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OCS Exam > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

What is the order from most common to most rare ankle sprains?

A

-Lateral
-Medial (5-10%)
-High (syndesmotic)

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2
Q

When are ankles the least stable, therefore most vulnerable to sprain?

A

In loose packed position of plantarflexion with inversion

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3
Q

What sprains are commonly misdiagnosed as high ankle sprains?

A

Grade II and III lateral ankle sprains

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4
Q

What is the recovery time of a grade I lateral ankle sprain?

A

2-10 days

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5
Q

What is the recovery time of a grade II lateral ankle sprain?

A

10-30 days

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6
Q

What is the timeframe for recovery of a grade III lateral ankle sprain?

A

30-90 days

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7
Q

What often comes with a grade III lateral ankle sprain?

A

Fracture

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8
Q

What are the tests for a lateral ankle sprain?

A

-Anterior Drawer
-Talar Tilt

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9
Q

What are some common sequelae with a lateral ankle sprain?

A

-Superficial peroneal/fibular nerve involvement
-Base of the 5th metatarsal
-Spiral fracture of the fibula
-Lateral malleoli fracture
-Navicular

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10
Q

What are the ottawa ankle rules?

A

-TTP at either malleoli, navicular, base of 5th metatarsal
-Inability to weight bear immediately and in emergency department (doesn’t have to be pretty, 2-3 steps)

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11
Q

What are signs of a medial/eversion ankle sprain?

A

-Localized pain over the deltoid
-Positive eversion talar tilt test

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12
Q

What are the mechanisms of injury for a high ankle sprain?

A

-Hyper-dorsiflexion
-Rotation and plantarflexion

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13
Q

How long is recovery from a high ankle sprain?

A

> 6 months

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14
Q

What are special tests for a high ankle sprain?

A

-syndesmotic squeeze
-ER stress test
-Fibular translation test

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15
Q

When to get off of the crutches?

A

When able to walk well

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16
Q

What is acute management of ankle sprain?

A

-RICE
-Crutches (reduce, don’t eliminate weightbearing)
-Early mobilization
-Maybe immobilize

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17
Q

When is a boot indicated for lateral ankle sprain?

A

Grade III

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18
Q

Why manual therapy with ankle sprains?

A

Improves pain and function

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19
Q

Why exercise therapy with ankle sprains?

A

Reduces risk of recurrent ankle sprains and functional instability

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20
Q

What to incorporate with neuromuscular reeducation with ankle sprains?

A

-SL Balance
-Unstable surfaces
-Dynamic movements

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21
Q

What are the two components of chronic ankle instability?

A

Mechanical instability (impaired arthrokinematics and joint degenerative changes)
Functional instability (altered neuromuscular control, strength deficits)

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22
Q

What have no effect in the treatment of acute ankle injuries?

A

Ultrasound
Laser therapy
Electrotherapy

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23
Q

What type of brace is recommended for return to sports after ankle sprain?

A

Lace-up or semi-rigid

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24
Q

What are the goals for closed chain dorsiflexion of the ankle?

A

38 degrees or 9-10 cm from wall

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25
Q

What are red flag/risk factors for malignancy?

A

-Constant pain not affected by position or activity
-Age over 50
-History of Cancer
-Failure of conservative intervention
-Unexplained weight loss (10% of person’s body weight without trying to lose weight)
-No relief with bed-rest

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26
Q

What cancers are most likely to matastasize to the spine?

A

-Prostate
-Breast
-Kidney
-Thyroid
-Lung

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27
Q

What is the description of diabetic neuropathy?

A

Aching and numbness of feet and distal lower extremity
-Burning, prickling, tingling, extreme sensitivity
-most often bilateral, can be unilateral
-Aggs/eases correlated with glucose

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28
Q

What are some vascular conditions to be aware of?

A

-Venous thromboembolism
-Intermittent claudication from peripheral arterial disease or iliac artery obstructive disease

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29
Q

When are venous thromboembolisms most often seen?

A

In patients with:
-cancer
-following surgery
-trauma
-prolonged immobilization

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30
Q

Which area of the leg are considered more dangerous to have venous thromboembolisms?

A

Proximal to the bifurcation of the popliteal vein

31
Q

What is the Well’s Criteria for venous thromboembolism?

A

-Active cancer within 6 mos +1
-Paralysis, paresis, or recent immobilization +1
-Recently bedridden >3 days or major surgery within 4 weeks +1
-Localized tenderness along deep venous system +1
-Entire lower-extremity swelling +1
-Calf sweling by >3 cm compared with other extremity +1
-Pitting edema
-Collateral Superficial veins +1
-Alternative diagnosis as likely or greater than that of DVT -2

32
Q

What conditions are correlated with peripheral arterial disease?

A

-Coronary artery disease
-Cerebrovascular disease

33
Q

How common is peripheral arterial disease in individuals over 70 y/o?

A

20% incidence; more with advancing age

34
Q

What characteristics are consistent with peripheral arterial disease?

A

-Cramping
-Tightness
-Tiredness
-Aching
-Relieved with rest

35
Q

What is highly diagnostic of peripheral arterial disease?

A

Palpation of the posterior tibial and dorsalis pedis pulses

36
Q

What are risk factors for peripheral arterial disease?

A

-Smoking
-Diabetes
-Hypertension
-Hypercholesterolemia
-Hyperhomocysteinemia
-C-reactive protein

(Hyperhomocysteinemia- high levels of homocysteine;
C-reactive protein - increases when there is inflammation in the body)

37
Q

What is c-reactive protein?

A

A protein created by the liver that rises in response to inflammation in the body.

38
Q

What factors are important to look for with risk pf peripheral arterial disease?

A

-Age (1 point for every 5 years 60 and above)
-Smoking (2 if ever smoked, 7 if current)
-Hypertension (1 for treated hypertension, 3 for not treated hypertension)

39
Q

How many points on the clinical prediction model for peripheral arterial disease warrants an
ABI?

A

7

40
Q

What is a normal ABI?

A

1.0-1.3

41
Q

What ABI is diagnostic for peripheral arterial disease?

A

<0.90
Severe is less than 0.4

42
Q

What is the ABI?

A

Lower extremity systolic pressure/brachial artery systolic pressure

43
Q

Where is pain from iliac artery occlusive disease?

A

-Buttocks
-Thigh

44
Q

What is leriche syndrome?

A

-Decreased femoral pulses
-Muscle Atrophy (including thigh)
-Impotence

45
Q

What areas are most commonly painful with Hip OA?

A

-Anterior groin (66%)
-Gluteal (71%)
-Anterior thigh (27%)
-Posterior thigh (24%)
-Anterior knee
-Posterior knee
-Anterior shin
-Calf

46
Q

What is the CPG for hip OA?

A

-Hip Pain
-Hip IR <15 degrees
-Pain with hip IR
-Matutinal stiffness <60 minutes
-Age >50 years

47
Q

What is the cluster for knee OA with knee pain?

A

-Age >50 years
-Morning stiffness <30 minutes
-Crepitus
-Bony tenderness
-Bony enlargement
-No palpable warmth

48
Q

What are some characteristics of imaging and lumbar spinal stenosis?

A

-Significant evidence in asymptomatic individuals
-No consistent relationship between image findings and results of treatment

49
Q

What are indications of lumbar spinal stenosis?

A

-Age>50
-Insidious onset of chronic, progressive low back pain, and more recent lower extremity symptoms
-Lumbar spine movement restrictions
-Intolerance of extension
-Preference of flexion

50
Q

What are included in the cluster for lumbar spinal stenosis?

A

-No pain while sitting
-Pain below buttock
-Age >65
-No pain with flexion
-Sitting best posture
-Standing or walking as worst posture

51
Q

What are predictor variables of lumbar spinal stenosis?

A

-Bilateral symptoms
-Leg pain more than back pain
-Pain during walking/standing
-Pain relief upon sitting
-Age >48 years

52
Q

What is the two stage treadmill test?

A

A test for lumbar spinal stenosis consisting of walking up to 10 minutes on a level treadmill, a treadmill inclined 15 degrees (both without using hands), and a recovery period. The time to symptoms on the treadmill are compared to the time needed to recover. Positive with:

-Longer time walking on incline (decreased time on level)
-prolonged recovery time after level walking

53
Q

What is the bicycle test of van Gelderen?

A

Pedal in an upright posture until the onset of symptoms and then lean forward. If the symptoms abate, they have lumbar spinal stenosis.

54
Q

What are the differences between relieving factors of neurogenic claudication vs. vascular claudication?

A

Neurogenic claudication eases with sitting, bending forward, squatting posture, vascular eases with rest

55
Q

What are the differences between aggravating factors of neurogenic claudication vs. vascular claudication?

A

Neurogenic claudication aggs with standing, upright posture; vascular aggs with any leg exercise

56
Q

Where is it pragmatic to provide thrust and non-thrust mobilization to individuals with lumbar stenosis?

A

-Thoracic
-Lumbar
-Pelvis
-Hip
-Knee
-Ankle

57
Q

What is the comprehensive treatment approach for lumbar spinal stenosis?

A

-Flexion-based exercise
-Gluteal strengthening
-Targeted stretching (psoas, rectus femoris)
-Progressive aerobic exercise

58
Q

What kind of walking program may be more helpful for individuals with lumbar spinal stenosis?

A

Inclined treadmill walking due to flexion

59
Q

What is the benefit of exercise with intermittent claudication?

A

-Improved maximal walking time

(compared with angioplasty and surgical treatment)
(Angioplasty - using a balloon to open a narrowed or blocked artery)

60
Q

What is the exercise program for individuals with peripheral arterial disease?

A

-at least 3x/week
-At least 30 minutes
-walking to near-maximal pain
-For at least 6 months

61
Q

What are the Ottawa Knee Rules?

A

-Age > 55
-Isolated tenderness of the patella
-Tenderness at the fibular head
-Inability to flex to 90
-Inability to bear weight both immediately and in the ER (4 steps)

62
Q

Are the Ottawa knee rules sensitive or specific?

A

Sn 100%, Sp 49%

63
Q

With a fall or blunt-trauma, what are the factors to decide for knee imaging?

A

-Age <12
-Age >50
-Inability to walk 4 weight-bearing steps in ER

64
Q

What is the difference in the ability to walk with the Pittsburg Decision Rule vs. Ottawa Knee rule?

A

PDR: full weight bearing
OKR: any amount of weight bearing

65
Q

What is the most common stress fracture location?

A

Tibia

66
Q

What are risk factors for tibial stress fracture?

A

-Women>men
-Military
-Runners >25 miles per week
-Walking
-Jumping
-Dancing
-Female athlete triad

67
Q

What are exam findings with tibial stress fracture?

A

-TTP to anterior aspect of the tibia
-Edema
-Pos tuning fork test

68
Q

Can tuning forks rule in/out stress fractures?

A

No, not confidently

69
Q

What is management for tibial stress fracture?

A

-Activity reduction

70
Q

What is used to diagnose tibial stress fractures?

A

MRI; also radiography or bone scan

71
Q

What are the Ottawa ankle rules?

A

-TTP at distal 6 cm of tibia/medial malleolus
-TTP at distal 6 cm of fibula/ lateral malleolus
-Inability to bear weight both immediately and in the ED for 4 steps

72
Q

What are the foot ottawa rules?

A

-TTP at base of 5th, navicular bone
-Inability to bear weight immediately and in the ED for 4 steps

73
Q

What are the history and exam findings for avulsion fractures?

A

Violent muscle contraction resulting in hearing/feelin a “pop” noted by painful passive stretch or active contraction of involved muscle with pain on palpation

OCS Exam (12 decks)

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