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MSK basics > ankle 2 - injury > Flashcards

ankle 2 - injury Flashcards

1
Q

what does pes clavus mean

A

high arch

the rearfoot is stuck in inversion and cannot get eversion to pronate

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2
Q

is pes clavus more supinated or pronated

A

supinated

the foot is rigid - poor shock absorbing foot

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3
Q

what is pes planus

A

flattened arch

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4
Q

what range of motion deficits do we expect for a patient with pes planus

A

limited DF

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5
Q

is pes planus more rigid or flexiable

A

flexiable - weak supinator muscles

or

rigid - bony structure abdnormality

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6
Q

what muscle creates the supination motion

A

tib post

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7
Q

what is the result of abnormal pronation

A

pronation that is in excessive in range
or when the foot should be supinated

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8
Q

what causes abnormal pronation

A

all 3 -planes are involved

frontal, transverse, sagittal plane

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9
Q

what is occuring the frontal plane to cause excessive pronation of the foot

A

tibial varus

subtalar varus

forefoot varus

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10
Q

what is occuring the transverse plane to cause excessive pronation of the foot

A

hip anteversion

internal femoral rotation

internal fibilar rotation

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11
Q

what is occuring the sagittal plane to cause excessive pronation of the foot

A

leg length

equinas

limited knee and or hip extension

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12
Q

what are the effects of abnormal pronation

A

callus/pain under the 2-4 met heads and plantar medial 1st MTP joint

hallux rigidus (stiff big toe)

mortons neuroma

plantar fascitis

metarsal stress fracture

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13
Q

what is mortons neuroma

A

the thinkening of tissue around one of the nerves leaving to your toe

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14
Q

what is result of abnormal supination

A

supination that is excessive motion in range or occurs when the foot should be pronating

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15
Q

with supination what do we see in the forefoot

A

valgus

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16
Q

first ray and supinated foot

A

plantar felxed

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17
Q

what other factors can cause supination in the foot

A

equinas = where the heel cannot reach the ground

leg length - the shorter side

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18
Q

what are some foot injuries that you see with abnormal supination

A

callus/pain under the 1st - 5th MT heads

seasomoiditis and/or stress fracture 5th met head

hammer toe

haglund’s deformity

chronic lateral ankle strain

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19
Q

what is a hammer toe

A

the toe is bent at the middle joint

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20
Q

what is haglund’s deformity

A

boney enlargement on the back of the heel

this can irritate soft tissue around the achilles tendon

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21
Q

what is the most common ankle sprain

A

inversion sprain

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22
Q

grade 1 ankle sprain

A

mild over stretching

no tearing

no functional instability

short recovery time

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23
Q

grade 2 ankle sprain

A

partial tear of the ligament

increased functional loss

swelling, effusion, and tenderness

recovery 10 - 30 days

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24
Q

grade 3 ankle sprain

A

complete rupture

restricst

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25
Q

what is the most common type of ankle sprain

A

inversion

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26
Q

what mechanisms are involved with inversion

A

talocural PF

subtalr inversion

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27
Q

what are inversion sprain

A

tenderness to palpation

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28
Q

what is equinas

A

when the ankle lacks DF flexibility

tightness in the calf muscles

in some patients this tightness is congenital

can be in one or both ankles

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29
Q

what are the upper chain issues seen with abnormal pronation

A

achilles tendinitis

anterior or medial knee pain

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30
Q

what are the upper chain issues seen with abnormal supination

A

achilles tendinitis

lateral knee or hip pain

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31
Q

what is a rigid plantar flexed 1st ray associated with

A

excessive supination

limited ST joint motion

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32
Q

what can rigid plantar flexed 1st ray lead to

A

lateral instability of the ankle

callus under the first and 5th met

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33
Q

what can we do for a rigid plantar flexed 1st ray

A

accomadated orthotic cut out for the 1st ray

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34
Q

what is the first ray

A

1st met and the medial cuneiform

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35
Q

what is the mechanism of an inversion ankle sprain

A

talocural PF

subtalar inv

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36
Q

which ligament is involved with a inversion ankle sprain

A

anterior talofibular ligament

talo-fibular ligament

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37
Q

what ligament is sometimes involved in severe inversion ankle sprain issues

A

post talo-fib

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38
Q

what are intrinsic risk factors to an inversion ankle sprain

A

limited DF ROM

decreased balance

decreased ankle proprioception

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39
Q

what are extrinsics risk factors to an inversion ankle sprain

A

sport type

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40
Q

what are some associated injuries with inversion strains

A

peroneal tendon injury

peroneal nerve issue

fracture of the dital tib fib, lateral malleolus, medial mallelus , base of the fifth met

sinus tarsi syndrome

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41
Q

what are the signs and sym of a inversion sprain

A

tenderness to palpation of the lateral collateral ligaments

swelling and discoloration of the lateral ankle region

painful limitation of the PF./inv

possible - pain and weakness to resisted ev

anatalgic gait

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42
Q

what tests will be positive for an inversion sprain

A

anterior drawer

medial talar tilt test

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43
Q

why do we see an antalgic gait with an inversion sprain

A

pain and decreased weight bearing

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44
Q

what are the ottowa ankle rule

A

pain in the malleolar or mid foot

either

cannot walk immediately after the incident or four steps in the ED

or

infer tibfib, inf medial and lateral malleolus

bone tenderness in the navicular or the base of the 5th met

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45
Q

would you perform manuel therapy for those with inversion sprain

A

yes

increase ROM and decrease pain

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46
Q

what should be the progression of exercises for those with inversion ankle sprains

A

isometrics

thera band

PRE - progressive resistance exercises

weight bearing exercises

(most of the emphasis is place of the ankle everters)

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47
Q

what are PRE

A

Gradually adding load and overload to the

48
Q

what is chronic ankle instability

A

recurrent ankle sprains or giving away that last for more then 6 months

49
Q

what is FAI

A

functional ankle instablity

50
Q

what is FAI caused by

A

distrubted ankle properioception

51
Q

how do you treat FAI

A

balance

SLS

return to position

52
Q

what kind of laxity do we see with chronic AI

A

anterior and inversion laxity

53
Q

what is sinus tarsi syndrome

A

chronic pain and inflammation of the lateral aspect of the subtalar joint

54
Q

where is the sinus tarsi

A

the lateral portion of the foot

between the talus and calcaneus

55
Q

what is sinus tarsi normally a secondary condition of

A

chronic ankle instability
in patients who hyperpronate

tthe STJ ligaments are lax

56
Q

what happens to the talus with hyperpronation

A

the talus is displaced into the sinus tarsi and this results in irritation

57
Q

what is sinus tarsi syndrome a result of

A

results from instability of the subtalar joint.

58
Q

what are the signs and symptoms of sinus tarsi syndrome

A

point tenderness - ant and inf to the lateral mall

patient is an over pronator

pain with amb that goes away with rest

59
Q

how do we treat sinus tarsi syndrome

A

low dye taping

or

orthotics

sertiod injections

60
Q

what is the purpose of low -dye taping

A

unloading the plantar fasciatis and providing medial ankle support

61
Q

eversion sprains - MOI

A

forced …

excessive pronation of the foot

excessive abd of a planted foot

62
Q

what ligament is normally implicated with a eversion sprain

A

the deltoid ligament

may also involve the distal tib-fib interosseous membrane

63
Q

what may be involved with a sever ankle eversion sprain

A

avulsion fracture of the calcaneal insertion of the deltoid ligament

64
Q

what is more common ankle inversion or eversion sprains

A

inversion

the distal tibfibextends below the joint line, and this provides more medial stability

65
Q

what are the signs and symptoms of an eversion sprain

A

tenderness of the deloitd ligament also maybe the tibiofibular ligament and interosseus membrane

swelling and possible discoloration

painful limitation in df/ev

possible - painful and weak inverters

antalgic gait

66
Q

what test could be positive for an eversion sprain

A

anterior drawer test

ER test

talar tilt

67
Q

for eversion sprain what muscle are we focus on strengthening

A

the invertors

68
Q

what ligamanents are involved with high ankle sprain

A

ant distal tibfib

distal interosseous membrane

69
Q

what is the MOI for high ankle sprains

A

forced ER of the foot

IR of the leg

70
Q

gait of someone with a high ankle sprain

A

patient will avoid dull DF in gait to min the stress on the distal tibfib joint

steppage gait

71
Q

what are the signs and sym of a high ankle sprain

A

TTP distal tibfib

mim swelling sometimes

patient will avoid dull DF in gait to min the stress on the distal tibfib joint

passive DF my reproduce sym

72
Q

what happens to the distal ant tibfib joint when we move into DF

A

the the distal tib fib to open up

73
Q

what is a steppage gait

A

the inability to lift the foot while walking due to weakness of the muscle that cause DF

foot drop during gait

could also be due to equinas

74
Q

what tests will be positive for a high ankle sprain

A

ER test

distal tibfib test

75
Q

what is a non-op treatment for a high ankle sprain

A

prolonged protected weight bearing - 4 weeks

delay functional advanced retraining until 8 weeks

external ankle support or brace is used for retraining

76
Q

what is the average recovery time for a high ankle sprain

A

> 6months

77
Q

are thrust mobs okay after an acute ankle injury

A

yes

78
Q

evidence based practice for PT after acute ankle sprain

A

manual therapy

thrusts and non-thrust mobilization

exercise therapy

balance and proprioceptive exercises

79
Q

what are some contraindications for manual therapy and ankle sprains

A

acute with sig pain

grade 3 sprains

injury of syndesmosis or fracture

history of surgery or fracture

80
Q

what is a syndesmosis

A

a fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments

81
Q

what is plantar fasciitis

A

inflammation fo the plantar fasciitis

82
Q

what are the feature of plantar fasciitis

A

tenderness at the medial tubercle of the fasciitis

worst witht he first few steps in the morning or after a long time sitting

pain with combined DF and great toe extension

slight PF aids relief of symptoms

83
Q

what is the mechanism Plant fas

A

excessive foot pronation

pes clavus foot

limited DF ankle

limted DF of the MTP joints

84
Q

where does the plantar fasciatis insert

A

the phalanges

85
Q

what is a another word for high arch

A

pes clavus

86
Q

what is a another word for low arch

A

pes planus

87
Q

excessive pronation and - plant fac

A

this will over stretch the plantar fascia

results in irritation

88
Q

pes clavus - plant fas

A

there is limited pronation during gait and this result in a rigid foot that is not able to absorb shock

therefore the plant fas is absorbing a lot of the shock

89
Q

limited ankle Df - plant fas

A

this may lead to more PF needed from the MTP joint and this will place more tension on the plantar fas

90
Q

limted MTP DF

A

this will place excessive tension on the plant fas during gait

91
Q

what are the signs and symptoms of Plant fas

A

pain wil palpation - calcaneal insertion

complain of severe pain on WB after period of rest - this may resolve as the patient walks and will reappear with increased activity

limited passive ankle DF and/or MTP Df

pronators - pes cavus deformity or RF/FF deformity

92
Q

how can you reproduce plant fas

A

palpate

passive extension of MTPs or resisted flexion

93
Q

what is the windlass effect

A

this is the mechanism that lift the medial long arch during toe off

94
Q

what happend to the plant fas during the windless mechanism

A

as the toe extends the plant fas lengthens and increases tension on the medial long arch

the increased tension pulls the are togethere and raises it to stablize the foot during toe off

95
Q

what is the purpose of windlass testing

A

the presence of fascial impairments in the foot

96
Q

what is the procedure for the windlass testing - sitting

A

stablize the ankle in neutral with one hand just proximal to the met-tarsal head

extend the proximal phalangy

97
Q

what is the procedure for the windlass testing - standing

A

pt on a stool with metarsal just off of the stool

98
Q

what is a positive test

A

pt pain is reproduced

99
Q

what is the treatment for plant fas

A

stretch PF, toe flexor, plantar fas

strengthing of toe flexor and intrinsics of the foot

deep friction massage the plant fas

orthotics to correction mechnical deficts

resting DF night split

100
Q

fat pad syndrome - location

A

plantar heel

non-isertional point of fascia on the medial calcaneal tubercle

101
Q

fat pad syndrome - related to

A

age related changes

fat pad degeneration

102
Q

fat pad syndrome - can result from

A

fall on heel

rep landing

training errors

103
Q

what are some treatment consideration for fat pad syndrome

A

activity modification

heel pads- cups

shoes with increased cushioning

orthotics with a heel pad

104
Q

tarsal tunnel syndrome - what is the mechanism that is occuring

A

entrapment neuropathy of the tibia nerve as it passes through the tarsal tunnel

105
Q

what can cause tarsal tunnel syndrome

A

edema or space occupying lesion in the tarsal tunnel

tendonitis of the muscles in the tarsal tunnel

fracture callous

gout crystals

deep varicose veins

tumors

excessive pronation -

106
Q

what are the signs and sym of tarsal tunnel syndrome

A

shooting and burning pain on the plantar aspect of the foot and heel

para or impaired sensation on the plantar aspect of the heel

stress with max DF/EV and MTP/IP extension for 10 sec

107
Q

would a tinel sign be positive for tarsal tunnel syndrome

A

possible

108
Q

what is a test that we can perform for tarsal tunnel syndrome

A

stress present with max DF/EV and MTP/IP extension held for 10 secs

tinel sign

109
Q

what are some treatment options for tarsal tunnel syndrome

A

activity mod

treat the inflammation if tendonitis is a contributing factor

orthotic if the patient is an over pronator

110
Q

what is a non conservative approach to tarsal tunnel syndrome

A

surgical release of the tarsal tunnel

111
Q

what is the MOI of achilles tendionpathy

A

chronic overuse syndrome

imbalance between recovery and use

112
Q

what pop do we normally see achilles tendionpathy

A

runners

30 - 50

increased activity

113
Q

what is the general presentation of achilles tendionpathy

A

pain is isolated to the tendon or its insertion

morning stiffness

warm up effect

decrease sport perfromance

reports of increase in training

114
Q

what is warm up effect

A

the pain will start to go away with the warm up

115
Q

what are the test for achilles tendionpathy

A

palpation

royal london hosiptal test

arc sign

116
Q
A

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