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foot and ankle Flashcards

1
Q

Grade 1 ankle sprain

A

no loss of function, no laxity (-) tests, Loss of 5 degrees total ROM, swelling .5cm or less

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2
Q

Grade 2 ankle sprain

A

Some loss of function, Positive Ant drawer test (ATFL), (-) talar tilt, no CCFL, 5-10 degree loss of ROM, swelling > .5 cm but less than 2 cm

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3
Q

Grade 3 ankle sprain

A

Near total loss of function, (+) ATFL and CCFL, ROM loss > 10deg, edema > 2cm,

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4
Q

Lateral ankle sprain (ligament rupture) cluster

A
  1. pain with palpation to ATFL
  2. (+) anterior drawer
  3. lateral edema
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5
Q

Ankle sprain A recommendations

A

Obj: take measures: edema, DF ROM, ant/post translation, SLS
- outcome measures FAAM (foot ankle assessment meaesure) and LEFS

Intervention: protected WB early
Acute: therex, mobs, prorgessive loading/sensorimotor training, manips, NWB and WB MWM to improve ankle DF

Tx: ice, and NOT using US - all A recommendations

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6
Q

Pain in AM

A
  • think plantar fasciitis or fat pad
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7
Q

Acute hyperextension of 1st MTP

A

think turf toe

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8
Q

Insidious onset of pain and swelling in 1st MTP

A

think gout

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9
Q

Numbness and tingling

A

think tarsal tunnel syndrome or mortons neuroma

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10
Q

Best outcome measure

A

FAAM (foot and ankle ability measure) - best

others: LEFS, foot function index FFI

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11
Q

Fat pad atrophy

A

differential vs Plantar fasciitis

  • location of pain different- pain in middle of heel vs front of heel (PF)
  • pain worse with walking barefoot (need to differentiate vs first steps in AM- PF)
  • palpation- compare size to contralateral fat pad

Tx: footwear (cushioned heel for runners), heel cup, changing to a mid/forefoot strike

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12
Q

Plantar Fasciitis treatment clinical guidelines

A

A- manual therapy, stretching, taping, orthotics

  • manual therapy- joint and of tissue mobs
  • taping- anti pronation and gastroc/sol taping
  • stretching- gastroc/sol, and PF
  • orthotics- supporting medial longitudinal arch (works best for people who respond positively to anti pronation taping)

US and dry needling not recommended

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13
Q

Mortons Neuroma

A
  • 3rd common digital nerve impingement
  • buring pain in plant 3rd web space
  • pain and parasthesias in toes can occur
  • “wrinkled socks sensation”

(+) mulders sign- metatarsal squeeze test
(+) digital nerve stretch test- ankle in DF, passively stretch toes on both sides to stretch digital nerve

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14
Q

Metatarsalgia

A

Inflammation under base of MTP’s

Tx: met pad, orthotics to distribute forces, shoe modification, injection

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15
Q

Mallet toe

A
  • DIP flexion, IP ext
  • associated with tight shoes, no real causitive reasons
  • can be caused by inflammatory arthiritis, trauma, sequela of hammer toe repair

Tx: toe sleeves (elevates toes to decrease pressure)

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16
Q

Hammer toe

A
  • IP flexion, DIP ext
  • older population, narrow shoes; can happen to just one or two toes
    Tx: foam to midfoot to offload pressure
  • splints to improve ROM restrictions (if flexible)
  • if rigid and symptomaic, surgery indicated
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17
Q

Claw toe

A

DIP, PIP flexion, MTP hyperextension

  • USUALLY NEUROLOGICAL DISORDER, affecting all toes; associated with cavus foot, tight achilles, and intrinsic muscular imbalances

Tx: foam to midfoot to offload pressure
- splints to improve ROM restrictions

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18
Q

deltoid ligament

A

involved in overpronation injuries, associated with flat foot deformity

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19
Q

midfoot bones

A

TMT (lisfranc) or CC, Talonavicular (chopart)

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20
Q

spring ligament

A

Important in preventing flat feet- plantar calcaneonavicular ligament

limits the talus from plantarflexing (which is alsso naviuclar dorsiflexing closed chain), thus supporting the medial longitudinal arch from lowering

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21
Q

tib posterior

A

largest cross sectional area and larger moment arm for muscles of supination= dominant supinator of foot
- important for raising medial longitudinal arch

22
Q

calcaneocuboid joint

A
  • supported by long plantar ligament- one of the strongest ligaments in the body- more stable, less movement than talonavicular jt
  • long plantar ligament supports longitudinal arch
23
Q

Flat foot positioning

A

forefoot abduction and dorsiflexion and rearfoot valgus

24
Q

peek a boo sign

A
  • you see the medial calcaneous while looking at a person fro the front ( indicative of subtle pes cavus)
25
Pes cavus tx
- high arches can lead to 5th MTP stress fx and lateral ankle sprains due to positioning - foot tends to be more structural deformity( can have achilles tightness) - tx looks to accommodate the rigid strucutre that has difficulty accommodating to terrain for shock absorption
26
Arch Height index
measure in NWB to 50% WB | - average change is 10 mm or 13.4 % of arch height
27
Navicular drop test
measure navicular height standing in subtalar neutral measure navicular height in regular standing, measure difference by marks of a card - difference of > 10mm indicates (+) test
28
royal london hospital test
tests for achilles tendonopathy - palpate along most tender point of achilles - have pt dorsiflex - palpate area again. (+) test if less pain with palpation with foot dorisflexed
29
coleman block test
- tests for rigid rearfoot - observe calcaneal position in standing - have pt stand on a box with 4th and 5th mets on, and rest of foot off - observe position of calcaneous - if they go from varus to neutral position, flexible deformity and orthotics may work - if no change, ,its a rigid deformity and orthotics wont make a difference
30
tinnels sign
at medial malleoli- testing for posterior tibial nerve impingement
31
mulders sign
metatarsal squeeze- looking for metatarsal neuroma
32
predictive signs of recurrent ankle sprain
- poor balance - high exposure (to activities that caused i.e. basketball player going back to basketball) - laxity tends to persist after a sprain, even after symptoms decrease indicating poor healing of ligaments CPR: 1. hx of ankle sprain 2. lack of full DF 3. no balance training in rehab 4. no use of external supports 5. inadequate dynamic warm up prior to activity
33
plantar fasciitis treatement
1. patient education 2. taping A 3. stretching (PF and gastroc/sol) A 4. orthotics A- prefab 5. night splints ( to decrease pain first few steps in AM)
34
Tarsal coalition
fusion of tarsals - usually calcaneonavicular and talocalcaneal - can resitrict subtalar joint motion and cause micro fracturing --> pain (in hindfoot) - imitates lateral ankle sprain symptoms, can lead to more sprains due to lack of subtalar ROM -
35
Lisfranc injury
- stirrup injury - damage to TMT joint- specifically lisfranc ligament which connects 2nd MTP to 1st cuneiform - MOI: usually a horizontal force to a plantarflexed ankle - tests: squeeze test of midfoot, single leg hop test tx: cast, immobilization if stable, if not, need ORIF
36
Severs disesase
- calcaneal apophysitis - self limiting inflammatory process of an avlused bone usually from childhood - can be due to overuse and microtrauma during sports - pt usually young athlete going through growth spurt c/o heel pain after starting a new sport special tests: squeeze test (calcaneous) single leg hop Tx: work on tightness, fix biomechanical issues. RICE, heel lifts, heel cups
37
Kohlers disease
" AVN of the navicular" - osteochondrosis (developmental derangement of normal bone growth) of navicular Tx: either arch support (mild symptoms) , short cast (mod-severe symptoms) - usually self limiting, surgery rarely indicated but can do arthrodesis of calcaneocuboid and talonavicular joints
38
Metatarsalgia
Pain in forefoot associated with stress under base of MTP - most commonly 1st and 3rd - absense of pain in interdigit space (more mortons neuroma) Tx: conservative- NWB, offloading, orthotics (met pad)
39
Mortons Neuroma
digital nerve irritation- (+) mulder sign - sharp neural pain, - usually digit space bw 3rd and 4th - neuroma develops due to biomechanical changes (lack of ankle DF --> increased reliance on digit ext) Tx: injection tends to help, shoe modification, offloading, biomehcanicsal corrections
40
Hallux Rigidus
- lack of hallux ext ROM due to pain or thickening with inflammation to first MTP synovium. Tx: primary: DECREASE motion by taping to decrease pain. typically ext is painful position - corrrect biomechanical faults such as limtied DF, tightness in calves which may lead to excessive hallux ext
41
non insertional achilles tendonopathy
6 cm proximal to tendon insertion - occurs more in athletes - prognosis good, with eccentric training program - may be due to overtraining
42
insertional achilles tendonopathy
- occurs more in fat people, sedentary - limit DF with eccentrics due to postential posterior ankle impingement (haglunds deformity) - can be due to more bony changes
43
haglunds deformity
bony enlargement posteriolaterally near calcaneous
44
Achilles tendon rupture
- (+) thompsons squeeze test - PF weakness, - palpable gap - increase passive ankle DF
45
Order of operations for suspected DVT
get d-dimer lab (99% sensitive)- if (+), get compressive US. If (-), can r/o
46
How old for Ottowa ankle to be applied to child?
16 years old
47
when are orthotics contraindicated for plantar fasciitis?
1 year, no evidence to support efficacy > 1 year of symptoms
48
Tests for achilles tendinitis
US or MRI. equally good
49
Special tests for achilles tendinitis
- royal london hospital test - achilles palpation test ( 2-6 cm proximal to heel) - decreased PF strength/endurance vs contra - arc sign where area of palpated swelling moves with DF and PF
50
Achilles tendinitis treatment
A: eccentric loading B: laser, Ionto C: stretching
51
Plantar Fasciitis CPG
``` - (+) windlass (-) tarsal tunnel - limited ankle DF pain with first steps in AM BMI > 25 heel pain after increase in activity ```
52
Posterior tib tendinosis
Tests: too many toes sign, fallen arch Tx: orthotics AND eccentric strengthening Sx: will also have pain with resisted inversion

T OCS (16 decks)

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