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T OCS > foot and ankle > Flashcards

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
Q

Pes cavus tx

A
  • 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
Q

Arch Height index

A

measure in NWB to 50% WB

- average change is 10 mm or 13.4 % of arch height

27
Q

Navicular drop test

A

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
Q

royal london hospital test

A

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
Q

coleman block test

A
  • 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
Q

tinnels sign

A

at medial malleoli- testing for posterior tibial nerve impingement

31
Q

mulders sign

A

metatarsal squeeze- looking for metatarsal neuroma

32
Q

predictive signs of recurrent ankle sprain

A
  • 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
Q

plantar fasciitis treatement

A
  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
Q

Tarsal coalition

A

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
Q

Lisfranc injury

A
  • 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
Q

Severs disesase

A
  • 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
Q

Kohlers disease

A

” 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
Q

Metatarsalgia

A

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
Q

Mortons Neuroma

A

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
Q

Hallux Rigidus

A
  • 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
Q

non insertional achilles tendonopathy

A

6 cm proximal to tendon insertion

  • occurs more in athletes
  • prognosis good, with eccentric training program
  • may be due to overtraining
42
Q

insertional achilles tendonopathy

A
  • 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
Q

haglunds deformity

A

bony enlargement posteriolaterally near calcaneous

44
Q

Achilles tendon rupture

A
  • (+) thompsons squeeze test
  • PF weakness,
  • palpable gap
  • increase passive ankle DF
45
Q

Order of operations for suspected DVT

A

get d-dimer lab (99% sensitive)- if (+), get compressive US. If (-), can r/o

46
Q

How old for Ottowa ankle to be applied to child?

A

16 years old

47
Q

when are orthotics contraindicated for plantar fasciitis?

A

1 year, no evidence to support efficacy > 1 year of symptoms

48
Q

Tests for achilles tendinitis

A

US or MRI. equally good

49
Q

Special tests for achilles tendinitis

A
  • 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
Q

Achilles tendinitis treatment

A

A: eccentric loading
B: laser, Ionto
C: stretching

51
Q

Plantar Fasciitis CPG

A 
- (+) windlass
(-) tarsal tunnel
- limited ankle DF
pain with first steps in AM
BMI > 25
heel pain after increase in activity
52
Q

Posterior tib tendinosis

A

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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