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OCS Prep > Ankle/ Foot > Flashcards

Ankle/ Foot Flashcards

1
Q

What are the five theories thought to cause a Morton’s Neuroma?

A 
1- Chronic trauma
2- Ischemic theory
3- intermetatarsal bursistis theory
4- Entrapment theory
5- Pronation theory
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2
Q

What are the clinical findings associated with Morton’s neuroma?

A

1- burning pain in the plantar 3 R.D. we space

  1. Pain in toes
  2. Pain worsened with walking in narrow shoes
  3. Mulders sign
  4. Digital nerve stretch test
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3
Q

Describe Mulder’s sign ?

A

Examiner grasps 1 st and 5th MT’s and squeezes while exerting for pressure at sire of expected lesion with opposite thumb

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4
Q

What is the most common moi for ankle sprains?

A
  • forefoot adduction, hindfoot Ir, ankle inversion in plantar flexion and Er of the leg beyond anatomical constraints
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5
Q

What is the most common ligament injured in ankle sprains?

A
  • up to 73% of injuries involve the ATFL
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6
Q

What is the primary restraint to inversion moment when the ankle is in a plantar flexed ?

A

The ATFL

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7
Q

Ottawa ankle rules

A

Ankle: pain in the malleolar zone (AND)

  • tenderness at the posterior aspect of the tip of lateral mall. OR
  • tenderness at the posterior aspect of the tip of the medial mall, OR
  • inability to bear weight immediately and in er
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8
Q

Ottawa foot rules

A

Foot: Pain in the mid foot zone (AND)

  • tenderness at 5th metatarsal base, OR
  • tenderness at the navicular bone, OR
  • inability to bear weight immediately or in ER
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9
Q

Characteristics of a Grade 1 ankle sprain .

A
  • no loss of function, no ligamentous laxity
  • (-) anterior drawer and Talar tilt
  • rom decreased by five degrees or less
  • recovery 7.2 days
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10
Q

Characteristics of a grade 2 ankle sprain.

A
  • some loss of function, some ligamentous laxity
  • (+) anterior drawer, (-) talar tilt,
  • decreased rom by >5 degrees , but less than 10
  • recovery time 15 days
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11
Q

Characteristics of a grade 3 ankle sprain

A
  • near total loss of function,
  • (+) anterior drawer and talar tilt
  • recovery: 3A- 30.7 days
  • recovery: 3B - 55.4 days
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12
Q

What two functional outcome measures have the strongest evidence for use when examining ankle sprains?

A
  • FAAM

- LEFS

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13
Q

How strong is the evidence to support the single leg hop test when evaluating a patient in the post acute period for ankle sprains?

A

Moderate evidence to use single leghop test

- diagonal, lateral and direction changes

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14
Q

What tests should not be used for ankle sprains?

A

Shuttle run,Cocontraction,Up/ down hop,Triple crossover

Single limb hurdle, single limb fwd hop for distance, single limb 6 m hop for time, single limb 30 m hop for time

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15
Q

What is the evidence to support Manual therapy for ankle sprains?

A

Moderate evidence for:

- stm, joint mobilizations, lymphatic drainage, anterior to posterior talar mobs

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16
Q

Evidence for cryotherapy in ankle sprains?

A

Strong evidence to support intermittent applications

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17
Q

Should you use ultrasound to treat ankle sprains?

A

Strong evidence against the use of US

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18
Q

What is the level of evidence for electro therapy and laser therapy for ankle sprains?

A

Conflicting evidence for both

- do not use

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19
Q

CPR for manual therapy and ankle sprains

A
  • symptoms worse when standing
  • symptoms worse in the evening
  • navicular drop> 5 mm
  • distal tibfib joint hypomobility
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20
Q

Can you recommend lace up braces for prevention of ankle sprains?

A
  • yes, studies support reduced incidence by a factor of 2-3 regardless of sex, age, BMI, competition level
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21
Q

What nerves can be injured with a grade 2- 3 inversion sprain?

A

Fibular and tibial nerves can show denervation

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22
Q

What are extrinsic Risk factors for acute lateral ankle sprain?

A
  • h/o lateral ankle sprain
  • do not use external support
  • does not warm up properly
  • lack of normal TCJ, DF ROM
  • do not participate in balance/ proprioception exercises
23
Q

What nerve innervates the Achilles’ tendon?

A

Sural nerve

24
Q

What are some common signs and symptoms of Achilles tendinopathy?

A
  • Intermittent pain related to exercise
  • stiffness or Pain at the beginning of exercise session
  • stiffness upon WB after periods of immobility
25
Q

What tests can you use for Achilles tendinopathy?

A
  • Thompson’s test
    • TTP Achilles’ tendon
    • decreased PF strength
    • arc sign area of palpated swelling moves with DF/PF
    • Royal London test - TTP along Achilles’ tendon in PF that decreases in DF
26
Q

What is the level of evidence to support eccentric exercises for Achilles tendinopathy?

A
  • Strong evidence to support eccentric exercises 3x 15 reps x 12 weeks
27
Q

What is the level of evidence for iontophoresis with Achilles tendinopathy.

A
  • Moderate evidence for 3 ml dexamethasone
28
Q

What is the level of evidence to support use of low level laser therapy for Achilles tendinopathy?

A
  • Moderate evidence for use of laser therapy

- 820 nm wavelength x .9 j per point at six points along Achilles’ tendon x 12 sessions over 8 weeks

29
Q

What is the typical clinical course for Achilles tendinopathy?

A
  • Improvement in function ca be expected in 6-12 weeks
  • long term follow up suggest 71-100%are able to return to prior level of activity
  • results are more favorable in athletic population
  • younger patients(33 years) better than older (48 years)
30
Q

Can you recommend night splints for Achilles tendinopathy?

A
  • night splints are not beneficial for Achilles tendinopathy
31
Q

Can you recommend heel lifts fir Achilles tendinopathy?

A
  • contradictory evidence to support use of heel lifts
32
Q

What two functional outcome measures can be used for examination of Achilles tendinopathy?

A
  • Victorian Institute of Sports Assessment ( VISA- A)

- foot and Ankle Ability Measure (FAAM)

33
Q

What are the risk factors for plantar fasciitis according to CPG?

A
  • Moderate evidence for:
  • BMI 25-30+
  • decreased ankle DF
  • work related WB activities
34
Q

What is the clinical course for plantar fasciitis?

A
  • clinical course an be over one year with symptoms lasting from 13.3 to 14.4months
35
Q

What outcome measures should clinicians use for plantar fasciitis?

A
  • FAAM
  • FHSQ
  • FFI
  • LEFS
  • VAS
36
Q

What interventions have strong evidence to manage Plantar fasciitis?

A
  • Strong evidence for:
  • manual therapy- cuboid thrusts, prox./ distal tib fib manipulation
  • stretching- 2-3x a day x 3 min
  • anti pronation taping- immediate pain reduction up to 3 weeks
  • foot orthosis- pre fab or custom 2 weeks to 1 year
  • night splints - 1-3 month program
37
Q

What interventions show weak evidence for management of plantar fasciitis?

A
  • Weak evidence for:
  • foot wear
  • low level laser therapy
  • weight loss management
38
Q

Should clinicians recommend corticosteroid injection t manage plantar fasciitis?

A

Weak evidence for injections

  • more harm than good
  • injection site pain, infection, PF rupture, fat pad atrophy, peripheral nerve damage
39
Q

Should clinicians use US to treat plantar fasciitis?

A

No, US can not be recommended for heel pain/ plantar fasciitis.

40
Q

What are the four stages of posterior tendinitis dysfunction?

A
  • Stage 1- TTP, swelling around tendon, but not foot
      • pain with heel raises
  • Stage 2- flat foot posture- “too many toes sign”
    • damage to spring ligament
    • can’t perform heel raise
  • Stage 3 - foot flat posture- rigid
  • Stage 4- degenerative ankle changes OA - severe foot flat
41
Q

What is the pathomechanical cause of PF?

A

Biomechanical stress on PF

  • mechanical overload
  • high BMI
  • tight Achilles
  • localized nerve entrapment - medial calcaneal/ Lateral plantar
42
Q

What is tarsal tunnel syndrome?

A

Compression of posterior tibial nerve in tarsal tunnel

- posterior to medial malleolus

43
Q

What are symptoms of tarsal tunnel syndrome?

A

Pain, parasthesia along plantar surface of foot

  • worse with prolonged standing and running
  • worse at night
44
Q

How is tarsal tunnel syndrome diagnosed?

A
  • Tarsal tunnel test, Tinel’s sign

- max DF, eversion and extension of toes while tapping tarsal tunnel

45
Q

How is tarsal tunnel managed?

A
  • Arch supports
  • mobilizations of mid foot
  • neural dynamics
  • strengthens foot intrinsic
46
Q

Name for shin splints

A

Medial tibial stress syndrome

  • exercise induced leg pain- better with rest
    • diffuse, vague pain
    • TTP along distal 2/3 posterior medial border of tibia
47
Q

Management of medial tibial stress syndrome

A
  • rest,iontophoreseis, phonophoresis, ice massage, US

- ESWT

48
Q

What are signs of stress fracture in the leg?

A
  • Repetitive stress
  • more localized symptoms
    • TYP along anterior proximal 1/3 of tibia
  • no neurological symptoms
49
Q

Management of stress fracture

A

Rest, activity modifications, may be NWB with crutches

50
Q

Describe the digital nerve stretch

test

A

Ankles held in PF on examiners knees

- Pain and discomfort in web space of affected foot

51
Q

What imaging tool is appropriate to diagnose Achilles tendonopathy?

A

US and MRI are equal in diagnosis g Achilles tendonopathy

52
Q

What would you expect to find on US for someone with plantar fasciitis?

A

Thickening of the plantar fascia is sign of plantar fasciitis
- decreases in pain s associated with de tease in thickness of plantar fascia

53
Q

Causes of tarsal tunnel syndrome

A
  • Overpronation that compress posterior tibial nerve
    • often bilateral
  • OA of the ankle
  • RA
  • Diabetes
  • Talonavicular coalition
  • ganglion cyst
54
Q

Describe the Sports Ankle Rating System

A
  • used for active population
  • consists of quality of life measures, clinical rating score, and single assessment numeric evaluation
  • the qol measure assesses the athletes quality of life
    • symptoms, work/ school activities, ADL, recreation/ sport activities and lifestyle.
  • clinical component assesses gait, motion, strength, stability, single limb balance, and lateral hopping

OCS Prep (7 decks)

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