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OPTIM OCS: LQ > Ankle: Pathologies 2 > Flashcards

Ankle: Pathologies 2 Flashcards

1
Q

Posterior tibialis dysfunction: differential dx

A
  • deltoid ligament sprain
  • FDL sprain
  • FHL injury
  • navicular stress fx
  • TTS
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2
Q

Posterior tibialis dysfunction: common demographics

A

Age > 40
Female
Overweight

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3
Q

Posterior tibialis dysfunction: Approximately (%) of cases are seen in females

A

80%

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4
Q

Posterior tibialis dysfunction: location of pain

A

along tendon distal to medial malleolus

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5
Q

Posterior tibialis dysfunction: swelling?

A

Yes - possible

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6
Q

Posterior tibialis dysfunction: atrophy?

A

May occur proximally

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7
Q

Posterior tibialis dysfunction: presentation

A

Adult acquired flat foot

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8
Q

Posterior tibialis dysfunction: More than ½ of all patients with a rupture have a history of…

A
  • HTN?
  • DM?
  • multiple steroid injections
  • obesity
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9
Q

Posterior tibialis dysfunction: making the diagnosis…what are the primary characteristics?

A
  • pain or swelling behind the medial malleolus

- change in foot shape

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10
Q

If the patient has pain or swelling behind the medial malleolus AND a change in foot shape, there is a sensitivity of (%) for diagnosis of posterior tibialis dysfunction

A

100%

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11
Q

Posterior tibialis dysfunction: pain worse with what activities/movements?

A
  • WB
  • inv/PF against resistance
  • Single leg toe raise
  • ache after walking long distances
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12
Q

Posterior tibialis dysfunction: foot posture observed

A
  • too many toes sign

- lacking normal heel varus when rising on toes

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13
Q

What is the primary stabilizer of the medial longitudinal arch?

A

Tibialis posterior

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14
Q

Posterior tibialis dysfunction: Often misdiagnosed as…

A

Medial ankle sprain

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15
Q

Posterior tibialis dysfunction: Can reach a prevalence of 10% in this group

A

Elderly women

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16
Q

Posterior tibialis dysfunction: Affects nearly (#) people in the US

A

5 million

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17
Q

Posterior tibialis dysfunction: pathogenesis

A
  • age related tendon degeneration
  • fibrotic changes from repeated microtrauma
  • abnormal forces from even mild flatfootedness
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18
Q

Posterior tibialis dysfunction: Why is flatfootedness a cause?

A

Lifelong greater demands on the posterior tibialis than a normal foot

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19
Q

Posterior tibialis dysfunction: How many stages?

A

4

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20
Q

Posterior tibialis dysfunction: Stage 1 symptoms

A
  • pain and swelling along posterior tib tendon
  • normal, painful heel raise
  • myofascial restrictions
21
Q

Posterior tibialis dysfunction: Stage 1

Appearance

A

Normal appearing tendon

22
Q

Posterior tibialis dysfunction: Stage I

Surgical treatment?

A
  • mostly conservative

- tendon debridement with osteotomy

23
Q

Posterior tibialis dysfunction: Stage 2-4

Symptoms

A
  • pain/swelling
  • too many toes sign
  • UA to perform heel raise
24
Q

Posterior tibialis dysfunction: Presentation

A
  • elongated posterior tib tendon
  • advanced degeneration
  • longitudinal tears
  • flexible planovalgus foot
25
Q

Posterior tibialis dysfunction: Stage 2

Surgery

A

Tendon transfer and corrective osteotomy

26
Q

Posterior tibialis dysfunction: Stage 3 presentation

A

Same as stage 2, but with

  • rigid, more severe planovalgus foot
  • radiographic degenerative changes
27
Q

Posterior tibialis dysfunction: Stage 3

Surgery

A

triple arthrodesis of subtalar, calcaneocuboid, and talonavicular joints

28
Q

Posterior tibialis dysfunction: Stage 4

Presentation

A

Same as stage 3 but with valgus tilt of talus

29
Q

Posterior tibialis dysfunction: Stage 4

Surgery

A

Pantalar arthrodesis of joints:

  • talocrural
  • subtalar
  • calcaneocuboid
  • talonavicular
30
Q

Posterior tibialis dysfunction: Stage 1

Assumed underlying pathology

A

Tendon pathology with or without synovitis

31
Q

Posterior tibialis dysfunction: Stage 2 assumed underlying pathology

A
  • Tendon pathology with or without synovitis

- damage to spring ligament and other soft tissue supports

32
Q

Posterior tibialis dysfunction: Stage 3 and 4 assumed underlying pathology

A
  • tendon pathology without synovitis
  • damage to spring ligament in most cases
  • may also include deltoid ligament and other soft tissue supports
  • development of joint contractures
33
Q

Posterior tibialis dysfunction: decision making

Stage II or less, UA to walk 15 feet

A

fracture boot

34
Q

Posterior tibialis dysfunction: decision making

Stage II or less, unable to walk 15 feet. Likely a candidate for

A

Surgery OR

Long term care with custom AFO

35
Q

Posterior tibialis dysfunction: decision making
Stage II or less, able to ambulate > 15 feet
Mild deformity

A

AFO off the shelf

Exercise

36
Q

Posterior tibialis dysfunction: decision making
Stage II or less, able to ambulate > 15 feet
Mild deformity

If off the shelf AFO + exercise is not successful, what is the response

A

Surgical candidate

37
Q

Posterior tibialis dysfunction: decision making
Stage II or less, able to ambulate > 15 feet
Severe deformity

A

Custom AFO

Exercise

38
Q

Posterior tibialis dysfunction: decision making
Stage II or less, able to ambulate > 15 feet
Mild deformity

If custom AFO + exercise fails…

A

Surgery

39
Q

Posterior tibialis dysfunction: decision making
Stage II or less, able to ambulate > 15 feet
Mild deformity

Custom AFO + exercise - if successful…

A

Off the shelf foot orthosis

Exercise

40
Q 
Posterior tibialis dysfunction: decision making
Severe deformity (stage III/IV)

First step

A

Fracture boot

41
Q 
Posterior tibialis dysfunction: decision making
Severe deformity (stage III/IV)

If fracture boot is successful, what’s next?

A

Custom AFO

42
Q 
Posterior tibialis dysfunction: decision making
Severe deformity (stage III/IV)

If fracture boot and/or custom AFO are unsuccessful…

A

Surgery

43
Q

Posterior tibialis dysfunction: for grade 1-2, what are the preferred manual therapy interventions?

A
  • manipulate TCJ/STJ

- manipulate cuboid

44
Q

Posterior tibialis dysfunction: Manipulate TC/ST joints for…

A

Restore dorsiflexion

45
Q

Posterior tibialis dysfunction: Why do a cuboid manipulation?

A

Due to plantar drop

46
Q

Posterior tibialis dysfunction: Important to restore strength of

A
  • Posterior tibialis

- foot intrinsic strength

47
Q

Posterior tibialis dysfunction: For grade 1-2, what are good exercises for restoring posterior tibialis strength?

A
  • TB and/or inversion on towel

- progress to standing calf raise with ball between heels to bias inversion

48
Q

Posterior tibialis dysfunction: Grades 1-2 injuries

May prescribe what if needed?

A

OTC arch supports

49
Q

Posterior tibialis dysfunction: Grades 1-2 treatment

Stretching

A

May need to address gastroc/soleus flexibility

ONLY with foot in neutral or supination to protect arch

OPTIM OCS: LQ (43 decks)

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