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MSK II > Foot and Ankle 1 (test 4) > Flashcards

Foot and Ankle 1 (test 4) Flashcards

1
Q

Functional questionaires for ankle sprains

A

cumberland ankle instability tool

foot and ankle ability measure

LE functional scale

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2
Q

incidence/prevalence of ankle sprain

A

very frequent in sports

up to 1/4 people are unable to attend work for >1 wk

persistent symptoms in 30-72%

80% reinjury rate following inversion sprain

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3
Q

risk factors for ankle sprain

A

previous sprain

lack of external support

lack of warm up

lack of coordination training

impaired DF

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4
Q

what may cause impaired dorsiflexion

A

shortened triceps surae

talar hypomobility (decreased posterior glide or ER)

fibrosed capsule (universal hypo; limited distx compared to other side and all glides limited)

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5
Q

limited DF may cause escessive load where

A

lateral foot bc talocrural jt NOT reaching CPP and staying in supination longer before pronating

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6
Q

common etiology of ankle sprains

A

PF > inversion

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7
Q

most commonly torn ankle ligament

A

anterior talofibular

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8
Q

when is the calcaneofibular ligament often torn

A

primarily with pure IV

on slack with PF so not torn then

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9
Q

what are the 3 lateral talocrural ligaments

A

Anterior talofibular (ATF)
Calcaneofibular (CF)
Posterior talofibular (PTF)

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10
Q

what are the subtalar or talocalcaneal ligaments involved in lateral sprains

A

intraarticular = anterior interosseous

extraarticular = lateral attaches and runs parallel to CF ligament so they will likely be damaged together

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11
Q

what mechanism may strain the calcaneifibular ligament and the lateral talocalcaneal ligament (LCL)

A

Inversion and DF

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12
Q

what mechanism may strain the anterior talocalcaneal ligament

A

inversion and plantar flexion

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13
Q

how might the bone be involved with a lateral ankle sprain (and mechanism)

A

avulsion fx or lateral malleolus (ligament attachment)

avulsion fx of 5th MT (excess action of peroneus brevis)

medial malleolus fx (excess IV)

cuboid displacement (excessive action peroneus long.)

ant. subluxed fibula on tibia (reversed m action of peroneals)

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14
Q

what muscles/tendins may be involved with a lateral ankle sprain

A

possible peroneal strain and/or sublux if retinaculum is torn

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15
Q

symptoms of a lateral ankle sprain

A

sudden onset with trauma by “rolling ankle” and foot turning inward

lateral ankle P!/swelling

limited and painful ROM especially with pointing foot inward

difficulat and painful WBing

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16
Q

observation with a lateral ankle sprain

A

swelling with possible ecchymosis

antalgic/asymmetrical gait

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17
Q

what is the purpose of the Ottawa and Bernese ankle clinical decision rules

A

determine the need for a radiograph

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18
Q

ROM findings with a lateral ankle sprian

A

primarily limited in PF and IV

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19
Q

resisted test findings for a lateral ankle sprain

A

weak and painful EV

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20
Q

acessory motion findings for lateral sprain

A

likely hypermobile anterior talar glides due to ATF laxity

possibly hypomobile cuboid from sublux

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21
Q

special tests for a lateral ankle sprain

A

anterior and reverse anterior drawer

ATF = anterior lateral drawer and reverse anterior lateral drawer and anterior lateral talar palpation

CF = medial talar tilt

PTF

subtalar = anterior interosseous and lateral interosseous

TTP over involved structures

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22
Q

etiology of medial ankle sprains

A

excessive EV

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23
Q

structures that may be involved with a medial ankle sprain

A

deltoid lig (connect tibia to talus, calcaneus, and navicular + medial arch reinforcement)

dubtalar or talocalcaneal ligaments (intraarticular = post interosseous and extra = medial)

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24
Q

non-ligamentous structures that may also be involved with medial sprains

A

bone = avulsion fx of medial malleolus

epiphyseal plate of medial malleolus

possible post tib strain and/or sublux if flexor retinaculum is torn

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25
Q

symptoms of a medial ankle sprain

A

sudden onset with trauma + ankle turning out

medial ankle pain/swelling

limited/painful ROM, especially turning out

pain with WBing

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26
Q

what could you observe with a medial ankle sprain

A

swelling

possible ecchymosis

antalgic/asymmetrical gait

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27
Q

ROM and MMT findings with medial ankle sprain

A

ROM = primarily pain/limits with EV

MMT = possible weak/painful IV

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28
Q

accessory motion findings for medial sprain

A

potentially hypermobile calcaneal EV glides

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29
Q

special tests for a medial ankle sprain

A

talocrural
-general = anterior and reverse anterior drawer
-specific = medial lig tests for deltoid ligs

subtalar
-general = medial calcaneal glide
-specific = post interosseous and medial lig tests

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30
Q

what is a syndesmotic sprain

A

high ankle sprain

31
Q

etiology of a syndesmotic sprain

A

primarily DF (bc talus is wider anterior than posterior)

excessive talar posterior glide with ER aka peeling mechanism

possibly EV

32
Q

what ligaments are involved with a syndesmotic in order

A

1st = Anterior inferior tibio fibular ligament
2nd = interosseous membrane or syndesmosis
3rd = posterior inferior tibio fibular ligament
4th = deltoid ligaments

33
Q

what bones may be involved with a high ankle sprain

A

talar or distal tib/fib fx

34
Q

symptoms of syndesmotic sprain

A

sudden onset with trauma with ankle bent up
often anterior ankle pain or swelling
limited and painful ROM, especially with DF
pain with WBing

35
Q

observation of a syndesmotic sprain

A

swelling

possible ecchymosis

antalgic/asymmetrical gait

36
Q

ROM and MMT findings for high ankle sprain

A

ROM = limited and painful with DF and possibly EV

MMT = weak and painful; no specific direction

37
Q

accessory motion findings for syndesmotic sprain

A

likely hypermobile post talar glides

38
Q

special tests for syndesmotic sprain

A

inferior tib/fib lig
-general = reverse post drawer
-specific = fibular ant/post translation

possibly same as medial ankle sprain

single leg hop test (inability is most sensitive test for syndesmotic test)

39
Q

what is chronic ankle instability

A

CAI

presence of functional or mechanical instability

40
Q

risk factors for CAI

A

increased talar curvature
lack of external support
lack of cordination training following prior sprain

41
Q

etiology of chronic ankle instability

A

past severe and or recurrent sprains

80% re-injury rate following IV sprain

42
Q

S&S of CAI

A

acute S&S if aggravated; otherwise may be asymptomatic

S&S of hypermobility/instability plus:
-decreased postural stability and plantar sensation
-altered muscle activation patterns
-aberrant joint motion
-fibula is significantly more lateral from tibia

43
Q

PT rx for sprains outside of MET/MT

A

90% success

brief immobilization period

modalities modtly conflicting evidence; cryotherapy good for pain/swelling/gait; US should NOT be used with acute

bracing/taping for protection/function
-bracing = reduced risk and frequency
-talar technique to limit anterior glide
-distal tib/fib technique for high ankle sprains; limits separation and anterior distal fibular glide

44
Q

MT for sprains

A

STM including lymphatic drainage for swelling

JM with MET
-ROM/proprioception/tissue tolerance
-AP talar JM
-hypo analgesic effect and subsequent increased ROM

45
Q

MET for sprains

A

goal = tissue proliferation and stabilization

positional/directional biases?

balance and neuromuscular training
-prevents reoccurance
-improved balance and inversion jt position sense and greater motor neuron excitability

46
Q

prognosis for return to activity for grade I sprain

A

1-2 weeks

avg 7.2 days with track and field athletes

47
Q

prognosis for return to activity for grade II sprain

A

2-6 weeks

avg 15 days with track and field athletes

48
Q

prognosis for return to activity for grade IIIsprain

A

> 6 weeks

avg 30-55 days with track and field athletes

49
Q

what is the MD Rx for CAI

A

CAI sx; “christman-snook procedure for mechanical ankle instability

drill holes in fibula and calcaneus

split portion of peroneus brevis tendon

tendon is inserted into drill holes and attached into itself

50
Q

outcomes of CAI sx for sprains

A

no one procedure is better than another

early functional rehab appears superior to 6 weeks immobilization in restoring early function

51
Q

what makes up the forefoot

A

metatarsals and phalanges

52
Q

what makes up the midfoot

A

navicular, cuboid, and cuneiforms

2nd MT is a keystone in between the medial and lateral cuneiforms

53
Q

what makes up the rearfoot

A

talus and calcaneus

54
Q

what makes up the lateral foot or column and what is its functional purpose

A

4th and 5th rays and cuboid and calcaneus

functions more for shokc absorption from heel strike to just before heel off

strong ligaments are a storehouse of potential energy on the lateral longitudinal arch

55
Q

what makes up the medial foot/column and its functional purpose

A

1dt ray thru the 3rd rays and the cuneiforms and talus

functions more for propulsion just before heel off to toe off

less ligament support vs lateral foot

56
Q

how much DF occurs with knee extension and flexion and when does it occur in the gait cycle

A

knee extended = during heel/toe off; 10-15 deg

knee flex = during stairs; 15-25 during ascent; 20-35 during descent

57
Q

how much PF is needed for stairs

A

15-30 deg for walking and stairs

58
Q

how much MTP hyperext is needed at the first MTP

A

at least 65 deg at heel/toe off

59
Q

what structures help maintain the arches of the foot

A

ligaments and aponeurosis = most support

shape of the bones and their relation to each other

muscles = only 15-25% of support so minimal ability to “strengthen” any abnormal arch flattening

60
Q

what is subtalar neutral

A

talus is centered in talocrural andn on calcaneus

aka position talus should be in

61
Q

best measurement of medial longitudinal arch

A

standing position = not predictable of dynamic fxn

measuring from video or 3D analysis is more reliable

62
Q

how does the foot move during the gait cycle from heel strike to foot flat

A

supination with heel strike (PF, IV and ADD)

PF eccentrically controlled by tibialis anterior

63
Q

how does the foot move from foot flat through heel off

A

DF, EV, ABD

eversion primary control is tibialis posterior

max ankle DF and talar ER with ABD of foot

64
Q

how does the foot move from mid stance to heel off

A

all arches are maximally flattened when all MT heads contact the ground

knee ER and hip IR while both maximally extend/hyperextend (up to 10 deg)

65
Q

how is potential energy built in the foot

A

foot ligaments
middle and posterior ankle ligaments
ankle PFs
interosseous membrane as tib/fib seperates with DF
knee and hip structures per prior lecture

66
Q

what happens from heel off to toe off in terms of load bearing and potential energy

A

1st ray bears most of the load of the foot

1st MTP maximally hyperextends and PE is built through the plantar fascia tightening

67
Q

what happens when PE is releases from toe off to swing

A

opposing motions occur for propulsion

great toe flexion
ankle PF and talus IR
knee flexes and IR
hip flexes and ER

68
Q

what is excessive pronation

A

earlier, extended, and or excessive combo of DF, EV, and ABD

69
Q

most common reason of excessive pronation related to hypermobility/instability

A

tib fib or talocrural hypermobility/instability (more common)

or

impaired LE control (top down influence)

70
Q

less common mechanism for hypermobility related excessive pronation

A

subtalar or medial knee hypermobility

71
Q

how can adj joint hypomobility cause excessive foot pronation

A

limited talocrural DF may lead to midfoot and forefoot excessive EV and ABD

limited knee ext may lead to excessive DF

hip wont compensate bc hip is IR where knee and talus are ER

72
Q

what might limited DF lead to

A

excessive loading on lateral foot and staying in supination longer = more common for lateral sprains

compensatory/excess knee ext

73
Q

LQ conditions associated with limited DF

A

1st MTP DJD
mortons
tarsal tunnel
plantar fascitis
5th MT stress fx
lateral ankle sprain
achilles tendinopathy
severs
MTSS

MSK II (18 decks)

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