Ankle & Leg Pathologies Flashcards
Closed-packed position
Point in joint’s ROM at which its bones are maximally congruent; most stable position of a joint.
Peripheral Vascular Disease
Swelling in foot and ankle
= associated with individuals with diabetes
STRESS TEST
Anterior Drawer Test
Positive
talus slides anterior from under the ankle mortise compared with the opposite side.
Possible “clunk: as talus subluxates & relocates
Tests for anterior talofibular ligament (ATF) instability
STRESS TEST
Inversion Stress Test (Talar Tilt)
Positive
Talus tilts or gaps excessively compared with uninjured side; pain is produced
Tests for calcaneofibular ligament instability
STRESS TEST
Eversion Stress Test
Positive
Talus tilts or gaps excessively compared to uninjured side; pain described in motion
Tests for deltoid ligament instability, especially tibiocalcaneal ligament
STRESS TEST
External Rotation Test (Kleiger’s Test)
Positive
DELTOID: medial joint pain; possible displacement of talus away from medial malleolus
SYNDESMOSIS: pain in anterolateral ankle at site of distal tibiofibular syndesmosis
Tests for injury to deltoid ligament cause by rotational stress or injury to distal tibiofibular syndesmosis
JOINT PLAY
Subtalar
Positive
Increased or decreased medial or lateral translation of the talus relative to the opposite side.
Amount of medial and lateral movement at subtalar joint.
JOINT PLAY
Cotton Test
Increased lateral translation of the talus relative to the opposite foot
Assesses amount of lateral translation of the talus within ankle mortise
JOINT PLAY
Distal tibiofibular joint play
Pain arising from syndesmosis or increased motion relative to unilateral side
Identify anterior posterior instability of distal tibiofibular syndesmosis
Least stable position for ankle complex
Open-packed position
Talar or Tibial chondral lesion (osteochondral defect)
Caused by combo of inversion, plantarflexion, and talar rotation that compress the superior medial articulating cartilage of talus against tibia
Squeeze Test
Pain is elicited, especially when it is away from compressed area
Identify fibular fractures or syndesmosis sprains
Maison-neuve fracture
spiral fracture of the proximal one-third of the fibula with concurrent disruption of the distal tibiofibular syndesmosis.
Pott’s Fracture
bimalleolar fracture
Os Trigonum Injury
Formed when Stieda’s process separates from talus
Os Trigonum syndrome (talar compression syndrome)
- inflammation of posterior joint
- inflammation of ligaments surrounding the os trigonum
- fracture of os trigonum
- pathology involving the Stieda’s process
Os Trigonum Fracture
sudden onset of pain after forced plantarflexion or dorsiflexion
Progressive degeneration of tendon
Peritendinitis -> Tendinosis -> Tendon rupture
Thompson Test
When calf is squeezed, foot does not plantarflex
Tests for Achilles tendon rupture
MTSS
Medial Tibial Stress Syndrome
Periostitis at posterior medial border of the tibia
Results in overuse (running)
Bump Test for Leg Stress Fractures
Positive
Pain emanating from fracture of calcaneus, talus, fibula, or tibia
Identify stress fractures of the leg or talus.
Compartment Syndromes
Increased pressure (exceeding capillary perfusion pressure) within compartment, resulting in local tissues not receiving an adequate supply of oxygen.
Chronic exertional compartment syndrome (CCS)
AKA: recurrent compartment syndrome/intermittent claudication
Occurs secondary to anatomic abnormalities obstructing blood flow in exercising muscles.
DO NOT APPLY PRESSURE!
Compartment Syndrome
Signs & Symptoms
Pain Pallor (redness) Pulselessness Paresthesia Paralysis
Deep Vein Thrombosis (DVT)
blood clot
Homans’ sign
exacerbation of symptoms with the knee flexed and forceful, passive dorsiflexion of ankle
Detect DVT
