Ankle, AT & foot pain CPG Flashcards

1
Q

Grade I

A
  • no loss of function
  • no ligamentous laxity (- anterior drawer / talar tilt tests)
  • little or no hemorrhaging,
  • no point tenderness
  • decreased total ankle motion of 5° or less
  • swelling of 0.5 cm or less.
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2
Q

Grade II

A
  • some loss of function
    • anterior drawer test (ATFL)
    • talar tilt test (no CFL)
  • hemorrhaging
  • point tenderness
  • decreased total ankle motion > 5° ,<10°,
  • swelling greater >0.5 cm <2.0 cm.
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3
Q

Grade III

A
  • near total loss of function
    • anterior drawer / talar tilt tests
  • hemorrhaging
  • extreme point tenderness
  • decreased total ankle motion > 10°
  • swelling greater than 2.0 cm

Stress radiographs

  • <3.0mm Grade IIIA
  • >3.0mm Grade IIIB
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4
Q

ankle & foot outcome measures

A
  • Ankle Sprain
    • FAAM (ADLs 8,Sport 9)
    • LEFS (MCID 9)
  • achilles tendinopathy
    • VISA-A
    • FAAM
  • Plantar foot pain
    • foot function index
    • foot health status questionaire
    • FAAM
    • LEFS
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5
Q

Ankle interventions

(acute phase)

A
  • external supports & bracing for more severe (STRONG)
  • manual therapy AP (Moderate)
  • physical agents
    • cryotherapy (STRONG)
    • diathermy (weak)
    • electrotherapy / laser (conflicting)
    • NOT ultrasound (STRONG)
  • Therex (STRONG)
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6
Q

ankle sprain interventions

(progressive loading / sensorimotor phase)

A
  • manual therapy (STRONG)
  • therex (weak)
  • sport-related (weak)
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7
Q

Ankle sprain risk factors

A
  • hx ankle sprain
  • do not
    • use an external support
    • warm up (static stretching / dynamic mvmt)
    • have WNL ankle DF ROM
    • participate in a balance/ proprioceptive prevention program if history previous injury
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8
Q

Achilles tendinopathy risk factors

A
  • Intrinsic
    • abnormal DF ROM
    • abnormal subtalar joint ROM
    • decreased PF strength
    • increased foot pronation
    • abnormal tendon structure
  • Extrinsic
    • training errors, environmental factors, faulty equipment
  • Medical
    • obesity
    • hypertension
    • hyperlipidemia
    • diabetes
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9
Q

Achilles tendinopathy signs/symptoms

A
  • Achilles tendon tenderness,
  • positive arc sign (palpated swelling moves

w/ DF & PF)

    • Royal London Hospital test
      • TTP 3cm proximal to insertion with slight PF, decreases with ankle DF
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10
Q

Achilles tendinopathy interventions

A
  • Strong
    • eccentric loading
  • Moderate
    • low-level laser
    • iontophoresis
  • Weak
    • stretching
    • foot orthoses
    • NOT night splint
  • Expert opinion
    • manual therapy
    • taping
  • Conflicting
    • heel lift
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11
Q

orthotics and…

A
  • LBP: prevention=equivocal; tx = neg
  • pain: negative
  • plantar fasciiitis
    • 3mo dec in pain, no long term >1 yr benefit
    • custom no better than COTS
    • chronic (>20 mo) = short term relief w/ custom
  • hallux valgus
    • custom orthotics = surgery @ 6 mo
    • surgery > orthotics @ 12 mo
  • pes cavus
    • no benefit
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12
Q

Plantar heel pain

risk factors

A
  • limited DF ROM
  • high BMI (non-athletic pop)
  • running
  • work-related WB actitivities
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13
Q

Plantar heel pain

A
  • plantar medial heel pain: most noticeable with initial steps after period of inactivity; also worse with prolonged WB
  • heel pain worse with recent increase in WB
  • pain with palpation of prox insertion of the plantar fascia
  • +windlass test
    • tarsal tunnel
  • limited AROM/PROM TCJ DF
  • abnormal FPI
  • high BMI
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14
Q

Plantar heel pain outcomes

A
  • FAAM
  • FHSQ
    • MCID pain 13; function 7; footwear 7
  • FFI
  • LEFS
    • MCID 8 (100)
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15
Q

Plantar heel pain interventions

A
  • STRONG
    • MT (joint/STM)
    • Stretching
    • anti-pronation & elastic therapeutic taping
    • Foot orthoses (if +taping)
    • night splints (1-3 months)
  • Weak
    • low-level laser
    • phonophoresis
    • NOT ultrasound
  • Conflicting
    • ionto
  • Foundational/expert
    • weight loss
    • therex
    • NOT TDN
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