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.
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.
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
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
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)
6
Q
ankle sprain interventions
(progressive loading / sensorimotor phase)
A
- manual therapy (STRONG)
- therex (weak)
- sport-related (weak)
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
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
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
- Royal London Hospital test
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
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
12
Q
Plantar heel pain
risk factors
A
- limited DF ROM
- high BMI (non-athletic pop)
- running
- work-related WB actitivities
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
14
Q
Plantar heel pain outcomes
A
- FAAM
- FHSQ
- MCID pain 13; function 7; footwear 7
- FFI
- LEFS
- MCID 8 (100)
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