Ankle And Foot Module 6 Flashcards
What types of osteoarthritis are there?
Degenerative and traumatic
What is expected with degenerative osteoarthritis?
Redness, inflammation and swelling (cartilage)
What is traumatic osteoarthritis?
OA progresses more rapidly due to previous joint injury
What are the symptoms of osteoarthritis?
Pain and stiffness particularly in the morning or after periods of rest
What is the criteria for diagnosis of osteoarthritis?
Age >50 years old
Stiffness > 30 minutes
Crepitus
Bony tenderness
Bony enlargement
No palpable warmth
What is the prescription for osteoarthritis?
Self limiting, medications, PT (progressive loading, cyclic loading, bracing, orthotics), surgery
What are the treatment options for severe ankle/foot osteoarthritis?
Ankle arthrodesis
Subtalar arthrodesis
Midfoot arthrodesis (fusion)
What is the post operative care after an ankle fusion?
8-12 weeks NWB
Shoe modification: rocker bottom
What is rheumatoid arthritis?
Inflammation of the joint capsule (synovium) followed by degeneration
Will often affect the metatarsals and digits, visual nodules
What percent of arthritis does rheumatoid arthritis account for?
3% of all arthritis diagnosis es, affects women 3x more than men, diagnosed often in 20-40 year olds
What is gout?
Excessive amounts of uric acid
Often affects the great toe
what is the prevalence of gout?
5.9% in men and 2% in women
What are some other forms of inflammatory arthritis?
Lupus, scleroderma, dermatomyositis/polymyositis, psoriatic arthritis, vasculitis syndromes (polyarteritis nodosa, henoch-schonlein purpura, Raynaud’s disease)
What are patterns of symptoms that may assist with the diagnosis of RA?
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
What are some laboratory tests common for diagnosing RA?
Rheumatoid factor, HLA (human lymphocyte antigen), ANA (antinuclear antibodies), blood cell count and sedimentation rate, aspiration of the effected joint, xray
What are some treatment options for inflammatory arthritis?
NSAIDs
Injectable steroids
Systemic steroids
Orthotic intervention
What are some questions to ask if you are suspecting systemic disease?
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?
What should you do when you suspect a systemic disease process?
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
What is the MOI for osteochondral injuries?
OCD s/p traumatic ankle sprain
Where are osteochondral injuries most common?
Talus (85%)
What are some signs and symptoms of osteochondral injuries?
Pain during terminal stance (closed pack position), decreased standing tolerance, aching during rest
What is osteochondral dissecans?
Condition resulting from loss of blood supply to a bone, can be congenital
What are some non surgical interventions for osteochondral injuries?
Period of immobilization and non-weight bearing to allow for cartilage to heal
What are some surgical interventions for osteochondral injuries?
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)
what are some signs/symptoms of osteochondral defects or loose bodies (“joint mouse”)
effusion
crepitus felt when palpating medial/lateral talus
mechanical condition: “catch/lock/give way” in various positions or activities
osteochondral defects or loose bodies can be differential diagnosis possibilities for some other conditions, how do we know its an osteochondral defect?
giving way as a chief complaint and discomfort without occurrence of a recent injury
what are some additional osseous disorders of the foot and ankle?
sever’s disease
accessory os trigonum
sinus tarsus syndrome
what is sever’s disease?
calcaneal apophysitis. localized pain and tenderness at the achilles attachment
what is accessory os trigonum?
accessory ossivle on the posterior-lateral process of the talus. pain posteriorly with maximum plantar flexion. accessory bone with rounded edges on radiographs
what is sinus tarsus syndrome?
injury to the structures contained within the sinus tarsus. hindfoot instability. tenderness inferior and anterior to the lateral malleolus, diff dx with ATFL sprain
