Acute Foot and Ankle Flashcards
What basketball player was out playing and landed on someone else’s foot, he said he “ went over it”. What could this mean in clinical language?
Went over, usually means inversion
The athlete heard a pop… what could this mean?
May have been a tissue fail
The athlete points to the lateral side of his ankle and said it hurts “ here”. What could have happened to that side?
Possibly too much inversion, may be ripped some thing on lateral side, ~ distal to lateral malleolus
If the athlete has bruising, what could this mean from a clinical perspective?
Must have damage some thing that has blood supply to it
- The amount of bruising can be very variable between different people
Is an athlete has swelling, wrapping around the malleolus and starting to move into the heel region in the lateral side, what could this mean from a clinical perspective? Why does this occur in the first place?
- probably asked for help a lot later than the injury happened
- likely had three days of inflammatory phase
- Probably walked on it, etc.
GRAVITY is draining fluid down if the foot isn’t rested and elevated ( in severe cases, it can move into toes and make toe “sausages” XD)
If something on the lateral side of the foot/ankle is damaged, what structures could have been impacted?
Include bones, ligaments, tendons
5 Bones
- talus, fibula, calcaneus, cuboid, metatarsals
3 Ligaments
- Talofibular (ANT), talofibular (POS), calcaneofibular
2 Tendons
- Peroneus longus, peroneus brevis
Describe the difference between a sprain and a strain
- a SPRAIN enters a bands of tissue that connect 2 bones together (aka ligaments)
- a STRAIN involves an injury to a muscle or to the band of tissue that attaches a muscle to a bone
A ligament can stop you until it fails… what are the three grades of ligament damage?
Mild, moderate, severe
Describe a mild ligament tear
Tearing of only a few of the ligament fibres
Describe a moderate ligament tear
A more severe partial, tearing of the ligament
Describe a severe ligament tear
Complete tear of the ligament (80/90+ fibres), every/almost all fibres failed
What kind of ligament tear doesn’t usually have bruising?
Mild
What type of ligament tear(s) will see bruising?
Moderate and severe
- Blood vessels, not OK
What factors of their story are important to consider before establishing the injury/ which parts of the story, but you need to translate into clinical language?
- WHAT IS THEIR STORY IN GENERAL: “layman’s” way of explaining what/when of the injury
- SOUND OR SENSATION: look for descriptions of “pop” that was felt or heard
- PAIN DISTRIBUTION: where does it hurt? Up to you to determine what “that side” or “here” means
- SWELLING/BRUISING DISTRIBUTION
- WEIGHT BEARING STATUS
What are the three types of weight-bearing status you can see in patients?
NWM (non weight bearing)
PWB (partial weight bearing)
FWB (full weight bearing)
Describe a high ankle sprain, explaining how it might happen, and how it impacts gait/weight-bearing status
- acute injury: usually in position with heavy load on ankle
- changes position quickly (cleats/skate sticking to the ground), when the foot turns away/changes direction they feel pain
- There’s usually limit walking abilities/weight-bearing more so than low ankle sprains
= tells us that the injury is on a WEIGHT-BEARING STRUCTURE
Which ligament and tendon might be involved in a high ankle sprain?
Inferior/distal tibiofibular ligament(creates a mortis for talus to sit in)
Extensor digitorum longus (similar pain location)
In terms of movement, and it’s effect on the affected structures, how many high ankle sprains happen?
- Dorsiflexion puts the widest part of the talus in and stretches ligament
- Additional rotation forces fibula away from tibia and opens joint
What’s another name for a high ankle sprain?
Syndesmotic sprain
Where does swelling and bruising occur during high ankle sprains?
- swelling is typically localized where ankle meets low leg
- as it becomes more severe, swelling will spread more
- bruising happens in same place as swelling
A soccer player hurt his toe when he fell at practice. His toe was forced into hyperflexion and foot into plantarflexion. What is this called? What structure may have been damaged?
TURF TOE!
- MTP joint forced into hyperextension
- Something failed on the plantar side, think about what gets pulled apart
Which tendon travels along planter side of MTP joint ? FLEXOR HALLICUS LONGUS (FHL)
Lateral ankle sprains, high ankle sprains, and turf toe are all…
Acute injuries
Which 4 ROM should you test when evaluating an ankle injury? Include average rom values.
DF (20), PF (55), INV (20) , EV (15)
What 4 ROM should you test when evaluating a toe injury?
Toe flexion, toe extension, DF, PF *Key structures that cross toe also cross ankle
Pain is most likely to show up when (3 things):
A) injured muscle contracts
B) injured tissue is pulled apart
C) injured joint surface is compressed
What is the relative risk of recurrent sprains with a brace?
0.30
What is the relative risk of first time sprains with a brace?
0.69
In lecture it was mentioned that soft tissue injuries meed PEACE and LOVE. What does the acronym PEACE stand for here?
Protect
Elevate
Avoid
Compress
Elevate
