Ankle/Foot Stability and Movement Coordination Impairments Flashcards
With Movement Coordination Impairments, what will we hear in the Hx?
- Recent Trauma
-MOI: Inversion, Eversion, Rotational Injury - Pop or Snap
- Localized Pain
With Movement Coordination Impairments, what will find with Joint Integrity and Mobility?
This will depend on the severity of the injury
- Grade 1: Pain with normal mobility
- Grade 2: Pain with hypermobility
- Grade 3: Pain-Free with Hypermobility
With Ankle Sprains, what are common sports that deal with Ankle Sprains?
- Basketball
- Football
- Soccer
With Ankle Sprains, what are the Risk Factors?
{Intrinsic vs Extrinsic Factors}
Intrinsic Factors
- Age 15-19
- Female
- Body Composition (Lower body mass)
- Physical Fitness (Weak Hip Abd and ER strength)
- Limited ankle DF
Extrinsic Factors
- Specific sports (Indoor and court sports
- Level of competition
With Ankle Sprains, what is the DD that we should consider?
Fx including Avulsion Fx’s
- Ottowa Ankle Rules
- Malleolar Fx
- Fibular
- Talar Fx
Tendinopathy
- Fibularis Longus/Brevis
- Posterior Tib.; Flexor Hallucis Longus; Flexor Digitorum Longus
Neuropraxia
- Posterior Tib. N.
With Lateral Ankle Sprains, what will we find in the Physical Exam?
Observation
- If acute = Redness, warmth, swelling
ROM
- A/PROM = P! Inversion and PF
- Limited DF
Resistive
- Strong and Painless
Joint Integ.
- Anterior Talar Glide
-Normal or hypermobile
-Painless or painful
- Hypomobile Posterior Glide w/ associated loss of DF
With Lateral Ankle Sprains, what will we find with Palpation and Special Test??
Palpation
- Painful and tenderness over affected ligament(s)
Special Test
- (+) Anterior Drawer
- (+) Talar Tilt
With Medial Ankle Sprains, what will we find in the Physical Exam?
Observation
- If acute = Redness, warmth, swelling
ROM
- A/PROM = P! Eversion
Resistive
- Strong and Painless
Joint Integ.
- Talar Glides
-Normal or hypermobile
-Painless or painful
- Hypomobile Posterior Glide w/ associated loss of DF
With Medial Ankle Sprains, what will we find with Palpation and Special Test??
Palpation
- Painful and tenderness over affected ligament(s)
Special Test
- (+) Kleiger (ER) Test
With High Ankle Sprains, what will we find in the Physical Exam?
Observation
- If acute = Redness, warmth, swelling
ROM
- A/PROM = P! DF and combined DF and Eversion
Resistive
- Strong and Painless
Joint Integ.
- Distal Tibiofibular Accessory Motion
-Pain
-Talar Glides
- Normal and Painless
With High Ankle Sprains, what will we find with Palpation and Special Test??
Palpation
- Painful and tenderness over affected ligament(s)
Special Test
- (+) Kleiger (ER) Test
- (+) Squeeze Test
What is the Prognosis of Ankle Sprains?
- Lateral Ankle Sprain, have High Recurrence Rates
- High Ankle Sprains, take 2-20 times longer
- Severity of Injury, West Point Ankle Sprain Grading System
What are Lisfranc Complex Injuries?
Injury to the Tarsometatarsal Articuations
- This can range from a Grade 1 sprain to a dislocation
Lisfranc Ligament Proper is a group of 3 ligaments located between the medial cuneiform and second metatarsal
What is the MOI for Lisfrac Injuries?
- Axial Load through supinated foot
- MVA, fall from height (greater than 3 meters), sport injuries
- More common with males
What is the DD of Lisfranc Injuries that we should consider?
- Midfoot Fx
- Cuboid Fx
- Navicular Compression Injury
- Tibialis Posterior Tendon Dysfunction
Rare:
- Dorsal Pedal injury
- Deep Fibular nerve injury
With Lisfranc Injuries, what may we Observe during the physical examination?
- Swelling and Pain in midfoot
- Difficulty walking/weightbearing
- Gap Sign {Visable separation between the first and second matatarsals in weight bearing}
-Plantar Ecchymosis
With Lisfranc Injuries, what may we find during the physical examination?
Joint Mob./Integrity
- Painful mobility testing
- Mobility differences
Palpation
- Localized tenderness to affected structures
What is the Prognosis for Lisfrac Injuries?
Mild Injuries
- 4-6 weeks
- Return to sport = longer
NFL Players
- 27 weeks post-injury
Surgical Repair
- If unstable and if the gap sign is > 2 mm
What is Turf Toe?
This is a Hyperextension Injury to the 1st MTP
- Most commonly occurs when the running athlete’s shoe sticks to the ground when trying to stop
What are the Risk Factors for Turf Toe?
- Running sports with stops and starts
- Collision sports
- Flexible footwear
-Artificial Turf - > 78° of 1st MTP Extension
What is the DD of Turf Toe we must consider?
- Gout
- Sesamoidits
- Morton’s Neuroma
- Metatarsalgia
With Turf Toe, what will we find during the Physical Examination?
Observation
- Swelling and Eccymosis
ROM
- Limited and painful 1st MTP (due to muscle guarding)
Joint integ. and Mobility
- Painful accessory motion
- Hypermobility in more severe injuries
Palpation
- Localized pain
Gait
- Painful push-off
What is the Prognosis for Turf Toe?
- Conservative Mangagement indicated
- Return to running/sport-specific activities
-2-6 weeks - Goals:
-1st MTP Extension = 60°
-Painfree heel raises
What is the treatment approach during the Inflammatory Phase of Healing?
- Protect injured tissue
-Boots, braces, rigid taping, ADs - ROM in pain-free directions and ranges
- Maintain ROM and muscle performance to surrounding regions
