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MSK II > Foot and Ankle 3 (test 4) > Flashcards

Foot and Ankle 3 (test 4) Flashcards

1
Q

structures involved in shin splints

A

anterior = anterior tibialis and lateral tibial shafted

posterior or medial tibial stress syndrome = tibialis posterior and medial tibial shaft

posterior more common (4-19% athletes)

periosteum
-connective tissue that surrounds bone except articular surfaces
-most densly innervated tissue

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2
Q

risk factors for medial tibial stress syndrome (MTSS)

A

female
high BMI
previous running injury
excessive pronation (increased navicular drop; primarily controlled by tibialis posterior)

increased PF ROM (unclear why)

greater hip ER (not understood)

no meaningful association with shoes

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3
Q

pathomechanics of MTSS

A

increased load on tibialis posterior leading to subsequent tension and inflammation of periosteal tissue

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4
Q

symptoms of MTSS

A

gradualonset medial shin pain

generally worsened with exercise and not ADLs

no cramping/burning/tingling

1/3 have coexisting leg injuries

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5
Q

observation of those with shin splints

A

overstriding leading to greater heel strike

impaired LE control
-excess pronation
-increased pelvic drop
-increased LE IR

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6
Q

resisted/MMT findings for MTSS

A

weak and possibly painful PFs

limited hip ext/abd strength and endurance

possibly weak and painful IV

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7
Q

special tests for MTSS

A

pain with hop on ball of foot due to plantar flexion of tibialis posterior

possible foot and or ankle instability

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8
Q

palpation findings for MTSS

A

TTP over posterior medial tibial border >5cm or 2 in in length

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9
Q

PT Rx for MTSS aside from MET and MT

A

POLICED
pt edu
taping/orthotics

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10
Q

specific edu for MTSS

A

movement pattern training
-not changed by strength alone
-reduced LE IR
-decreased heel strike + cue for shorter/faster steps

shoe wear
-light/supportive/cushioned
-rotate shoes
-change running shoes every 250-500 miles

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11
Q

purpose/effectiveness of taping/orthotics for MTSS

A

taping to assist tibialis posterior

foot orthotic for
-excess pronation
-heavy heel strikers

air cast for functional support that allows ankle motion

walking boot in severe cases

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12
Q

MET and MT for MTSS

A

MT for any joint dysfunction like limited DF

MET primary focus = unloading tibia and tibialis post

hip ER/EXT/ABD

improve PF and IV strength
-soleus supports 8x BW
-gastroc/soleus counters distal tibia bending
-tibialis posterior is primary invertor

address spinal stabilization as needed

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13
Q

differential dx for medial tibial stress syndrome

A

bone stress injuries of tibia
-stress reaction (periosteal and/or marrow inflammation)
-stress fx (cortical break)

compartment syndrome

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14
Q

bones stress prevalence/incidience

A

females > males

common in adolescent (specifically early HS age)

tibia most common bone

most common in people who dont let body rest (6-7 days/ wk sports participation)

common in runners

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15
Q

common bones for stress injuries

A

tibia = most common in runners
fibula = distal most common
metatarsals
-base of 5th most common; prone to avulsion

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16
Q

what are the 3 zones of injury for metatarsals

A

zone 1 = 90% of fxs and mostly with sprains

zone 2 = most susceptible to AVN

zone 3 = typically from repetitive stress

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17
Q

risk factors for bone stress injury

A

high forces
impaired LE control
longer stride
greater heel strike
repetitive jumping/walking
weakness
lack of recovery from training
high training load

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18
Q

pathogenesis of bone stress injuries

A

increased loads and frequency w/o recovery

osteoclastic activity exceeds osteoblastic activity

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19
Q

symptoms of bone stress injuries

A

generally worse pain eith ADLs and exercise and may become constant

20
Q

signs of bone stress injuries

A

typical fx S&S
bone pain reproduced with hop test
imaging
-radiograph = may not show for 2-6 weeks
-MRI = gold standard; doesnt refelct healing

21
Q

PR Rx for bone stress injuries (lifestyle changes)

A

adress diet and hormonal limits due to possibly decreased bone density
-meet energy expenditure
-Vit D
-Calcium
-regular menstrual cycle

well managed sleep/stress/BMI

meds = antacids prevent gut absorption of calcium

22
Q

important facts related to bone stress injuries

A

adolescent bone doesnt equal adult bone

bone density decreases before growth spurt and takes up to 4 years after to increase

average growth spurt = 11.9 female and 13.6 males

average menarche = 12 years

SO WHAT = there is a period of skeletal weakness after a growth spurt especially with females who are also dealing with hormonal and skeletal changes and greater affects on BMD and muscle strength

23
Q

load management rx for bone stress injury

A

graded unloading to ambulate without pain

gradual and progressive return to activity while addressing risk factors and etiologies

24
Q

prognosis for tibial stress fx

A

BMD lowest at 3 mothts post fx in BOTH legs

BMD returned to baseline between 3-6 months

reinjury to either is likely prior to 3 months

all were at bseline BMD at 6 months, surpassed at 12 months

25
Q

etiology of compartment syndrome

A

Blunt trauma

overuse

26
Q

pathogenesis of compartment syndrome

A

increased swelling with limited fascial extensibility

compression of neurovascular structures in the anterior leg compartment

27
Q

S&S of compartment syndrome

A

recent blunt trauma or overuse to anterior compartment

cramping/burning/tingling

lengthening/use of DFs adds compression/P!

possibly weak DF

28
Q

S&S of compartment syndrome

A

pain
palpable tenderness
pulselessness
pallor - balancing
paraesthesias
paralysis

29
Q

Rx for compartment syndrome

A

unrelenting 6 Ps = medical emergency due to neurovascular compromise and need for surgical fasciotomy to prevent tisse death

modifiable 6 Ps = PT directed at source of inflammation and fascial extensibility; sx may be necessary

30
Q

what is a Pott’s fx

A

ankle fx

bi-malleolar = distal fibula + distal tibia

tri malleolar = tibia + fibula + posterior tibial rim

31
Q

prevalence of fxs in rear, mid, and forefoot fx

A

rear = calcaneus = most common

mid = rare except for navicular

fore = most common region of fx

32
Q

most common foot joint that deals with ARJC and why

A

1st MTP

in WBing:
-2x the load of lesser toes
-40-60% of BW
-1-2x BW with sports

gets rigid for propulsion with greatest forces from just before heel off to toe off

33
Q

etiology of ARJC in the foot

A

longer 1st ray

trauma

genetic

34
Q

symptoms of ARJC in foot

A

gradual onset
AM stiffness < 30 min
dorsal joint P!
antalgic/asymmetrical gait

35
Q

observation of ARJC in foot

A

hallux valgus

possible excessive pronation (greater load on 1st ray)

claw toe = MTP hyperext + IP flex

hammer toe = MTP hyperext + PIP flex + DIP hyperext

mallet toe = neutral MTP and PIP with flexed DIP

dorsal sput at 1st MTP

gait issues/poor LE control

36
Q

ROM for ARJC at the foot

A

capsular pattern for great toe = loss of ext > abd (hallux limitus/rigidus)

37
Q

combined motion, stress tests, and AM for ARJC at foot

A

consistent block

possible + for compression/distx

AM = hypomobile 1st MTP, DF, and/or sesamoid bones

38
Q

PT Rx for foot ARJC outside of MT and MET

A

POLICED

proper footwear to unload cartilage and accomodate for deformaties/impaired biomechanics

assistive devices

39
Q

MT for ARJC at foot

A

most effective early on or with younger pts

applied to MTP, sesamoids, and ankles

40
Q

MET for ARJC at foot

A

tissue integrity/mobility

address any LE control contributing to excessive pronation

41
Q

MD RX for ARJC at foot

A

injections = poor evidence; don’t use

sx
- past = bone excision and fusion

-newer = lapiplasty = 3D correction.of dysfunction through the midfoot to better address causative excessive pronation

42
Q

what is morton’s neuritis/-oma

A

compression of interdigital nn

acute inflammatory = neuritis

chronic fibrous cyst = neuroma

43
Q

etiology of mortons neuritis/-oma

A

excessive pronation

small toe boxes with/without heels

limited 1st MTP ext shifts load to lateral foot

44
Q

pathomechanics of morton’s neuritis

A

excessive pronation leading to excessive intermetatarsal compression

45
Q

what is tarsal tunnel syndrome

A

aka posterior tibial neuralgia

entrapment of tibial n at flexor retinaculum/medial malleolus

46
Q

etiology/pathomechanics of tarsal tunnel

A

excessive pronation leading to excessive tension and compression of tibial n

47
Q

nerve compression rx

A

POLI-ED (NO C)

JM/orthotic/MET to reduce compresison by assisting with abnormal mechanics

MET also to create neural motion/flossing

MSK II (18 decks)

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