Foot and Ankle- Intro thru Lateral Sprains Flashcards
How much dorsiflexion is needed with the knee extended during heel/toe off?
10-15 degrees
What happens if you dont have the required DF for heel/toe off?
- compensating somewhere, could be a problem in the knee
- body is good at hiding things, can turn into symptoms on down the road
What is the required plantarflexion for walking and stairs?
~ 15-30 degrees
How much 1st MTP hyperext is needed for heel/toe off?
at least 65 degrees
How much dorsifleixon is needed with the knee flexed during stair ascent?
- 15-25 degrees
How much dorsiflexion is needed during stair descent with the knee flexed?
- 20-35 degrees
How can we assess differently to address DF functionally (such as stair ascent/descent)
Measure with the knee flexed!!
What are the three foot arches?
- medial, lateral and transverse
What are the three foot arches maintained by?
- ligaments and aponeurosis
- shape of the bones and their relation to eachother
- muscles
What provides MOST of the support for the three arches of the foot?
- ligaments and aponeurosis
What should we know about muscle support of the arches?
- only 15-20% of support so minimal ability to strengthen abnormal arch flattening
What is subtalar joint neutral?
- talus centered in talocrural and on calcaneus
- aka the position the talus should be in
What should we know about measuring subtalar neutral?
- common and widely taught
- POOR RELIABILITY and VALIDITY
- may produce positive results but is NOT measuring or assessing what is proposed
- A better method should be pursued
What should we know about measuring the medial longitudinal arch?
- Standing position is NOT predictable of dynamic function
- Dynamic 2D such as measuring from a video or 3D analysis are a reliable measure of MLA
What is a grade 1 / 1st degree sprain?
- mild S&S, activity may continue; fibers are stretched but not torn so minimal to no change during ligamentous special tests
What is a grade 2 / 2nd degree sprain?
- Moderate S&S; activity stops, fibers stretched and torn so increased laxity with a softer/later end feel during ligamentous tests
What is a grade 3/ 3rd degree sprain?
Severe S&S; activity stops; fibers torn completely with possible avulsion; significant increase in laxity with empty end feels during ligamentous tests
What are some functional questionnaires for sprains?
- Cumberland ankle instability tool
- foot and ankle ability measure
- lower extremity functional scale
What is the incidence / prevalence of ankle sprains?
- one of the MOST frequent injuries in sports
How many people miss work due to sprains?
- Up to 1/4 of people unable to attend work for > 1 week
How many individuals have persistant symptoms after an ankle sprain?
- 30-72%
What is the re-injury rate following an inversion sprain?
80%, due to lack of control and stability
What are risk factors for ankle sprains?
- previous ankle sprain(S)
- lack of external support
- lack of warm up
- lack of coordination training
- Impaired DF
What are some reasons for impaired dorsiflexion?
- shortened triceps surae (calf)
- Talar hypomobility
> decreased posterior glide
> decreased ER - Fibrosed capsule
> universal hypomobility
> no distraction and limited glides in all directions
What can limited dorsiflexion delay? excessively load?
- delays pronation and excessively loads the lateral foot
What is the etiology of lateral sprains?
excessive PF and IV
What are the structures involved with a lateral sprain?
- talocrural ligaments: ATF, CF, PTF
- Subtalar/ talocalacneal ligaments
- bone, capsule, other ligaments, muscle tendons
What is the MOST commonly torn lateral ligament of the ankle?
ATFL
What ligament is primarily torn with pure IV and will be slack in PF?
CFL
What are the subtalar or talocalcaneal ligaments involved with a lateral ankle sprain?
- Anterior: Interosseous lig
- Lateral - attaches and runs parallel to CF lig so they will likely be damaged together
What are some fx of bone issues that can happen with a lateral sprain?
- avulsion fx of lateral malleolus due to ligamentous attachment
- avulsion fx of 5th metatarsal from excessive action of peroneus brevis
- medial malleolus fx due to compression with excessive IV
What bony structures can be displaced or subluxed with a lateral ankle sprain?
- cuboid displacement due to excessive action of peroneus longus
- fibular anteriorly subluxed on tibia by reversal of muscle action of peroneals
What are some muscles/tendons that can be impacted by a lateral ankle sprain?
- possible peroneal strain and/or subluxation if retinaculum torn
What can happen to the epiphyseal plate with a lateral ankle sprain?
- epiphyseal plate avulsions - lateral malleolus and 5th metatarsal
What are some symptoms of a lateral ankle sprain?
- sudden onset with trauma by “rolling ankle” and the foot turning inward
- lateral ankle pain and swelling
- limited and painful ROM, esp pointing foot and turning inward
- difficult and painful WB
What are some signs of a lateral ankle sprain with observation?
- swelling and possible ecchymosis
- antalgic and asymmetrical gait
What is the CDR for imaging for the lateral ankle called?
- Ottawa and Bernese Ankle Clinical Decision Rules - determine need for radiographs
What will we find in our ROM with a lateral ankle sprain?
- primarily limited and painful in PF and IV
What will with find in our resisted testing/MMTs with a lateral ankle sprain?
- possibly weak and painful eversion
What are some special tests for the lateral ligamentous structures?
- talocrural: generally with anterior and reverse anterior drawer
- ATF with antlat drawer and reverse antlat drawer, and the antlat talar palpation
- CF with medial talar tilt
- PTF
What are some subtalar ligaments we need to do special testing for with a lateral ankle sprain?
- anterior interosseous
- lateral talocalcaneal
What will be TTP with a lateral ankle sprain?
INVOLVED STRUCTURES
