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DPT 730/1: MSK > Exam 4- ankle/foot > Flashcards

Exam 4- ankle/foot Flashcards

1
Q

what is the most frequent injuries in the world of sports

A

ankle sprains

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2
Q

what are RF for sprains in the ankle

A

previous ankle sprains
lack of external support
lack of warm up
lack of coordination training

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3
Q

what is impaired DF due to

A

shortened gastroc
talar hypomobility
fibrotic capsule

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4
Q

what can happen if pt has limited DF

A

excessively load on lateral foot due to TC jt not reaching CPP and staying in supination longer

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5
Q

what is the cause of lateral ankle sprains

A

excessive PF and inv

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6
Q

what structures are commonly injured with lateral ankle sprains

A

ATF
CF
PTF

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7
Q

what subtalar lig can be affected with lateral ankle sprains

A

anterior interosseous

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8
Q

what other structures can be damaged with lateral ankle sprains

A

avulsion of lat malleolus/5th MTP
medial malleolus fx
cuboid displacement
fibula ant subluxing on tibia
peroneal strain

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9
Q

what would a pt report with lateral ankle sprains

A

sudden onset
ankle rolling in
lateral ankle pain/swelling
pain with WB

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10
Q

what is in a SCAN for lateral ankle sprain

A

ob- swollen and bruising, painful asymmetric gait
CDR for fx
ROM- limited and painful PF and INV
RST- weak and painful EV

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11
Q

what is in a BE for lateral ankle sprain

A

AM- hyper ant talar glides due to ATF lax
sp test- ant/reverse ant drawer, medial talar tilt, subtalar lateral
palpation- antlat talar, TTP

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12
Q

what can cause medial ankle sprain

A

excessive eve

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13
Q

what structures can be damaged with medial ankle sprain

A

deltoid lig
subtalar- posterior and medial

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14
Q

what is the function of the deltoid lig

A

support medial arch

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15
Q

which deltoid lig if torn can cause reinforcements to the medial arch to be compromised

A

tibiocalcaneal- calcaneus can over eve/pro and let medial arch collapse

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16
Q

what other structures can be damaged during medial ankle sprain

A

avulsion of medial malleolus
post tib strain
lateral malleolus fx

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17
Q

what are symptoms of medial ankle sprain

A

sudden onset
ankle rolling out
pain with WB

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18
Q

whats in the SCAN for medial ankle sprain

A

ob- swelling and bruising, painful asymmetric gait
CDR fx
ROM- limited and painful with eve
RST- weak/painful inv

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19
Q

what is in a BE for medial ankle sprain

A

AM- hypermobile calcaneal eve
sp test- ATF. deltoid, subtalar posterior and medial
palpation- TTP

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20
Q

what can cause a high ankle sprain

A

primarily DF, excessive post glide with ER

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21
Q

what is the order of lig structures most likely torn with a high ankle sprain

A

AITFL
interosseous membrane
PITFL
deltoid lig

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22
Q

why is a talar or distal tib/fib fx likely with a high ankle sprain

A

CPP more bony congruency

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23
Q

what are symptoms of a high ankle sprain

A

sudden onset
ankle bent up
anterior ankle pain/swelling
pain with WB

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24
Q

what is in a SCAN for a high ankle sprain

A

ob- swelling and bruising, painful asymmetric gait
CDR fx
ROM- painful and limited DF and eve
RST- weak and painful

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25
Q

what is in the BE for high ankle sprain

A

AM- hypermobile post talar glide
sp test- inferior tibfib, medial, single hop test
TTP

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26
Q

what are RF for CAI

A

increased talar curvature
lack of external support
lack of coordination training

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27
Q

what can cause CAI

A

past severe recurrent sprain

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28
Q

what are S&S of CAI

A

no trauma
acute S&S if aggravated
decrease postural stability
altered m activation patterns
aberrant motion
fibula slightly more lateral than tibia

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29
Q

what is the PT rx for ankle sprains

A

POLICED
JM with MET
MET
STM
bracing/taping
pt edu

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30
Q

when does taping lose mechanical stability

A

after 30 minutes

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31
Q

what taping technique is indicated for high ankle sprains

A

distal tibfib
limits seperation and anterior distal fibular glide

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32
Q

what is the primary purpose of MET for acute ankle sprains

A

tissue proliferation
stabilization

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33
Q

what is the primary purpose for chronic ankle sprains

A

stabilization

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34
Q

what position/directional bias should we start with for a lateral ankle sprain

A

eve and DF

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35
Q

what position/directional bias should we start with for a medial ankle sprain

A

inv and PF

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36
Q

what position/directional bias should we start with for a high ankle sprain

A

PF and others that are nonprovoking

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37
Q

why do neuromuscular training for ankle sprains

A

prevent reoccurrence
improve balance and inversion jt position sense

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38
Q

what is the RTP for grade 1 sprain

A

1-2 weeks

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39
Q

what is the RTP for grade 2 sprain

A

2-6 weeks

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40
Q

what is the RTP for grade 3 sprain

A

> 6 weeks

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41
Q

what is the function of the lateral column of the foot

A

shock absorption from heel strike to just before heel off

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42
Q

what is the function of the medial column of the foot

A

propulsion just before heel off to toe off

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43
Q

what is the ROM for DF with knee flx during stairs

A

ascent- 15-25
descent- 20-35

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44
Q

what is the ROM for DF with knee ext during heel off/toe off

A

10-15

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45
Q

what is the functional ROM for PF

A

15-30

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46
Q

what ROM is needed for 1st MTP with toe off

A

65

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47
Q

what has the least support to arches

A

m provide limited support to arch

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48
Q

what is subtalar neutral

A

talus centered in talocrural and on calcaneus

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49
Q

what is eccentrically controlling heel strike in the ankle

A

ant tib

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50
Q

what is eccentrically controlling midstance/heel off in the ankle

A

post tib

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51
Q

what happens to the arches during midstance through heel off

A

maximally flatten to the ground

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52
Q

what is the potential energy structures within the foot

A

foot lig
middle and posterior lig
ankle pf
interosseous membrane

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53
Q

what carries the most load of the foot

A

1st ray

54
Q

how is PE built during heel off to toe off

A

1st MTP ext causing maximally plantar fascia tightening

55
Q

what happens in toe off to swing for the foot

A

great toes flexes
ankle pf and talus IR
knee flx and IR
hip flx and ER

56
Q

what can cause excessive pronation

A

tibfib or TC hypermobility
impaired LE control
adjacent jt hypomobility

57
Q

where could adjacent hypomobility be if we see excessive pronation

A

TC DF= mid/forefoot excessive EV and ABD
limited knee ext

58
Q

what can happen if limited TC DF is found

A

excessive load on lateral footby staying in supination too long

59
Q

what are RF/causes of achilles tendinopathy

A

reduced DF limiting PE of achilles
limited calf flexibility
weak calf
L4-S1 regional interdependence
male
older age
obesity
systemic inflammation

60
Q

what is happening to the achilles during tendinopathy

A

repetitive lengthening and compression from limited DF or excessive EV
lack of PE due to limited DF
collagen disorganization
thickened tendon

61
Q

what can be impacted with achilles tendinopathy

A

force transfer
impaired motor control

62
Q

what are symptoms of achilles tendinopathy

A

gradual onset limits WB
localized pain and stiffness- more with inacitivity, less with mild activity, more with mod activity

63
Q

what is in a SCAN for achilles tendinopathy

A

ob- thick tendon. impaired LE control
ROM- Pain/limited DF
RST- pain with PF and weak antigravity

64
Q

what is in a BE for achilles tendinopathy

A

AM- hypo talar DF
sp test- arc sign, royal london, SL heel raise, SL hop test
m length- gastroc
palpation- TTP proximal of insertion, more medial= plantaris

65
Q

what is the PT Rx for achilles tendinopathy

A

pt edu
POLICED
modalities
STM
JM
MET
bracing/taping
orthotics

66
Q

what is the prognosis of achilles tendinopathy

A

2x wk for 6-12 weeks

67
Q

what are MD rx for achilles tendinopathy

A

injections
debridement
remove plantaris

68
Q

what causes Sever’s disease

A

growth with high activity

69
Q

what are RF for sever’s disease

A

high sports activity
poor fitting shoes
training errors
shortened PF
foot dysfunction

70
Q

what are symptoms of sever’s disease

A

gradual onset of heel pain with overuse
bilateral more than unilateral

71
Q

what is in a SCAN for sever’s disease

A

ob- foot dysfunction, impaired LE control
ROM- limited DF
RST- weak and painful PF, weak DF

72
Q

what is in a BE for sever’s disease

A

sp test- squeeze heel, sever’s sign (pain with heel raise)
m length- short gastroc
palpation- TTP over cap

73
Q

what is the PT Rx for sever’s disease

A

pt edu
POLICED
U shape foam
JM
orthotics
MET

74
Q

what orthotic helps with sever’s disease

A

heel lifts specifically gel heel cups

75
Q

why should MET be performed for sever’s disease

A

impaired LE control

76
Q

what is the prognosis of sever’s disease

A

75% resolved at 1 month
95% at 3 month

77
Q

what are the clear RF for plantar fasciopathy

A

increased PF ROM = ankle instability and resulting excessive pronation
high BMI
running
impaired 1st MTP EXT
increased age

78
Q

what are unclear RF for plantar fasciopathy

A

decreased DF= limits PE
excessive dynamic pronation
excessive standing calcaneal eve

79
Q

how does plantar fascia assist gait

A

windlass effect that is PE developed by normal foot and ankle motion

80
Q

what structures are involved with plantar fasciopathy

A

foot intrinsic= strains
heel pad thinning
achilles fibers connected
bone spur- plantar fascia thickening

81
Q

what can cause plantar fasciopathy

A

fasciosis
neoplastic
inflammation

82
Q

what are the symptoms of plantar fasciopathy

A

gradual onset of heel pain
medial more affected with first step in AM
worse with WB

83
Q

what can we observe with plantar fasciopathy

A

thick plantar fascia
impaired LE control
excessive dynamic pronation
static calcaneal eve

84
Q

what is in a SCAN for plantar fasciopathy

A

ROM- limited/painful DF and 1st MTP ext
RST- weak and painful toe flx

85
Q

what is in a BE for plantar fasciopathy

A

sp test- plantar fascia taut
palpation- TTP over medial calcaneal arch

86
Q

what is the PT Rx for plantar fasciopathy

A

Pt edu
POLICED
modalities
MT
MET
taping
orthotics

87
Q

how can MT improve plantar fasciopathy

A

normalize mobility and m length for pain ROM and function

88
Q

what joints should be focused on for MT for plantar fasciopathy

A

impaired DF and 1st MTP ext

89
Q

how does stretching benefit plantar fasciopathy

A

calf and plantar fascia both improve pain

90
Q

how can other joints affect plantar fasciopathy

A

knee limited ext causes tibia IR causing excessive pronation
hip/knee kinematics or impaired LE control can affect the foot and how it compensates

91
Q

what passive treatment is better for a pt with plantar fasciopathy

A

orthotics

92
Q

what MET is good for plantar fasciopathy

A

toe ext with achilles tendinopathy RX
post tib
hip antigravity

93
Q

what structures can be involved with shin splints

A

post tib
ant tib
periosteum

94
Q

what are risk factors for medial tibial stress syndrome

A

female
high BMI
running injury
excessive pronation
increased PF ROM
greater hip ER ROM

95
Q

what causes medial tibial stress syndrome

A

increased load on post tib leading to subsequent tension and inflammation

96
Q

what are the symptoms of medial tibial stress syndrome

A

gradual onset of medial shin pain
worse with exercise, NOT ADLs
no cramping, burning, or tingling
1/3 have co existing leg injuries

97
Q

what is in the SCAN for medial tibial stress syndrome

A

ob- overstriding leading to greater heel strike, impaired LE control
RST- weak and painful PF and inv, limited hip ext/abd strength

98
Q

what is in BE for medial tibial stress syndrome

A

pain with heel raises
palpation- TTP over post med border of distal 2 in tibia

99
Q

what us the PT Rx for medial tibial stress syndrome

A

POLICED
Pt edu
taping/orthotics
MT- limited DF
MET

100
Q

what movement patterns help with medial tibial stress syndrome

A

reduce LE IR
decrease hell strike- land soft

101
Q

what MET should be done for medial tibial stress syndrome

A

improve hip antigravity
improve PF and INV
address spinal stabilization

102
Q

what is the primary focus of MET for medial tibial stress syndrome

A

unload post tib and tibia

103
Q

what is the difference between stress reaction and fx

A

stress reaction = periosteal inflammation
stress fx= cortical break

104
Q

what area is most. common for bone stress injury in runners

A

tibia

105
Q

what is the most common metatarsal for bone stress injury and AVN

A

5th

106
Q

what zone of the 5th MTP is susceptible for AVN

A

zone 2

107
Q

what are the RF for bone stress injuries

A

high forces
impaired LE control
longer stride
repetitive jumping
weak
lack of training

108
Q

what is the pathology of bone stress injuries

A

increasing load and frequency without recovery

109
Q

what are the symptoms of bone stress inuries

A

worse with ADLs and exercise

110
Q

what is the PT Rx for bone stress injuries

A

diet= decreased BMD

111
Q

when does BMD decrease and increase

A

decrease at growth spurt
increase 4 yrs after

112
Q

how should PT be managed with adolescent bone stress injuries

A

cannot have pain
graded loading

113
Q

when does BMD return to baseline for tibial stress fx

A

between 3-6 months post fx

114
Q

what can cause compartment syndrome

A

blunt trauma
overuse

115
Q

what is the pathology of compartment syndrome

A

increased swilling with limited fascia extensibility that compresses neurovascular structures in the ant leg compartment

116
Q

what are symptoms of compartment syndrome

A

recent blunt trauma or overuse
primarily cramping, burning, tingling
lengthening DF adds compression
DF weakness

117
Q

what are the 6 Ps for compartment syndrome

A

pain
palpation
paresthesia
paralysis
pallor
pulselessness

118
Q

what is Pott’s fx

A

bimalleolar- distal tibfib
trimalleolar- distal tibfib plus post tib rim

119
Q

what is the most common tarsal fx

A

calcaneus

120
Q

what is the most common region to have a fx below the knee

A

forefoot- 5th MTP

121
Q

what can cause ARJC in the foot

A

longer 1st ray
trauma
genetics

122
Q

what are symptoms of ARJC in the foot

A

gradual onset
AM stiffness
dorsal jt pain
painful asymmetric gait especially with inclines

123
Q

what can we observe with a patient that has ARJC in the foot

A

hallux valgus
mallet toe
hammer toe
claw toe

124
Q

what is in a SCAN for ARJC in the foot

A

ROM- great toe loss of EXT>ABD
CM- consistent block
ST- + compression

125
Q

what accessory motion can be performed with ARJC in the foot

A

hypo 1st MTP ext (sup glide)
DF
sesamoid bones

126
Q

what MET is good for ARJC in the foot

A

impaired LE control contributing to excessive pronation

127
Q

what is morton’s neuritis/oma

A

compression of interdigital nerves

128
Q

what can cause morton’s neuritis/oma

A

excessive pronation
small show box with/without heels
limited 1st MTP ext

129
Q

what is tarsal tunnel

A

entrapment of tibial n at flexor retinaculum

130
Q

what can cause tarsal tunnel

A

excessive pronation leading to excessive tension and compression of tibial n

DPT 730/1: MSK (11 decks)

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