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PHTH 517 > Ankle/Foot Disorders > Flashcards

Ankle/Foot Disorders Flashcards

1
Q

low ankle sprain - grade I

A
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2
Q

lower ankle sprain - grade II

A
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3
Q

lower ankle sprain - grade III

A
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4
Q

medial ankle sprain -MOI

A

Mechanism of injury is excessive eversion and DF
- results in injury to the deltoid ligament

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5
Q

high ankle sprain - MOI

A

Extreme dorsiflexion or external rotation

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6
Q

ankle sprain treatment: acute, subacute, advanced healing stage

A
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7
Q

chronic ankle instability - MOI

A

acute inversion injuries/laxity

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8
Q

CAI - signs and symptoms

A
  • frequency episodes of ankle sprains
  • reports of “giving way”
  • pain, weakness, instability, diminished self-report of function, swelling
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9
Q

CAI - diagnosis

A

Anterior drawer and tenderness

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10
Q

CAI - treatment

A

Balance and strength

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11
Q

tibialis posterior tendon function

A

PF, inversion, stabilizes the medial longitudinal arch

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12
Q

tibialis posterior tendon pathogenesis

A

Tenosynovitis
Incomplete tear
Complete disruption

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13
Q

tibialis posterior tendonitis subjective findings

A
  • Insidious onset of pain, with pain felt in one of 3 locations:
  • Distal to the medial malleolus in the area of navicular
  • Proximal to the medial malleolus
  • At the musculotendinous origin (medial shin splints), or insertion
  • Swelling on the medial aspect of the ankle
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14
Q

tibialis posterior tendonitis objective findings

A
  • Swelling and tenderness posterior and inferior to the med. Malleolus, along the course of the post. Tib tendon, and to its insertion into the navicular
  • Medial arch is decreased or completely flattened
  • Heel shows increased valgus
  • Pain on resisted ankle PF and inversion
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15
Q

peroneal tendons pathology

A

tenosynovitis and sprains

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16
Q

peroneal tendons symptoms

A
  • pain in the outer part of the ankle or just behind the lateral malleolus
  • pain commonly worsens with activity and eases with rest
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17
Q

achilles tendinitis/tendinosis - subjective findings

A
  • Gradual onset of pain and swelling in the Achilles tendon 2 to 3 cm. proximal to the insertion of the tendon
  • Exacerbated by activity
  • Some patients will present with pain and stiffness along the Achilles tendon when rising in the morning or pain at the start of activity that improves as activity progresses
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18
Q

achilles tendonitis - objective findings

A
  • Tenderness & warmth to palpation along tendon
  • Decreased active and passive DF
  • Gait may include: antalgia, premature heel off, leg may be held in ER
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19
Q

achilles tendonitis treatment

A

eccentric strengthening of the calf
correction of lower chain asymmetries
achilles stretching
modify extrinsic causes - training errors, improper shoes

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20
Q

achilles tendon rupture - MOI

A
  • sudden unexpected dorsiflexion of ankle with knee extended or repeated microtrauma
  • eccentric loading
21
Q

achilles tendon rupture subjective

A

young to middle aged

22
Q

achilles tendon rupture diagnosis

A

thompson’s test

23
Q

achilles tendon rupture - non-operative treatment

A

serial casting over 10-12 weeks

24
Q

heel pain causes

A

obesity, excessive walking/sporting activity, tight plantar fasciitis, and flattening of the arch

25
Q

plantar fasciitis - subjective findings

A
  • pain and tenderness on the plantar medial aspect of the heel esp during initial WB in the morning or after a prolonged period of nonweight bearing
  • pain usually worsens with activity
26
Q

plantar fasciitis - objective findings

A
  • localized pain on palpation along the medial edge of the fascia or at the origin on the anterior edge of the calcaneus
27
Q

plantar fasciitis treatment

A

foot intrinsics

28
Q

retrocalcaneal bursitis- causes

A
  • Repetitive trauma from shoe wear and sports
  • Gout, RA and ankylosing spondyloarthropathies
  • Bursal impingement between the Achilles tendon and an excessively prominent posterior-superior aspect of the calcaneus.
29
Q

retrocalcaneal bursitis- subjective findings

A
  • posterior ankle pain
  • pain with walking
30
Q

retrocalcaneal bursitis- signs

A
  • tenderness
  • lump
  • inflammation
31
Q

retrocalcaneal bursitis- treatment

A
  • reduce swelling and inflammation
  • achilles tendon stretching exercises
32
Q

hallux valgus (“bunion”) - signs

A
  • Bunion
  • inflamed overlying bursa and skin
  • Valgus and pronation deformity of hallux.
  • Painful callus on 2nd toe
  • Second toe is forced into hyperextension by deviated great toe
  • Transfer metatarsalgia/thickened skin over MT heads.
  • Increased valgus angle at first MTP joint
    Valgus angle at first MTP joint >20 degrees
    Angle between 1st & 2nd MT >9 degrees
33
Q

hallux valgus (“bunion”) - treatment

A
  • Properly fitted, low heeled stiff-soled shoes
  • Wide, square shaped toe box
  • Toe portion stretched to accommodate bunion
  • Extra-depth shoe to accommodates dorsiflexed second toe
  • Splint separates first and second toe; “spacer”
  • Silicone bunion pad to alleviate direct pressure
  • Acute pain management
  • Rest
  • Apply moist heat
  • Analgesics
34
Q

flat foot/pes planus - flexible

A
  • Disappearance of the internal longitudinal arch when weight bearing
  • Reappearance of the internal longitudinal arch when non weight bearing
  • Jack Test (hyperextension of the hallux): appearance of the internal longitudinal arch
  • Heel Rise Test: Patient should stand with his natural stance
    After that, patient should raise the heel. If the patient presents a flexible planus foot the heel moves in varus position
35
Q

flat foot/pes planus - rigid etiology

A

Congenital vertical talus & tarsal coalition

36
Q

flat foot/pes planus - rigid symptoms

A

Foot pain
difficulty walking on uneven surfaces
foot fatigue
peroneal spasm

36
Q

flat foot/pes planus - rigid treatment

A

4-6 weeks of cast immobilization

37
Q

metatarsal stress fracture - subjective findings

A
  • Pain & swelling on weight bearing
  • Hx of sudden increase in activity, change in running surface, prolonged walking
38
Q

metatarsal stress fracture - objective findings

A
  • Swelling, ecchymosis, and tenderness over fractured metatarsal
  • May not show up on radiographs for 2-3 weeks
39
Q

Morton’s neuroma - subjective findings

A
  • symptom of shooting/constant pain on walking, - relieved by rest and removal of footwear
  • clinical sign of third/second cleft tenderness and - palpable click on metatarsal squeeze test
40
Q

Morton’s neuroma - pathology

A

Not a true neuroma but rather a perineural fibrosis of the common digital nerve as it passes between metatarsal heads

41
Q

tarsal tunnel - objective findings

A
  • Positive tinel sign
  • Percuss with and without weight bearing
  • Pain with passive DF or eversion
  • Decreased 2-point discrimination on the plantar aspect of the foot
  • Varus or valgus deformity of the heel
  • Weakness of the foot intriniscs with sustained PF of the toes
42
Q

tarsal tunnel - subjective findings

A
  • Patient reports poorly localized burning sensation
  • pain and paresthesia at the medial plantar surface of the foot
  • Worse after activity, and worse at end of work day
43
Q

turf toe - subjective findings

A
  • Complaints of red, swollen, stiff first MTP joint
    Joint may be tender on plantar and dorsal surface
  • May have limp and may be unable to run or jump
  • Hx of a single DF injury or multiple injuries to the great toe
44
Q

turf toe - treatment

A
  • Rest, ice, compressive dressing, elevation
    NSAIDS
  • Toe taped to limit DF
  • Grade I sprains can return to sport as soon as symptoms allow
  • Grade II usually need 3-14 days of rest
  • Grade III usually need crutches for a few days and up to 6 weeks rest from sports
  • Guide: Return to sport with the toe can be dorsiflexed 90 degrees
45
Q

turf toe - objective findings

A
  • Grade I sprain = minor stretch injury to the soft tissue restraints with little pain, swelling or disability
  • Grade II sprain= partial tear f the capsuloligamentous structures with moderate pain, swelling, ecchymosis, and disability
  • Grade III sprain = complete tear of the plantar plate with severe swelling, pain, ecchymosis, and inability to bear weight normally
46
Q

turf toe - MOI

A

Most commonly occurs with hyperextension, and varus/valgus stresses of the1st MTP joint

47
Q

cuboid syndrome

A
  • Disruption of the structural congruity of the calcaneo-cuboid joint complex
  • Injury of the calcaneo-cuboid ligaments

PHTH 517 (5 decks)

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