Exam 3 Flashcards
what is subtalar joint arthritis
degenerative condition of articular cartilage of STJ
treatment of subtalar joint arthritis
conservative and surgical for pain relief and swelling reduction
subtalar joint anatomy
posterior, middle and anterior facets of calcaneous and talus articulate
medial, posterior, and lateral talocalcaneal ligaments, cervical ligaments
calcaneofibular ligaments limits execessive inversion
deltoid ligament limits eversion
causes of subtalar joint arthritis
post traumatic: intraarticular fracture of calcaneus or talus fracture
direct injury to plantar surface of talus or AVN of talus
STJ dislocation
STJ arthritis
flatfoot deformity
posterior tibial tendon tendinitis
RA
symptoms of subtalar joint arthritis
pain in medial or lateral hind foot
swelling over sinus tarsi
morning stiffness
gets better with activity
worsens in damp, cold weather
worse with WB
limping
limited ROM
Tests for subtalar joint arthritis
Xrays: STJ narrowing, osteophytes, sclerosis, cysts
CT scan: alignment, arthritis
treatment for subtalar joint arthritis
conservative: NSAIDS, corticosteroids, icing, US, LLLT, estim, iontophoresis, footwear mods, activity mods, orthotics and bracing if deformity, surgery
what is a STJ osteochondral injury
injury to the articular surface of taller dome in the ankle joint
causes of STJ osteocondral injury (OLT)
single traumatic event or repeat micro-trauma
inversion sprain w/ DF or w/ PF
symptoms of STJ OLT
pain, swelling, catching, stiffness, instability
STJ OLT classifications
stage 1: fracture
stage 2: partial detachment of osteochondral fragment
stage 3: completely detached fragment without displacement
stage 4: detached and displaced fragment
stage 5: subcentral cyst
testing for STJ OLT
xray of weight bearing
MRI
treatment of STJ OLT
immobilization
NWB 6 weeks –> progressive WB
icing
US
joint/ soft tissue mobilization
BAPS board
surgery to restore surface anatomy of talar dome
what is STJ tarsal coalitions
abnormal connection of 2+ bones in the foot
commonly occurs between calcaneus and navicular or between talus and calcaneus
symptoms of STJ tarsal coalitions
decreased motion in foot joints
stiffness
pain
rigid flat foot
recurrent ankle sprains
limp
tired legs
muscle spasms
causes of STJ tarsal coalitions
occurs during fetal development usually
infection
arthritis
previous injury to area
testing fot STJ tarsal coalitions
xrays
CT scan (gold standard)
MRI
treatment of STJ tarsal coalitions
only if causing symptoms
NSAIDS
massage
ROM exercises
US
steroid injections
orthotics
immobilization
resection surgery
fusion surgery
tarsal tunnel syndrome compartments
3 with muscles routed from leg to foot
1 with tibial nerve and posterior tibial artery surrounded by muscles
symptoms of tarsal tunnel syndrom
pain in proximal medial arch
parathesias
worse during day
burning and tingling
symptoms of tarsal tunnel syndrome
pain in proximal medial arch
parathesias
worse during day
burning and tingling
tests and signs for tarsal tunnel syndrome
NCV: posterior tibial nerve latency
tinel sign: sharp tap on posterior medial malleolus
pedal plantar sensation
longitudinal arch swelling
pes planus
weakness in posterior tibialis
tests and signs for tarsal tunnel syndrome
NCV: posterior tibial nerve latency
tinel sign: sharp tap on posterior medial malleolus
pedal plantar sensation
longitudinal arch swelling
pes planus
weakness in posterior tibialis
treatment of tarsal tunnel syndrome
icing
massage
taping
US
orthotics
wider shoes
NSAIDs
steroid injections
surgery
orthotics
use of orthotics for tarsal tunnel syndrome
corrects excessive pronation to reduce pressure
Lis-Franc injury mechanisms
type 1: direct force to dorsal of foot, most common, forced hyper plantar flexion with medial/lateral component, MVA, crush injury, fall from high level
type 2: indirect, low energy fall, sports related, twist of fall, twist of PF, forced ER of foot
evaluation of Lis-Franc
pain with palpation/ WB, swelling in mid region, widening of mid foot, bump on top of mid foot
piano-key test
mid foot squeeze
single limp heel rise
hard castle classification for Lis-Franc
type A: injuries with an incongruity of whole joint
Type B: injuries where a partial segment in displaced
Type C: first metatarsal is displaced medially and other 4 are displaced laterally
Myserson classification for Lis-Franc
type A (total incongruity)
type B (partial incongruity)
type C (divergent)
Nunley and Vertullo classification for Lis-Franc
stage 1: no diaphysis
stage 2: 2-5mm diaphysis, no arch height loss
stage 3: 2-5mm diaphysis, arch height loss
fleck sign
small bony fragment in Lisfranc space
associated with avulsion lisfranc ligament
fleck sign
small bony fragment in Lisfranc space
associated with avulsion lisfranc ligament
treatment of Lisfranc fracture
stable: NWB 4-6 weeks, ambulation, rehab exercises
displaced: surgery (open reduction)
injury management for Lisfrance fracture
NWB 2-3 weeks
WB with specialized boot 1-2 months
gradual WB with walking boot 4-8 weeks
stiff sole show
custom orthotic arch
rehab for Lisfranc fracture
ankle and foot ROM exercises
toe and mid foot flexibility
massage of mid foot
calf stretching
ankle and foot strengthening
balance
plyometrics
icing
laser
estim
avulsion fractures of ankle and foot
bone pulled away from ligamentous or tendinous attachment in single impact or repetitive long term impact
avulsion fractures of ankle or foot mechanism
inversion sprain peroneus brevis
symptoms of avulsion fractures of ankle or midfoot
pain
swelling
bruising
decreased ROM and strength
gait and ambulation deviations
balance problems
diagnosis of avulsion fracture of ankle or midfoot
x ray
rehab for avulsion fracture of ankle or midfoot
acute (2 weeks post op): PROM, icing, reduce edema and pain, massage, US
recovery (0-6 weeks): boot first 3 weeks w/ PWB, AROM for toes and MT joints, strengthen, AROM/PROM for ankle and subtalar joint, proprioception, active resistive ROM, FWB
functional (6-8 weeks post op): strengthening and conditioning of LE, increased neuromuscular control
what is plantar fascitis
over use injury with inflammatory reaction at insertion of plantar fascia to calcaneus
heel spur in severe cases
plantar fascia anatomy
fibrous tissue that attaches to medial calcanea tubercle and extends to the forefoot
symptoms of plantar fasciitis
heel pain and plantar arch pain
WB pain in morning and start of exercise that diminishes and then returns after
ache/bruise at anteromedial regions of calcaneus and point tenderness
persistent pain and inflammation
causes of plantar fasciitis
training errors
improper footwear
pes cavus (supinating)
pes Plans (pronating) with heel eversion
decreased PF strength
reduced flexibility of PF muscles
plantar fasciitis treatment
taping
rest
ice
boot, splint, cast
night splint
orthotics
US
laser
injection
orthotics for plantar fasciitis
effective for plantar fasciitis w/ pes cavus, hyper pronation, increased stress, increased shearing forces
achilles tendon
connects heel to gastrocnemius and soles heads and inserts into posterior superior third of calcaneus
non insertional achilles tendinitis
mid portion of tendon
in active, young people
chronic micro tearing
swelling, thickening, calcifying
poor blood supply
insertional achilles tendinitis
lower portion of tendon
calcifying of tendon
bone spurs
insertional achilles tendinitis factors
varus deformity
rear foot supination
repetitive stress at heel strike
cavus foot
causes of acute non insertional achilles tendinitis
recent changes to training
pes cavus
improper footwear
symptoms of acute non insertional achilles tendinitis
swelling
edema
crepitus
TTP
symptoms of chronic non insertional achilles tendinitis
burning pain
worse and beginning and end of workout
prone to rupture
ROM achilles tendinitis
limited DF
excessive rear foot inversion
STJ supination
rigid forefoot
ROM achilles tendinitis
limited DF
excessive rear foot inversion
STJ supination
rigid forefoot
tests for achilles tendinitis
xrays
US
MRI
treatment of achilles tendinitis
ice
taping
heel lifts
NSAIDs
US
BAPS board
stretch posterior leg muscles
orthotics
surgery
restore tendon length and flexibilty
prevent and correct causing factors
return to previous activity
factors for achilles rupture
men more than women
sudden explosive movement
jumping, running, throwing
corticosteroids and antibiotics
signs of complete achilles rupture
popping
4-5cm gap
sharp pain
inability to walk
rehab for achilles tendon rupture
heel lift
ice
US
Estim
stretching
massage
balance
strengthen gastrocsoleus
diagnosis achilles tendon rupture
thompson test
xrays
ultrasound
MRI
open chain, tibia glides ___ with extension?
anteriorly
open chain, tibia glides ____ with flexion?
posteriorly
closed chain, femur glides ____ with extension?
posteriorly
closed chain, femur glides ____ with flexion?
anteriorly
what motion does tibia move during terminal extension in open chain? what causes this
external rotation
because medial condyle is larger
what motion does tibia move during flexion in open chain? what causes this?
internal rotation
because medial condyle is larger
popliteus and semi membranous helps
what motion does femur move during terminal extension in closed chain?
internal rotation
what motion does femur move during flexion in closed chain?
external rotation
what direction does patella glide with flexion?
distally
location of knee pain
generally where patient is pointing to
pain extending above or below knee could be referred from?
lumbar spine
L3-S1 locations
L3: anterior thigh
L4: knee
L5: lateral thigh, knee, leg
S1: posterior knee
what deformity typically occurs with knee OA?
genu varum because OA worse on medial side
symptoms of knee OA
pain, muscle weakness, medial joint laxity, joint stiffness, limited function, disability
knee OA risk factors
excess weight
past trauma/ surgery
developmental abnormality
quad weakness
abnormal tibia rotation
treatment for OA
pt. education
taking rests/ breaks
bed positioning
bracing
activity modification
assistive device
ROM exercises
strengthening (quads, glutes, hip abductors)
STM
low impact cardio
indication for TKR
severe pain with WB
loss of function
extensive loss of cartilage
gross instability
failure of conservative treatment
marked knee deformity
types of TKR
bicompartmental (tibia and femur replaced)
unicompartmental (femur replaced )
tricompartmental (tibia, femur, and post. patellar replaced)
ligaments with TKR
meniscus, ACL, PCL removed
MCL and LCL usually stay
factors for best outcome TKR
60-75yo
healthy weeight
active but not too active
non smokeer
strong uninvolved leg
TKR post op precautions
reduce swelling
scar mobilization
icing
get to 90 degrees flexion to discharge from hospital
stretching hamstrings, calves, ITB
patellar mobilizations
ankle pump, quad sets, OKC
gait training and WBAT
maintain full knee extension
