ankle 2 - injury Flashcards
what does pes clavus mean
high arch
the rearfoot is stuck in inversion and cannot get eversion to pronate
is pes clavus more supinated or pronated
supinated
the foot is rigid - poor shock absorbing foot
what is pes planus
flattened arch
what range of motion deficits do we expect for a patient with pes planus
limited DF
is pes planus more rigid or flexiable
flexiable - weak supinator muscles
or
rigid - bony structure abdnormality
what muscle creates the supination motion
tib post
what is the result of abnormal pronation
pronation that is in excessive in range
or when the foot should be supinated
what causes abnormal pronation
all 3 -planes are involved
frontal, transverse, sagittal plane
what is occuring the frontal plane to cause excessive pronation of the foot
tibial varus
subtalar varus
forefoot varus
what is occuring the transverse plane to cause excessive pronation of the foot
hip anteversion
internal femoral rotation
internal fibilar rotation
what is occuring the sagittal plane to cause excessive pronation of the foot
leg length
equinas
limited knee and or hip extension
what are the effects of abnormal pronation
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
what is mortons neuroma
the thinkening of tissue around one of the nerves leaving to your toe
what is result of abnormal supination
supination that is excessive motion in range or occurs when the foot should be pronating
with supination what do we see in the forefoot
valgus
first ray and supinated foot
plantar felxed
what other factors can cause supination in the foot
equinas = where the heel cannot reach the ground
leg length - the shorter side
what are some foot injuries that you see with abnormal supination
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
what is a hammer toe
the toe is bent at the middle joint
what is haglund’s deformity
boney enlargement on the back of the heel
this can irritate soft tissue around the achilles tendon
what is the most common ankle sprain
inversion sprain
grade 1 ankle sprain
mild over stretching
no tearing
no functional instability
short recovery time
grade 2 ankle sprain
partial tear of the ligament
increased functional loss
swelling, effusion, and tenderness
recovery 10 - 30 days
grade 3 ankle sprain
complete rupture
restricst
what is the most common type of ankle sprain
inversion
what mechanisms are involved with inversion
talocural PF
subtalr inversion
what are inversion sprain
tenderness to palpation
what is equinas
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
what are the upper chain issues seen with abnormal pronation
achilles tendinitis
anterior or medial knee pain
what are the upper chain issues seen with abnormal supination
achilles tendinitis
lateral knee or hip pain
what is a rigid plantar flexed 1st ray associated with
excessive supination
limited ST joint motion
what can rigid plantar flexed 1st ray lead to
lateral instability of the ankle
callus under the first and 5th met
what can we do for a rigid plantar flexed 1st ray
accomadated orthotic cut out for the 1st ray
what is the first ray
1st met and the medial cuneiform
what is the mechanism of an inversion ankle sprain
talocural PF
subtalar inv
which ligament is involved with a inversion ankle sprain
anterior talofibular ligament
talo-fibular ligament
what ligament is sometimes involved in severe inversion ankle sprain issues
post talo-fib
what are intrinsic risk factors to an inversion ankle sprain
limited DF ROM
decreased balance
decreased ankle proprioception
what are extrinsics risk factors to an inversion ankle sprain
sport type
what are some associated injuries with inversion strains
peroneal tendon injury
peroneal nerve issue
fracture of the dital tib fib, lateral malleolus, medial mallelus , base of the fifth met
sinus tarsi syndrome
what are the signs and sym of a inversion sprain
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
what tests will be positive for an inversion sprain
anterior drawer
medial talar tilt test
why do we see an antalgic gait with an inversion sprain
pain and decreased weight bearing
what are the ottowa ankle rule
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
would you perform manuel therapy for those with inversion sprain
yes
increase ROM and decrease pain
what should be the progression of exercises for those with inversion ankle sprains
isometrics
thera band
PRE - progressive resistance exercises
weight bearing exercises
(most of the emphasis is place of the ankle everters)
what are PRE
Gradually adding load and overload to the
what is chronic ankle instability
recurrent ankle sprains or giving away that last for more then 6 months
what is FAI
functional ankle instablity
what is FAI caused by
distrubted ankle properioception
how do you treat FAI
balance
SLS
return to position
what kind of laxity do we see with chronic AI
anterior and inversion laxity
what is sinus tarsi syndrome
chronic pain and inflammation of the lateral aspect of the subtalar joint
where is the sinus tarsi
the lateral portion of the foot
between the talus and calcaneus
what is sinus tarsi normally a secondary condition of
chronic ankle instability
in patients who hyperpronate
tthe STJ ligaments are lax
what happens to the talus with hyperpronation
the talus is displaced into the sinus tarsi and this results in irritation
what is sinus tarsi syndrome a result of
results from instability of the subtalar joint.
what are the signs and symptoms of sinus tarsi syndrome
point tenderness - ant and inf to the lateral mall
patient is an over pronator
pain with amb that goes away with rest
how do we treat sinus tarsi syndrome
low dye taping
or
orthotics
sertiod injections
what is the purpose of low -dye taping
unloading the plantar fasciatis and providing medial ankle support
eversion sprains - MOI
forced …
excessive pronation of the foot
excessive abd of a planted foot
what ligament is normally implicated with a eversion sprain
the deltoid ligament
may also involve the distal tib-fib interosseous membrane
what may be involved with a sever ankle eversion sprain
avulsion fracture of the calcaneal insertion of the deltoid ligament
what is more common ankle inversion or eversion sprains
inversion
the distal tibfibextends below the joint line, and this provides more medial stability
what are the signs and symptoms of an eversion sprain
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
what test could be positive for an eversion sprain
anterior drawer test
ER test
talar tilt
for eversion sprain what muscle are we focus on strengthening
the invertors
what ligamanents are involved with high ankle sprain
ant distal tibfib
distal interosseous membrane
what is the MOI for high ankle sprains
forced ER of the foot
IR of the leg
gait of someone with a high ankle sprain
patient will avoid dull DF in gait to min the stress on the distal tibfib joint
steppage gait
what are the signs and sym of a high ankle sprain
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
what happens to the distal ant tibfib joint when we move into DF
the the distal tib fib to open up
what is a steppage gait
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
what tests will be positive for a high ankle sprain
ER test
distal tibfib test
what is a non-op treatment for a high ankle sprain
prolonged protected weight bearing - 4 weeks
delay functional advanced retraining until 8 weeks
external ankle support or brace is used for retraining
what is the average recovery time for a high ankle sprain
> 6months
are thrust mobs okay after an acute ankle injury
yes
evidence based practice for PT after acute ankle sprain
manual therapy
thrusts and non-thrust mobilization
exercise therapy
balance and proprioceptive exercises
what are some contraindications for manual therapy and ankle sprains
acute with sig pain
grade 3 sprains
injury of syndesmosis or fracture
history of surgery or fracture
what is a syndesmosis
a fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments
what is plantar fasciitis
inflammation fo the plantar fasciitis
what are the feature of plantar fasciitis
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
what is the mechanism Plant fas
excessive foot pronation
pes clavus foot
limited DF ankle
limted DF of the MTP joints
where does the plantar fasciatis insert
the phalanges
what is a another word for high arch
pes clavus
what is a another word for low arch
pes planus
excessive pronation and - plant fac
this will over stretch the plantar fascia
results in irritation
pes clavus - plant fas
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
limited ankle Df - plant fas
this may lead to more PF needed from the MTP joint and this will place more tension on the plantar fas
limted MTP DF
this will place excessive tension on the plant fas during gait
what are the signs and symptoms of Plant fas
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
how can you reproduce plant fas
palpate
passive extension of MTPs or resisted flexion
what is the windlass effect
this is the mechanism that lift the medial long arch during toe off
what happend to the plant fas during the windless mechanism
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
what is the purpose of windlass testing
the presence of fascial impairments in the foot
what is the procedure for the windlass testing - sitting
stablize the ankle in neutral with one hand just proximal to the met-tarsal head
extend the proximal phalangy
what is the procedure for the windlass testing - standing
pt on a stool with metarsal just off of the stool
what is a positive test
pt pain is reproduced
what is the treatment for plant fas
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
fat pad syndrome - location
plantar heel
non-isertional point of fascia on the medial calcaneal tubercle
fat pad syndrome - related to
age related changes
fat pad degeneration
fat pad syndrome - can result from
fall on heel
rep landing
training errors
what are some treatment consideration for fat pad syndrome
activity modification
heel pads- cups
shoes with increased cushioning
orthotics with a heel pad
tarsal tunnel syndrome - what is the mechanism that is occuring
entrapment neuropathy of the tibia nerve as it passes through the tarsal tunnel
what can cause tarsal tunnel syndrome
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 -
what are the signs and sym of tarsal tunnel syndrome
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
would a tinel sign be positive for tarsal tunnel syndrome
possible
what is a test that we can perform for tarsal tunnel syndrome
stress present with max DF/EV and MTP/IP extension held for 10 secs
tinel sign
what are some treatment options for tarsal tunnel syndrome
activity mod
treat the inflammation if tendonitis is a contributing factor
orthotic if the patient is an over pronator
what is a non conservative approach to tarsal tunnel syndrome
surgical release of the tarsal tunnel
what is the MOI of achilles tendionpathy
chronic overuse syndrome
imbalance between recovery and use
what pop do we normally see achilles tendionpathy
runners
30 - 50
increased activity
what is the general presentation of achilles tendionpathy
pain is isolated to the tendon or its insertion
morning stiffness
warm up effect
decrease sport perfromance
reports of increase in training
what is warm up effect
the pain will start to go away with the warm up
what are the test for achilles tendionpathy
palpation
royal london hosiptal test
arc sign
