Ankle Flashcards
Morton’s Neuroma
thickened nerve benign in nature between third and fourth metatarsal head.
Potts Fracture & mechanism interview
fracture affecting one or both malleoli which can occur in combination with an inversion injury and can sometimes be difficult to distinguish clinically between a fracture and moderate to severe ligament sprain.
Mechanism usually landing from jump or sudden change of direction e.g. in football or rugby.
(bimalleolar)
Overuse/ Stress Fracture
Potts Fracture & mechanism exam
+ Palpation
+ Observation and Functional task e.g. gait.
+ Active range of motion
Anterior ankle impingement
“Footballers or Athletes Ankle” - due to repeated microtrauma osteophytes develop as a defence mechanism to reduce movement at the ankle. Can lead to impingement.
Gout
crystal-induced arthritis, occurs in people with excessive blood levels of soluble urate.
Metatarsals fracture
March fracture 2nd/3rd
Fracture 5th in distance running.
Tibia, fibula, navicular (Brukner et al. 1996)
Avulsion Fracture
fracture exam
+ Palpation
+ Observation and Functional task e.g. gait.
+ Active range of motion
fracure Base 5th MT (peroneus brevis and tertius)
PMH – Osteoporosis, relative energy deficiency (REDS), long-term steriod use, Cancer
Localised Pain worse on weight-bearing relieved when weight taken off.
Limp.
Bone- severs disease calcaneal apophysitis
(apophysitis)
Apophysitis - Apophyses are the sites of attachment of tendons at long bones. The epiphyseal plate is two to five times weaker than the surrounding fibrous structures (ligaments, tendons, and joint capsule) in children and adolescents.
Bone- severs disease calcaneal apophysitis
I-3
Age – Childhood
Sporty children who complain of pain after sport locally over the heal
Localised Pain and swelling
Bone- severs disease calcaneal apophysitis E3
Observation and Palpation
Pain on isometric plantarflexion
Bone anterior impingement syndrome
I2
PMH- Ankle sprains- reduced proprioception
SH- Sports that require full dorsiflexion, e.g. footballers, dancers, athletes.
Bone anterior impingement syndrome
E3
Palpation- pain at joint line
Passive movement- symptomatic in full DF
Active movement- symptomatic in full DF
Osteoarthirisis
I6
Location of symptoms:
- Most common 1st MTPJ (7.8%*)
- Then 2nd cuneometatarsal (3.9%*)
- Then Talonavicular (5.8%*)
- Then navicularcuniform (5.2*)
Talocrural OA post fracture.
*Population prevalence of symptomatic radiographic OA (Roddy and Menz 2018)
Gradual onset or post trauma
>45-years or over
Joint pain related to activity and weightbearing
Mild swelling
No early morning stiffness (EMS) or morning stiffness that lasts no longer than 30-minute
Osteoarthirisis
E4
Passive/ Accessory motion – Non-contractile structures
Observation – mild effusion, hallux valgus
Calluses or blisters over bony changes (osteophytes)
Active range.
Rheumatoid arthritis
I6, E3
Up to 90% of those with RA will report foot problems
(National Rheumatoid Arthritis Society)
Location: Metatarsalphalangeal joints, subtalar, talocrural and mid-tarsal.
Early morning stiffness (EMS) for longer than 30minutes.
Swelling and heat
General health: may have malaise (feeling unwell), fatigue and low grade fever as systemic.
Extra-articular- rheumatoid nodules, vasculitis, pulmonary fibrosis, carditis, ocular disease
Rheumatoid arthritis
E3
Palpation – swelling and temperature
Observation- Swelling
Passive/ Accessory range of motion – non-contractile structures.
Achilles tendinopathy
- Retrocalcaneal bursitis
- Achilles tendonitis
Enthesitis- (Enthesis- where a tendon or ligament attaches to bone)- pathological feature of spondylarthritis.
- Achilles tendonitis
Muscle injuries and tendonitis I7
Rupture- Achilles tendon rupture
Strains – Gastrocnemius
Tendonitis
- Achilles tendonitis
- Peroneal tendons
- Tibialis Posterior
- FHL – ballet dancers
Mechanism of injury – sudden (strain/ rupture) versus gradual onset (tendonitis).
Muscle injuries and tendonitis E3
Muscle testing – contractile tissue
Palpation – show me where you pain is?
Pain on passive movement in opposite direction.
Shin splints/ medial tibial stress syndrome interview
Pain (“ache”) increasing during exercise or after exercise, reduces with rest. Worse running on hard, non-compliant surfaces (concreate, treadmills)
Pain located in lower 2/3 of tibia
High BMI
SH- athletes who run and jump e.g. netball, tennis, gymnastics
Training overload
Shin splints/ medial tibial stress syndrome exam
Palpation- pain on palpation along the posteromedial border of tibia >5cm
Tibialis posterior, flexor digitorum longus and soleus muscles are overloaded. Can associated with:
- Pronation as arch has an important role to absorb shock
- Increased ankle plantar flexion
Increased hip external rotation
Plantar fascitis - despite its itiis in the name pathophysiology, it is due to degeneration not trauma
interview
Location of pain: medial heel and midfoot pain
Worse on standing in the morning and when bare foot.
Female>male
PMH: obesity
SH: Prolonged standing/walking e.g hairdresser
Plantar fascitis - despite its itiis in the name pathophysiology, it is due to degeneration not trauma
exam
Palpation
Passive DF and toe extension (PF on stretch)
Associated with reduced dorsiflexion
Ligament injuries interview
Mechanism of injury - excessive inversion. “twisted ankle”
Swelling and bruising
Difficulty weight-bearing
X-ray- no fracture
Ligament injuries- exam
Passive movements – inversion reproduces symptoms
Accessory movements – Anterior draw to test instability anteriorly (ATFL)
Palpation
Anterior talofibular ligament most common, followed by Calcaneofibular ligament. Injury to posterior talofibular ligament is only in severe ankle sprains often accompanied by fractures, dislocations or both.
Associated with Potts Fracture
