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kin 2236 athletic injuries > (2) Lecture 12: Foot and Ankle Problems 2.0 > Flashcards

(2) Lecture 12: Foot and Ankle Problems 2.0 Flashcards

1
Q

Subungual Hematoma

A
  • bleeding underneath toenail = pressure + pain
  • common in distance running + squash b/c of deceleration (toe hits end of toe box)

Can also be acute
- drop weight on it, get stepped on

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2
Q

Treatment of Acute Subungual Hematoma

A
  • need to evacuate blood to decrease pressure
  • done w/ sterile heated paper clip
  • use pliers to hold clip
  • press into nail = blood will release
  • new nail will grow underneath and push old nail off
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3
Q

Prevention of subungual hematoma

A

PAD FOREFOOT = holds foot back

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4
Q

Ingrown Toenail

A
  • more common in MALES
  • LARGE TOE is most often affected
  • inflamed skin grows over lateral nail fold
  • usually result from LATERAL pressure of poorly fitting shoes, improper trimming or repeated trauma
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5
Q

Prevention of Ingrown Toenail

A

Proper Trimming

  1. Trim weekly by cutting STRAIGHT across
  2. Avoid rounding so margins don’t penetrate tissues on side
  3. Should be left long enough to clear underlying skin, but not too much that it pushes into sock
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6
Q

Ingrown Toenail Treatment for Mild to Moderate cases

A
  1. soak in warm water to make tissue soft
  2. tease tissue back, away from nail
  3. take strand of cotton ball, wet it and roll until cylindrical
  4. tuck cotton along border of nail
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7
Q

Tape Method of Treatment for Ingrown Toenail

A
  • place one end of tape along the tip of lateral nail fold on affected side + tuck it slightly inside nail fold
  • pull nail fold gently outward to make insulated space btwn side of nail and nail fold + attach tape to side od big toe
  • then fix other end of tape to toe pad w/o stretching the tape
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8
Q

Ankle stability comes from…

A
  1. shape of bones
  2. passive stabilizers (capsule + lig)
  3. dynamic stabilizers (muscles)
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9
Q

Ankle joint

A

Talocrural joint

  • ankle mortise is U shaped at top of talocrural jt

Made up of
- lower end of tibia
- medial malleolus (tibia)
- lateral malleolus (fibula)

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10
Q

Malleoli

A

Lateral malleolus is LONGER and more posterior than medial

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11
Q

Talus

A
  • NO muscles that attach to it
  • convex on top and concave on sides (better articulation + plantar/dorsiflexion)
  • trochlear surface (top) is wider anteriorly than posteriorly

With dorsiflexion, wider portion lies btwn malleoli

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12
Q

Fibula

A

with DORSIFLEXION
- fibula externally rotates and moves superiorly
- external rotation of fibula increases tension in structures that hold tibia and fibula together
- opposite happens in plantar flexion

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13
Q

How to rule out a fracture?

A

OTTAWA ANKLE RULES

Ankle X-Ray is needed if there is pain in malleolar zone and:
- bone tenderness at posterior edge or tip of lateral/medial malleolus
- inability to bear weight for 4 steps

Foot X-Ray is needed if there is pain in midfoot zone and:
- bone tenderness at base of 5th metatarsal or navicular
- inability to bear weight for 4 steps

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14
Q

Ottawa Ankle Rules

A

Used to rule out a fracture

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15
Q

External Rotation Test

A

ER Test

Used to diagnose FIBULAR FRACTURE

Indirect test: hand on medial side + externally rotate

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16
Q

Passive Stabilizers of Ankle

A

Ankle is surrounded by fibrous capsule
- thin + weak anteriorly + posteriorly

Talocrural joint is further strengthened medially and laterally by ligaments
- some communicated w/ capsule (ATFL, PTFL) and others don’t (CFL)

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17
Q

ATFL

A

Anterior Talofibular Ligament

  • WITHIN capsule = increase swelling
  • begins on lateral malleolus and travels anteriorly to talus
  • WEAKEST of lateral ligaments
  • increased strain in PLANTAR FLEXION + INVERSION as talus glides forward out of mortise
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18
Q

Anterior Drawer Test

A

Passive stabilizer special test

  • used to determine damage to ATFL
  • tested in SLIGHT PLANTAR FLEXION
  • hold heel with one hand and shin just above ankle with other hand. Pull heel up and shin down
  • positive test = foot slides forward and/or clunking sound as it reaches endpoint

Look for pain, laxity, endpoint

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19
Q

CFL

A

INVERSION + DORSIFLEXION

  • extracapsular ligament
  • neutral ankle position = starts on anterior part of lateral malleolus, below ATFL and runs downwards and backwards to attach to lateral calcaneus
  • provides stability to lateral talocrural jt as it moves into DORSIFLEXION
  • does not directly stabilize jt (stabilizes talocrural jt)

3.5x stronger than ATFL

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20
Q

PTFL

A

Posterior Talofibular Ligament

  • WITHIN capsule = increase swelling
  • starts on lateral malleolus and travels posteriorly around talus at 180 deg to ATFL
  • primarily supports talocrural jt in DORSIFLEXION
  • secondary support to talocrural jt
  • some fibres communicate w/ ATFL
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21
Q

Deltoid ligament

A

EVERSION

  • limits talar/subtalar abduction or lateral eversion
  • broad

6 bands w/ variability
- ANTERIOR is tight in PLANTAR FLEX.
- middle portion in neutral
- POSTERIOR is tight in DORSIFLEX.

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22
Q

Talar Tilt Test

A
  • to determine extent of injury to CFL (inversion) or DELTOID (eversion)
  • foot at 90 degrees + calcaneus inverted (pain and excessive motion = CFL and possibly ATFL + PTFL tested)
  • calcaneus everted = DELTOID ligament is tested
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23
Q

Dynamic Stabilizers of Ankle

A
  • peroneus/fibularis longus and brevis may contract to slow down or stop movement in dangerous range
  • controls rear for SUPINATION
  • anterior muscles may contract to slow plantar flexion or supination
  • medial muscles may prevent eversion sprains
24
Q

Muscles involved w/ eversion sprain

A
  • Peroneus longus
  • Peroneus brevius
  • Peroneus tertius
  • Ext. Digitorum Longus
  • Achilles Tendon
25
Q

Muscles involved w/ inversion sprain

A
  • Tib. Posterior
  • Tib. Anterior
  • Ext. Hallicus Longus
  • Flex. Digitorum Longus
  • Flex. Hallicus Longus
26
Q

Ankle Sprains

A
  • most common injury in sports
  • 85% LATERAL, 10% SYNDESMOSIS, 5% MEDIAL
27
Q

Properties of Ligaments

A
  • wave or crimp across ligament
  • injury is correlated to load-deformation curve
  • 3 phases of curve: toe, liner, rupture region
28
Q

Toe and Early Liner Region

A
  • initial concave region
  • normal physiological range of strain = 0-2% of length

Early linear region = 2-4%
- due to flattening of crimp

Repeated cycling of stretch in this range is REVERSIBLE

29
Q

Ligament Sprains

A
  • pathological irreversible ligament elongation
  • intra and inter-molecular cross-link are disrupted until failure

Early part = mild/grade 1 (<50%)
Grade 2 = 50-80% fibre disruption (obvious laxity)
Grade 3 = 80-100% fibres (rupture zone)

30
Q

When do ankle sprains usually occur?

A
  • usually occur w/ loading + unloading
  • CKC plantar flexion = talus is positioned anteriorly in ankle mortise
  • main restraint for excessive anterior talar glide is ATFL
  • while loaded, ankle is more stable in mortise
31
Q

CKC

A

Closed Kinetic Chain

distal aspect is in contact w/ ground

32
Q

OKC

A

Open Kinetic Chain

NOT in contact w/ ground
- ex. quad extension

33
Q

Restraint for excessive anterior talar glide

A

ATFL

34
Q

What ligament is first line of defense for ankle?

A

Depends on:
- mechanism (inversion vs eversion)
- ankle position (plantar flex. vs dorsiflex)

35
Q

Deltoid Ligament Sprain

A
  • LEAST common sprain
  • MOI: EVERSION
  • stability of medial ankle depends on deltoid lig supported by lateral malleolus
36
Q

Symptoms of Deltoid Lig Sprain

A
  • MOI: EVERSION
  • pain on MEDIAL side of ankle
  • instability w/ high grade sprain
37
Q

Signs of Deltoid Lig Sprain

A
  • pain w/ active + passive EVERSION
  • pain, laxity, endpoint? findings w/ TALAR TILT test (EVERSION)
  • possible pain w/ resisted inversion
  • may have increased pronation
  • pain on palpation over deltoid lig
38
Q

ATFL Sprain

A
  • MOST common sprain
  • MOI: INVERSION in PLANTAR flexion
39
Q

Symptoms of ATFL Sprain

A
  • MOI: INVERSION in plantar flexion
  • pain on LATERAL side of ankle, anterior to malleolus
40
Q

Signs of ATFL Sprain

A
  • pain w/ active + passive inversion in plantar flexion
  • pain, laxity, endpoint? findings w/ ANTERIOR DRAW TEST
  • possible pain w/ resisted eversion (dynamic stabilizers)
  • pain on palpation over ATFL
41
Q

CFL Sprain

A
  • MOI: INVERSION in DORSIFLEXION
  • 3.5x stronger than ATFL
42
Q

Symptoms of CFL Sprain

A
  • MOI: INVERSION in neutral to slight dorsiflexion
  • pain on LATERAL side of ankle below malleolus
43
Q

Signs of CFL Sprain

A
  • pain w/ active + passive INVERSION in neutral
  • findings w/ TALAR TILT test (INVERSION)
  • possible pain w/ resisted eversion (dynamic stabilizers)
  • pain over CFL ligaments
44
Q

Subjective Assessment of Ankle Sprain

A

MOI
- inversion or eversion
- plantar flexed or dorsiflexed

Were you able to continue?
- unable to bear weight/gross instability
- able to walk = grade 2 injury
- able to run after = grade 1 injury

Did you hear or feel a pop/crack?

Swelling? How quickly?
- capsular vs non-capsular

45
Q

Objective Assessment of Ankle Sprain

A
  • swelling
  • obvious deformity

Weight bearing
- static: equal pressure front/back, side to side
- dynamic: guarded/painful movement

46
Q

Actions when ATFL is on tension

A

inversion + plantar flexion

47
Q

Action when CFL is on tension

A

inversion + dorsiflexion

48
Q

Action when anterior portion of DELTOID ligament is on tension

A

eversion + plantar flexion

49
Q

Peroneus Longus action

A

eversion

50
Q

Tibialis Posterior action

A

inversion

51
Q

Ankle Special Tests

A
  • manual muscle testing
  • anterior drawer test
  • talar tilt test

Always rule out fracture first
- external rotation
- Ottawa ankle rules

52
Q

Positive Anterior Drawer Test

A
  • significant anterior movement
  • no endpoint
  • minimal pain
53
Q

Ankle Sprain Prognostic Indicators

A
  • higher age, poor weight-bearing status
  • NOT ACHIEVING FULL ROM WITHIN 2 WEEKS may be sign of accompanying injury
  • medial pain on palpation + pain w/ dorsiflexion
54
Q

Ankle Sprain Treatment

Inflammation/Destruction

A
  • NSAIDs to reduce pain
  • ice, compression + elevation
  • protected injured tissue (crutches)
  • optimal loading = maintain ROM in uninjured tissue
55
Q

Ankle Sprain Treatment

Repair

A
  • heat = increased blood flow
  • begin ROM and idealize
  • maintain strength of uninjured tissue
  • gentle strengthening of injured tissue once ROM is achieved
  • increase weight-bearing
  • begin proprioception exercise
56
Q

Ankle Sprain Treatment

Late Repair/Remodeling

A
  • idealize strength of dynamic stabilizers
  • continue w/ balance and coordination training

kin 2236 athletic injuries (20 decks)

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