Foot and Ankle Conditions Flashcards
Ligament Sprains: Grades
- 95% of all lig sprains are lateral
- Grade 1: no loss of fxn, min tearing of ATFL
- Grade 2: some loss of fxn, partial disruption of ATFL, CFL
- Grade 3: complete loss of fxn w/ complete tearing of ATFL, CFL & PTFL
Ligament Sprains: Dx
MRI if necessary
Ligament Sprains: PT
reduction of p! and inflammation w/ manual therapy and mod correction of biomechanical faults
Achilles’ Tendonosis/tendonopathy
degenerative condition of the achilles tendon.
Achilles’ Tendonosis/tendonopathy: Dx
(+) Thompsons test
Achilles’ Tendonosis/tendonopathy: Meds
Acetaminophen and NSAIDS, Corticosteriod injection or by mouth
Achilles’ Tendonosis/tendonopathy: PT
General Bursitis/Tendonopathy tx
Fractures of the Ankle: Type
Unimalleolar: med or lateral
Bimalleolar: med and lateral
Trimalleolar: med, lat & post tub of tibia
Fractures of the Ankle: Dx
plain film imaging - growth plate fractures are of concern, especially types III and IV
Fractures of the Ankle: PT
intervention emphasizes return of fxn w/o p!,
early PROM to prevent capsular adhesions and
funx training/restoration
Tarsal Tunnel Syndrome:
- Entrapment of posterior tibial nerve/branch within tarsal tunnel
- caused by overuse, excessive pronation, tendonitis of long flexor/post tib tendons
- Symptoms include:
- pain numbness tingling along medial ankle to plantar surface of the foot
Tarsal Tunnel Syndrome: Dx
electrodiagnostic tests, (+) tinels of tarsal tunnel
Tarsal Tunnel Syndrome: meds
NSAIDs, Acetominophen and Neurontin
Tarsal Tunnel Syndrome: PT
Use of orthoses to maintain neutral alignment of foot and possible neurodynamic mobilization
Flexor Hallucis Tendonopathy
commonly seen in ballet performers, tendonitis in acute stages may become chronic
Flexor Hallucis Tendonopathy Meds
NSAIDs Acetaminophen Corticosteriods
Pes Cavus:
- “hollow foot” deformity observed includes
- increased height of long arch,
- dropping of ant arch,
- metatarsal heads lower than hind foot,
- plantar flexion and splaying of forefoot
- claw toes
- Fxn is limited due to altered arthokinematics reducing ability to absorb forces through foot
- Etiology includes genetics, neurological disorders, contracture of soft tissues
Pes Cavus: dx
clinical exam and biomechanical screen of LE
Pes Cavus: PT
patient education, reduction of high impact sports, use of proper footwear and possibly orthoses
Pes Planus
- deformity including reduction in heigh of medial longitudinal arch, normal in infants/toddlers
- Results in decreased ability for foot to provide a rigid lever for push off during gait,
- Etiology includes genetics, muscle weakness, ligament laxity, paralysis, excessive pronation, trauma or dx (RA)
Pes Planus Dx
clinical exam
Pes Planus PT
intervention emphasizes patient education and appropriate footwear and orthotic fitting
Talipes Equinovarus:
- Postural: results from intrauterine malposition
- Results in plantar flexed, adducted, and inverted foot (postural)
- Talipes: abnormal development of head/neck of talus
- PF at STJ, talocalcaneal, talonavicular, and calcaneocuboid joints & supination at mid tarsal joints
- due to hereditary NMS disorders (myelomingocele)
Talipes Equinovarus: DX
clinical exam
Talipes Equinovarus: PT
manipulation followed by casting or splinting for postural
Talipes requires surgical intervention to correct deformity followed by casting or splinting
Equinus:
Plantar flexed foot, w/ compensatory STJ or mid tarsal pronation secondary to limited DF.
Etiology includes congenital bone deformity, neurological disorders CP, contracture of gastric/soleus, trauma or dx
Equinus: Dx
clinical exam
Equinus: PT
flexibility exercises of shortened muscle structures within foot, joint mobilization and strengthening of intrinsic/extrinsic foot ms
Hallux Valgus
- Medial deviation of head of 1st MT from midline of body,
- metatarsal and base of proximal 1st phalanx move medially while distal moves laterally.
- Etiology varies: biomechanical malalignment (excessive pronation), ligament laxity, hereditary, weak ms, tight foot wear
- Normal: 8-20 deg
Hallux Valgus DX
clinical exam
Hallux Valgus PT
orthotic fitting and patient education
Metatarsalgia
- Etiologies:
- Mechanical (tight triceps surae and/or achilles tendon, collapse of transverse arch, short first ray, pronation of forefoot) or
- Structural changes in transverse arch, possibly leading to vascular compromise in tissues of forefoot.
- Changes in footwear
- Complaint: p! at 1st/2nd MT heads after long WB
Metatarsalgia Dx
clinical exam
Metatarsalgia meds
NSAIDs Acetaminophen and Neurontin
Metatarsalgia PT
correction of biomechanical faults, impved flexibility of triceps sure and modalities to decrease pain prescription of orthotics and education regarding footwear
Metatarsus Adductus
- Etiology: congenital, muscle imbalance or neuromuscular disease such as polio.
- Types:
- Rigid: medial subluxation of tarsometatarsal its, hind foot is slightly in valgus w/ navicular lateral to head of talus
- FLexible: adduction of all 5 metatarsals at the tarsometarsal joints
Metatarsus Adductus Dx
clinical exam
Metatarsus Adductus PT
intervention includes strengthening and regaining proper alignment of foot (orthosis)
Charcot-Marie-Tooth Disease
peroneal ms atrophy that affects motor and sensory nerves, may begin in child/adulthood and affects ms in lower leg/foot but eventually progresses to ms of hands and forearm
Varies with degree of genetic dominance
Charcot-Marie-Tooth Disease Dx
electrodiagnostic testing and clinical exam
Charcot-Marie-Tooth Disease Meds
NSAIDs Acetaminophen, Neurontin
Charcot-Marie-Tooth Disease PT
no specific tx to prevent since it is genetic prevent contractors, skin breakdown, and maximize patients functional capacity Pt education and ambulation training
Plantar Fasciitis
- Etiology usually mechanical,
- chronic irritation from overpronation,
- limited ROM of 1st MTPand talocrural joint,
- tight triceps surae,
- acute injury,
- rigid cavus foot
Plantar Fasciitis Dx
clinical exam, differentiated from tarsal tunnel by negative tinels
Plantar Fasciitis Meds
NSAIDs Acetaminophen and Corticosteriod injections
Plantar Fasciitis PT
- regain proper foot alignment
- modalities to reduce inflammation
- flexibility of plantar fascia (pes cavus)
- careful flexibility of triceps surae
- joint mobilizations
- night splints
- strengthen inverters of foot
- pt education regarding footwear
- orthotic fitting
Rearfoot Varus
subtalar varus, calcaneal varus abnormal alignment of tibia, shortened soft tissues, or malunion of calcaneus = right inversion of calcaneus w/ STJ neutral
Rearfoot Valgus
abnormal malalignment of knee (genu valgum) or tibial valgus = eversion of calcaneus w/ STJ neutral *due to increased mobility of hind foot, fewer msk problems develop from this deformity than rear foot varus
Forefoot Varus
congenital abnormal deviation of head and neck of talus = inversion of forefoot when STJ in neutral
Forefoot Vaglus
congenital abnormal development of head/neck of talus = eversion of forefoot when STJ in neutral
Rearfoot/Forefoot Deformities Dx
Clinical Exam
Rearfoot/Forefoot Deformities PT
regain proper alignment improve flexibility of shortened soft tissues orthotic fitting and patient education regarding selection of footwear
