROM
increased frontal plane motion
weakness of everters
decreased proprioception
118
pt ed for lateral ankle sprain
RICE
re-injury rates - each sprain increases
119
manual therapy for lateral ankle sprain
STM:
acute - effleurage
CAI: plantar fascia
subacute: cross friction
mobs:
post talocrural for DF
post distal tib fib
calcaneocuboid
taping/bracing to control foot posture
120
ther ex for lateral ankle sprain
mobility:
early - NWB uniplanar ROM
stretching to increase DF
strength:
early - isos
later - PF, foot intrinsics
proprio:
acute: NWB circles, alpha, figure 8
double limb to single limb
BAPS
sport specific
121
overview of syndesmotic injury
25% of all sprains
restrains post translation of tibia
longer recovery than lateral
122
MOI of syndesmotic injury
talus in lateral rotation
ankle DF
123
impairments of syndesmotic injury
pain
swelling
limited ROM
124
pain pattern of syndesmotic injury
diffuse anterolateral or posteromedial pain
125
risk factors of syndesmotic injury
males
high level athletes
history of previous ankle injury
126
observation of syndesmotic injury
swelling
antalgic gait
pain with push off
127
exam of syndesmotic injury
dec ankle PF
tender, painful DF
+ stress test, squeeze, lateral rotation
128
pt ed for syndesmotic injury
ADs
rest, ice, elevation
safe RTS - 13.4 weeks
surgical expectations
129
manual therapy for syndesmotic injury
retrograde massage for swelling
mobs: as needed
CAM boot
130
ther ex for syndesmotic injury
early:
AROM
NWB calf stretches progress to light resistance
bilateral heel raises
light proprio
late:
unilat progressing to plyos and sport spec
131
overview of medial ankle sprain
injury to deltoid lig
least common of the three
often occurs with other injuries
132
MOI for medial ankle sprain
forced eversion and lateral rotation
TONS OF FORCE
133
pain pattern for medial ankle sprain
medial ankle sprain
chronic: giving way
134
risk factors for medial ankle sprain
male
gymnastics, rugby, soccer, football
135
observation for medial ankle sprain
swelling, bruising
pronated foot on affected side
136
exam for medial ankle sprain
+ talar tilt, kleiger reproduces medial ankle pain
painful weakness of post tib
137
pt ed for medial ankle sprain
RTS - 6-8 weeks
138
manual therapy for medial ankle sprain
STM: CFM
mobs: as indicated
bracing in initial period
139
ther ex for medial ankle sprain
AROM similar to lateral
isos
post tib activation
tripod
short foot
try to get neutral foot
140
overview of achilles tendonopathy
decreased tendon strength and stiffness
up to 18.5% of runners
insertion vs mid-portion
141
MOI of achilles tendonopathy
degen, overuse
haglund's deformity
fluoroquinolones - antibiotic
142
pain pattern of achilles tendonopathy
at mid point or insertion
143
risk factors of achilles tendonopathy
active vs inactive and overweight
poor CC mech
males
family hx
35+
haglund
144
observation of achilles tendonopathy
haglund
early heel off with gait
145
exam of achilles tendonopathy
painful PF
limited DF
tender to palpation
+ thompson with full rupture
146
pt ed of achilles tendonopathy
manage modifiable RF
147
manual therapy of achilles tendonopathy
mob: post TC for DF
STM: gastroc/soleus
modalites
heel lift, night splints
148
ther ex of achilles tendonopathy
heavy load/slow speed:
full ROM, 6 sec/rep
increase resis and decrease reps
eccentrics:
PF with knee flexed and extended
B concentric with uni ecc - 15 reps
gradual increase from AROM up to plyos
149
overview of fibularis dysfunction
only 60% are accurately diagnosed on intital exam
150
moi for fib dys
gradual overuse
lateral ankle instability
151
pp for fib dys
lateral ankle and foot pain
152
RF for fib dys
CAI; lat lig injuries
sports with rep mvmts
forefoot valgus
rearfoot varus with pes cavus
153
obs for fib dys
may have swelling, atrophy
tendons may sublux - popping
154
exam for fib dys
dec eversion secondary to pain or dec subtalar mobility
impaired balance
155
pt ed for fib dys
act mod
shoe assessment
lateral heel wedge
156
man therapy for fib dys
sub talar and distal post fib glides
STM: fibular muscles, Dfs
157
ther ex for fib dys
gastroc/soleus stretching
self ankle/foot mobs
resisted eversion with band
foot in/extrinsics strengthening
heel raises
eccentrics for tendinopathy
balance progressions
outward pivots
158
overview of post tib tendinopathy
usually chronic, degen
can lead to deformation
up to 90% improve with conservative
159
MOI for post tib tendinopathy
overuse leads to degen
elongation leads to flat foot
160
impairments for post tib tendinopathy
tender medial lower leg
weakness of inv/ev
dec ankle DF
161
PP for post tib tendinopathy
grad onset of med ankle and foot pain
worse with WB and may progress to pain at rest
162
RF for post tib tendinopathy
middle age
high BMI
pronated feet
limited DF
running or other sports
163
obs for post tib tendinopathy
pronated feet, loss of med arch
rearfoot valgus
porlonged pronation wo calc inv at toe off
164
exam for post tib tendinopathy
FPI - 6: pronated foot score
pain with active/resisted inversion
navi drop
weak ant tib, fibularis, gastroc
165
pt ed for post tib tendinopathy
act mod
shoe assessment - need cushioning and support
166
MT for post tib tendinopathy
TC or ST mobs
CF to tendon
orthotics
167
ther ex for post tib tendinopathy
gastroc/soleus stretching; self mob
post tib, intrinsics, fib, ant tib, gastroc strength
tripod, short foot
inward pivot
168
overview of calcaneal apophysitis
most common cause of heel pain in peds
169
MOI for calcaneal apophysitis
repeated traction of ach on ossification of calc
170
pp for calcaneal apophysitis
atraum post heel pain
no pain in am
asymm in bilat
171
rf for calcaneal apophysitis
6-17
males
dec DF
forefoot varus
overweight or active
new sport season
172
obs for calcaneal apophysitis
parents may report growth spurt
pronated foot
173
exam for calcaneal apophysitis
pain with DF
limited DF
tender to palp
one leg heel stance
calcaneal squeeze
174
pt ed for calcaneal apophysitis
act mod
shoe assess
prefab orthotics
175
mt for calcaneal apophysitis
post and distraction to TC
STM: gastroc/soleus
taping with athletic tape
176
ther ex for calcaneal apophysitis
gastroc/soleus strengthening
address muscle imbalances
correct poor mech
177
overview of plantar fasciopathy
15% of all foot complaints
middle age
distance running
178
MOI for plantar fasciopathy
inflam or degen
179
pp for plantar fasciopathy
inferomedial heel pain
worse with first steps in the morning
180
RF for plantar fasciopathy
dec cross sectional intrinsic mass
high BMI
limited ankle DF
pes cavus/planus
181
obs for plantar fasciopathy
abnormal foot posture
182
exam for plantar fasciopathy
tender
+ windlass
dec 1st MTP ext
- tarsal tunnel
183
pt ed for plantar fasciopathy
footwear
184
mt for plantar fasciopathy
cross friction
passive stretching
post TC glide
subtalar med/lat glides
taping to determine if orthotics will help
185
ther ex for plantar fasciopathy
self stretching
gastroc/soleus stretching
short foot
foot intrinsic strengthening
heel raises
concen and eccen loading
tripod with perturbations
bilat to unilat
186
MOI for disorders at 1st MTP
rep mvmt, overuse
ill fitting or high heels
trauma
187
pp for disorders at 1st MTP
at or just prox to 1st MTP
188
RF for disorders at 1st MTP
pronated foot (except sesamoiditis)
improper footwear
189
obs for for disorders at 1st MTP
varies
hall val: lateral migration
sprain: swelling, bruising
sesamoiditis: swelling at forefoot
pain worse in extension
190
exam for disorders at 1st MTP
OA test - axial grind
dec hallux ext and ankle DF
weak toe flexors foot intrinsics
191
pt ed for disorders at 1st MTP
proper footwear
val: wide toe box
lim/rig/turf: rocker bottom
192
mt for disorders at 1st MTP
1st MTP distraction, dorsal mobs
TC post glides
subtalar for hallval
STM
taping
193
ther ex for disorders at 1st MTP
stretching and self mob of 1st
stretch calf
strengthen toe flexors foot intrinsics
first ray stability
inward/outward pivots
194
pp for interdigital neuroma
plantar aspect of distal forefoot and toes
worse with WB/pressure
improves with rest
195
rf for for interdigital neuroma
pronated foot
female
middle age (50)
runners, dancers
on toes
compressive footwear
196
obs for for interdigital neuroma
pronated foot
197
exam for for interdigital neuroma
tender web space
reproduced sym with forefoot squeeze
weak foot intrinsics
negative lumbar/hip exam
198
pt ed for interdigital neuroma
proper footwear
wider toe box or rocker bottom
199
mt for interdigital neuroma
mobs to treat impairments
STM: not evidence for
custom orthoses with metatarsal arch
200
ther ex for interdigital neuroma
mobility as indicated
foot intrinsic strength
inward pivots
NM re-ed
201
pp for metatarsalgia
plantar pain under MT heads of lesser toes
worse with barefoot walking or in heels
not radiation
202
rf for metatarsalgia
female
middle age
elite athletes with rapid inc in training or shoe changes
203
obs for metatarsalgia
callus under affected
stands with weight shifted backward
204
exam for metatarsalgia
tender MT
dec MTP extension and ankle DF
weak foot intrinsics and toe flexors
neg lumbar/hip exam
205
pt ed for metatarsalgia
proper footwear - rockerbottom shoe
206
mt for metatarsalgia
mobs: indicated
STM: indicated
taping: MT pads
207
ther ex for metatarsalgia
indicated
plantar stretching
foot intrinsic and toe flexor strength
inward/outward pivots
208
overview of lisfranc injury
rare
refer for imaging
injury to bones/ligs at TMT
usually mild and involve dorsal ligs
209
MOI for lisfranc injury
supination with axial load
high energy
210
impairments for lisfranc injury
pain/swelling in midfoot
pain with WB
gap sign
pain with passive pronation/abduction of forefoot
211
treatment for lisfranc injury
mild improve with conservative
212
overview of kohler's disease
transient loss of blood flow to navi
younger peds - 3-7 yo
males
managed by phys
should recover all function
213
MOI for kohler's disease
unknown, rare
possible compression between talus and cuneiform leads to ischemia
214
impairments for kohler's disease
medial midfoot pain
antalgic gait, pressure of lateral foot
swelling and tenderness at navi
215
overview of medial tibial stress syndrome
common in athletes
216
clinical diag for medial tibial stress syndrome
pain at distal 2/3 of medial lower leg and ankle
worse with activity
pain repro with palp
other path have been ruled out
216
MOI for medial tibial stress syndrome
recent increase in activity
bone overload
fasciopathy
217
pp for medial tibial stress syndrome
medial lower leg pain (>5)
pain with activity
218
rf for medial tibial stress syndrome
female
hisoty of running injuries
poor running mech, distance, intensity,
footwear, terrain changes
pronated feet
219
obs for medial tibial stress syndrome
pronated feet
220
exam for medial tibial stress syndrome
tender for 5+ cm
+ navi drop
rule out compartment syndrome
- tuning fork
221
pt ed for medial tibial stress syndrome
relative rest
gradual RTS
running form - switch to midfoot strike
222
MT for medial tibial stress syndrome
mobs indicated
STM indicated
taping - anti-pronation, post tib deload
otc orthotics
223
ther ex for medial tibial stress syndrome
mobility as indicated
strength:
foot intrinsic
eccen gastroc, soleus
inverters, everters
core and gluteal strength
balance progressions
inward pivots
224
overview of tarsal tunnel syndrome
entrapment or compression of tibial nerve in tarsal tunnel
225
MOI for tarsal tunnel syndrome
trauma
rep stress
excessive DF and pronation
226
pp for tarsal tunnel syndrome
medial ankle and foot pain
nervy
227
rf for tarsal tunnel syndrome
female
prolonged standing
running
gymnastics
dancers
228
obs for tarsal tunnel syndrome
hypermobile
pronated feet
229
exam for tarsal tunnel syndrome
+ tinel, DF eversion test
tender abd hall
atrophy, weakness
230
pt ed for tarsal tunnel syndrome
relative rest
proper footwear - stability
231
mt for tarsal tunnel syndrome
mobs as indicated
STM as indicated: gastroc, soleus, post tib
taping to promoted neutral foot
232
ther ex for tarsal tunnel syndrome
stretching to PFs and toe flexors
strengthen foot intrinsics and extrinsic
balance progressions
inward pivots
233
pp for ankle and foot stress fractures
pain, tender involved bone
234
rf for ankle and foot stress fractures
intrinsic:
abnormal supination or pronation
older age
female
poor nutrition
LLD
extrinsic:
training intensity
surface
footwear
235
exam for ankle and foot stress fractures
+ tuning fork
referred for imaging
236
pt ed for ankle and foot stress fractures
address RF
act mod
relative rest
237
mt for ankle and foot stress fractures
mobs as indicated
STM as indicated
taping to promote neutral foot
taping for shock absorption for supination
238
ther ex for ankle and foot stress fractures
address faulty biomech
address muscle imbalance and mobility deficits
glutes, hips
dynamic valgus
239
what are custom foot orthoses?
contoured device specific to one's foot structure
240
who benefits from CFO?
rear/forefoot deformity
flexible, unstable foot
hallux valgus
plantar fasciitis
241
what is platelet-rich plasma injection?
plasma and platelets from autologous blood are separated and then injected into injured tissue
242
who benefits from PRP?
possible achilles, chronic PF, lesions of talus
high ankle sprain had faster RTS and less pain
243
is PRP commonly used?
no
most insurances font cover it because it is investigational
244
what is extracorporeal shockwave therapy?
sound waves promote cellular repair
it is very painful
245
who benefits from EST?
chronic PF
achilles
morton's neuroma
246
what is lateral ligament repair/reconstruction?
repair: rejoining of ends of ATF/CF ligs
can be reinforced with suture tapes
partial WB in 2-4 weeks
full WB in 4-8 weeks
ROM restricted post surgery
247
who benefits from LLR?
those with chronic ankle instability
248
what is ORIF?
surgery that corrects ankle instability from chronic or unstable fractures
no mobs until fully healed
will they need surgery to remove hardware?
249
who benefits from ORIF
pts with unstable or complex fractures
mostly bi or trimalleolar
bi: lateral and medial fx
tri: lateral, medial, posterior fx
250
what is ankle syndesmosis surgery and who benefits?
surgical fixation or tightrope surgery
dec space between tib and fib
tightrope allows for more ROM than fixation
for those who do not benefit from conservative management
251
what is an achilles repair and who benefits?
reattach torn tendons
must be done asap to avoid tendon shortening
high retear rate
for younger, active pts within two weeks of rupture
252
protocol for achilles repair
early:
protection, immobilize, gradullay inc WB
intermediate:
restore strength and ROM, normalize gait and proprio
late:
agility drills, RTS
full ability 6-9 months
RTS 9-12 months
253
surgeries for plantar fasciopathy and who benefits?
open or minimally invasive
heel spur resection
puts strain on plantar ligaments
for those with chronic pf that do not improve with conservative
254
what are hallux and 1st MTP surgeries?
arthrodesis - fusion
joint replacement
osteotomy
lapidus bunion correction - may cause more pain in long run
255
who benefits from big toe surgery?
severe OA at 1st MTP - fails conservative
severe hallux deformity
256
surgeries for end stage ankle arthritis
ankle arthrodesis
total ankle arthroplasty
for those with sever ankle pain and mobility deficits
257
rehab considerations for ankle surgeries
NWB to allow for good bone healing
