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PHTH 517 > Other Ankle Disorders > Flashcards

Other Ankle Disorders Flashcards

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1
Q

Heel pain is usually caused by?

A

Plantar fasciitis which is often associated with heel spurs

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2
Q

What are the causes of heel pain?

A

obseity (increased forces)
excessive walking/sports (muscle fatigue)
plantar fascia tightness
flattening of the arch

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3
Q

What are some treatments associated for heel pain?

A

Orthoses
PT
injection
NSAIDs
very rarely a surgical release in bad cases

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4
Q

What are the subjective findings that we get regarding plantar fascitis?

A

pain and tenderness on the inside of the heel
- happens during wb

in the morning or after being off your feet for a while and gets worse with activity

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5
Q

What are the objective findings for plantar fascitis?

A

pain during palpation at the
- inner edge of the fascia
- origin on the anterior edge of the calcaneus

firm pressure is needed to get the max tenderness

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6
Q

What is the typical prognosis regarding plantar fascitis?

A

~90% who go through treatment will get better in 12 months or so

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7
Q

What are the two bursae that accounts for bursitis in the foot?

A

retrocalcaneal and subcutaneous calcaneal bursa

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8
Q

What are the causes of retrocalcaneal bursitis?

A
  • constant trauma from shoes and sports
  • Gout, RA and ankylosing spondyloarthropathies
  • busal impingement
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9
Q

What structures usually impinge the bursa?

A

between the achilles tendon and BULGING posterior-superior aspect of the calcaneus

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10
Q

What is the subjective findings of a retrocalcaneal bursitis?

A

posterior ankle pain
pain with walking

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11
Q

What are the signs regarding retrocalcaneal bursitis?

A

tenderness
lump
inflammation

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12
Q

What is conservative measures regarding retrocalcaneal bursitis?

A

PT
taking account shoe wear
if so, injections:
- reduce swelling and inflammation
- paired wtih achilles tendon stretching

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13
Q

What is surgical measures regarding retrocalcaneal bursitis?

A

PUMP BUMP!!
- removing the calcaneal superoposterior prominence
- taking away the damanged buursa
- tendon debridement of the tendon insertion

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14
Q

A hallux valgus (or “bunion”) is caused by?

A

Big toe moving towards smaller toes but leaves big bump
- the bump is caused by the base of 1st MTP joint deviated laterally

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15
Q

What are some common aetiology regarding a bunion?

A

Familial
Inappropriate footwear, Toe box (small toe box)
Flatfeet
Long first ray
1st MTP being out of place from the joint articular surface
Metatarsus primus varus
Rheumatoid arthritis

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16
Q

What is metatarsus primus varus?

A

The 1st MT bone connecting the phalax to the big toe is rotated and angled away from the 2nd MT bone

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17
Q

What is the pathogenesis of a bunion?

A
  • weird angle between the big toe and 2nd toe around > 9 deg while the valgus angle of MTP joint is greater than 20 deg
  • forefoot fanning
  • joints are unsuitable = osteoarthritis
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18
Q

What are the signs of a bunion?

A
  • there is inflammation of overlying bursa and the skin
  • valgus and pronation deformity of the hallux
  • painful callus on the 2nd toe
  • thick skin over the MT heads
  • increased valgus angle at the big toe
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19
Q

Why is there a callus on the 2nd toe?

A

Second piggy is forced into hyperextension because of that stupid big toe

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20
Q

How are bunions managed?

A

again, look at the kinetic chain and the planes
- possible x-rays
- any devitations up the chain

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21
Q

What is the aim of a conservative treatment for bunions?

A

Relieve pressure over the bunion itself

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22
Q

What are the appropriate shoes for bunions?

A

fitted with low heel and stiff soled shoes
- wide, squared toe box
- more depth to account for DF second toe

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23
Q

What are other treatments for bunions?

A

Splint - splits the 1st and 2nd toe (a spacer)

Silicone bunion pad to take off the pressure

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24
Q

What are the acute pain management for bunions?

A
  • rest
  • moist heat pack
  • analgesics
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25
What is the **indications for surgical management** for bunions?
was not able to handle the conservative management bad deformity or bunion pain
26
What are the **different categories** of flat foot/pes planus?
Flexible (99%) Rigid (1%)
27
How do we **determine the type** of pes planus?
Through the jack test or heel raise test ## Footnote Check lab notes
28
**Flexible planus foot** is indicated by?
INTERNAL longitudinal arch - **GOING AWAY** during **WB** - **BEING SEEN** during **NWB**
29
What is indicated by the **jack test** and **how is it performed**?
By hyperextending the big toe = the internal longitudinal arch is present
30
What is indicated by the **heel raise test** and **how is it performed**?
Patient is in the natural stance then raise their heel flexible planus = heel goes to varus (in)
31
What is the **etiology** of rigid pes planus?
vertical talus from birth tarsal coalition ## Footnote Tarsal coalition - abnormal connection of two or more bones in the foot
32
What are the **unsual connections** of the tarsal coalition?
calcaneo-navicular talocalcaneal - can be bony, cartilagenous or fibrous
33
What are the **symptoms** of rigid pes planus?
Foot pain Hard time walking on uneven surfaces foot fatigue peroneal spasm
34
What is the **treatment** for rigid pes planus?
4-6 weeks of cast immobilization surgical: - resection of connecting bar - soft tissue interposition - subtalar arthrodesis - even triple arthrodesis
35
What is the purpose of **subtalar arthrodesis**?
An operating designed to make the arch of the foot more stable but keeping some supination and pronation - the joints involve are the: **talonavicular and calcanocuboid**
36
Which metatarsals are **most frequently injured**?
The 2nd and 3rd piggies
37
What is the **common reasoning** regarding MT stress fracture?
stress or fatigue fracture after cyclical submax loads ex. running, bad shoes, jogging long distances after not doing so at all
38
What are the **subjective findings** of MT stress fracture?
Pain and swelling on WB **Hx of sudden activity increase** running surface change long walks
39
What are the **objective findings** of MT stress fracture?
- swelling - ecchymosis - tenderness over the fractured MT *may not show up in imagining for 2-3 weeks*
40
What is **Morton's Neuroma**?
tissues get thick around the nerves towards your toes (interdigital nerve entrapment) - neuropathy
41
What is the **etiology** of morton's neuroma?
trauma ischemia entrapment
42
What is the **pathology** of morton's neuroma?
Not a true neuroma but rather a perineural fibrosis of the common digital nerve
43
Where does the **common digital nerve pass through**?
Passes between the metatarsal heads - 3rd and 4th
44
What is the **perineural fibrosis**?
swelling and growth of tissues surrounding the nerves that pass between the bones of the foot
45
What is the **subjective findings** seen in morton's neuroma?
* shooting/constant pain when walking * **relieved by rest and taking shoes off** * 3rd and 2nd cleft tenderness * click on MT squeeze test ## Footnote cleft - butt crack of piggies
46
What **population** does morton's neuroma common in?
**8-10x** more in women than men
47
What is the **non-operative treatment** for morton's neuroma?
metatarsal pad orthoses injection excision
48
What is the **recommended shoes** for Morton's Neuroma?
shoes with wide toe box **DO NOT WEAR:** - tight or pointed-toed shoes - shoes with heels more than 2 inches high
49
How is **post-op** Morton's Neuroma handled?
compression dressing placed with a post-op shoe
50
How does the **dorsal approach** affect treatment for Morton's Neuroma?
Allows for **immediate WB** and suture removal **after 2 weeks**
51
How does the **plantar incision** affect treatment for Morton's Neuroma?
slows down WB and suture by **adding 2 weeks** - normal shoe by **3-4 weeks** - return to sport in **4-6 weeks**
52
What is the **cause** of tarsal tunnel?
Posterior tib entrapment since it **passes between the flexor retinaculum and medial malleolus** - can be acute or insidious
53
How is tarsal tunnel **diagnosed**?
**Patient reports of:** - poorly localized burning sensation or pain - tingling at the medial plantar surface of the foot - gets worse after movement - worset at the end of the day ## Footnote Paresthesia = tingling
54
What are the **objective findings** of tarsal tunnel?
* (+) tinel sign * pain with PROM DF and eversion * Decreased 2 point discrimination on plantar aspect of foot * Vagus or valgus deformity of the heel * Weak foot intrinsics w/ sustained PF of toes
55
What is the **treatment** of tarsal tunnel?
local cortocisteroid injections orthoses making the foot intrinsics stronk = restore medial longitudinal arch
56
What is the **pathology** of turf toe?
Sprain of the 1st MTP joint on big toe
57
What is the **mechanism of injury** for turf toe?
**Hyperextension and varus/valgus stress** on the 1st MTP joint
58
What are the **subjective findings** of turf toe?
- red, swollen, stiff 1st MTP joint - joint can be tender on plantar and dorsal surface - gait can be limp and be unable to run or jump - hx of a single DF injury or multiple injuries to the great toe
59
What are the **objective findings** of turf toe?
Depending on the grades of severity
60
What is indicated for a **grade 1 sprain** for Turf Toe?
**minor stretch injury** to the soft tissue restraint - little pain - minor swelling - minor disability
61
What is indicated for a **grade 2 sprain** for Turf Toe?
partial tear of capsulo-ligamentous structures - moderate pain - swelling - ecchymosis - moderate disability ## Footnote ecchymosis = discoloration
62
What is indicated for a **grade 3 sprain** for Turf Toe?
complete tear of the plantar plate - severe swelling - pain - ecchymosis - can't bear weight normally
63
What are the **basic treatment** for turf toe?
R.I.C.E NSAIDS Toe taped for DF limit - but also grade based **Guide: return to sport needs a DF of 90 degrees**
64
What is the **timeline for grade 1** turf toe sprain?
return to sport as soon as sx allow
65
What is the **timeline for grade 2** turf toe sprain?
Need 3-14 days of rest
66
What is the **timeline for grade 3** turf toe sprain?
**crutches** for a few days and **up to 6 weeks of rest** from activity
67
What is the **specific treatment** regarding **grade 1** turf toe sprain?
can use narrow athletic tape to **immobilize the big toe to restrict pain** - place a firm insert in the shoe to limit movement and promote healing
68
What is the **specific treatment** regarding **grade 2** turf toe sprain?
may need immobilizing the foot in a brace or walking boot - allowing several weeks of rest
69
What is the **specific treatment** regarding **grade 3** turf toe sprain?
**IT DEPENDS ON THE SEVERITY** - surgery may be needed if there is a fracture of a bone (!!!) - damage to the cartilage (the tissue that lines the bones of the joints) - complete tearing of the tendon - excessive movement of the joint causes sublux
70
What is a **cuboid syndrome**?
When the structures near the cuboid bone are injured = one of the bones is moved or out of place - often misdiagnosed - small valid and reliable diagnostic tests - **uncommon (< 3%) after lateral ankle sprain** ## Footnote structures = calcaneo-cuboid ligaments
71
What is the **importance** of the cuboid?
The keystone of the lateral column of the foot: - **concave cuboid rest on the convex navicular and lateral cuneiform**
72
How does the **cuboid connecting to the navicular** important?
The only mid-tarsal that articulates with the navicular - **links the lateral column with the MLA of the foot**
73
Where does the **peroneus longus** pass through?
slings to the side and down **into the fibrous-osseus tunnel** in the plantar aspect of the cuboid
74
What does the **aetiology** of cuboid syndrome?
Degree and direction of the force of the peroneus then **SUDDEN inversion of the midfoot** with it being unlocked = **medial and inferior glide of the cuboid** - cuboid will sublux to the middle and down into the plantar direction ## Footnote tearing of the interosseous ligaments occurs
75
What is the **objective signs** of cuboid syndrome?
- pain over the cuboid - pain in toe-off - can't do plyometrics - pain along the medial arch and/or length of 4th MT - palpate prominence on plantar lateral aspect of the foot - limited and painful on DF, INV and EV @ CC joint - painful dosal glides of cuboid
76
What are the **recommended treatment** of cuboid syndrome?
Cuboid whips cuboid squeeze mobs with movement Re-training of intrinsics of the foot = creating stable midfoot in closed chain rehab of whole kinetic chain
77
What is the **subequent treatment** after a cuboid whip?
Peroneal and gastroc stretching intrinsic/extrinsic foot strengthening neuro/proprioceptive control exercise

PHTH 517 (16 decks)

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