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MPT1 > Ankle Pathology > Flashcards

Ankle Pathology Flashcards

1
Q

What age group does club feet (rigid equinas) affect?

A

peds

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2
Q

club foot leads to…

A

increased tone in plantar flexors and increased inversion

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3
Q

club foot may lead to this gate

A

toe walking

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4
Q

What joint should you measure ROM if you suspect club foot?

A

talocrural joint - patient may lose dorsiflexion because they spend too much time in plantarflexion

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5
Q

sever’s disease affect’s what age group?

A

adolescents (must be before the growth plate fuses)

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6
Q

What is severs disease?

A

apophysitis of the calcaneous at the achilles insertion

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7
Q

what do you find upon examination for severs disease?

A
  • tender to palpate (achilles tendon insertion)
  • pain with eccentric contractions
  • often due to repetitive motion and overuse
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8
Q

What is the number one cause of ED visits?

A

ankle sprains because they fear a fracture

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9
Q

What is a differential diagnoses you want to rule out when you suspect an ankle sprain?

A

ankle fracture

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10
Q

What joint is involved with ankle sprains?

A

talocrural joint

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11
Q

What ligaments are involved in a high ankle sprain?

A
  • interosseous membrane
  • anterior tib-fib
  • posterior tib-fib
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12
Q

What MOI would make you suspect a high ankle sprain?

A

ER and dorsiflexion of foot MOI

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13
Q

What is the most common ankle sprain? the least?

A

lateral, medial

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14
Q

What ligaments are involved in a medial ankle sprain?

A

Deltoid lig:
- ant tibio-talar
- tibio-navicular
- calcaneo - tibio
- post tibio-talar

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15
Q

What MOI causes a medial ankle sprain?

A

moment of eversion

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16
Q

What MOI causes a lateral ankle sprain?

A

moment of inversion

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17
Q

What is the most commonly sprained ankle ligament?

A

Anterior talo-fibular (ATF)

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18
Q

What are the 3 ligaments involved in a lateral ankle sprain?

A
  • anterior talo-fibular (ATF)
  • calcaneo- fibular
  • posterior talo-fibular
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19
Q

What causes a subtalar joint ankle sprain?

A

significant trauma like a car accident, much less common, very problematic

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20
Q

What ligaments are involved in a subtalar joint ankle sprain?

A
  • interosseous talo-calcaneal
  • cervical ligament
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21
Q

What are key point in these portions of an eval?
1 - subjective
2 - visual observation
3 - ROM
4 - Palpation
5 - special tests

A

1 - MOI is #1!
2 - should see swelling or bruising
3 - will probably lose ROM because you’re guarding ankle
4 - find certain ligs
5 - only really used for chronic ankle sprain issues

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22
Q

What are the 2 classification systems for ankle sprains?

A

1 - functional
– grade 1 to 3 based on instability
2 - ligament
grade 1: ATF
grade 2: calcaneo-fib
grade 3: post talo-fib

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23
Q

What are two special tests for lateral ankle sprains?

A

anterior drawer test
inversion stress test

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24
Q

Why do we use xrays with an inversion stress test?

A

use degree measurement to gage amount of instability/# of ligs involved

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25
Q

ottowa ankle rules

A
  • over 55
  • can’t do more than 4 steps
  • post edge/tip of lateral malleolus tender
  • base of 5th metacarpal tender
  • navicular tenderness
  • post edge/tip of medial malleolus tender
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26
Q

What are 3 xray views we use to differentiate ankle fractures with ankle sprains?

A
  • anterioposterior view
  • mortise view of ankle
  • lateral view of ankle
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27
Q

What does the anterioposterior xray view tell us

A
  • general shape/postition/texture
  • medial talus/tibia (2-3 cm wide)
  • lateral talus/tibia (6mm overlap)
28
Q

What does the mortise view of the ankle tell us?

A

the lower leg and foot IR 15-20 degrees (to move fibula out of the way = better view of the talus)

29
Q

What does the lateral view xray tell us?

A

can look at the calcaneus and the achilles tendon

30
Q

If you cannot see the Kager’s triangle in the lateral view of an ankle xray what does that mean?

A

there is an injury to the achilles tendon

31
Q

Why would you rather have a CT scan than an xray?

A

its the go to for bony pathology at the ankle (could see posterior malleolar fracture better in slides)

32
Q

What xray views would you want to see for a foot fracture?

A
  • dorsoplantar
  • medial oblique view of foot
33
Q

what does the dorsoplantar view of the foot tell us?

A

shows the forefoot/midfoot joint

34
Q

What does the medial oblique view of the foot show us?

A

tarsals/metatarsals

35
Q

What imaging is best to see a stress fracture at the ankle or foot?

A

MRI

36
Q

Other than a fracture, what other differential diagnosis at the ankle would you want to rule out?

A

articular cartilage injury (will complain of catching or locking, can happen on the talus or tibial plafond)

37
Q

What are 3 general lower leg pathologies you want to be on the lookout for?

A
  • medial tibial stress syndrome
  • chronic compartment syndrome
  • tendinopathy
38
Q

medial tibial stress syndrome is also known as…

A

shin splints

39
Q

What are the two ways to grade shin splints?

A

functional or bony

40
Q

describe the functional grades of injury for shin splints

A

1 - pain occurring after activity
2 - before, during and after activity not affecting performance
3 - before, during, and after affecting performance
4 - pain so severe performance is impossible

41
Q

describe the bony grades of injury for shin splints

A

0 - normal bony remodeling
1-3 - mild, mod, or severe stress reaction
4 - stress fracture

42
Q

What are some exam findings that have been found to contribute to shin splints/stress fractures

A
  • greater pelvic tilt excursion
  • peak hip IR (pronation)
  • decreased knee flexion (land too stiff)
  • greater hip adduction (IR and over pronation)
  • greater rearfoot eversion (over pronation)
  • females at greater risk (Q angle)
  • pronated foot type (overload tibia)
  • varus load
  • cumulative load
43
Q

What are some biomechanical factors associated with medial tibial stress syndrome

A
  • higher standing tibia varus angle
  • reduced static dorsiflexion
  • more rearfoot eversion at heel-off
  • longer duration of eversion during stance
44
Q

What are the lower leg compartments

A
  • anterior
  • post (deep/superficial)
  • lateral
45
Q

What factors should you include in your exam when concerned about compartment syndrome?

A
  • motor
  • sensory
  • vascular
46
Q

Where are we concerned about tendinopathy in the lower leg?

A
  • achilles (most common)
  • posterior tib
  • peroneal (fib) tendons
  • anterior tib (least common)
47
Q

What are the 2 pathologies for achilles tendinopathy

A

mid-substance and insertional

48
Q

What are the two etiology factors for achilles tendinopathy

A
  • intrinsic vs extrensic (fluoroquinolones)
  • anatomical (degenerative/biomechanical)
49
Q

What will you find upon exam/diagnosis for achilles tendinopathy?

A
  • with resisted and passive testing plantar flexion is weak
  • palpation on the tendon will be painful
50
Q

Loss of ________ leads to planar fascitis

A

dorsiflexion

51
Q

What are the possible structures involved in plantar fascitis

A

plantar fascia, heel pad, medial > lateral plantar nerves

52
Q

What is the most common cause of heel pain?

A

plantar fasciopathy

53
Q

> 80% of patients experience resolution of plantar fascitis in 12 months regardless of ______-

A

treatment

54
Q

What are risk factors of plantar fasciopathy

A
  • high BMI
  • running, work related weight-bearing
  • limited dorsiflexion
55
Q

symptoms of plantar fasciopathy

A

pain after prolonged inactivity
- improves with activity
- often increases late in the day
- stretching plantar fascia makes it feel better
- palpation of plantar fascia is painful

56
Q

When examining plantar fascia you must look at these joints for ROM/position

A
  • talocrural joint (dorsiflexion)
  • 1st MPT - (extension through big toe)
  • subtalar joint and midtarsal joint position (evert too much loads fascia more)
  • 1st ray mobility (transfer of force issue)
57
Q

hallux valgus bony structure involves…

A

prox phalange, 1st metatarsal, 2nd metatarsal, medial/lat sesamoids, 1st MPT joint congruency

58
Q

What ligaments are involved in hallux valgus

A
  • synovial capsule
  • collateral lig
  • fibrous plantar plate
  • lisfranc’s lig
59
Q

What are some etiology risks for hallux valgus

A

family history (#1), females, foot shape (narrow heel, wide forefoot, long/short 1st metatarsal), foot wear (too narrow or loads forefoot), RA, Pes planus, LOSS OF ANKLE DORSIFLEXION

60
Q

What do you want to examine for hallux valgus

A
  • medial longitudinal arch height
  • 1st MPT joint angle
  • gait

will always want to palpate too

61
Q

What ROM considerations do you have for hallux valgus

A
  • ankle dorsiflexion
  • 1st ray mobility
  • 1st MTP joint
62
Q

definition of metatarsalgia

A
  • irritation of the bone and soft tissue around metatarsal head
  • more common at 2-4th metatarsals because being over pronated loads middle metatarsals more
63
Q

etiology of metatarsalgia

A
  • over pronation
  • tight gastroc/soleus (probs weak)
  • activities that facilitate forefoot weight bearing like sports and high heels
64
Q

What do you want to rule out with palpation for metatarsalgia

A

stress fractures, other comorbidities and risk factors

65
Q

What is one geriatric concern we have at the ankle?

A

OA

66
Q

_________ is key!

A

palpation

MPT1 (10 decks)

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