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Peripheral Musculoskeletal Science > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

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Biology 101 flashcards
1
Q

define a low/lateral ankle sprain (LAS)

A

-“An acute traumatic injury as a result of excessive inversion of the rear foot or a combined plantar flexion and adduction of the foot”

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2
Q

what is the clinical presentation of low/ lateral ankle sprain

A

o Acute signs and symptoms eg. Heat, swelling, redness, pain
o most have supination injury mechanism (PF + inversion, with or without ADD/IR)
o some have pronation/eversion mechanism (DF,EV,ER and ABD) resulting from external force
o non-contact injuries caused by sub-optimal foot position at foot strike when running, landing or take off
o F>M
o Children>adolescents>adults

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3
Q

how do you diagnosis a LAS

A

o MOI?
o Palpation
o AROM and PROM of TCJ,STJ,mid-foot, fore-foot and 1st MTPJ, PF, DF, Inver, Ever
o Specific muscle tests such as Extensor hallucis longus, tibialis anterior, tibialis posterior, fib longus and brevis and flexor hallucis longus
o Knee to wall test
o Resisted isometric muscle tests
o Ligament stress tests such as Anterior drawer, and talar tilt (increased laxity)

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4
Q

how do you treat or manage a LAS

A

o Grade 1 and 2
 SPRICEMM
 POLICE
o Grade 3
 The above plus CAM-walker,moon-boot
 Surgery, reconstruction or ligament repair
o Important to manage the inflammatory response and pain
o Manage severe ankle sprains by immobilisation
o All ankle sprains – a limited period of joint protection with a graduated return to FWB is indicated (first 12-48 hours needs to be unloaded and protected)

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5
Q

How do you rehab a LAS

A

o Grade 1 and 2
 SPRICEMM
 POLICE
o Grade 3
 The above plus CAM-walker,moon-boot
 Surgery, reconstruction or ligament repair
o Important to manage the inflammatory response and pain
o Manage severe ankle sprains by immobilisation
o All ankle sprains – a limited period of joint protection with a graduated return to FWB is indicated (first 12-48 hours needs to be unloaded and protected)

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6
Q

What is a high ankle sprain (HAS)

A

inferior-tibiofibular joint/ syndesmotic sprain

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7
Q

What is the MOI for HAS

A

o Forced ER of the foot – damages syndesmosis and widens mortise, can also tear interosseous membrane and/or fracture proximal fib caused by powerful AB/ER forces to the forefoot
o hyper-DF – talus forcing malleoli apart, can rupture ATFL and PTFL, usually occurs when foot is planted and athlete falls or is pushed forward
o All Weber C #’s and 50% Weber B #

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8
Q

what are subjective features of HAS

A

o focal pain above ankle joint
o does not look too bad, minimal swelling and bruising sometimes
o poor tolerance of WBing
o LEVEL OF PAIN IS DISPROPORTIONATE TO SEVERITY

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9
Q

what are the objective/physical features of HAS

A

o NOTE: tests need to be done within the hour of injury or 4-7 days after
o No single test is sufficiently accurate for diagnosis so need to combine S+S and tests
o ‘Kleiger’s test’ (ER stress test)
o ‘syndesmosis squeeze test’
o ‘fibular translation test’ to diagnose
o Inability to hop
o +ve DF-ER stress test and squeeze test
o Syndesmosis TOP

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10
Q

how do you treat/manage HAS

A

G1: Tape to support syndesmosis joint, FWB
G2: boot immobilisation, NWB-FWB day 21, strapped for activity
G3: boot immobilisation, NWB-FWB 5 weeks, strapped for activity

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11
Q

what is a Lisfranc Ligament Injury

A
  • Lisfranc ligament is between the big toe and second toe

- MOI – direct blow to the joint or by axial loading along the metatarsal with medial or lateral rotational force

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12
Q

what are the subjective features of chronic ankle instability (CAI)

A

 3 main clinical features:
 Mechanical instability
 Perceived Instability
 Recurrent sprain (episodes of giving way)
o Perceived instability is most consistent predictor of disability

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13
Q

what are the objective features of chronic ankle instability

A

 +ve manual stress tests eg. Anterior drawer, posterior drawer and talar tilt
 Impaired balance e.g star excursion test, side-side hop test, figure 8 hop test

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14
Q

how do you diagnosis a CAI

A

o No ankle effusion
o Full pain free ankle
 Acute: Hip dominant landing strategy
 Sub acute: changes persist, increase in hip stiffness and pre-landing inversion
 Strategies change in both limbs
 Increased postural sway in balance test

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15
Q

how do you treat CAI

A

o Prevent further episodes
o Teach optimal landing strategy
o Improve proprioception
o Taping and bracing can help short term but need to be used in conjunction with neuromuscular training
o Proprioceptive (NeurMusc) training programmes must have balance component

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16
Q

what is osteochondral talar dome lesions

A

injury or abnormality of the talar articular cartilage and adjacent bone

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17
Q

what are clinical features/diagnosis of osteochondral talar dome lesions

A

o MOI is either atypical sprain such as landing with compression or shearing force or associated with typical ankle sprain (PF, Add, Inver)
o Pain on WBing
o Poor tolerance of compression or loading
o Ache as rest
o Talocrural joint swelling
o Injury fails to resolve is a huge indicator of something more sinister
o Persistent swelling
o Scan assists diagnosis

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18
Q

what are physical features of osteochondral talar dome lesions

A

o Persistent effusion
o TOP of talar dome
o Altered joint mobility
o Compression and shearing tests provocative

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19
Q

what is post-traumatic synovitis

A
  • Is a persistent and disabling synovitic reaction to trauma
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20
Q

What are the symptoms of post-traumatic synovitis

A 
o	Early symptoms:
	Same as acute ankle sprain
o	Later symptoms:
	Ankle fails to progress
	Persistent swelling and pain
	Overall slow recovery
	Loss of ROM
	TOP along joint line
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21
Q

what is an anterior and posterior impingement

A

o Is a secondary injury due to repetitive loading/collisions between articular margins and soft tissues

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22
Q

what are the clinical features of anterior and posterior instability

A

o Painful limitation of ROM
o Usually from post-trauma e.g ankle sprain, forced PF (ballet)= posterior; or forced DF (kicking a ball) = anterior
o Can have osteophyte formation due to repeated capsule-ligamentous traction of ankle joint

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23
Q

What is chronic ankle instability

A

both mechanical and functional instability of the ankle joint and
where symptoms of giving way” and instability have been
present for at least one year post-initial sprain injury

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24
Q

what is functional ankle instability

A

Reports of frequent episodes of “giving way” of the affected

ankle joint and feelings of instability during function (With/without actual mechanical instability)

25
Q

what is the treatment/management for anterior and posterior instability

A

o Conservatively manage by de-loading it
o Possibly use a heel lift (anterior impingement)
o Address biomechanical and training issues
o Graded return to activity
o Cortisone injection can be used or surgical debridement

26
Q

what is the sinus tarsi syndrome

A
  • Sinus tarsi is an anatomical space bound by the talus and calcaneum
  • It is inflammation of the sub-talar ligaments, synovium and fat pad within osseous canal
27
Q

what are clinical features of sinus tarsi syndrome

A

o Report of anterolateral ankle joint pain
o Report rear foot instability during activity
o Swelling in front of lateral malleoli
oTOP over sinus tarsi
o Altered Rom of subtalar
o Pain on passive inversion and eversion

28
Q

what is medial tibial stress syndrome

A
  • MTSS is a non-inflammatory bone stress reaction caused by chronic repetitive loading that induces tibial bending forces. Bending occurs at narrowest point (middle to distal 1/3 of tibia) which is where MTSS occurs
29
Q

What are clinical features of medial tibial stress syndrome

A

o Pain at attachment of posterior compartment muscles to tibia (esp. tib post)
o MOI is:
 Intrinsic - excessive pronation, PF muscle tightness and running technique (overpronating)
 Extrinsic – change in training surfaces, foot wear, TLERI?
 Excessive or prolonged pronation can lead to eccentric loading of supinators.

30
Q

what are stress fractures clinical features

A

o Gradual onset with deep, nagging pain with exercise and at rest afterwards
o TOP
o X-ray can help but only in later stages, bone scan with give +ve result

31
Q

what are common sites of stress #

A 
	Femoral neck
	Pubic ramus
	Femoral shaft
	Tibia
	Navicular
	Metatarsal shaft
32
Q

what are subjective features of stress #’s

A

-Look at notes (pg 92 in peri musc notes workbook)

33
Q

what is compartment syndrome

A
  • Pressure related pain secondary to increased compartment pressure during exercise
  • May be to do with inadequate vascular outflow which impedes oxygenation of muscle and neural tissue
  • Activity dependent
34
Q

what are the 3 compartments that can be affected in compartment syndrome

A

o Anterior – deep fibular nerve (common)
o Posterior – superficial fibular nerve
o Deep posterior – tibial nerve (common)

35
Q

what is the clinical presentation of compartment syndrome

A

o Gradual onset of pressure pain in the affected compartment
o Feeling of tightness and fullness in the affected compartment
o Mechanically patterned – it is worse after a predictable duration of exercise
o Relieved with rest
o TOP

36
Q

treatment of compartment syndrome

A

o Poor response to conservative treatment
o Surgery commonly required
Look at notes–> pg 93

37
Q

what is plantar fasciosis

A
  • Is a non-inflammatory stress reaction of the plantar aponeurosis at the medial calcaneal tubercle
  • Behaves like an overuse tendinopathy
38
Q

what are the sujective features of plantar fasciosis

A

 Gradual onset of burning pain in proximal aspect of medial, longitudinal arch
 Common in running athletes or sedentary people with unaccustomed loading
 Behaves like a tendinopathy e.g AM/post-rest stiffness and pain upon WBing, symptoms may ease with activity
 Aggravated by WBing that load plantarfascia
 Night/rest pain, can be associated with calcaneal oedema
 Can develop acutely  partial tears not uncommon

39
Q

what are physical features of plantar faciosis

A

 Avoid loading through 1st MTPJ with heel raises
 Pain on DF/SL heel raise when loading the 1st MTPJ
 Loss of 1st MTPJ extension – usually due to decreased plantar flexion length
 Local, mild swelling
 Acute tear may have inflammatory symptoms
 TOP – medial calcaneal tubercle especially
 Local thickening, texture change and crepitus

40
Q

MOI of ligaments

A

LOOK AT NOTES

41
Q

what is the bifurcate ligament

A

lateral calcaneonavicular ligament and anterior calcaneocuboid ligament

42
Q

how is the bifurcate ligament injured

A

injured by strong inversion producing an avulsion fracture at the calcaneus

43
Q

Disgnosis/management for bifurcate ligament injury

A
  • TOP and PF/SUP
  • get MRI or x-ray
  • immobilise for 4 weeks
44
Q

where is the lateral calcaneocuboid ligament and its MOI

A
  • under the anterior C-C ligament

- injured by typical sprain mechanism

45
Q

diagnosis and treatment for lateral calcaneocuboid ligament

A
  • TOP and inversion
  • Can send for x-ray/MRI
  • treat like a typical ankle sprain
46
Q

What is a weber A #

A

Fracture of the fibula distal to syndesmosis. An oblique medial malleolus fracture may also be present

47
Q

what ligaments can be injured with weber A #

A

occur with a sprain of the lateral ligaments. ATFL, CFL and PTFL would all be implicated due to their proximal attachments being around the lateral malleolus

48
Q

what is a weber B#

A

Fracture of the fibula at the level of the syndesmosis.

49
Q

what ligaments can be injured with weber B#

A

occur with sprain of the medial ligaments. Deltoid ligaments would be implicated as they all proximally attach on the medial malleolus

50
Q

what is a weber C#

A

Fracture of the fibula proximal to syndesmosis. .

51
Q

what ligaments can be injured with weber C#

A

occur with syndesmotic injury so syndesmosis is implicated but also deltoid ligaments due to widening of mortise and associated medial malleoli fracture

52
Q

what are the ottawa ankle rules

A

-An ankle XR is required if any of the following are evident:
oTenderness or pain at:
Posterior edge of tibia (6cm) or tip of medial malleolus – important for Weber #’s
Posterior edge of fibula (6cm) or tip of lateral malleolus – important for Weber #’s
Base of 5th metatarsal - important for avulsion fracture
Navicular
oUnable to WB at time of the injury - indicative of serious pathology esp if associated with huge inflammatory response
oUnable to walk 4 steps in clinic or ED - indicative of serious pathology esp if associated with huge inflammatory response

53
Q

what are key subjective features following traumatic injury to ankle and foot

A
  • precise location of pain
  • MOI
  • Audibe cracking/popping–> may indicate #
  • ability to WB after injury imediately–> if can’t then srs injury
  • location, degree and severity of swelling
  • delayed/optimal/inadequate inital management
  • prior Hx of similar injury
54
Q

what are the common complications of acute ankle ligament injury

A
  • CAI/FAI
  • Talar dome #
  • post traumatic synovitis
  • ankle impingment
  • oedema–> figure 8 method of palpation = navicular tuberosity, distal tip of lateral maleolus, distal tip of medial maleolus, base of 5th metatarsal
  • # ’s
55
Q

what is the reliability, sensitivity and specificity of foot and ankle disability index (FADI)

A

o Not good for diagnosis
o Shows changes in activity limitations, participation restrictions and disability over time
o FADI Sport – is sport sensitive to deficits associated with CAI and better at picking up Fx deficits so better for higher functioning patients

56
Q

what is the reliability, sensitivity and specificity of identification of functional ankle instability (idFAI)

A

o Useful to determine risk of developing FAI

o Better able to diagnose FAI

57
Q

what is the reliability, sensitivity and specificity of foot and ankle ability measure (FAAM)

A

o Often used with FADI
o Both have an ADL and a sport sub-scale
o Can distinguish between a healthy athlete and one with CAI – not sure if its sensitive enough or specific enough to diagnose though

58
Q

what some intrinsic factors that may lead to development of tissue injury

A

o Physiological make up e.g pronated foot, supinated foot, high arches
o Gender – F>M get LAS, Males may be at more risk of traumatic injury due to high impact sports
o Bone density
o Muscle mass – compresses other tissues
o Circulation – causes compartment syndrome if tissues not vascularised properly

59
Q

what some extrinsic factors that may lead to development of tissue injury

A

o Training load – an increase in training load too soon increases risk of injury
o Environment – indoor sports have more ankle sprains
o Foot wear – ill-fitting shoes can cause overuse injuries
o Equipment – a bike that is ill fitting can cause an overuse of the achilles maybe?

Peripheral Musculoskeletal Science (3 decks)

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