(4) Pathologies of the ankle foot Flashcards
Where does achilles tendinopathy occur?
2 to 6cm proximal to the insertion of the tendon into the calcaneus
What is a common MOI of the Achilles tendon?
Running and jumping
What are intrinsic risk factors for Achilles tendinopathy?
- prior LL tendinopathy or fracture
- decreased isokinetic plantar flexor strength
- abnormal gait pattern
- biomechanical abnormalities
- training during cold weather
What are extrinsic risk factors of achilles tendinopathy?
- excessive mechanical overload
- poor shock absorption
- training on hard surfaces
- increased interval training
What are common signs and symptoms of achilles tendinopathy?
- localised pain
- morning pain
- pain worse after exercise
- swelling, thickening
- pain on single leg heel raise
- pain on palpation
What is the rehab protocol for achilles tendinopathy?
- Advice (activity modification)
- Education
- Ice
- Exercise rehab (Eccentric loading, heavy slow resistance)
- Target modifiable risk factors
What does the heavy slow resistance training look like for achilles tendinopathy?
- x3/week
- each session consists 3 2-legged exercises
1. heel raise with bended knee in seated calf raise machine
2. heel raise with straight knee on plate with BB
3. heel rises with straight knee in leg press machine - 3/4 sets with 2/3 minute rests
What ligaments is the Lateral Ligament Complex (LLC) composed of?
- Anterior taliofibular (ATFL)
- Calcaneofibular (CFL)
- Posterior talofibular (PTFL)
What is the MOI for LLC injuries?
Inversion of plantarflexed ankle
What are signs of a grade 1 (mild) LLC injury?
- minor swelling
- palpatory tenderness
- minimal functional loss
- no increased instability
What are signs of a grade 2 (moderate) LLC injury?
- partial ligament tear
- moderate pain
- swelling and tenderness
- mild to mod instability
- mod functional disability
What are signs of a grade 3 (severe) LLC injury?
- complete tear of ligament
- joint capsule rupture
- bruising and swelling
- significant loss function
- increased instability
- unable bear weight
What are the signs and symptoms of LLC injuries?
- sudden onset
- pain and swelling
- ecchymosis
- decreased ROM
- muscle weakness
- altered weight bearing
- decreased single leg stance test
- Instability
What does Rx for LLC injuries involve?
- Based on phase of healing, severity and comorbidities
- PRICE/POLICE
- Early weight bearing
- ROM & proprioception
- +/- manual therapy
- exercise rehab
What is a deltoid ligament sprain?
Occurs as a result of eversion injuries
What is a high ankle sprain?
- Distal tibiofibular syndesmotic ligament
- MOI: external rotation and/or ankle dorsiflexion
What is Chronic Ankle Instability (CAI)?
Perception by patient of abnormal ankle with a combination of symptoms including recurrent sprains, pain, swelling and avoidance activities
What causes Chronic Ankle Instability (CAI)?
- develop after initial ankle sprain or multiple LLC injuries
- mechanical instability: laxity
- functional instability: proprioceptive and muscular deficits
- sensorimotor deficits
What are the signs and symptoms of CAI?
- history of/recurrent LLC sprains
- giving way
- +/- pain
- anterior draw/talar tilt
What is the Rx for CAI?
- proprioceptive and balance-training programs
- 4/52 rehab
What is Plantar Fasciitis?
inflammation of the band of tissue in the foot that supports your arch and connects to your heal
What are the causes of plantar fasciitis?
- spontaneous
- middle-aged
- woman >men
- lots of walking
- poor plantar flexion
What are symptoms of plantar fasciitis?
- Heel pain with weight bearing or walking
- agg: prolonged standing & initial steps after rest
- localised tenderness
- pain passive extension toes
What is the treatment for plantar fasciitis?
- conservatively
- ice
- anti-inflammatory meds
- shoe inserts
- plantar fascia specific stretches
What is Psoriatic Arthritis?
A chronic inflammation of the skin and joints, usually causing joints become swollen, stiff and painful.
What are symptoms of Psoriatic Arthritis?
- pain
- swelling
- stiffness
- dactylitis
What is the Rx protocol for psoriatic arthritis?
- if suspect refer to GP
- Pharmacological support
What is Gout?
- crystal arthropathy
- formation of uric acid crystals in a joint
What are symptoms of Gout?
- sudden episodes
- pain one/more joints
- hot and swollen
- tender shiny red skin
What is Ankle Impingement Syndrome?
Impingement or abnormal entrapment or contact of structures resulting in pain or restricted motion
What is Anterior Ankle Impingement?
Entrapment of structures along the anterior margin of the tibiotalar joint in terminal dorsiflexion
What causes anterior ankle impingement?
- Intra-articular osteophytes
- compression triangular soft tissue mass in anterior joint space
- chronic inflammation
- synovitis
- thickened anterior tibiofibular ligament
What is Posterior Ankle Impingement?
compression of the structures posterior to the tibiotalar and talocalcaneal joints during terminal plantar flexion
What causes posterior ankle impingement?
- hypertrophy or elongation of lateral tubercle of posterior process talus
- Tibiotalar or subtalar degenerative joint disease
- Flexor hallucis longus irritation
What can be seen on clinical examination in a patient with Anterior Ankle Impingement?
- anterolateral ankle joint tenderness
- recurrent anterolateral joint swelling
- pain during SL squat
- pain with activities
- absence of lateral ankle instability
What is the treatment for ankle impingement?
- Advice
- Ice & NSAID’s
- Exercise rehab
- Corticosteroid injection
- Orthotics
What can be seen during clinical examination of Posterior Ankle Impingement?
- loss mobility
- pain posterior aspect
- pain with forced plantarflexion
- prominent posterior talar process
- hyper-plantar flexion test
What is Tibialis Posterior Tendinopathy?
pain and inflammation around the inside of the foot
What are the signs and symptoms of tibialis posterior tendinopathy?
- Gradual onset
- localised pain medial ankle or foot pain
- pain/inability perform single leg heel raise
- lower medial arch height
What is the Rx for Tibialis Posterior Tendinopathy?
- exercise rehab
- orthotics
- absence of evidence
What is Posterior Tibial Tendon Dysfunction?
- inflammation or tearing of the posterior tibial tendon
- progression stage I/II tibialis posterior tendinopathy to III/IV
What are the signs and symptoms of posterior tibial tendon dysfunction?
- gradual foot deformity
- valgus heel
- flattened medial longitudinal arch
What is the Rx for Posterior Tibial Tendon Dysfunction?
Surgery stage III/IV
