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PT 515 Musculo > Foot/Ankle Potential Pathologies > Flashcards

Foot/Ankle Potential Pathologies Flashcards

1
Q

Foot/Ankle Potential Pathologies

A 
Fx
Achilles Tendon Rupture
DVT
Sprains
Instability
Strains
Plantar Fasciitis
Osteochondral Injuries
OA
Capsular Restrictions
Peripheral Nerve injuries
Diabetic Foot
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2
Q

Foot fractures common sites

A

5 Met
Stress fx of the mets
Calcaneus

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3
Q

Foot fx common MOI

A

overuse or trauma

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4
Q

Stress fx symptoms

A

swelling
tenderness
gait change
reproduction of cc by performing activity

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5
Q

Special tests stress fx

A

Metatarsal compression test

Tuning fork

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6
Q

Ottawa Ankle Rule Ankle X-Ray required if

A
  • Pain in anterior aspect of medial or lateral malleoli and anterior talar dome area
  • Bone tenderness at posterior medial malleolus
  • Bone tenderness at lateral malleolus
  • Inability to bear weight on the limb immediately after the injury and in the ER
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7
Q

Ottawa Ankle Rule Foot X-Ray required if

A
  • Pain in dorsal medial and lateral aspect of the midfoot
  • Bone tenderness at the base of the 5th metatarsal
  • Bone tenderness at navicular
  • Inability to bear weight on limb immediately after the injury and in the ER
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8
Q

Metatarsal Compression Test

A

Morten’s Test
Positive pain with metatarsal fx or neuroma
False positive in pt with metatarsalgia
Unclear evidence to support this

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9
Q

Tuning Fork

A

For fibular fx
Pt supine, stethoscope is placed on fibular head, hit a tuning fork on lateral malleolus
Positive if there is a different sound in bilateral comparison
Minimal evidence to support it

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10
Q

Achilles Tendon Rupture

A

MOI: trauma jumping or landing, prolonged steroid use?
Symptoms: “Hit” in the back of the anke, “pop”, weak
Special tests:
-Bilateral Toe Raise
-Thompsons test

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11
Q

Thompson Test

A

Squeeze gastroc w/ patient in supine, foot should PF
Positive test if nonresponsive ankle PF during test
Unclear evidence to support this

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12
Q

Deep Vein Thrombosis

A 
MOI: Insidious, after recent surgery or immobilization
Signs/symptoms
-calf pain, ankle swelling
-Antalgic gait
Special Tests:
-Homan's sign
-Calf Swelling
-Well's CPR for DVT
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13
Q

Homan’s Sign

A

Positive test is popliteal and/or calf pain
Many presentations may lead to false positive
Minimal evidence to support this

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14
Q

Calf Swelling

A

Positive test if bilateral comparison is difference of 15 mm for men or 12 mm for women
Minimal evidence to support this

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15
Q

Well’s Clinical Prediction Rule for DVT

A

Asking questions regarding recent events
Positive test related to score on the test
Strongly supported by evidence
Great for screening and ruling out an ER trip

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16
Q

Ligamentous Injuries

A

Inversion/Supination: Lateral ligaments
Eversion/Pronation: Deltoid ligaments
Syndesmosis Injuries

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17
Q

Acute Lateral Ankle Sprain

A 
MOI: Trauma Inv/PF
Symptoms:
-Difficulty in activity
-Lateral ankle pain
-Medial ankle pain: Kissing lesion
-Swelling
-Ecchymosis
-Painful WB and ROM
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18
Q

Kissing Lesion

A

Medial aspect compromised because of medial malleolus and talus contact during inversion

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19
Q

Grade I Acute Ankle Sprain

A

Mild (2 weeks rehab)
-Mild effusion, no hemmorrhage
-Negative anterior drawar, negative varus laxity
-Pain with inversion and PF
Little to no limp, but trouble with hopping

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20
Q

Grade II Acute Ankle Sprain

A

More swelling, hemmorrhage likely present
Positive anterior drawer, no varus laxity at neutral
Limping with walking, unable to raise on toes/hop/run

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21
Q

Grade III Acute Ankle Sprain

A 
Immobilization 1-10 days, 8-10 weeks of rehab
Diffuse swelling, hemmorrhage
Significant instability
Complete tears of ATFL and CFL
Unable to FWB
Decreased ROM
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22
Q

Chronic Ankle Sprains

A

Patient reports giving way with no pain in between inversion episodes
Leads to chronic instability
If ll. are lengthened beyond patients control then surgery is necessary

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23
Q

Anterior Drawer Ankle

A

Positive test if pain reproduced laterally or excessive gapping betwen the distal lateral malleolus and calcaneous

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24
Q

Longitudinal fibularis tendonitis/subluxation

A

-Swollen, tender, painful posterior to lateral malleolus
-Pain with AROM eversion
-Minimal response to PT intervention
May seem like lateral ankle sprain

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25
Q

OCD/Loose bodies within joint

A

Effusion
Crepitus felt when palpating medial/lateral talus
“catch” “lock” “give way”
Can look like lateral ankle sprain

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26
Q

Anteriorlateral synovitis or impingement

A 
No swelling
Point tenderness at anteriolateral junction of tib/fib
Pain with DF, Increased activity, stairs
May look like lateral ankle sprain
Use Forced DF test to rule in or out
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27
Q

Talar Tilt

A
  • Positive if pain is reproduced or excessive gapping between the distal lateral malleolus and calcaneous
  • DF to bias PTFL, Neutral for CFL, PF for ATFL
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28
Q

Posterior Drawer Test

A

Positive test if pain is reproduced or excessive gapping between distal lateral malleolus and calcaneus

29
Q

Eversion Stress Test

A
  • Positive test if pain is reproduced medially over deltoid ligament or excessive compression at lateral aspect between distal lateral malleolus and calcaneus
  • For acute medial ankle sprain
30
Q

Syndesmosis Injuries

A 
MOI: Leg rotation with immobile foot
S/S: Pain in anterior distal shin; difficulty ambulating and decreased ROM (DF>PF)
Special Tests: 
-Fibular translation test
-Crossed Leg test
-Kleiger test
31
Q

Fibular Translation test

A

Positive if pain produced with fibular translation and more displacement compared to contralateral side
-Tests for syndesmosis injury

32
Q

Crossed Leg Test

A

Positive test if pain produced is chief complaint
Therapist assists by applying gradual pressure w/ test
-Tests for syndesmosis injury

33
Q

Kleiger Test (ER stress test)

A

Positive if pain produced is cc.
Unclear evidence to support this test, it may also test medial ligaments.
-Tests for syndesmosis injury

34
Q

Musculotendinous Injury

A

MOI: Poor footwear; Tight muscles; Overuse Imbalance

S/S: Pain with active contraction and passive lengthening

35
Q

Posterior heel Musculotendinous injury

A

Achilles tendonitis (Insertional v. Non-insertional)
Acute Rupture
Chronic Rupture

36
Q

Medial Foot musculotendinous injury

A

Posterior tibialis tendon insufficiency

37
Q

Non-Insertional Achilles Tendonitis

A

Above insertion of achilles tendon
MOI: Overuse; increased running intensity; shoe change
Types:
-Paratendonitis
-Tendonosis
-Paratendonitis with tendonosis
S/S:
-may improve w/ mild activity
-Mild ache in posterior leg post activity
-more pain after prolonged activity or stairs
-Tenderness or stiffness, especially in am
-bulbous area mid-tendon

38
Q

Insertional Achilles Tendonitis

A

At insertion onto calcaneus
MOI: Overuse, increased running intensity, shoe change
Types:
-Haglund’s Deformity
-Pretendon Bursitis
-Retrocalcaneal Bursitis
S/S:
-may improve w/ mild activity
-Mild ache in posterior leg post activity
-more pain after prolonged activity or stairs
-Tenderness or stiffness, especially in am
-Active inflammation
-Tenderness, swelling over insertion

39
Q

Paratendonitis

A

Inflammation of the lining around the tendon

40
Q

Tendonosis

A

Noninflammatory, age related degeneration of the tendon itself

41
Q

Paratendonitis with tendonosis

A

Paratendon inflammation with infratendinous degeneration

42
Q

Haglund’s deformity

A

Enlargement on the back of the heel

43
Q

Pretendon bursitis

A

located anterior to the tendon

44
Q

Retrocalcaneal bursitis

A

located posterior to the tendon

45
Q

Achilles Tendonitis special tests

A

SLS (single leg stance) heel raises
Thompson test
Foot/ankle biomechanical exam

46
Q

Achilles Tendon Rupture

A 
Age: Typically 30-40
Weekend warrors; explosive activities
Medications
-Antibiotics
-Systemic corticosteroids
Palpable defect; severe loss of function
47
Q

Surgical vs Non surgical Achilles Tendon Rupture

A

Less risk of re-rupture with non-surgical repair
Non-surgical:
-Immobilized in 20 degrees PF for at least 4 weeks w/ progressive WBAT
Surgical:
-Standard vs accelerated program
-Initially NWB w/ immobilization 4-6 weeks
-Slowly increased WB in CAM boot with DF ROM neutral at 6 weeks
-Accelerated protocol may be earlier WB and Earlier DF Neutral

48
Q

Posterior Tibialis Tendon Dysfunction/Insufficiency

A 
MOI: Inflammation and degeneration of the tendon progresses to lengthening and mechanical insufficiency
S/S: 
-Acute or gradual onset
-pain in medial long arch 
-secondary pain in lateral hindfoot 
-pain/weak MMT
-hindfoot valgus
-medial talar bulge
Special Tests: Too many toes sign, No inversion w/ heel raise
49
Q

PTTI Stage I

A

S/S: Pain with inversion

Rx: Rest tendon, modalities, walking brace

50
Q

PTTI Stage II

A

S/S: History of pain 2-3 years, no rearfoot inversion during unilateral heel raise
Rx: Walking brace 4 weeks and orthotics (6 months)

51
Q

PTTI Stage III

A

S/S: Fixed hindfoot deformity (Valgus) with a compensated forefoot, arthrosis of STJ
Rx: Triple arthrodesis (fusion), heel cord lengthening

52
Q

Plantar Fasciitis

A

MOI: Direct repetitive microtrauma, pes planus or cavus, increased BMI, prolonged standing, reduced DF ROM
S/S:
-Pain/stiffness in AM and after prolonged sitting
-Recent change in intensity of running
-worse walking barefoot
-point tenderness over medial calcaneal tubercle

53
Q

Plantar Fasciitis differential diagnosis and treatment

A

Achilles tendonitis vs peripheral nerve entrapment
Acute
-85% of patients will get better within 10 months
-NSAIDs, DF, night splints, OTC insoles
Chronic
-Repetitive partial tear and chronic irritation
-Patients with symptoms past 10 months need to consider different diagnosis and r/o entrapment symptoms

54
Q

NWB examination

A

PROM IR/ER Hip
Tibial Torsion
Subtalar Neutral
Forefoot to rearfoot position

55
Q

Weight bearing examination

A 
Tibial varum
Rearfoot valgus/varus
Navicular drop test
Forefoot adduction/abduction
Bilateral comparison of navicular height (Feiss line)
56
Q

Osteochondral Injuries

A 
MOI: OCD s/p traumatic ankle sprain
Most common in the talus
S/S: Pain during terminal stance, decreased standing tolerance, aching during rest
Special Tests:
-Blind stance ability vs FTPO
-Treadmill tolerance test
-Step-up tolerance test
-Step-down tolerance test
-unilateral toe raise tolerance test
-balance tests
57
Q

Non-surgical intervention osteochondral injuries

A

Period of immobilization and NWB to allow for cartilage to heal

58
Q

Surgical Invterventions osteochondral injuries

A

Debridement
Fixation of the injured fragment
Microfraxture or drilling of the lesion
Transfer or grafting of bone and cartilage

59
Q

Rheumatoid Arthritis

A

Inflammation of the joint capsule

Will often affect the metatarsals and digits

60
Q

Gout

A

Excessive amounts of uric acid

Often affects the great toe

61
Q

Osteoarthritis

A

Degenerative

  • Redness, inflammation, swelling
  • Pain and stiffness particularly in the morning or after rest
  • OA progresses more rapidly due to previous joint injury
62
Q

Osteoarthritis Criteria for diagnosis

A 
Age >50
Stiffness >30 minutes
Crepitus
Bony tenderness
Bony enlargement
No palpable warmth
63
Q

Capsular Restriction

A 
MOI: Post ankle immobilization, develops over time
Presentation
-Capsular pattern during AROM/PROM
TC pattern PF>DF
1st MTP pattern DF>PF
64
Q

Tarsal Tunnel Syndrome

A 
MOI: Insidious, RA
S/S:
-Difficulty localizing pain, diffuse burning, worse at night
Special tests:
-Tinel's sign at the tarsal tunnel
65
Q

Distal Tarsal Tunnel Syndrome

A 
Baxter's nerve: lateral plantar nerve
Population 40-50 y/o
MOI: >9 month hx of plantar fascia type pain, long distance runners
S/S
-Pain at medial calcaneal tubercle
-Decreased sensation at lateral heel
-Unable to abduct 5th digit
66
Q

Diabetic Peripheral neuropathy

A

Neuropathic Ulcers

67
Q

Diabetic Charcot neuropathy

A

Osteomyelitis

Charcot Neuropathic Fractures and dislocations

68
Q

Diabetic Foot

A

Prevention is the best treatment

  • Daily foot inspections
  • Appropriate footwear
  • Custom diabetic inserts
69
Q

SLR Nerve biases

A

Tibial nerve bias: DF, eversion
Fibular nerve bias: PF Inversion
Sural nerve bias: DF, Inversion

PT 515 Musculo (18 decks)

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