Ankle: Ligament Pathology 3 Flashcards
Ankle impingement: usually occur secondary to
Trauma
Ankle impingement: Pain located where?
- sinus tarsi
- syndesmosis
- posterior ankle
- anterolateral gutter
Ankle impingement: usually occur due to
- hypermobility
- disruption of stabilizing structures
Ankle impingement: Disruption of stabilizing structures…
- bones
- joint capsules
- ligaments
- tendons
Ankle impingement: Recurrent ankle pain with (motions)
Either DF or PF
Osseous impingement: what is it?
Abnormal calcification within the joint
Osseous impingement: abnormal calcification within the joint, specifically where?
- talus
- tibia
- fibula
Osseous impingement: May be the direct result of
- Anterior ankle capsule traction with repetitive minor trauma
- results from PF during activity
Osseous impingement: Once the spur forms, DF may cause what?
- entrapment of bordering soft tissue
- contact with opposing bony structures
- causes chronic pain during activity
Posterior impingement: occurs when?
Talus and/or neighboring soft tissue become compressed between the tibia and calcaneus with repetitive or extreme PF
Posterior impingement: What may initiate posterior impingement?
- acute inversion ankle injuries
- overuse injuries involving trauma in ankle PF
Heel pain: posterior heel pain differential dx
- retrocalcaneal bursitis
- haglund’s deformity
- Achilles tendinopathyh
- S1 radiculopathy
- Sever’s disease
Heel pain: What is Sever’s disease?
Abnormal stress at the epiphysis
Heel pain: Plantar heel pain differential dx
- plantar fascia microtrauma
- tibial nerve entrapment
- fat pad atrophy
- heel spur
- stress fx
- TTS
- subtalar hypomobility
- systemic problems
- S1 radiculopathy
Heel pain: Systemic issues that may cause plantar heel pain
- Reiter’s syndrome
- gout
- RA
Plantar fasciitis: what tissue may be affected?
- plantar fascia
- plantar ligament
- bone spur
- adverse nerve tension
Plantar fasciitis: potential causes
- recent weight gain
- recent change in activity
- overuse
- dec GSC flexibility
Plantar fasciitis: Pain most often where
At attachment of central slip
Plantar fasciitis: Onset
Insidious
Plantar fasciitis: Pain worse after period of
NWB
Plantar fasciitis: Pain gradually improves at first with activity but worsens after
Prolonged activity
Plantar fasciitis: Pain with (toe motion)
DF of 1st MTP
Plantar fasciitis: Sharp pain with palpation, (does/does not) refer/travel
Does not
Plantar fasciitis: Strong association with
BMI in nonathletic population
Plantar fasciitis: risk factors
Weak association with
- increased age
- decreased ankle DF
- decreased 1st MTP extension
- prolonged standing
Plantar fasciitis: risk factors
Inconclusive
- static foot posture
- dynamic foot motion
Plantar fasciitis: Risk factors
No association with
- height in nonathletic population
- height, weight, and BMI in athletic population
Plantar fasciitis: Commonly accompanies strength deficits where?
Intrinsic and extrinsics
Plantar fasciitis: In nonathletes, the pain is often from irritation of
Medial calcaneal nerve
Plantar fasciitis: In nonathletes, the pain is often from irritation of the medial calcaneal nerve. Palpation at the nerve should be (better/worse) than palpation of MCT
Worse
Plantar fasciitis: In nonathletes, the pain is often from irritation of the medial calcaneal nerve. Palpation of the nerve often worse with what special testing positions
SLR
Slump
Plantar fasciitis: for treatment, focus on
- foot intrinsic
- foot extrinsic
- LQ biomechanics
Plantar heel pain: (%) will report improvement in symptoms within 1 year
80%
Plantar heel pain: Evidence for use of dexamethasone or acetic acid through iontophoresis in the short term
Moderate evidence
Plantar heel pain: Moderate evidence that ionto should be used how long for pain relief and improved function
Short term 2-4 weeks
Plantar heel pain: Evidence
Calf muscle and/or PF specific stretching can be used to provide short term pain relief and improvement in calf flexibility
Moderate
Plantar heel pain: Calf stretching
Moderate evidence to use for short term (how long) pain relief and improvement in flexibility
2-4 mos
Plantar heel pain: Evidence
Calcaneal low dye taping
Weak
Plantar heel pain: Weak evidence for calcaneal low dye taping to provide (short/long) term relief
Short term 7-10 days
Plantar heel pain: Evidence
Prefabricated or custom foot orthoses
Strong
Plantar heel pain: Strong evidence to support use of prefabricated or custom foot orthoses for (short/long) term relief
Short term - 3 mos
Plantar heel pain: evidence
Use of prefabricated or custom foot orthoses for long term > 1 year management
NO evidence to support
