Ankle And Foot Module 6

Question 1

What types of osteoarthritis are there?

Answer 1

Degenerative and traumatic

Question 2

What is expected with degenerative osteoarthritis?

Answer 2

Redness, inflammation and swelling (cartilage)

Question 3

What is traumatic osteoarthritis?

Answer 3

OA progresses more rapidly due to previous joint injury

Question 4

What are the symptoms of osteoarthritis?

Answer 4

Pain and stiffness particularly in the morning or after periods of rest

Question 5

What is the criteria for diagnosis of osteoarthritis?

Answer 5

Age >50 years old
Stiffness > 30 minutes
Crepitus
Bony tenderness
Bony enlargement
No palpable warmth

Question 6

What is the prescription for osteoarthritis?

Answer 6

Self limiting, medications, PT (progressive loading, cyclic loading, bracing, orthotics), surgery

Question 7

What are the treatment options for severe ankle/foot osteoarthritis?

Answer 7

Ankle arthrodesis
Subtalar arthrodesis
Midfoot arthrodesis (fusion)

Question 8

What is the post operative care after an ankle fusion?

Answer 8

8-12 weeks NWB
Shoe modification: rocker bottom

Question 9

What is rheumatoid arthritis?

Answer 9

Inflammation of the joint capsule (synovium) followed by degeneration
Will often affect the metatarsals and digits, visual nodules

Question 10

What percent of arthritis does rheumatoid arthritis account for?

Answer 10

3% of all arthritis diagnosis es, affects women 3x more than men, diagnosed often in 20-40 year olds

Question 11

What is gout?

Answer 11

Excessive amounts of uric acid
Often affects the great toe

Question 12

what is the prevalence of gout?

Answer 12

5.9% in men and 2% in women

Question 13

What are some other forms of inflammatory arthritis?

Answer 13

Lupus, scleroderma, dermatomyositis/polymyositis, psoriatic arthritis, vasculitis syndromes (polyarteritis nodosa, henoch-schonlein purpura, Raynaud’s disease)

Question 14

What are patterns of symptoms that may assist with the diagnosis of RA?

Answer 14

Symmetric involvement may indicate RA or lupus, Raynaud’s phenomenon may indicate auto-immune disease, isolated swelling of 1-2 of lesser toes is suggestive of psoriatic arthritis, gout occurs often in the first MTP joint in middle aged males

Question 15

What are some laboratory tests common for diagnosing RA?

Answer 15

Rheumatoid factor, HLA (human lymphocyte antigen), ANA (antinuclear antibodies), blood cell count and sedimentation rate, aspiration of the effected joint, xray

Question 16

What are some treatment options for inflammatory arthritis?

Answer 16

NSAIDs
Injectable steroids
Systemic steroids
Orthotic intervention

Question 17

What are some questions to ask if you are suspecting systemic disease?

Answer 17

Has there been any change in activity level?
Previous similar episodes?
Are symptoms localized or are multiple joints involved?
Is there bilateral involvement?
How long has the problem been present?
Any family history?
Risk factors?
Occupational or recreational exposure to the outdoors?

Question 18

What should you do when you suspect a systemic disease process?

Answer 18

Apply results of written and verbal responses to the history, a review of systems, with subjective and objective clinical exam findings to make the determination if the patient is
1) appropriate for PT
2) appropriate for PT with referral to others, or
3) not appropriate for PT and requires referral elsewhere

Question 19

What is the MOI for osteochondral injuries?

Answer 19

OCD s/p traumatic ankle sprain

Question 20

Where are osteochondral injuries most common?

Answer 20

Talus (85%)

Question 21

What are some signs and symptoms of osteochondral injuries?

Answer 21

Pain during terminal stance (closed pack position), decreased standing tolerance, aching during rest

Question 22

What is osteochondral dissecans?

Answer 22

Condition resulting from loss of blood supply to a bone, can be congenital

Question 23

What are some non surgical interventions for osteochondral injuries?

Answer 23

Period of immobilization and non-weight bearing to allow for cartilage to heal

Question 24

What are some surgical interventions for osteochondral injuries?

Answer 24

Debridement (removing injured cartilage and bone)
Fixation of the injured fragment
Micro fracture or drilling of the lesion (revascularize via chondroplasty)
Transfer or grafting or bone and cartilage (osteoarticular transfer system OATS, mosaicoplasty)

Question 25

what are some signs/symptoms of osteochondral defects or loose bodies (“joint mouse”)

Answer 25

effusion
crepitus felt when palpating medial/lateral talus
mechanical condition: “catch/lock/give way” in various positions or activities

Question 26

osteochondral defects or loose bodies can be differential diagnosis possibilities for some other conditions, how do we know its an osteochondral defect?

Answer 26

giving way as a chief complaint and discomfort without occurrence of a recent injury

Question 27

what are some additional osseous disorders of the foot and ankle?

Answer 27

sever’s disease
accessory os trigonum
sinus tarsus syndrome

Question 28

what is sever’s disease?

Answer 28

calcaneal apophysitis. localized pain and tenderness at the achilles attachment

Question 29

what is accessory os trigonum?

Answer 29

accessory ossivle on the posterior-lateral process of the talus. pain posteriorly with maximum plantar flexion. accessory bone with rounded edges on radiographs

Question 30

what is sinus tarsus syndrome?

Answer 30

injury to the structures contained within the sinus tarsus. hindfoot instability. tenderness inferior and anterior to the lateral malleolus, diff dx with ATFL sprain