Ankle & Foot Injuries Flashcards
What is the first objective of treating an ankle/foot injury?
- Site of pain
- Mechanism of injury
- Observation
- Careful, sequential physical examination
What are some of the common ankle/foot/calf injuries?
- Inversion
- Eversion
- Rotation
- Impact/forced DF or PF
- Overload - tendinopathies (achilles, tib post)
- Sudden acceleration/deceleration (gastroc tear/achilles rupture)
What does an inversion injury involve?
- Lat ligaments (ATFL, CFL, PTFL)
- Never simple, usually not isolated
- Can involve chondral surfaces, bone, tendon injury (perineal), kissing lesion
What should you look for with an eversion injury and why?
Fracture - medial ligaments are very robust & strong, if there is enough force to rupture them, there’s enough force to fracture
What is associated with rotation injuries?
- Spiral fracture
- Syndesmosis (splaying of tib/fib
Why is syndesmosis a not to be missed condition?
It doesn’t heal well if missed
What is associated with impact/forced DF or PF?
- Syndesmosis
- Fracture
- Osteochondral (issues with bone/cartilage)
- Impingements
What is a common site of injury in sprinters?
Medial head of gastroc - tear
What is an example of an osteochondral injury in the ankle?
Talar dome lesion
What is Kohler disease? (NTBM)
- Spontaneous resorption of navicular bone
- Happens in children
- Avascular necrosis
- Presents with weird painful foot
What is a Lisfranc injury? (NTBM)
- Base of 2nd MT dislodged from recess into cuneiform
- Common in contact sports, going down stairs, something rolling over foot
When does a tib post rupture often occur?
In post-menopausal women
Where is the tarsal tunnel and what does it contain?
Behind the medial malleolus, contains important arteries, nerves
What are the causes of tarsal tunnel syndrome?
Anything that occupies the tarsal tunnel space
- Trauma
- Fractures
- Post traumatic fibrosis
- Talocalcaneal coalitions
- Soft tissue masses
- Ganglion cysts
- Lipomas
- Varicosities
- Synovial hypertrophy
- Flexor hallucis hypertrophy
- Muscle anomalies
What are the symptoms of tarsal tunnel syndrome?
- Pins and needles
- Tight sensation in foot
- Pain
- Triggering of tendons
What is CELP?
Chronic exertion or leg pain (shin pain)
What is the most common site for stress fractures?
Tibia
What is PAES?
Popliteal artery entrapment syndrome
What is Chronic exertional compartment syndrome (CECS)?
- Increased pressure within a space causes compression of nerves/arteries & potential damage of tissues
- Eased with rest
What is a characteristic of CECS?
Limb feels really hard
What is MTSS?
Medial tibial stress syndrome
What is the difference between a stress fracture and MTSS?
Stress fracture is a pin point, MTSS extends about 5cm
What is tarsal coalition?
- Painful, very stiff foot
- Bony bridge at sub-talar joint
What are the treatment principles for the acute phase?
- Establish SIN
- Identify impairments
- Identify causes
- Treat causes
What are the treatment principles for the subacute phase and onwards?
- Regain ROM
- Regain movement control
- Regain strength
- Regain function/participation
What is important in lateral ankle sprains?
Ensuring perineal muscles stay active as they will maintain the stability of the joint
What is acute compartment syndrome & why is it a NTBM condition?
- Pressure is significantly elevated
- Does not subside with rest
- Emergency surgery required to release pressure & avoid ischaemic injury
What is complex regional pain syndrome (type 1) & why is it a NTBM condition?
- Post-traumatic
- Localised pain out of proportion to injury
- Delayed recovery
- Early mobilisation & avoidance of surgery key to management
