Acute Lower Extremity

Question 1

strain/sprains
1. strain vs. spain
2. stress vs. strain
3. grade of strain

Answer 1

1. strain is tearing of muscle or tendon, sprain is tearing of ligament
2. as stress increases, collagen uncrimps, within elastic range still able to recoil without dmg, in plastic range permanent stretch of tissue, enters the injury range, past end of plastic range is break/failure
3. grade 1 mild has microtears in a few fibres of the tissue but the bulk of the tissue is intact, still able to limit ROM (lig) with some pain; grade 2 moderate has partial tear more ROM (lig); grade 3 severe is complete tear

Question 2

turf toe

Answer 2

1. Dmg to the MTP joint when there is toe hyperextension
2. potential structures FHL, MTP joint capsule, metatarsal, sesamoid bones, (plantar fascia/plate?)
3. stand on tip toes to test

Question 3

syndesmosis sprain

Answer 3

1. high ankle sprain
2. potential dmg to interosseous membrane and tibiofibular ligament; highly unstable since mortise can separate
3. test with prone DF and ER (force talus into mortise and rotate foot) or with Thompson squeeze test (squeeze just below the gastroc to pull apart the bottom of the syndesmosis joint

Question 4

jones fracture

Answer 4

breaking the fifth metatarsal between shaft and base;

Question 5

assessing ankle and foot swelling: figure 8 method for ankle

Answer 5

positioned with testing foot resting over the end of bed and ankle in 90 deg dorsiflexion:
1. start between ATF and lat malleolus
2. wrap medially on the dorsal side to navicular tuberosity
3. laterally to base of 5th metatarsal along plantar side
4. across tib ant tendon, tip of med malleolus
5. across Achilles’ tendon, ending at start

Question 6

Ottawa ankle rules

Answer 6

test for:
1. Bony tenderness along distal 6 cm of the posterior edge of tip of lateral malleolus
2. Bony tenderness along distal 6 cm of the posterior edge of tip of medial malleolus
3. Bony tenderness at the base of the 5th metatarsal
4. Bony tenderness at the navicular
5. Inability to bear weight both immediately after injury and for 4 steps
Ankle x-ray if 1-2, and 5; foot x-ray if 3-5; not applicable to pregnant people, diminished ability to follow, or under 6 yrs old

Question 7

ankle taping

Answer 7

1. pre-tape assessment: history, skin sensitivities and integrity, distal circulation
2. position ankle in neutral and place heel pad over Achilles and lace pad over ant bend of ankle
3. start powerflex where gastroc begins to taper, circling lat to med with half tape width overlap
4. at top of lat malle start figure 8 across dorsal side to med midfoot, plantar side to base of metatarsal, across top of medial malle, behind Achilles and finish at lat malle; X across top of foot
5. heel lock 1 more posterior than 8 to MLA, across plantar side, up lat side to Achilles to med malle
6. heel lock 2 from med malle more posterior than 8 across lat side, up to Achielles to med malle; X on bottom of heel
7. cover windows and circle back up leg with half tape overlap
8. victory tape stirup 1 cup heel and pull up with even tension across both malleoli to top of base layer, 2nd stirup half tape width behind 1st, 3rd stirrup half tape width in front 1st, secure with one circle at top, apply one fig 8 and 2 heel locks, individual circles from top to malleoli overlaping by half
9. check for effectiveness and distal circulation and feedback from athelete

Question 8

lateral ankle injury

Answer 8

caused by inversion:
1. Musculotendinous = Peroneus longus/brevis
2. Ligamentous = CF, PTF, ATF
3. Inversion stress tests x3
4. anterior drawer for ATT and ATF: ATT and ATF prevent talus from sliding forward, test by pulling talus out of mortise

Question 9

medial ankle injury

Answer 9

caused by eversion:
1. Musculotendinous = tib post, FHL, FDL
2. Ligamentous = ATT, PTT, TN, TC
3. inversion stress tests x3
4. anterior drawer for ATT and ATF: ATT and ATF prevent talus from sliding forward, test by pulling talus out of mortise