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DDX of Ankle > Ankle DDX > Flashcards

Ankle DDX Flashcards

1
Q

tight compartment syndrome

history , diagnoses

A

caused by muscle expansion
- occurs when the tissue pressure within a closed muscle compartment exceeds the perfusion pressure and results in muscle and nerve ischemia.

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2
Q

tight compartment syndrome

presentation

A
  • severe cramping, diffuse pain and tightness
  • pain decreases or disappears with rest
  • pain increases with activity
  • pain may increase or become present with warm up
  • ROM is limited in acute phase
  • Gradual to sudden on set
  • sensation is sometimes is altered
  • may be muscle weakness or paralysis
  • stretching increases pain
  • radiograph will be normal
  • bone scan will be negative
  • pulse is sometimes affected
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3
Q

Special test for compartment syndrome

A

no special test for this syndrome

-restricted DF is positive

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4
Q

Treatment for Compartment syndrome

A
  • relieve pain
  • limit pain causing activities
  • manual therapy

-symptoms will not fully be relieved without surgical intervention

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5
Q

L4 root lesion hx, dx aka radiculopathy

A
  • pain in the lower back and hip radiating down the back of the thigh into the leg
  • caused by damage to the lower spine which causes compression of the nerve roots which exit the spine
  • compression can lead to tingling, radiating pain, numbness, paraesthesia and occasional shooting pains
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6
Q

L4 root lesion presentation

A
  • sensation diminished and pain on Medial aspect of lower leg, medial ankle, big toe
  • restricted DF is positive
  • patellar reflex may be diminished or missing
  • knee extensors
  • motor and sensory innervation may be diminished
  • could be mistaken as “sciatica”

Pain and numbness would radiate down the buttocks to the back of the upper thigh but then could radiate around to the front of the shin. Symptoms typically would stop at the ankle and not descend into the foot (with rare exceptions).

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7
Q

L4 root lesion special test

A

Femoral Nerve Stretch Test:
Tests for nerve root impingement at L2, L3, L4
-Test position:
-Patient prone with a pillow under the abdomen; examiner at side of patient
-Action:
Examiner passively extends hip while keeping knee flexed to 900
-Positive test:
Pain in anterior and lateral thigh

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8
Q

L4 root lesion treatment

A
  • Traction
  • Thermal /cold therapy
  • manual therapy (massage)
  • Stretching, strengthening of low back muscles
  • Preventing further injury or stress to the spine through improved ergonomics and posture
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9
Q

tibialis anterior tendinitis hx, dx

A
  • occurs due to activities placing large amounts of stress through the tibialis anterior muscle.
  • These activities may include fast walking or running (especially up or downhill or on hard or uneven surfaces) or sporting activity (such as running or kicking sports). -Patients may also develop this condition following direct rubbing on the tibialis anterior tendon.
  • This may occur due to excessive tightness of strapping or shoelaces over the tendon.
  • subjective and objective examination
  • X-ray, Ultrasound or MRI scan may be required to assist with diagnosis and assess the severity of the condition.
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10
Q

tibialis anterior tendinitis treatment

A 
soft tissue massage
ultrasound
stretching into PF
joint mobilization
dry needling
ankle taping
bracing
ice or heat treatment
exercises to improve strength, flexibility and balance
-ankle pumps
-inversion/eversion
activity modification 
a gradual return to activity program
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11
Q

tibialis anterior tendinitis special test

A

Resisted DF

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12
Q

tibialis posterior tendonitis (hx, pathology)

A
  • occurs when the posterior tibial tendon becomes inflamed or torn
  • the tendon may not be able to provide stability and support for the arch of the foot, resulting in flatfoot

-An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time.

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13
Q

tibialis anterior tendinitis imaging

A

MRI

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14
Q

tibialis posterior tendonitis (hx, pathology)

A
  • occurs when the posterior tibial tendon becomes inflamed or torn
  • the tendon may not be able to provide stability and support for the arch of the foot, resulting in flatfoot

-An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time.

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15
Q

tibialis posterior tendonitis (treatment)

A
  • orthotics and braces
  • Surgery to remove the inflamed tissue or repair a simple tear
  • eccentric strengthening exercises
  • immobilization
  • steroid injection
  • rest
  • ice
  • NSAIDS
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16
Q

tibialis posterior tendonitis (imaging)

A

?

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17
Q

tibialis posterior tendonitis (treatment)

A
  • orthotics and braces
  • Surgery to remove the inflamed tissue or repair a simple tear
  • eccentric strengthening exercises
  • immobilization
  • steroid injection
  • rest
  • ice
  • NSAIDS
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18
Q

tibialis posterior tendonitis (imaging)

A

MRI

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19
Q

“Shin splint” (hx, pathology)

A

Shin splints are a common exercise-related problem. The term “shin splints” refers to pain along the inner edge of the shinbone (tibia).

Shin splints typically develop after physical activity. They are often associated with running. Any vigorous sports activity can bring on shin splints, especially if you are just starting a fitness program.

Can be caused by

  • Irritated and swollen muscles, often from overuse
  • Stress fractures, which are tiny breaks in the lower leg bones
  • Overpronation or ‘‘flat feet” – when the impact of a step makes your foot’s arch collapse
  • Weakness in stabilizing muscles of the hips or core
  • Poor lumbar spine function
20
Q

rupture of tibialis posterior (hx, pathology)

A

Whenever the tibialis posterior muscle contracts or is stretched, tension is placed through the tibialis posterior tendon. If this tension is excessive due to too much force or repetition, damage to the tibialis posterior tendon may occur. This can range from minor tearing of the tendon with subsequent inflammation to a complete tibialis posterior tendon rupture.

21
Q

“Shin splint” special tests (findings, clinical prediction rules)

A

Shin Palpation Test
-squeeze the lower two-thirds of the lower leg, including the shin bone (tibia) and surrounding musculature, “with enough pressure to squeeze out a wet sponge.” If there’s any pain present, you’re positive on that test.

Shin Edema Test
-Along the lower two-thirds of the tibia, as shown, press your finger in and hold for five seconds. When you remove your finger, does an indentation remain behind? If so, you have “pitting edema”—basically an accumulation of fluid under the skin—and you’re positive for the test.

A positive result on the second test is much less common than on the first test—and it’s also a much more accurate sign that trouble (in the form of shin splints) is on the way. And the researchers also found one more key warning sign: the women in the study were three times as likely to develop shin splints than the men. What this means (strangely enough) is that the tests are better at predicting shin splints in men, since they’re less likely to develop them in the first place.

22
Q

rupture of tibialis posteriorspecial tests (findings, clinical prediction rules)

A

may be confirmed with an MRI scan or ultrasound

23
Q

“Shin splint” (imaging)

A

bone scan

24
Q

rupture of tibialis posterior (hx, pathology)

A

Whenever the tibialis posterior muscle contracts or is stretched, tension is placed through the tibialis posterior tendon. If this tension is excessive due to too much force or repetition, damage to the tibialis posterior tendon may occur. This can range from minor tearing of the tendon with subsequent inflammation to a complete tibialis posterior tendon rupture.

25
Q

rupture of tibialis posterior(presentation)

A
  • pain on the inside of their foot, ankle and lower leg
  • unable to raise their heel in standing and may have a visibly flattened inner arch of the foot when compared to the normal side.
  • visible swelling or thickening of the inner lower leg or ankle
26
Q

peroneal nerve lesion treatment (conservative, surgical, therapeutic exercises)

A

Orthotics, including braces or foot splints, which may be custom-built into the patient’s shoe
-PT for gait training

27
Q

tibial nerve lesion(hx, pathology)

A

Can be caused by :

Having flat feet or fallen arches, which can produce strain or compression on the tibial nerve
Swelling caused by an ankle sprain which then compresses on the nerve
Diseases such as arthritis or diabetes which can cause swelling, thus resulting in nerve compression
An enlarged or abnormal structure, such as a varicose vein, ganglion cyst, swollen tendon, or bone spur, that might compress the nerve

  • Often injured by pressure on the inner part of the ankle.
  • -Injury or disease of structures near the knee
  • The tibial nerve may also be affected by diseases, such as diabetes
28
Q

tibial nerve lesion (presentation)

A 
Shooting pain in the foot
Numbness
Tingling or burning sensation
Pain in the bottom of the foot and toes
Weakness of foot muscles
Weakness of the toes or ankle
pt may have difficulty with toe flexion, inversion, and PF
29
Q

peroneal nerve lesion(hx, pathology)

A

aka foot drop
-can be caused by an injury to the spinal cord or from other underlying diseases, such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), or Parkinson’s disease. Sometimes, drop foot is a complication from hip replacement surgery, or other injuries ( knee or joint dislocation or fracture, herniated disc)

These nerves provide sensation to the anterior (front) and lateral (side) parts of the legs and to the top of the feet. They innervate muscles in the legs which lift the ankle and toes upward (dorsi flexion).

30
Q

tibial nerve lesion treatment (conservative, surgical, therapeutic exercises)

A

Surgical
-Tarsal tunnel release

Orthosis (e.g., braces, splints, orthotic devices) may be recommended to reduce pressure on the foot and limit movement that could cause compression on the nerve.

PT- pain control, ice, rest, limit functional activities

31
Q

peroneal nerve lesion special tests (findings, clinical prediction rules)

A

peroneal nerve test

32
Q

peroneal nerve lesion treatment (conservative, surgical, therapeutic exercises)

A

Orthotics, including braces or foot splints, which may be custom-built into the patient’s shoe
-PT for gait training

33
Q

peroneal nerve lesion imaging

A

?

34
Q

tibial nerve lesion(hx, pathology)

A

Can be caused by :

Having flat feet or fallen arches, which can produce strain or compression on the tibial nerve
Swelling caused by an ankle sprain which then compresses on the nerve
Diseases such as arthritis or diabetes which can cause swelling, thus resulting in nerve compression
An enlarged or abnormal structure, such as a varicose vein, ganglion cyst, swollen tendon, or bone spur, that might compress the nerve

  • Often injured by pressure on the inner part of the ankle.
  • -Injury or disease of structures near the knee
  • The tibial nerve may also be affected by diseases, such as diabetes
35
Q

L5 (S1) nerve root lesions (presentation)

A

Without calf muscle strength, the length of stride on that leg will be shorter, creating a limp. With the activity of running, the stride length will be even shorter, making the limp more noticeable. Climbing and descending stairs will be noticeably more difficult with the weak leg. All athletic endeavors will be more limiting.

  • Weak PF
  • Numbness, paresthesias (pins and needles) and pain
  • Initial pain will occur in the buttocks and radiate down that leg through the back of the thigh, the back of the leg and the bottom of the foot.
36
Q

L4 (L5) nerve root lesions treatment (conservative, surgical, therapeutic exercises)

A
  • Traction
  • Thermal /cold therapy
  • manual therapy (massage)
  • Stretching, strengthening of low back muscles
  • Preventing further injury or stress to the spine through improved ergonomics and posture
37
Q

L5 (S1) nerve root lesion special tests (findings, clinical prediction rules)

A

straight leg raise test

spine percussion

38
Q

tibial nerve lesion imaging

A

?

39
Q

L4 (L5) nerve root lesions(hx, pathology)

A

The L5 nerve innervates the tibialis anterior, the foot and toe dorsiflexor, the peroneal muscles and the gluteus medius muscle. Weakness of any of these muscles can create a pathological gait.

40
Q

Tibiofibular ligament (hx, pathology)

A

High ankle sprains occur from rotational injuries, much like ankle fractures. They are common in sports, especially impact sports. An external rotation, when the foot is turned towards the outside with respect to the leg, most commonly causes these tears.

41
Q

L4 (L5) nerve root lesions special tests (findings, clinical prediction rules)

A
  • straight leg raise test

- spine percussion

42
Q

Tibiofibular ligament special tests (findings, clinical prediction rules)

A

Two important tests also include the “squeeze test” and the” external rotation test.” The squeeze test is performed by squeezing the leg just below the knee to see if pain radiates to the high ankle ligament area, which would suggest a high ankle sprain. With the external rotation test, the knee is bent and the ankle is placed in neutral or 90 degrees with the foot in relation to the leg, and the foot is turned to the outside. If there is pain at the syndesmosis or the high ankle ligament area, then this indicates injury.

43
Q

L4 (L5) nerve root lesions imaging

A

?

44
Q

Tibiofibular ligament imaging?

A

?

45
Q

L5 (S1) nerve root lesions (presentation)

A

Without calf muscle strength, the length of stride on that leg will be shorter, creating a limp. With the activity of running, the stride length will be even shorter, making the limp more noticeable. Climbing and descending stairs will be noticeably more difficult with the weak leg. All athletic endeavors will be more limiting.

  • Weak PF
  • Numbness, paresthesias (pins and needles) and pain
  • Initial pain will occur in the buttocks and radiate down that leg through the back of the thigh, the back of the leg and the bottom of the foot.
46
Q

L5 (S1) nerve root lesions treatment (conservative, surgical, therapeutic exercises)

A
  • Traction
  • Thermal /cold therapy
  • manual therapy (massage)
  • Stretching, strengthening of low back muscles
  • Preventing further injury or stress to the spine through improved ergonomics and posture
47
Q

Tibiofibular ligament (hx, pathology)

A

High ankle sprains occur from rotational injuries, much like ankle fractures. They are common in sports, especially impact sports. An external rotation, when the foot is turned towards the outside with respect to the leg, most commonly causes these tears.

DDX of Ankle (1 decks)

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