clinical aspects lower leg Flashcards
compartment syndromes result from increased pressure within a myofascial compartment resulting in
ischemia and pain
acute compartment syndrome occurs due to?
trauma (fractures, crush injuries, severe burns)
chronic compartment syndrome is also referred to as? and what is usually the cause
external compartment syndrome from exercise related soreness- runners or walkers
what areas of the leg are most commonly affected by chronic compartment syndrome?
anterior and deep posterior
how is compartment syndrome usually diagnosed?
measuring the compartmental pressure before and during exercise
resting pressure more than 12 mm/hg
one minute exercise pressure more than 20 mm/hg
pain along the medial aspect of the tibia, usually involving the tibialis anterior muscle is called?
shin splints or medial tibial stress syndrome
ski boot syndrome is a term used to describe?
compression neuropathy of the deep fibular nerve as it leaves the anterior compartment- tight fitting ski boots or shoes
what are the clinical features associated with compression of the deep fibular nerve?
motor- loss of dorsiflexion of foot and extension of toes, diminished inversion
sensory- loss of sensation to skin in webspace between digits 1-2
what condition is due to microscopic tears in the collagen fibers of the tendons just prox to attachment of calcaneus?
achilles tendonitis
what is the most common cause and symptoms of achilles tendonitis?
repetitive activities- baseball, tennis, runners and dancers; pain is most common symptom while running or walking
what decreases the symptoms of achilles tendonitis?
heel lifts and stretching
what is the usual cause of a rupture of the tendon calcaneus?
poorly conditioned people with history of tendonitis- forceful plantar flexion
symptoms of a ruptured tendon calcaneus?
hear an audible snap and feel intense pain, have a palpable gap with greater dorsiflexion and less plantar flexion
surgery only required in extremely active individuals
calcaneal tendon reflex tests for segmental innervation of?
S1 and S2
what is a condition with narrowing or occlusion of the posterior tibial artery and its branches resulting in painful leg cramps and a diminished posterior tibial artery pulse?
peripheral arterial disease
what is the most frequently injured major joint?
ankle- sprains most common
which ligaments in a sprained ankle are most commonly damaged?
lateral ligaments because they aren’t as strong as deltoid,
anterior talofibular most vulnerable and calcaneofibular
why does a sprained ankle usually occur?
inversion type injury or avulsion fracture of the lat malleolus of fibula
what is another name for a sprain at the inferior tibiofibular joint?
high ankle sprain
what is different about a high ankle sprain vs a classic ankle sprain?
usually more significant and severe and require longer rehabilitation time
which fracture occurs when a foot is forcibly everted (externally rotated)?
Pott’s fracture
Pott’s fracture can result in what other issues? (3)
1 tearing of deltoid ligament
2 fracture of shaft of fibula
3 fracture of lat malleolus
a potts fracture has how many degrees of damage?
1st-3rd degrees
what is the cause of plantar fascitis?
aponeurosis becomes stretched and tiny tears develop which become inflamed and painful
when is plantar fascitis most commonly seen and what are the symptoms?
runners or high impact sports with overuse or bad footwear; pain is more severe after sitting or first thing in the morn (first step pain)
if a bone spur develops on the medial aspect of the calcaneus from plantar fascitis individuals will notice
pain on that aspect of the foot when walking (due to bursae becoming inflamed)
what is a condition where the tibial nerve and or the medial plantar nerve are compressed as they pass deep to flexor retinaculum?
Jogger’s foot or tarsal tunnel syndrome
what are symptoms of joggers foot/ tarsal tunnel syndrome?
- burning, sharp pain behind medial malleolus and may radiate to plantar surface of foot
- intermittent symptoms, may become constant overtime
- parasthesia and numbness may occur
what are the causes of tarsal tunnel syndrome?
trauma
hypertrophy of deep posterior leg muscles
“flat feet”
plantar nerve reflex tests?
L4, L5, S1 and S2 and results in flexion of digits
if the response of the plantar nerve reflex is abnormal, digits 2-5 will abduct and digit 1 will extend, this is called?
positive babinski response
babinski response is normal in infants until?
4 months after birth
what is a condition in which plantar nerves are compressed between the heads of the metatarsals and the transverse metatarsal ligaments?
morton’s neuroma- intermetatarsal neuroma or interdigital
mortons neuroma usually affects what and is caused by what?
affects the nerves in the spaces between 3-4 digits and caused by a benign tumor on the nerve
what are the symptoms of mortons neuroma?
dull cramping or burning sensation which becomes more pronounced and sharp; common in runners, dancers and tight shoes
what is a foot deformity characterized by lateral deviation of MP joint of digit 1?
hallux valgus
what is the cause of hallux valgus?
pressure of footwear or arthritis, can be congenital and more common in females and increased age
when a sesamoid bone is displaced by deviation and ends up in the space between the heads of the 1st and 2nd metatarsals it causes the joint to lock and is called?
hallux rigidis
if the first digit overlaps the second digit inferiorly it can cause the development of ____ on the 2nd digit where it rubs against shoe
corns
when bursae of hallux becomes tender and inflamed its called a?
bunion
what is a common deformity of digit 2-3 which can be congenital; the affected digits are hyperextended at the MP and DIP joints and flexed at PIP joints
hammer toe
what is a condition with a hyperextension injury at the MP joint of digit 1 and is due to damage of the plantar capsular ligament?
turf toe
a structural deformity of the talus bone usually from birth and cause shortening and contracture of muscles and ligaments
club foot (talipes equinovarus)
club foot is more common in?
males than females and is genetic
what is the term used for a normal foot with normal arches?
pes rectus
what is the term used to describe a foot with inadequacy in medial longitudinal arch and arches become depressed and collapsed?
pes planus
what is the term for an arch lacking in weight bearing but appears normal when not weight bearing?
flexible flat foot-usually due to loose or degenerative ligaments, common in childhood, usually resolves with age
what is the term for an arch that lack even when not weight bearing?
rigid flat foot- usually due to bone deformities, can be congenital or acquired
what describes a secondary consequence of damage to a ligament or atrophy of a muscle and changes arch?
acquired flat foot, fallen arch
when the medial longitudinal arch is unduly high?
pes cavus or clawfoot- muscle imbalance (polio)
