Ankle/ Foot

Question 1

severs disease

Answer 1

Sever’s disease occurs when the growth plate in the back of the heel becomes inflamed and painful
calcaneal apophysitis

Question 2

What is a Sand Toe Injury VS Turf toe Injury?

Answer 2

Sand Toe- Flexion based toe injury
Turf Toe- Ext based toe injury

Question 3

most common compartment for compartment syndrome?

Answer 3

anterior

Question 4

Signs of anterior compartment Syndrome

Answer 4

• Decreased DF strength- 2/2 compression of deep fibular nerve
  -5p’s : pain, pallor, paresthesias, pulselessness, paralysis

Question 5

the following radiographic views would best assess syndesmotic instability in a patient if he tolerates weight bearing through the involved lower extremity?

Answer 5

Mortise view in unilateral stance

Question 6

signs and symptoms of acute compartment syndrome

Answer 6

-Stretch of muscles in the compartment may cause pain
-decreased sensation in nerve fields affected by the compartment
-Pain out of proportion to injury in the presence of a long bone fracture especially open fracture

Question 7

What areas would be affected with acute anterior compartment syndrome?

Answer 7

deep peroneal nerve runs through the anterior compartment of the leg, -
the web space between the 1st and 2nd toes

Question 8

signs of lateral acute compartment syndrome

Answer 8

same as all acute compartment syndromes and weakest of peroneals, decr sensation n/T lateral leg

Question 9

Signs / sx;s of DVT

Answer 9

-Collateral superficial veins (nonvaricose)
-Major surgery within the past week
-unilateral pitting edema
-Localized tenderness along the distribution of the deep venous system

Question 10

RISK FACTORS FOR DEVELOPING PATELLOFEMORAL PAIN

Answer 10

-Decreased lower extremity explosive strength (vertical jump)
-Decreased quadriceps flexibility
-Increased medial patellar mobility

Question 11

Pivot shift can rule IN, Lachman can rule IN or OUT

Question 12

What minimizes load on MCL tear?

Answer 12

loading in flexion

Question 13

How to help return to running after collateral leg tear?

Answer 13

keep in flexion- start with running on toes- avoids ext

Question 14

What kind of exercise and ROM would limit loading to LCL/lateral corner

Answer 14

0º–90º ROM and open chain limit loading to LCL/lateral corner
The 0º–90º limits loading seen by deeper flexion while the open chain minimizes loading that is requisite to weight-bearing, so this is the best option.

Question 15

What kind of exercises/movements load MCL?

Answer 15

Closed-chain extension loads to MCL

Question 16

What kind of exercise typically protects the meniscus?

Answer 16

open chain

Question 17

What kind of exercise causes increased loading on LCL/lateral corner repair?

Answer 17

Full flexion closed chain

Question 18

What is vital to assess in PF foot injury?

Answer 18

cuboid subluxation
lis franc injuries

Question 19

Discuss ankle bracing:

Answer 19

studies have shown that prophylactic ankle bracing can DECR the incidence (but not necessarily the severity) of ankle sprains.
-They do not decrease the incidence of acute knee or other lower extremity injuries.
-A biomechanical study in female basketball players found that while a hinged ankle brace may provide better ankle support, it also increases knee internal rotation and abduction angles that could contribute to knee injuries.
-Taping has not been shown to be more effective than bracing.

Question 20

What are good ACUTE phase treatments for Gr 2 ankle sprAIN?

Answer 20

-Early mobilization of joints (following ligamentous injury actually stimulates collagen bundle orientation and promotes healing, although full ligamentous strength is not reestablished for several months). 
- ice and horeshoe pad along lateral malleolus

Question 21

prognosis for grade 2 ankle sprain

Answer 21

He should be able to return to tennis in approximately 3-4 weeks

Question 22

How are grade 3 Lisfranc injuries best treated?

Answer 22

Open reduction internal fixation
Grade 3 Lisfranc require percutaneous screw fixation. Grade I and II sprains can typically be managed with closed reduction and immobilization.

Question 23

What is the typical mechanism of injury for a Lisfranc injury?

Answer 23

Forceful external rotation and pronation of the foot
forefoot abduction and plantarflexion forces to the TMT joint.

Question 24

tarsal tunnel syndrome

Answer 24

The tibial nerve or its branches (medial plantar nerve or first branch of the lateral plantar nerve) can be compressed posterior to the medial malleolus. The compression can be from a variety of sources - usually unknown. The symptom complex caused by this compression (vague burning pain to the medial ankle, tenderness and usually + Tinel’s sign, sometimes paresthesia or sensory disturbance to the tibial nerve distribution on the plantar foot) is referred to as tarsal tunnel syndrome.

Question 25

Jones fracture

Answer 25

Fracture of base of 5th metatarsal

Question 26

Zone 2 Jones Fractures

Answer 26

Acute fractures in zone 2 are at risk of mal- or non-union. Most cases will be able to be treated non-surgically with cast immobilization for 6-8 weeks, but early internal fixation may be considered for some patients, such as the athlete in this scenario. Mismanagement of a fifth metatarsal fracture may result in metatarsalgia with a plantar callus or chronic lateral foot pain.

If Zone 1 is the “head” of your fifth metatarsal, Zone 2 is the “body” extending out from it, further away from the middle of your foot.

Question 27

Treatment for Status post syndesmotic ankle sprain

Answer 27

Placing the patient in neutral dorsiflexion or slight plantarflexion provides an ‘open pack’ position to be immobilized in. The wider anterior portion of the talar dome pushes the distal tibiofibular syndesmosis apart with increased dorsiflexion.

Question 28

What is A curved, combination lasted shoe ?

Answer 28

board lasted in the rearfoot and slip lasted in the forefoot.  Combination lasted shoes allow for more control of the rearfoot but without limiting flexibility of the forefoot. 

Question 29

There is not good evidence for night splints

Question 30

Treatment for tendinopathy

Answer 30

Both stretching the gastroc/soleus complex and eccentric exercise are appropriate for tendinopathy. Eccentric exercise has a growing body of evidence supporting its efficacy over concentric exercise in Achilles tendinopathy. One theory that may explain why eccentric exercise is more effective is that it is thought to counteract the failed healing response that apparently underlies tendinopathy and facilitates tendon remodeling.

Question 31

Which areas of the critical areas for stress fractures and why are they “critical”?

Answer 31

anterior tibia,
medial malleolus,
talus, navicular,
fifth metatarsal, and
sesamoids
Critical stress fractures require special attention due to a higher rate of nonunion

Question 32

Which are the non critical stress fracture areas?

Answer 32

Noncritical stress fractures in the lower leg, foot, and ankle include the
medial tibia,
fibula, and
metatarsals 2, 3, and 4.
Treatment of these stress fractures requires relative rest.

Question 33

OCD in ankle

Answer 33

palpate medial talar dome
need MRI

Question 34

os trigonum syndrome

Answer 34

-bony and soft tissue compression in post tibiocalcaneal interval
-2/2 repetitive PF stress
-seen in soccer players, ballet dancers
findings:
Pain, especially when pushing off your big toe or pointing your toes down.
Reduced range of motion (less ability to fully move your foot).
-decr PF strength,
- tenderness btw achilles and peroneals during WB and push off
, posterior ankle edema
- can be seen with flexor hallicus longus tenosynovitis 2/2 constant pressure on os trigonum from the FHL tendon

also called: Posterior ankle impingement syndrome.
Hindfoot impingement syndrome.
Nutcracker-type impingement (because the os trigonum gets compressed when you point your toes down).
Posterior tibiotalar impingement syndrome.
Talar compression syndrome.

os trigonum is an accessory (extra) bone that sits in the back of the lateral ankle near the heel bone

Question 35

Freiberg’s Disease

Answer 35

AVN in the metatarsal.
-usually in adolescent females
-swelling and hyperkertosis beneath affected head
-crepitus and loose bodies may be palpable
-hallux valgus deformity fund in 50% cases
-need imaging to rule out stress fracture, joint sepsis, metatarsalgia

Question 36

Stener lesion

Answer 36

can happen with skier’s thumb- partial or complete tear of 1st MTP joint
-distal end of UCL and the aponeurosis of adductor pollicis become intertwined at base of prox phalanx
-since UCL is no longer in contact w insertional site- it can’t heal
-swelling at the 1st MTP and a palpable mass in same area

Question 37

Freiberg disease

Answer 37

-caused by osseous infraction at the head of a metatarsal;
-the exact etiology is unknown.
The disease is more common in females and athletes.

The goals of treatment are early identification to place the patient in conservative therapy to allow healing and prevent progression to advanced arthritis.

Question 38

Epoetin alpha

Answer 38

used to treat severe anemia in patients on kidney dialysis or for those not on dialysis.

increase one’s red blood cell mass, which allows the body to transport more oxygen to muscles and therefore increase stamina and performance. EPO has been shown to increase performance parameters such as maximal oxygen consumption (VO2max) and time to exhaustion, which is why it’s commonly abused in endurance sports.