ankle and foot module 2 Flashcards
what are some areas we can see muscle and tendon strains in the foot and ankle?
anterior and medial tibial stress syndrome (shin splints)
posterior tibial tendon dysfunction (PTTD)
fibularis strain
achilles tendinopathy
others
what body function/structure is involved with anterior tibial stress syndrome?
inflammation and degeneration of the “proximal” anterior compartment muscles
periosteal irritation
tibialis anterior and extensor hallucis longus
what body function/structure is involved with medial tibial stress syndrome?
inflammation and degeneration of the “distal” anterior compartment muscles
periosteal irritation
tibialis posterior and medial soleus
what is the chief complaint of shin splints?
pain during or after activity
pain anterior shin (sharp, localized or dull, throbbing)
tenderness along tibialis anterior muscle or anterior tibia
what are examination findings for shin splints?
(anterior) AROM DF/PF pain, PROM PF pain, PROM DF painfree
weak dorsiflexion/inversion
(posterior) PROM PF/inv painfree, weak PF/inversion
flat feet
non-supportive or old running shoes
what are some important differentials for shin splints?
Chronic exertional compartment syndrome
tibial stress fracture
radiculopathy
what is chronic exertional compartment syndrome?
extremely painful when pressure within LE compartment increases
pain will increase during exercise, and stops soon after ceasing
diagnosis requires referral to physician. the pressure within the LE compartments are measured before and after exercise
what is a tibial stress fracture?
bone scan or MRI are more sensitive to find acute stress fracture
what body function/structure is involved with posterior tibial tendon dysfunction (PTTD)
inflammation and degeneration of the tendon
progresses to lengthening and mechanical insufficiency of the posterior tibialis m tendon
what is another name for PTTD?
posterior tibial tendon insufficiency (PTTI)
what is the chief complaint with PTTD?
acute or gradual onset of a flat foot
pain in the medial longitudinal arch and ankle, lateral hindfoot
tenderness along the posterior tibial tendon course
what are some common examination findings for a patient with PTTD?
reduced calcaneal inversion during heel rise
weak inversion/plantarflexion
+ too many toe signs
medial talar bulge
how many stages of PTTD are there?
4
what is stage 1 of PTTD?
pain with ankle inversion, tendon length normal, swelling and tenderness inferior to medial malleolus
what is stage 2 of PTTD?
evolving for months-years, tendon elongated, no rearfoot inversion during single limb heel raise, passive rearfoot mobility normal
what is stage 3 of PTTD?
fixed rearfoot deformity (valgus calcaneus) with a compensated forefoot (varus) = flat foot, minimal tendon pain, compressive pain in lateral foot/sinus tarsi
what is stage 4 of PTTD?
further talocrural joint degeneration and fractures
what is stage 4 of PTTD?
further talocrural joint degeneration and fractures
what are some important differential diagnosis for PTTD?
charcot foot
over-pronated foot without PTTD
what body function/structure is involved with fibularis muscle group tendonopathy?
inflammation and degeneration of the tendon
progresses to lengthening and mechanical
what is the chief complaint with fibularis muscle group tendonopathy?
pain during or after activity, distal fibula
h/o lateral ankle sprain or chronic ankle instability
tenderness posterior and inferior to lateral malleolus
what are some common examination findings with fibularis muscle group tendonopathy?
AROM talocrural inv/ev pain, PROM inversion pain, PROM eversion painfree
weak eversion/plantarflexion
walking on lateral border of foot (comp. load intolerance)
non-supportive or old running shoes
what are some important differential diagnosis for fibularis tendopathy?
chronic ankle instability
stress fracture
synovitis
chronic fibularis subluxation
what body function/structure is involved with achilles tendinopathy?
inflammation and degeneration of the tendon
progresses to lengthening and mechanical insufficiency of the gastroc/soleus m tendon
what is the chief complaint with achilles tendinopathy?
localized pain in posterior distal leg or heel
pain and stiffness following periods of inactivity
intermittent pain experienced during activity and exercise, may improve with mild activity
pain with stair climbing, calf stiffness especially in AM
what are common examination findings with achilles tendinopathy?
AROM plantarflexion and DF pain, PROM DF pain, PROM PF (painfree)
decreased ability to perform repetitive unilateral heel raises compared to the contralateral side; may have decreased DF ROM
increased running frequency or distance, change in shoewear
what is non-insertional achilles tendinopathy?
location is 2-6 cm proximal to insertion, zone of decreased vascularity
bulbous area may be noted in mid-substance of tendon with or without pain
what are some types of non insertional achilles tendionpathy?
paratendonitis
tendonosis
paratendonitits with tendonosis
what is paratendonitis?
inflammation of the lining around the tendon
what is tendonosis?
noninflammatory, age related degeneration of the tendon itself
what is paratendonitis with tendonosis?
paratendon inflammation with intratendinous degeneration
what is insertional achilles tendinopathy?
location- at achilles distal insertion on calcaneous
tenderness, swelling over insertion at calcaneous
what types of insertional achilles tendinopathy are there?
haglund’s deformity and subcutaneous calcaneal bursitis (“pump bump”)
what is Haglund’s deformity?
deformity of the posterior calcaneus putting retrocalcaneal bursa and achilles tendon at risk for increased compression
what is the operative treatment for insertional achilles tendinopathy?
haglund deformity, retrocalcaneal bursa is aggressively resected
inflamed or calcified achilles tendon tissue is resected
post operative mobilization starting at 1 month based on tissue health
what are some important differential diagnosis for achilles tendinopathy?
acute achilles tendon rupture or partial tear
retro-calcaneal bursitis, subcalcaneal bursitis or haglunds deformity
posterior ankle impingement
os trigonum syndrom
achilles tendon ossification
systemic inflammatory disease
what are some other strains?
