Ankle Classification/Diagnoses Flashcards
Inversion Ankle Sprain
Location of Symptoms
-pain, swelling over lateral ankle
Eversion Ankle Sprain
Location of Symptoms
-pain, swelling on medial ankle
Cuboid Syndrome
Location of Symptoms
- lateral plantar pain
- feels like rock in shoe
- pain is constant and lasts longer than normal healing processes of lat ankle sprain
Cuboid Syndrome
Mechanism of Injury
- plantarflexion + inversion injury
- minor subluxation of calcaneocuboid alignment that irritates the ligaments, cuboid and peroneus longus
Tendon Injury–Achilles Rupture
Location of Symptoms
- sudden pain over post ankle/leg
- balled up muscle
Tendon Injury–Posterior Tibial Tendonitis
Location of Symptoms
- pain at medial malleoli along tendon
- pain medial ankle but can progress to lateral ankle if not treated
Tibial Stress Syndrome/Fracture
Location of Symptoms
- Pain along post medial tibia or ant lat
- proximal 2/3 of tibia
-“shin splints”
Posterior Tibial Nerve Entrapment
Location of Symptoms
- local edema
- burning pain and paresthesia to sole of foot
Plantar Fasciitis
Location of Symptoms
- pain on heel of foot
- pain plantar surface of foot
- pain in morning but eases with movement
OA/DJD
Location of Symptoms
- Pain and stiffness in foot/ankle
- swelling
- stiff in morning
(foot OA less common)
Bursitis
Location of Symptoms
- calcaneal/retrocalcaneal bursitis=tender/painful at calcaneous
- subcalcaneal bursitis=tender under heel on plantar surface
(rule out plantar fasciitis, heel spur)
Sprain
Agg Factors
- WB
- walk
- jump
Cuboid Syndrome
Agg Factors
- pain in terminal stance
- single leg hop
Tendon Injury
Agg Factors
- achilles/post tib: unable to stand on toes
- achilles: push off with gait
Tibial Stress Syndrome/Fracture
Agg Factors
- walking
- standing on toes
- push off
Posterior Tibial Nerve Entrapment
Agg Factors
- walking
- prolonged standing
Plantar Fasciitis
Agg Factors
- walking
- jumping
- WB in morning
OA/DJD
Agg Factors
- walking
- jumping
- WB
Bursitis
Agg Factors
- rubbing of heel by shoe
- repetitive irritation
- running
- walking
Sprain
Ease Factors
- ice
- NSAIDs
- decr WB
Cuboid Syndrome
Ease Factors
- rest
- avoid prolonged terminal stance
Tendon Injury
Ease Factors
-avoid WB
Tibial Stress Syndrome/Fracture
Ease Factors
- ice
- massage
- NSAIDS
-if fracture=pain at rest
Post Tibial Nerve Entrapment
Ease Factors
- NWB
- avoid pronation
OA/DJD
Ease Factors
- rest
- NSAIDS
- increased movement
Plantar Fasciitis
Ease Factors
-stretch
-massage
-ice
NSAIDS
Bursitis
Ease Factors
- rest
- ice
- NSAIDS
- shoes that don’t rub
Inversion Sprain
History
- plantarflexion + Inversion injury
- check integrity of superficial peroneal nerve
- weak lateral collateral ligaments
Eversion Sprain
History
- stress on medial collateral ligaments (deltoid)
- due to excessive eversion
- can be accompanied with talus or medial malleoli fracture
Cuboid Syndrome
History
- plantarflexion + inversion –>sublux of cuboid laterally and posteriorly
- more common in pts with history of ankle sprains and over pronation during gait
- forefoot valgus
- tight peroneus longus
Tendon Injury–Achilles Rupture
History
- MOI: explosive push off at terminal plantarflexion
- men>women
- 30-40 years old
- history of chronic achilles tendonitis
Tendon Injury–Post Tib tendonitis
History
- Hx of over pronation
- flat foot
- tender midfoot (esp with toe raises)
- loss of arch
Tendon Injury Risk Factors
- Diabetes
- Obesity
- RA
- Women over 50 (post tib dysfunction)
Tibial Stress Syndrome/Fracture
History
- inflam of contractile portoin of post tib
- irritation of interosseous membrane due to overpronation
- periostitis
- overuse
- recent increase in activity
Periostitis
over use stresses of ant tib at origin attachment
-it is eccentrically over worked with achilles is tight
Posterior Tib Nerve Entrapment
History
- worse at end of day
- flat foot
- post tib dysfunction
- Hx deltoid ligament sprain
Plantar Fasciitis
History
- obesity
- overuse
- acute (step on hard object)
- occupational (prolonged stand/walk)
OA/DJD
History
- over weight
- OA in other joints
- family Hx
- history of microtrauma to ankle/foot
- forefoot valgus
- flat foot
- overpronation
- decr ROM all directions
Bursitis
History
- excessive running (rubbing on post calc)
- tightness/restriction of achilles tendon
Sprain
Neurodynamic Testing
-PF/Eversion + SLR
common peroneal
Tendon Injury
Neurodynamic Testing
-DF/Inversion + SLR
sural nerve–achilles tendonitis
Tibial Stress Syndrome/Fracture
Neurodynamic Testing
-PF/Inversion + SLR
common peroneal
Post Tib N Entrapment
Neurodynamic Testing
SLR with tibial nerve tension
Plantar Fasciitis
Neurodynamic Testing
-DF/Eversion + SLR
tibial
Sprain
Neurological Exam
-inversion: check superficial peroneal nerve
Post Tib Nerve Entrapment
Neurological Exam
-sole of foot
Sprain
ROM
- inversion, eversion
- DF, PF
Cuboid Syndrome
ROM
- pn with PF + inversion
- midtarsal mobility reproduces Sx
Achilles Rupture
ROM
- unable to PF
- check DF
Post Tibial Tendonitis
ROM
- pn with inversion and PF (resisted motion)
- pn with passive eversion
- pn with active PF + eversion
Tibial Stress Syndrome/Fracture
ROM
- PF, DF (passive/active)
- ankle pron/sup
Post Tib N Entrapment
ROM
- PF, DF
- Inv, Ever
Plantar Fasciitis
ROM
- df may be limited
- pain with df + great toe extension
OA/DJD
ROM
- Capsular pattern
- decr PF and DF
____* DF needed for normal gait mechanics
10*
Bursitis
ROM
- bursitis won’t cause decr motion
- but check for tight gastroc/soleus causing burisitis
Sprain–ATFL
Special Tests
-ant drawer
Sprain–Calcaneofibular lig
Special Tests
-talar tilt
Sprain–Deltoid lig
Special Tests
-Klieger
Cuboid Syndrome
Special Tests
check for misplaced cuboid
Tendon Injury–Achilles Rupture
Special Tests
-Thompson
Post Tib N Entrapment
Special Tests
-Tinel
OA/DJD
Special Tests
- rule out other conditions
- check for loss of motion
Sprain
Palpation
-Palp over ligament affected
Cuboid Syndrome
Palpation
-over calcaneocuboid causes pain
Tendon Injury
Palpation
- pain over tendon
- ball of muscle in calf
Tibial Stress Fracture
Palpation
-tuning fork
Post Tib Nerve Entrapment
Palpation
-post tib nerve
Plantar Fasciitis
Palpation
pn with pressure over plantar fascia
OA/DJD
Palpation
compression through joint + rotary movement reproduces symptoms
Bursitis
Palpation
-post calcaneous tender
Muscle Length/Strength Testing of Ankle/Foot Disorders
- peroneus longus
- peroneus brevis
- tibialis ant
- gastrocnemius
- soleus
Outcome Measure
-LEFS
