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NMSK1 - physio 1 > ankle & foot soft tissue injuries > Flashcards

ankle & foot soft tissue injuries Flashcards

1
Q

in which position is the ankle **most & least stable **in?

A
  • most stable - dorsiflexion
  • least stable - plantar flexion
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2
Q

what type of ankle injury is the most common & by what mechanism does it occur by?

A
  • lateral ligament sprain
  • occurs via inversion and plantar flexion (activities with quick change of direction, uneven surfaces etc)
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3
Q

out of the 3 lateral ankle ligaments, which one is most often affected, and after that which ligament can follow ?

A
  • anterior talo-fibular ligament (ATFL)
  • CFL ligament after
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4
Q

what us a syndesmosis sprain?

what is it also called?

A
  • also called a high ankle sprain
  • involves the ligaments between the distal tibia and fibula at the distal tibiofibular syndesmosis
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5
Q

what is the function of the syndesmosis joint?

A
  • provides** strong stabilisation** and **dynamic support **to the ankle
  • maintains the** integrity **between the distal tibia and fibula
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6
Q

what are examples of tests that cna be done to test the distal tib-fib joint / syndesmosis?

A
  • squeeze test
  • external rotation stress test
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7
Q

what are examples of clinical features of a lateral ankle sprain?

A
  • history with a plantar flexion/ inversion injury
  • pain over area
  • **weight bearing may be affected **
    * bruising and tenderness
  • reduced ROM initially, esp PF and Inv
  • positive stress tests eg talar tilts
  • ensure to outrule fracture
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8
Q

what are the ottawa ankle rules?

A
  • important rules that a physio must test with an ankle injury to ensure there is no fracture
  • careful around malleolar zones, mid foot etc
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9
Q

what are the signs and symptoms of a grade I mild ankle sprain/tear?

A
  • point tenderness
  • minimal swelling and bruising
  • single ligament involved
  • usually ATFL
  • no anterior drawer test- not pos
  • no or little limp
  • little functional loss
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10
Q

what are the signs and symptoms of grade II ankle sprains?

A
  • some bruising
  • local swlling
  • margins of achilles tendon less defined
  • may be pos for anterior drawer
  • limp with walking
  • unable to run
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11
Q

what are the signs and symptoms for a grade III ankle sprain?

A
  • swelling on both sides of achilles tendon
  • may be tenderness medially and laterally
  • positive anterior drawer test for ankle
  • unable to weight bear fully
  • significant pain inhibition - ie patient cant feel pain due to disruption of nociceptors
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12
Q

which ligament does the anterior drawer test test?

A

ATFL

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13
Q

what does the anterior drawer test for the ankle involve?

A
  • foot relaxed and knee flexed
  • examiner stabilises the tib/fib and holds the foot in approx 20 degree PF, draws the talus forwrad
  • best tested 4-5 days post injury
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14
Q

what ligament does the talar tilt test test?

A
  • calcanofibular ligament
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15
Q

what does the talar tilt test involve?

A
  • patient is lying in supine
  • foot is relaxed and knee is flexed
  • tilt the talus into adduction & abduction
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16
Q

what exercise is important for ankle sprains?

A
  • active ROM, progress ROM to restore full range
  • strengthening exercise
  • balance and proprioception exercise
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17
Q

what effects do manual therapy / mobilisations etc have on an ankle sprain?

A
  • short term effects
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18
Q

what effect do NSAID’s have on ankle sprains?

A
  • short term reduction in pain
  • longer use may delay natural healing as inflammation is a necessary component of healing
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19
Q

how long should immobilisations be for grade III ankle sprains?

A
  • max 10 days with rigid support
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20
Q

what is the differnece between mechanical and functional instability?

A
  • mechanical - joint motion** beyond the physiological limits** ie ligament laxity
  • functional - joint motion beyond voluntary contorl but within normal physiological limits
21
Q

what us chronic ankle instability - CAI?

A
  • condition characterised by a recurring giving way of the lateral side of the ankle
22
Q

what are the key muscle groups for strengthening after the ankle injury?

A
  • plantar flexors
  • dorsiflexors
  • inverters and evertors
23
Q

why us proprioception training so important for ankle sprains?

A
  • it can improve how quickly the foot and ankle can respond to unsteadiness
  • balance training also heightens muscle strength, coordination and joint motion
24
Q

by what mechanism do medial ankle ligament injuries happen?

A

eversion injury

25
Q

why are medial ankle ligament injuries less common than the lateral ligament injuries?

A
  • as the medial ligament is much stronger
26
Q

what can a medial ankle ligament injury occur in association with?

A
  • may occur with lateral ligament sprain (if the force is extrememely strong and goes from lateral to medial side )
  • fracture of the medial ankle
27
Q

what is tarsal tunnel syndrome?

A

entrapment of the posterior tibial nerve as it passes behind the medial malleolus

28
Q

what are examples of causes of tarsal tunnel syndrome?

A
  • tenosynovitis of the tib posterior tendon
  • excessive pronation (toes outwards)
  • overuse with excessive ankle movement
  • overly tight shoes or laces
  • RA
29
Q

what are examples of clinical features of tarsal tunnel syndrome?

A
  • severe sharp pain into the sole of the foot
  • aggravated by WB - walking, running and standing
  • can be worse in bed at night due to venous stasis
  • may have pins and needles - due to nerve compression
  • may have weakness of toe flexors
30
Q

what does the conservative management of tarsak tunnel syndrome involve?

A
  • pain reflief meds
  • local corticosteroid injetion
  • correct foot deformity - eg with orthotics
  • restore strength if possible
  • neural mobilisation
31
Q

what does the surgical management of tarsal tunnel syndrome involve?

A

surgical decompression of nerve

32
Q

what is mortons neuroma?

A
  • benign (non cancerous) tumour of a nerve - the bifurication of the common plantar figital nerve
33
Q

how can morton’s neuroma occur?

A
  • not clearly established
  • chronic trauma theory
  • entrapment theory
  • ischaemic theory
34
Q

what are the signs and symptoms of morton’s neuroma?

A

*** shooting, stabbing or burning **pain
* worse with WB
* feeling like a pebble or lump is stuck under foot
* **pins and needles **and numbness
* made worse by tight shoes, high heels etc
* common at 3rd and 4th metatarsals

35
Q

what kind of treatment can be very effective for morton’s neuroma?

A
  • corticosteroid injection
36
Q

what is metatarsalgia?

A
  • plantar pain in metatarsal region
37
Q

what are examples of causes of metatarsalgia?

A
  • hallux valgus (bunion @ big toe)
  • morton’s neuroma
  • stress fracture
  • arthritis
38
Q

what are the** signs and symptoms **of metatarsalgia?

A
  • sharp aching or burning pain in the ball of the foot
  • worse with WB
  • may or may not have tingling or numbness
39
Q

describe the epidemiology of an achilles tear

A
  • more common in males
  • age 25-40 (high energy) and also 60+ (low energy) - more associated with a degenerate process
  • may be missed in 25% of patients
  • often dont have pain prior to rupture
40
Q

what are key findings in the subjective exam of an achilles tear?

A
  • acute injury
  • sudden onset - with sharp pain
  • audible snap or tear
  • may report swelling or brusing
41
Q

what does the physical exam for an achilles tear involve?

A
  • positive thompson test
  • decreased plantar flexion (contraction)
  • presence of a palable defect (palpation)
  • increased pasive ankle dorsiflexion (stretch)
  • will find it hard to push off during gait and also do a double or single leg heel raise
42
Q

what does the surgical managment of an achilles tendon tear involve?

A
  • 0-2 weeks - walking in boot with wedges and use of 2 crutches
  • 6-8 weeks boot
  • rehab - SL stance, leg press, stationary bike
  • by 6 weeks - working on ankle ROM
  • no stretching achilles for 6 months
  • more than 8 weeks and beyond - shoes with heel lift, seated/standing heel raise 50% weight hearing, PF with theraband
43
Q

describe the epidemiology of achilles tendinopathy

A
  • males can get it just as much as females
  • peak age - 40-59 years
  • distance runners and multi-directional sport is most common
  • sedentary people
  • common with systemic conditions
  • morning stiffness
  • 1 in 3 report bilateral symptoms
44
Q

what is noticed with the physical examination of achilles tendinopathy?

contract, palpate and stretch

A
  • pain with double/ single leg heel raise and pain with hop or jump
  • pain with ankle dorsiflexion
  • pain and thickness at site of tendinopathy
  • ROM may be altered
45
Q

what are the common injuries that can occur in the peroneal tendon (fibularis tendon)?

A
  • tenosynovitis - ie tendon sheath swelling
  • tendinopathy - overuse
  • tear
  • subluxing or dislocating tendons
46
Q

what is plantar fasciopathy?

A
  • degeneration and over use of the plantar fascia of the sole of the foot
  • plantar fascia - strong band of connective tissue that runs from the heel to the metatarsals
47
Q

what are the potential clinical signs and symptoms of plantar fasciopathy?

A
  • patients report localised heel pain on the medial side
  • worse standing after rest especially 1st thing in the morning
  • improves during the day
  • exacerbated with prolonged walking and exercise
48
Q
A

NMSK1 - physio 1 (36 decks)

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