Foot/ankle pathologies Flashcards
what is Invovled in Acute compartment syndrome
Tib ant, Extensor Hallucis longus, and Extensor digitorum longus
Pressure created within the closed fibro-osseous space causing ischemia to vascular and neurological component in the area
causes of Anterior compartment syndrome
heel contact on hard surfaces, muscle imbalance (tight gastroc/soleus)
Sings and symptoms of Acute and chronic Anterior compartment syndrome
Acute: medical emergency, bleeding and swelling, severe and persistent pain, skin=taut, shiny hot and hard
paresthesia, motor loss pin with passive stretch
Chronic: Pain increases with activity and decreases with rest
Ache and tightness, ischemia stops activity
Paresthesia during exercise
Pain presents at ant/lateral region of tibia
what causes Posterior compartment syndrome
Valgus deformity of the subtalar joint, running terrain, poor flexibility, poor foot wear, alignment abnormalities, excessive pronation
What structure is involved in Posterior compartment syndrome
Tib post, Flexor hallucis Longus and Flexor Digitorum Longus
Sign and symptoms of posterior compartment syndrome
Pain and discomfort along the post/medial border of tibia, swelling and palpable tenderness along the tendon, MMT reveals weak plantar flexion and inversion, excessive foot pronation
Tibial stress fractures causes
1/2 occur in the tibia or fibula
Repeated stress and muscle force on the bone
Tibial stress fractures sign and symptoms
gradual onset (2-3 week period)
Pain and swelling at beginning and decrease with rest
Later constant pain for hours - hall mark =nocturnal pain
Common site; 2-3 inches above malleolus
Differentiating test for Compartment syndrome, Tibial stress fracture, Periositis
History question, observation, Tinel (Fibula) Girth measurement MMT (tib ant) Pitted edema, Tuning fork
What are another names for Tibial Periostitis
Medial Tibial stress syndrome, Tenoperiostitis, Soleus syndrome
What causes Tibial periostitis
Overuse, excessive pronation
inflammation of periosteum, repeated muscular contraction. 18% of running injuries, if left untreated, it can progress to a stress fracture
Sings and symptoms of periosititis
Pain is localized to distal posteromedial border of the tibia
excessive pronation
often bilateral
worse in the AM and with exercise then decreases after warm up It returns toward the end of exercise period and continue afterwards (Tendinitis)
Worse during preswing phase of gait
Difference between Compartment syndrome, Stress fracture, Periostitis
Compartment syndrome: paresthesia, motor loss, ischemia stops activity. Pain increases with activity and decreases with rest
stress fracture: Pain and swelling at beginning and decrease with rest, later, constant pain for hours, nocturnal pain
Tibial periostitis: Pain is localized to distal posteromedial border of the tibia, excessive pronation, pain worse in the morning and decrease with warm up, worse during preswing phase of the gait
Difference between Tibialis posterior tendinitis, plantar fasciitis, tarsal tunnel,
Tibialis posterior tendinitis: Pain along medial border of tibia (middle/distal 1/3) involves FHL, FDL, Post. Tib, pain during loading response in gait, weak planter flexion and inversion, crepitus
Plantar fasciitis: repetitive plantar flexion/bone spur. pain along anterolateral surface of calcaneus (weight bearing), medial border toward metatarsal heads Pain worsens with activity (esp preswing and toe off) possible at night. Hall mark: first few steps after non weight bearing
Tarsal tunnel: aka jogger’s foot involves tibial nerve. Pain in medial ankle, mimic plantar fasciitis, weakness with toe flexion, night pain, altered sensation over sole of foot and toes. Tinel positive or increase signs with forced eversion and or dorsiflex
What can cause shin splints (ant. Leg pain)
Compartment syndrome
Tibial stress fractures
Periostitis
