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CATA 263 > lecture 8: conditions of the lower leg and foot > Flashcards

lecture 8: conditions of the lower leg and foot Flashcards

1
Q

what is the ankle ligament joing called

A

talocrural

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2
Q

if you get an invnersion sprain, that is an injury to the medial or lateral ligaments

A

lateral

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3
Q

what are the 2 types of ligamnets of the talocrural

A

deltoid and lateral

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4
Q

what are the deltoid ligaments

A

tibionavicular
tibiocalcanueal
tibiotalar

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5
Q

what are the lateral ligaments

A

anterior talofibular
calcaneofibular
posterior talofibular

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6
Q

are deltoid ligs or lateral ligs moer commonly injured

A

lateral

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7
Q

true or false: muscles cannot cause ankle injuries

A

false, because of the insertions of them

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8
Q

what are some muscles that cross the ankle

A 
gastroc
soleus 
fib long brev and terius
tib ant
tib post
all the deep muscles psoterior and anteriorly
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9
Q

what is the fncntion of arches

A

Arches function as support and weigth distribution from the talus to the toes.

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10
Q

the medial and lateral long. arches are supported by what 80%

A

plantar fascia

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11
Q

what are some of the structures that support the medial and lateral long arches

A

plantar fascia
spring lig
long and short plantar
tib post

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12
Q

what happens if tib post is not strong

A

arch will fall and you will get flat feet

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13
Q

what is another name for the stpring lig

A

calcaneonavicular

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14
Q

explain the spring lig

A

they stretch on load bearing and recoil back to proel you forward

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15
Q

where does the transverse arch run across

A

the tarsals and metatarsals

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16
Q

what is the dome or the transverse arch

A

2nd metatarsal bone

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17
Q

wehere does the structural support for the transverse artch cme from

A

metatarsal ligaments and the transverse head of the ADD hallucis muscle.

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18
Q

true or false: the scieatic branches

A

true

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19
Q

where does the sciatic branch

A

proximal to the popliteal fossa

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20
Q

what are the 5 main nerves of the LE

A

tibial
saphenous
superficial and deep peroneal
sural nerve

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21
Q

what msucles are supplied by tibial nerve

A

Gastrocnemius m.
Soleus m.
Plantaris muscle
Tibialis post. Muscle

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22
Q

what nerve innervates the medial ankle

A

saphenous

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23
Q

what is inervated by superficial peroneal nerve

A

ankle evertors and 2nd-4th toes

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24
Q

the deep peroneal nerve innervates what

A

Ankle dorsiflexors
Toe extensors
Skin between 1st-2nd toe

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25
Q

the sural nerve is what type of innervation

A

cuteanous

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26
Q

what does the sural nerve innervate

A

Cutaneous innervation of the lateral ankle, heel and foot.

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27
Q

what are the 2 main toe deformities

A

hallux valgus

hallux rigidus

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28
Q

what is hallux valgus

A

exces adduction of the big toe

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29
Q

what are some common reasons for hallux valgus

A

shoes

sports

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30
Q

what is hallux regidus

A

degernative artritis in first MTP

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31
Q

what is the angle for hallux rigidus

A

less than 60 degrees

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32
Q

the toe will become steeper or flatter with hallux rigidus

A

flattar

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33
Q

if you have hallux rigidus and your foot becomes flatter, what will be more likely of occuring

A

plantar fascinitis

achilies tendonitis

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34
Q

what are the causes of claw, hammer and mallet toe

A

Congenital or caused by improper fitted shoes, neuromuscular disease, arthritis or trauma

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35
Q

what can claw, hammer and mallet lead to

A

callus formation (rubbing on the toe of the shoe)

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36
Q

what is metatarsalgia (morton)

A

discomfor around the metabtasal heads

pain under foot and ball of foot

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37
Q

metatarsalgia does what to the arches

A

flattening of tranverse arch

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38
Q

what are some causes of metatarsalgia

A

compression of a nerve

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39
Q

metatarsalgia causes callus fomration where

A

middle 3 metatarsal heads (most on the 2nd

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40
Q

where is there the most callus formation for metatarsalgia

A

2nd

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41
Q

what are the factors leading to metatarsalgia

A 
Excessive BW
Timited calf flexibility
Fallen transverse arch
Hammer toe
Pes planus or pes cavus
Narrow toe box
Faulty technique (cycling, running, jumping, etc.)
Repetitive jumping and landing
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42
Q

true or false: a narrow toe box can cause metatarsalgia

A

true

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43
Q

where are bunions usually found

A

Usually found on the medial aspect of MTP joint of the great toe and lateral aspect of base of 5th (bunionette)

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44
Q

what is bunions?

A

thickening of skin as it constantly rubs against inside of the shoe

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45
Q

what is usually preceeding by hallux valgus

A

bunions

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46
Q

buions are usually preceeded by what

A

hallux vagus

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47
Q

true or false: usually you need surgery to remove bunions

A

yes

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48
Q

is surgery the only option for bunions

A

no , you can also strengthen the abductor hallucis l

or use orthotics

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49
Q

what is the management of buinon and hallux valgus

A

Orthotics that will re-align the big toe
Strengthening exercises of the ABD pollicis
Surgery to remove and shave the excess of bone

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50
Q

what are the 2 conservative approaches for management of buinions and hallux

A

orthorics to reallign big toes

stttrengthing of aBD pollicus

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51
Q

what is the invasive apprach for bunions and hallux valgus

A

surgery to remove and shave the excess of bone

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52
Q

what is retrocalcanueal bursitis

A

Inflammation of the bursae that is between the calcaneus and the achilles tendon.

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53
Q

where is the retrocalcneal bursitis located

A

b/w calcaneous and achiles tendon

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54
Q

what does the retrocalcneal bursa do

A

serves as a cussion and luberifdicationn

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55
Q

how can you get retocalc bursitis

A

Pressure on heel from shoes/skates etc. or malalignment of Achilles

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56
Q

in what motion will you have discomfort for retrocalc bursitis

A

Active plantarflexion discomfort

running, jumping wtc

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57
Q

what is the management for retocalc bursistis.

A

Ice
Stretching of the calf
Biomechanical analysis to address the malalignment of the achilles tendon if present
Change shoes/ skates

58
Q

the ice applied for retrocalc bursitis reduces swilling?

A

no just for numbing and deceasing pain

59
Q

why is stretching the calf good for managemnt of bursitis

A

because it will decrease swelling

60
Q

what is turf toe

A

Sprain of plantar capsule ligament of first MTP joint

61
Q

what is the MOI for turf toe

A

force hyperextension or hyper flexion (reverse turf toe) of the great toe

62
Q

what are the signs and symptoms for turf toe

A

Pain, swelling, tenderness great toe
Toe extension painful (flexion)
Can be associated with tear of flexor tendons, sesamoid fracture, bone bruises

63
Q

what is the managment for turf toe

A

Rest
Limit running activities
Encourage swimming or aquatherapy

Limit excessive MTP extension/flexion
Taping
Carbon plate

64
Q

what is a carbon plate

A

stiff, prevents front part of the shoe to bend and helps with extension

65
Q

what are the common MTP and IP joing injuries

A

Sprains and dislocations to the MTP and IP joints of the toes

66
Q

what is the MOI for MTP and IP joint injuries

A

tripping or stubbing the toe, valgus and varus forces commonly affect the first and fifth toes

67
Q

what are the S/S for MTP and IP joint injuries

A

pain, immediate swelling, dysfunction, gross deformity (ie dislocation)

Joint capsule: volar and dorsal surfaces
Collateral ligaments: tenderness laterally

68
Q

where will you find pain the the collateral ligs for MTP and IP joint injuries

A

tenderness laterally

69
Q

what is the managemnt for joint sprains

A

Rest
Maintain PROM
Manage swelling
Strengthening when possible

70
Q

what are the most ocmmon ankle injuries

A

inversion

71
Q

true or false: inversion ankle sprains are only chronic

A

false can be acute and chronic

72
Q

true or false: you will only have pain on lateral aspect of the ankle for inversion sprain

A

false May have pain on medial aspect of ankle from talus coming into contact with tibia (also pinch deltoid ligament)

73
Q

why is it possible to have medial pain on an inversion sprain

A

from talus coming into contact with tibia (also pinch deltoid ligament)

74
Q

what muscles absorb some of the strain at the ankle to prevnt damge to ligmaents

A

peroneal musles

75
Q

what happens to incvesion sprains if the impact is violent

A

may lead to fracture/ bone contusion of the medial malleolus

76
Q

what are the lateral ligmanets that get injured during inversion sprain

A

anterior talofib
calcenuofib
posterior talofib

77
Q

what is the MOI for inversion injuries

A

changing directions rapidly, stepping on another athletes foot

78
Q

when you do inversion and plantar flexion, what ligament is most taut

A

ATFL

anterior talofib

79
Q

when you do inversion and dorsiflexion, wjhich lig is most taut

A

CFL

Calcaneo

80
Q

what nerve is afected in dorsi

A

sural

81
Q

what nerves are affected with inversion

A

deep and superficial pernoea

82
Q

what is the MOI for eversion ankle sprain

A

forces dorsiflexion and eversion

Possible nerve associated

83
Q

in eversion sprains, what other structure xan be torn

A

flexor retinaculum

84
Q

most injuries to deltoid ligs are associated with what other injuries

A

fibular fracture
syndesmotic ankle sprain
severe lateral ankle sprain

85
Q

what is management for ankle sprains

A

PEACE AND LOVE

86
Q

WHAT does peace and love stand for

A

protection, elevation, avoid anti inf, compression, educ

load, optimisn, vascularization, execrise

87
Q

true or false: use ice to reduce swelling of ankle sprans

A

false, only for pain

88
Q

what is the MOI for syndesmossi sprain

A

external rotation of the talus within the mortise creating an external rotation force on the fibula with respect to the tibia
(fib seperates from tib)

89
Q

what is the unfancy name for syndesmosis sprain

A

high ankle sprain

90
Q

what ligament is disrupted in syndesmosis sprain

A

Disruption of distal tibiofibular ligament with Potential injury to deltoid ligament

91
Q

true or false: syndesmosis sprain is easy to heal

A

false it takes long because there is not alot of vasculature around it

92
Q

true or false: high ankle sprains are sometime so painful it can be confused with a fracture

A

true

93
Q

if there is an syndesmosis sprain, what other lig will compensate

A

ligaments at the fibular head ligmanet

94
Q

how do you heal a fully ripped syndesmossi sprain

A

permanent screws

95
Q

true or false: muscle strains seldom occur in the lower leg

A

true except for gstroc

96
Q

what is the MOI for gastroc soleus complex

A

forceful dorsiflexion and knee exptension

97
Q

what head is more likely to get strained after the age of 40

A

medial

98
Q

true or false: NEVER stretch a strained muscle

A

true

99
Q

what is the management for muscle strain

A

Start with peace & love
Start strengthening ASAP
Will take between 2 weeks and 2 months depending on the grade of the strain

100
Q

why is it imporant to start strengthing early for muscle strains

A

beacuse when there is cotnraction, the msucle approximates and the collagen fibers heal

101
Q

what is the healing process for straign

A

btween 2 weeks and 2 months depending on the grade

102
Q

where will you feel tendinopathy in achiles

A

just proximal to its insertion on the calcaneus

103
Q

where will you feel tendinopathy in tibia posterior

A

just behind medial malleolus

104
Q

where will you feel tendinopathy in tib ant

A

on the dorsum of the foot just under the extensor retinaculum
where

105
Q

where will you feel tendinopathies of pernoeal tendons

A

just behind the lateral malleolus and at the distal attachment on the base of the 5th metatarsal

106
Q

what is the cmomon MOI for tendinopathy in lower leg

A

Lack of flexibility of gastrocnemius-soleus complex
Changes from soft to hard surfaces vice versa
Changes in training intensity
Inadequate muscle strength (fatigue)
RTP to soon following injury

abnormal foot mechanisms (ie arches

107
Q

true or false: arches have no effect on tendinopathy of lower leg

A

false, abnormal foot mechanics can contribute

108
Q

what does tibialis psoterior tendon dysfunction reflect loss of

A

loss of support from the spring, deltoid, and talocalcaneal interosseous ligaments, talonavicular capsule and plantar fascia

109
Q

if you have tibialis posterior tendon dysfunction, yoy will have icnreased or decreased laxity

A

increased

110
Q

what predisposes someone to tib post tendon dystfunction

A

pes planus

111
Q

what will someone with tib post tendon dynfunction lack

A

lackthe windlass mechanism (arch should increase if big toe goes into extension)

112
Q

where will you feel pain for achiles tendon disorders

A

posterior heal pain due to abnomrla loading

113
Q

what are the leading factors of achlies tenon disorders

A 
Hyper pronation of the foot
Limited mobility of subtalar joint
Limited ROM of ankle 
Leg length discrepancy
Weaknesses in posterior chain structures 
Training errors
114
Q

tendinoptathy of achilies tendon is at risk of what

A

complete rupture

115
Q

what is the most common hind foot provel in runners

A

plantar fascitis

116
Q

plantar facistis is only caused by intrinsic facors

A

false, also extrinsic

117
Q

where will you feel pain for plantar facistis

A

Pain on medial heel with weight bearing (especially first few steps in the morning)
Pain increases with passive dorsiflexion and toe extension
Tenderness also noted at superior abductor halluces muscle

118
Q

patients will lack windlass mechanism in what 2 disorders

A

tib post tendon dysfunctuin

plantar fasictis

119
Q

what is exertional compartment syndrome

A

excised induced pain and swelling

120
Q

what are the 2 most commonly affected comparents of the leg

A

anterior and deep psoterior

121
Q

what will you feel for exrertional compartment sybdomr

A

Tight, cramp like or squeezing feeling felt over compartment

122
Q

exertional compart syndrome affects only 1 leg

A

false, usually botth

123
Q

how do you relieve symptoms of exrcetional compartment syndrome

A

rest

124
Q

what is acute compartment syndrome

A

increase pressure within lower leg spaces

125
Q

what does acute compartment syndrome compromise

A

neurovascular structures

126
Q

what is the cause of acute compartment syndorme

A

Caused by direct blow to anterolateral leg, or tibial fracture complication

127
Q

when does acute compartment syndrome become an emergency

A

if it doesnt get better after restt

128
Q

true or false: you can only have acute compoartment syndrome

A

false, also chronic

129
Q

what is the fancy name for shin spilintts

A

medial tibial stress syndrome

130
Q

what is shin splints

A

Periostitis along the posteromedial tibial border

131
Q

what muscles impact medial tibial stress sundrome

A

Soleus, flexor digitorum longus and Tibialis posterior

132
Q

what usually causes shin spints

A

training eror

133
Q

what is the imporant of soleus in terms of shin splints

A

: makes up the medial 1/3 of the heel cord as it inserts on the calcaneus. Excessive and prolonged pronation of the foot causes eccentric contraction of the soleus resulting in periostitis.

134
Q

how many days of rest for MTSS

A

5-7 days of rest

135
Q

true or false: you cannot do active rest during MTSS

A

false, you can do activities that do not increase symptoms/ load management

136
Q

what is management of MTSS

A 
5 to 7 days of rest or active rest including activities that do not increase symptoms/ load management
PEACE & LOVE
Assess for stress fracture
Evaluate running and gait mechanics
Evaluate resting foot positioning and posture
Change shoes if appropriate
Include foot orthotics if appropriate
Increase flexibility of tight muscles
Increase strength of weak muscles
Increase mobility of hypomobile joints
137
Q

what are the 3 neurological conditions

A

mortons neuroma
tarsal tunnel syndrome
sural nerve s=entrapment

138
Q

what is mortons neuroma

A

pinching of interdigital nerve between metatarsal heads of the 2nd-3rd toe

139
Q

what is tarsal tunnel syndrome

A

posterior tibial nerve becomes entrapped beneath the flexor retinaculum

140
Q

what is sural nerve entrapment

A

numbness along the dorsolateral aspect of the foot

141
Q

what can cause sural nevre entrapment

A

Can be caused by multiple factors (tight gastroc, 5th meta #, cast, achilles repair)

CATA 263 (17 decks)

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