Exam 4- ankle/foot Flashcards
what is the most frequent injuries in the world of sports
ankle sprains
what are RF for sprains in the ankle
previous ankle sprains
lack of external support
lack of warm up
lack of coordination training
what is impaired DF due to
shortened gastroc
talar hypomobility
fibrotic capsule
what can happen if pt has limited DF
excessively load on lateral foot due to TC jt not reaching CPP and staying in supination longer
what is the cause of lateral ankle sprains
excessive PF and inv
what structures are commonly injured with lateral ankle sprains
ATF
CF
PTF
what subtalar lig can be affected with lateral ankle sprains
anterior interosseous
what other structures can be damaged with lateral ankle sprains
avulsion of lat malleolus/5th MTP
medial malleolus fx
cuboid displacement
fibula ant subluxing on tibia
peroneal strain
what would a pt report with lateral ankle sprains
sudden onset
ankle rolling in
lateral ankle pain/swelling
pain with WB
what is in a SCAN for lateral ankle sprain
ob- swollen and bruising, painful asymmetric gait
CDR for fx
ROM- limited and painful PF and INV
RST- weak and painful EV
what is in a BE for lateral ankle sprain
AM- hyper ant talar glides due to ATF lax
sp test- ant/reverse ant drawer, medial talar tilt, subtalar lateral
palpation- antlat talar, TTP
what can cause medial ankle sprain
excessive eve
what structures can be damaged with medial ankle sprain
deltoid lig
subtalar- posterior and medial
what is the function of the deltoid lig
support medial arch
which deltoid lig if torn can cause reinforcements to the medial arch to be compromised
tibiocalcaneal- calcaneus can over eve/pro and let medial arch collapse
what other structures can be damaged during medial ankle sprain
avulsion of medial malleolus
post tib strain
lateral malleolus fx
what are symptoms of medial ankle sprain
sudden onset
ankle rolling out
pain with WB
whats in the SCAN for medial ankle sprain
ob- swelling and bruising, painful asymmetric gait
CDR fx
ROM- limited and painful with eve
RST- weak/painful inv
what is in a BE for medial ankle sprain
AM- hypermobile calcaneal eve
sp test- ATF. deltoid, subtalar posterior and medial
palpation- TTP
what can cause a high ankle sprain
primarily DF, excessive post glide with ER
what is the order of lig structures most likely torn with a high ankle sprain
AITFL
interosseous membrane
PITFL
deltoid lig
why is a talar or distal tib/fib fx likely with a high ankle sprain
CPP more bony congruency
what are symptoms of a high ankle sprain
sudden onset
ankle bent up
anterior ankle pain/swelling
pain with WB
what is in a SCAN for a high ankle sprain
ob- swelling and bruising, painful asymmetric gait
CDR fx
ROM- painful and limited DF and eve
RST- weak and painful
what is in the BE for high ankle sprain
AM- hypermobile post talar glide
sp test- inferior tibfib, medial, single hop test
TTP
what are RF for CAI
increased talar curvature
lack of external support
lack of coordination training
what can cause CAI
past severe recurrent sprain
what are S&S of CAI
no trauma
acute S&S if aggravated
decrease postural stability
altered m activation patterns
aberrant motion
fibula slightly more lateral than tibia
what is the PT rx for ankle sprains
POLICED
JM with MET
MET
STM
bracing/taping
pt edu
when does taping lose mechanical stability
after 30 minutes
what taping technique is indicated for high ankle sprains
distal tibfib
limits seperation and anterior distal fibular glide
what is the primary purpose of MET for acute ankle sprains
tissue proliferation
stabilization
what is the primary purpose for chronic ankle sprains
stabilization
what position/directional bias should we start with for a lateral ankle sprain
eve and DF
what position/directional bias should we start with for a medial ankle sprain
inv and PF
what position/directional bias should we start with for a high ankle sprain
PF and others that are nonprovoking
why do neuromuscular training for ankle sprains
prevent reoccurrence
improve balance and inversion jt position sense
what is the RTP for grade 1 sprain
1-2 weeks
what is the RTP for grade 2 sprain
2-6 weeks
what is the RTP for grade 3 sprain
> 6 weeks
what is the function of the lateral column of the foot
shock absorption from heel strike to just before heel off
what is the function of the medial column of the foot
propulsion just before heel off to toe off
what is the ROM for DF with knee flx during stairs
ascent- 15-25
descent- 20-35
what is the ROM for DF with knee ext during heel off/toe off
10-15
what is the functional ROM for PF
15-30
what ROM is needed for 1st MTP with toe off
65
what has the least support to arches
m provide limited support to arch
what is subtalar neutral
talus centered in talocrural and on calcaneus
what is eccentrically controlling heel strike in the ankle
ant tib
what is eccentrically controlling midstance/heel off in the ankle
post tib
what happens to the arches during midstance through heel off
maximally flatten to the ground
what is the potential energy structures within the foot
foot lig
middle and posterior lig
ankle pf
interosseous membrane
what carries the most load of the foot
1st ray
how is PE built during heel off to toe off
1st MTP ext causing maximally plantar fascia tightening
what happens in toe off to swing for the foot
great toes flexes
ankle pf and talus IR
knee flx and IR
hip flx and ER
what can cause excessive pronation
tibfib or TC hypermobility
impaired LE control
adjacent jt hypomobility
where could adjacent hypomobility be if we see excessive pronation
TC DF= mid/forefoot excessive EV and ABD
limited knee ext
what can happen if limited TC DF is found
excessive load on lateral footby staying in supination too long
what are RF/causes of achilles tendinopathy
reduced DF limiting PE of achilles
limited calf flexibility
weak calf
L4-S1 regional interdependence
male
older age
obesity
systemic inflammation
what is happening to the achilles during tendinopathy
repetitive lengthening and compression from limited DF or excessive EV
lack of PE due to limited DF
collagen disorganization
thickened tendon
what can be impacted with achilles tendinopathy
force transfer
impaired motor control
what are symptoms of achilles tendinopathy
gradual onset limits WB
localized pain and stiffness- more with inacitivity, less with mild activity, more with mod activity
what is in a SCAN for achilles tendinopathy
ob- thick tendon. impaired LE control
ROM- Pain/limited DF
RST- pain with PF and weak antigravity
what is in a BE for achilles tendinopathy
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
what is the PT Rx for achilles tendinopathy
pt edu
POLICED
modalities
STM
JM
MET
bracing/taping
orthotics
what is the prognosis of achilles tendinopathy
2x wk for 6-12 weeks
what are MD rx for achilles tendinopathy
injections
debridement
remove plantaris
what causes Sever’s disease
growth with high activity
what are RF for sever’s disease
high sports activity
poor fitting shoes
training errors
shortened PF
foot dysfunction
what are symptoms of sever’s disease
gradual onset of heel pain with overuse
bilateral more than unilateral
what is in a SCAN for sever’s disease
ob- foot dysfunction, impaired LE control
ROM- limited DF
RST- weak and painful PF, weak DF
what is in a BE for sever’s disease
sp test- squeeze heel, sever’s sign (pain with heel raise)
m length- short gastroc
palpation- TTP over cap
what is the PT Rx for sever’s disease
pt edu
POLICED
U shape foam
JM
orthotics
MET
what orthotic helps with sever’s disease
heel lifts specifically gel heel cups
why should MET be performed for sever’s disease
impaired LE control
what is the prognosis of sever’s disease
75% resolved at 1 month
95% at 3 month
what are the clear RF for plantar fasciopathy
increased PF ROM = ankle instability and resulting excessive pronation
high BMI
running
impaired 1st MTP EXT
increased age
what are unclear RF for plantar fasciopathy
decreased DF= limits PE
excessive dynamic pronation
excessive standing calcaneal eve
how does plantar fascia assist gait
windlass effect that is PE developed by normal foot and ankle motion
what structures are involved with plantar fasciopathy
foot intrinsic= strains
heel pad thinning
achilles fibers connected
bone spur- plantar fascia thickening
what can cause plantar fasciopathy
fasciosis
neoplastic
inflammation
what are the symptoms of plantar fasciopathy
gradual onset of heel pain
medial more affected with first step in AM
worse with WB
what can we observe with plantar fasciopathy
thick plantar fascia
impaired LE control
excessive dynamic pronation
static calcaneal eve
what is in a SCAN for plantar fasciopathy
ROM- limited/painful DF and 1st MTP ext
RST- weak and painful toe flx
what is in a BE for plantar fasciopathy
sp test- plantar fascia taut
palpation- TTP over medial calcaneal arch
what is the PT Rx for plantar fasciopathy
Pt edu
POLICED
modalities
MT
MET
taping
orthotics
how can MT improve plantar fasciopathy
normalize mobility and m length for pain ROM and function
what joints should be focused on for MT for plantar fasciopathy
impaired DF and 1st MTP ext
how does stretching benefit plantar fasciopathy
calf and plantar fascia both improve pain
how can other joints affect plantar fasciopathy
knee limited ext causes tibia IR causing excessive pronation
hip/knee kinematics or impaired LE control can affect the foot and how it compensates
what passive treatment is better for a pt with plantar fasciopathy
orthotics
what MET is good for plantar fasciopathy
toe ext with achilles tendinopathy RX
post tib
hip antigravity
what structures can be involved with shin splints
post tib
ant tib
periosteum
what are risk factors for medial tibial stress syndrome
female
high BMI
running injury
excessive pronation
increased PF ROM
greater hip ER ROM
what causes medial tibial stress syndrome
increased load on post tib leading to subsequent tension and inflammation
what are the symptoms of medial tibial stress syndrome
gradual onset of medial shin pain
worse with exercise, NOT ADLs
no cramping, burning, or tingling
1/3 have co existing leg injuries
what is in the SCAN for medial tibial stress syndrome
ob- overstriding leading to greater heel strike, impaired LE control
RST- weak and painful PF and inv, limited hip ext/abd strength
what is in BE for medial tibial stress syndrome
pain with heel raises
palpation- TTP over post med border of distal 2 in tibia
what us the PT Rx for medial tibial stress syndrome
POLICED
Pt edu
taping/orthotics
MT- limited DF
MET
what movement patterns help with medial tibial stress syndrome
reduce LE IR
decrease hell strike- land soft
what MET should be done for medial tibial stress syndrome
improve hip antigravity
improve PF and INV
address spinal stabilization
what is the primary focus of MET for medial tibial stress syndrome
unload post tib and tibia
what is the difference between stress reaction and fx
stress reaction = periosteal inflammation
stress fx= cortical break
what area is most. common for bone stress injury in runners
tibia
what is the most common metatarsal for bone stress injury and AVN
5th
what zone of the 5th MTP is susceptible for AVN
zone 2
what are the RF for bone stress injuries
high forces
impaired LE control
longer stride
repetitive jumping
weak
lack of training
what is the pathology of bone stress injuries
increasing load and frequency without recovery
what are the symptoms of bone stress inuries
worse with ADLs and exercise
what is the PT Rx for bone stress injuries
diet= decreased BMD
when does BMD decrease and increase
decrease at growth spurt
increase 4 yrs after
how should PT be managed with adolescent bone stress injuries
cannot have pain
graded loading
when does BMD return to baseline for tibial stress fx
between 3-6 months post fx
what can cause compartment syndrome
blunt trauma
overuse
what is the pathology of compartment syndrome
increased swilling with limited fascia extensibility that compresses neurovascular structures in the ant leg compartment
what are symptoms of compartment syndrome
recent blunt trauma or overuse
primarily cramping, burning, tingling
lengthening DF adds compression
DF weakness
what are the 6 Ps for compartment syndrome
pain
palpation
paresthesia
paralysis
pallor
pulselessness
what is Pott’s fx
bimalleolar- distal tibfib
trimalleolar- distal tibfib plus post tib rim
what is the most common tarsal fx
calcaneus
what is the most common region to have a fx below the knee
forefoot- 5th MTP
what can cause ARJC in the foot
longer 1st ray
trauma
genetics
what are symptoms of ARJC in the foot
gradual onset
AM stiffness
dorsal jt pain
painful asymmetric gait especially with inclines
what can we observe with a patient that has ARJC in the foot
hallux valgus
mallet toe
hammer toe
claw toe
what is in a SCAN for ARJC in the foot
ROM- great toe loss of EXT>ABD
CM- consistent block
ST- + compression
what accessory motion can be performed with ARJC in the foot
hypo 1st MTP ext (sup glide)
DF
sesamoid bones
what MET is good for ARJC in the foot
impaired LE control contributing to excessive pronation
what is morton’s neuritis/oma
compression of interdigital nerves
what can cause morton’s neuritis/oma
excessive pronation
small show box with/without heels
limited 1st MTP ext
what is tarsal tunnel
entrapment of tibial n at flexor retinaculum
what can cause tarsal tunnel
excessive pronation leading to excessive tension and compression of tibial n
