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PHTH 517 - Ortho Midterm LE > Ankle Tendon Disorders > Flashcards

Ankle Tendon Disorders Flashcards

1
Q

What is the gross anatomy that affects the tibialis posterior tendon?

A

Posteromedial tendon
- origin: posterior surface of tibia
- insertion: to the 3 cuneiforms, base of 2-4 MT, cuboid and navicular tubercle

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2
Q

What is the function of the tibialis posterior tendon?

A

plantar flexion
inversion
stabilizes the medial longitudinal arch

Important tendon in the foot
- affection of which causes more functional disability than TA rupture

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3
Q

What is the pathogenesis for the tibialis posterior tendon?

A

Tenosynovitis
incomplete tear
complete disruption

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4
Q

What two populations that are affected by the tibialis posterior tendon injury?

A
  • younger patients with inflammatory arthropathy/traumatic rupture
  • older, typically female patients with degenerative tears
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5
Q

What are the subjective findings of the posterior tibial tendonitis?

A

insidious onset of pain with pain in one of the 3 locations:
- distal to medial malleolus near the navicular
- proximal to medial malleolus
- at the muscle origin or insertion

Swelling on the medial surface of the ankle

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6
Q

What are the objective findings of the posterior tibial tendonitis?

A

Swelling and tenderness at the posterior and inferior of the medial malleolus
- along the course of the TP tendon to the insertion

Medial arch is decreased or all the way flat

Heel shows increased valgus

Pain at resisted ankle PF and inversion

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7
Q

What are the imaging used for posterior tibial tendonitis dx?

A

X-ray for degeneration
MRI for muscle

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8
Q

How do we manage tenosynovitis of the tibialis posterior?

A

Rest
NSAIDs
Short leg walking cast
orthoses
steroid injection in tendon sheath
synovectomy

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9
Q

How do we manage an incomplete tear of the tibialis posterior?

A

Repair or augmentation of:
- flexor digitorum longus
- flexor hallucis longus

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10
Q

How do we manage a complete disruption of the tibialis posterior?

A
  • repair in traumatic young cases
  • tendon transfer with medial calcaneal displacement osteotomy (mobile hindfoot)
  • subtalar/triple arthrodesis (fixed hindfoot)
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11
Q

Explain the importance of taking account of kinetic chain during treatment

A

To think about tissues/injuries in what plane they are in - in order to decrease the compensation/pre-injury of the other structures in that plane

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12
Q

What is the anatomy of the peroneal tendons?

A

Peroneus longus and brevis are posterolateral tendons
- origin: fibula and interosseous membrane
- insert: at the base of metatarsal I and V

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13
Q

What is the pathology of the peroneal tendon injuries?

Two possible injuries

A

Tenosynovitis = common in high arch foot because of the increase in movement

Sprain/subluxation = inversion of ankle injuries

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14
Q

What are the sx of peroneal tendon injuries?

A

pain in the outer part of the ankle or just behind the lateral malleolus
- pain commonly worsens with activity and better with rest

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15
Q

How is a peroneal tendon injury diagnosed?

A
  • Examination: tenderness or subluxation
  • X-rays to determine fracture
  • MRI
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16
Q

What is the non-surgical treatment for peroneal tendon injury?

A

Rest
Short leg walking cast or brace
lateral heel wedge
PT
NSAIDs and cortisone injections

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17
Q

What is the surgical treatment for peroneal tendon injury?

A
  • Tenosynovectomy = repair of the tear
  • Stabilization of dislocating tendons by groove deeping
  • peroneal retinaculum reconstruction
  • bone block procedures
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18
Q

What is achilles tendinitis?

In what population?

A

Pertiendinous inflammation
- usually seen in adults around 30s and 40s
- Most commonly affects runners

Older adults because of natural degeneration and weakness over time

19
Q

What is achilles tendinosis?

A

Clinical inflammation but objective pathological evidence for cellular inflammation is lacking

20
Q

What is a non-insertional achilles injury?

A

occurs proximal to retrocalcaneal bursa
usually responds well to non-operative treatment

21
Q

What is an insertional achilles injury?

A

tenderness is localized in the calcaneal tendon insertion
more difficult to treat

22
Q

What are the subjective findings of achilles tendonitis?

A
  • Gradual onset of pain and swelling in the tendon (around 2-3 cm proximal to the insertion)
  • gets worse with activity
  • pain and stiffness along the tendon in the morning or pain when activity starts but gets better as move movement happens
23
Q

What are the objective findings of achilles tendonitis?

A
  • tenderness and warm to palpate along the tendon
  • decreased AROM and PROM DF
  • gait can have: antalgia, early heel off or leg in ER
24
Q

What is the conservative treatment of achilles tendonitis?

A

Rest
Ice
NSAIDs
Orthoses
PT:
- eccentric strengthening of calf
- correction of lower chain asymmetries

Lower chain asymmetries (low back pain, knee flexion contracture, foot pronation)

25
Q

What is the operational treatment of achilles tendonitis?

A

sometimes, achilles tendon decompression and debridement if the sx is unrelieved by 6 months of conservative measure
- 90% will have significant relief of sx
- 10% will have sx improvement
- complete symptomatic cure is NOT GUARNTEED

26
Q

What is type 1 achilles tendinitis?

A

pain is only experienced after activity
- reduce by 25%

27
Q

What is type 2 achilles tendinitis?

A

pain that happens both during and after activity but does not affect performance
- reduce activity by 50%

28
Q

What is type 3 achilles tendinitis?

A

pain during and after acitivity but does affect performance
- stop activity for the time being

29
Q

What is the treatment for insertional achilles tendinopathy?

A

Floor level eccentric will decrease pain greater than full ROM
= because it provides less stress on the insertion

30
Q

What is the treatment for non-insertional achilles tendinopathy?

A

Eccentric exercises can take around 3-6 months to greatly improve sx
- 70% return to sports around 3 months
Morning stiffness pain is usually the first sx to get better
Pain and tenderness is usually the last to resolve

When starting = some increased soreness but should not go above a 4/10

31
Q

What population is affected greatly by achilles tendon rupture?

A

Common sporting incidence affecting the young and middle ages

Young - not strong enough
Middle age - became weaker

32
Q

What is the mechanism of injury usally involved by an achilles tendon rupture?

A

Loading on a DF ankle with the knee extended
Repeated microtrauma
eccentric loading
sudden dorsiflexion that came out of nowhere
direct blow or laceration

33
Q

What are we considering regarding the mechanism of injury for an achilles tendon rupture?

A

We need to consider other systemic conditions:
- gout
- hyperparathyroidism
- Previous steroid injections

  • impairement of tendon health
34
Q

What is the recovery timeline for an achilles tendon rupture?

A

A major injury that will need 6-8 months to recovery when treated properly

35
Q

What is the patient hx with an achilles tendon rupture?

A

They report being kicked in the leg or shot in the leg

36
Q

What is the purpose of a thompson’s test?

A

Evaluates the integrity of the achilles tendon

37
Q

What is the process of a thompson’s test?

A

Patient in prone or kneels on chair with the feet of the edge
PT squeezes the gastroc and watching for PF

38
Q

What is a positive thompson’s test?

A

no PF when the muscle is squeezed

39
Q

What is a non-operative treatment for achilles tendon rupture?

A

Usually indicated in older patients and minimally displaced ruptures
- cast for 10-12 weeks
- None or minimal DF

40
Q

What is the operative treatment for achilles tendon rupture?

A

Usually indicated for younger patients with:
- clinically displaced ruptures
- delayed presentation between 48-72 hours
- neglected ruptures from casting treatment

41
Q

What are the complications regarding treatment of achilles tendon rupture?

A

Wound healing
Sural nerve injury
DVT

sural nerve is right in the middle and in contact with achilles tendon

42
Q

What is the patient return, satisfaction and rerupture % for non-operative ruptures?

A

Return = 69%
Satisfaction = 66%
Re-rupture = up to 33%

43
Q

What is the patient return, satisfaction and rerupture % for operative ruptures?

A

Return = 83%
Satisfaction = 93%
Re-rupture = 2-3%

PHTH 517 - Ortho Midterm LE (10 decks)

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