lecture 8: conditions of the lower leg and foot Flashcards
what is the ankle ligament joing called
talocrural
if you get an invnersion sprain, that is an injury to the medial or lateral ligaments
lateral
what are the 2 types of ligamnets of the talocrural
deltoid and lateral
what are the deltoid ligaments
tibionavicular
tibiocalcanueal
tibiotalar
what are the lateral ligaments
anterior talofibular
calcaneofibular
posterior talofibular
are deltoid ligs or lateral ligs moer commonly injured
lateral
true or false: muscles cannot cause ankle injuries
false, because of the insertions of them
what are some muscles that cross the ankle
gastroc soleus fib long brev and terius tib ant tib post all the deep muscles psoterior and anteriorly
what is the fncntion of arches
Arches function as support and weigth distribution from the talus to the toes.
the medial and lateral long. arches are supported by what 80%
plantar fascia
what are some of the structures that support the medial and lateral long arches
plantar fascia
spring lig
long and short plantar
tib post
what happens if tib post is not strong
arch will fall and you will get flat feet
what is another name for the stpring lig
calcaneonavicular
explain the spring lig
they stretch on load bearing and recoil back to proel you forward
where does the transverse arch run across
the tarsals and metatarsals
what is the dome or the transverse arch
2nd metatarsal bone
wehere does the structural support for the transverse artch cme from
metatarsal ligaments and the transverse head of the ADD hallucis muscle.
true or false: the scieatic branches
true
where does the sciatic branch
proximal to the popliteal fossa
what are the 5 main nerves of the LE
tibial
saphenous
superficial and deep peroneal
sural nerve
what msucles are supplied by tibial nerve
Gastrocnemius m.
Soleus m.
Plantaris muscle
Tibialis post. Muscle
what nerve innervates the medial ankle
saphenous
what is inervated by superficial peroneal nerve
ankle evertors and 2nd-4th toes
the deep peroneal nerve innervates what
Ankle dorsiflexors
Toe extensors
Skin between 1st-2nd toe
the sural nerve is what type of innervation
cuteanous
what does the sural nerve innervate
Cutaneous innervation of the lateral ankle, heel and foot.
what are the 2 main toe deformities
hallux valgus
hallux rigidus
what is hallux valgus
exces adduction of the big toe
what are some common reasons for hallux valgus
shoes
sports
what is hallux regidus
degernative artritis in first MTP
what is the angle for hallux rigidus
less than 60 degrees
the toe will become steeper or flatter with hallux rigidus
flattar
if you have hallux rigidus and your foot becomes flatter, what will be more likely of occuring
plantar fascinitis
achilies tendonitis
what are the causes of claw, hammer and mallet toe
Congenital or caused by improper fitted shoes, neuromuscular disease, arthritis or trauma
what can claw, hammer and mallet lead to
callus formation (rubbing on the toe of the shoe)
what is metatarsalgia (morton)
discomfor around the metabtasal heads
pain under foot and ball of foot
metatarsalgia does what to the arches
flattening of tranverse arch
what are some causes of metatarsalgia
compression of a nerve
metatarsalgia causes callus fomration where
middle 3 metatarsal heads (most on the 2nd
where is there the most callus formation for metatarsalgia
2nd
what are the factors leading to metatarsalgia
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
true or false: a narrow toe box can cause metatarsalgia
true
where are bunions usually found
Usually found on the medial aspect of MTP joint of the great toe and lateral aspect of base of 5th (bunionette)
what is bunions?
thickening of skin as it constantly rubs against inside of the shoe
what is usually preceeding by hallux valgus
bunions
buions are usually preceeded by what
hallux vagus
true or false: usually you need surgery to remove bunions
yes
is surgery the only option for bunions
no , you can also strengthen the abductor hallucis l
or use orthotics
what is the management of buinon and hallux valgus
Orthotics that will re-align the big toe
Strengthening exercises of the ABD pollicis
Surgery to remove and shave the excess of bone
what are the 2 conservative approaches for management of buinions and hallux
orthorics to reallign big toes
stttrengthing of aBD pollicus
what is the invasive apprach for bunions and hallux valgus
surgery to remove and shave the excess of bone
what is retrocalcanueal bursitis
Inflammation of the bursae that is between the calcaneus and the achilles tendon.
where is the retrocalcneal bursitis located
b/w calcaneous and achiles tendon
what does the retrocalcneal bursa do
serves as a cussion and luberifdicationn
how can you get retocalc bursitis
Pressure on heel from shoes/skates etc. or malalignment of Achilles
in what motion will you have discomfort for retrocalc bursitis
Active plantarflexion discomfort
running, jumping wtc
what is the management for retocalc bursistis.
Ice
Stretching of the calf
Biomechanical analysis to address the malalignment of the achilles tendon if present
Change shoes/ skates
the ice applied for retrocalc bursitis reduces swilling?
no just for numbing and deceasing pain
why is stretching the calf good for managemnt of bursitis
because it will decrease swelling
what is turf toe
Sprain of plantar capsule ligament of first MTP joint
what is the MOI for turf toe
force hyperextension or hyper flexion (reverse turf toe) of the great toe
what are the signs and symptoms for turf toe
Pain, swelling, tenderness great toe
Toe extension painful (flexion)
Can be associated with tear of flexor tendons, sesamoid fracture, bone bruises
what is the managment for turf toe
Rest
Limit running activities
Encourage swimming or aquatherapy
Limit excessive MTP extension/flexion
Taping
Carbon plate
what is a carbon plate
stiff, prevents front part of the shoe to bend and helps with extension
what are the common MTP and IP joing injuries
Sprains and dislocations to the MTP and IP joints of the toes
what is the MOI for MTP and IP joint injuries
tripping or stubbing the toe, valgus and varus forces commonly affect the first and fifth toes
what are the S/S for MTP and IP joint injuries
pain, immediate swelling, dysfunction, gross deformity (ie dislocation)
Joint capsule: volar and dorsal surfaces
Collateral ligaments: tenderness laterally
where will you find pain the the collateral ligs for MTP and IP joint injuries
tenderness laterally
what is the managemnt for joint sprains
Rest
Maintain PROM
Manage swelling
Strengthening when possible
what are the most ocmmon ankle injuries
inversion
true or false: inversion ankle sprains are only chronic
false can be acute and chronic
true or false: you will only have pain on lateral aspect of the ankle for inversion sprain
false May have pain on medial aspect of ankle from talus coming into contact with tibia (also pinch deltoid ligament)
why is it possible to have medial pain on an inversion sprain
from talus coming into contact with tibia (also pinch deltoid ligament)
what muscles absorb some of the strain at the ankle to prevnt damge to ligmaents
peroneal musles
what happens to incvesion sprains if the impact is violent
may lead to fracture/ bone contusion of the medial malleolus
what are the lateral ligmanets that get injured during inversion sprain
anterior talofib
calcenuofib
posterior talofib
what is the MOI for inversion injuries
changing directions rapidly, stepping on another athletes foot
when you do inversion and plantar flexion, what ligament is most taut
ATFL
anterior talofib
when you do inversion and dorsiflexion, wjhich lig is most taut
CFL
Calcaneo
what nerve is afected in dorsi
sural
what nerves are affected with inversion
deep and superficial pernoea
what is the MOI for eversion ankle sprain
forces dorsiflexion and eversion
Possible nerve associated
in eversion sprains, what other structure xan be torn
flexor retinaculum
most injuries to deltoid ligs are associated with what other injuries
fibular fracture
syndesmotic ankle sprain
severe lateral ankle sprain
what is management for ankle sprains
PEACE AND LOVE
WHAT does peace and love stand for
protection, elevation, avoid anti inf, compression, educ
load, optimisn, vascularization, execrise
true or false: use ice to reduce swelling of ankle sprans
false, only for pain
what is the MOI for syndesmossi sprain
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)
what is the unfancy name for syndesmosis sprain
high ankle sprain
what ligament is disrupted in syndesmosis sprain
Disruption of distal tibiofibular ligament with Potential injury to deltoid ligament
true or false: syndesmosis sprain is easy to heal
false it takes long because there is not alot of vasculature around it
true or false: high ankle sprains are sometime so painful it can be confused with a fracture
true
if there is an syndesmosis sprain, what other lig will compensate
ligaments at the fibular head ligmanet
how do you heal a fully ripped syndesmossi sprain
permanent screws
true or false: muscle strains seldom occur in the lower leg
true except for gstroc
what is the MOI for gastroc soleus complex
forceful dorsiflexion and knee exptension
what head is more likely to get strained after the age of 40
medial
true or false: NEVER stretch a strained muscle
true
what is the management for muscle strain
Start with peace & love
Start strengthening ASAP
Will take between 2 weeks and 2 months depending on the grade of the strain
why is it imporant to start strengthing early for muscle strains
beacuse when there is cotnraction, the msucle approximates and the collagen fibers heal
what is the healing process for straign
btween 2 weeks and 2 months depending on the grade
where will you feel tendinopathy in achiles
just proximal to its insertion on the calcaneus
where will you feel tendinopathy in tibia posterior
just behind medial malleolus
where will you feel tendinopathy in tib ant
on the dorsum of the foot just under the extensor retinaculum
where
where will you feel tendinopathies of pernoeal tendons
just behind the lateral malleolus and at the distal attachment on the base of the 5th metatarsal
what is the cmomon MOI for tendinopathy in lower leg
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
true or false: arches have no effect on tendinopathy of lower leg
false, abnormal foot mechanics can contribute
what does tibialis psoterior tendon dysfunction reflect loss of
loss of support from the spring, deltoid, and talocalcaneal interosseous ligaments, talonavicular capsule and plantar fascia
if you have tibialis posterior tendon dysfunction, yoy will have icnreased or decreased laxity
increased
what predisposes someone to tib post tendon dystfunction
pes planus
what will someone with tib post tendon dynfunction lack
lackthe windlass mechanism (arch should increase if big toe goes into extension)
where will you feel pain for achiles tendon disorders
posterior heal pain due to abnomrla loading
what are the leading factors of achlies tenon disorders
Hyper pronation of the foot Limited mobility of subtalar joint Limited ROM of ankle Leg length discrepancy Weaknesses in posterior chain structures Training errors
tendinoptathy of achilies tendon is at risk of what
complete rupture
what is the most common hind foot provel in runners
plantar fascitis
plantar facistis is only caused by intrinsic facors
false, also extrinsic
where will you feel pain for plantar facistis
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
patients will lack windlass mechanism in what 2 disorders
tib post tendon dysfunctuin
plantar fasictis
what is exertional compartment syndrome
excised induced pain and swelling
what are the 2 most commonly affected comparents of the leg
anterior and deep psoterior
what will you feel for exrertional compartment sybdomr
Tight, cramp like or squeezing feeling felt over compartment
exertional compart syndrome affects only 1 leg
false, usually botth
how do you relieve symptoms of exrcetional compartment syndrome
rest
what is acute compartment syndrome
increase pressure within lower leg spaces
what does acute compartment syndrome compromise
neurovascular structures
what is the cause of acute compartment syndorme
Caused by direct blow to anterolateral leg, or tibial fracture complication
when does acute compartment syndrome become an emergency
if it doesnt get better after restt
true or false: you can only have acute compoartment syndrome
false, also chronic
what is the fancy name for shin spilintts
medial tibial stress syndrome
what is shin splints
Periostitis along the posteromedial tibial border
what muscles impact medial tibial stress sundrome
Soleus, flexor digitorum longus and Tibialis posterior
what usually causes shin spints
training eror
what is the imporant of soleus in terms of shin splints
: 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.
how many days of rest for MTSS
5-7 days of rest
true or false: you cannot do active rest during MTSS
false, you can do activities that do not increase symptoms/ load management
what is management of MTSS
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
what are the 3 neurological conditions
mortons neuroma
tarsal tunnel syndrome
sural nerve s=entrapment
what is mortons neuroma
pinching of interdigital nerve between metatarsal heads of the 2nd-3rd toe
what is tarsal tunnel syndrome
posterior tibial nerve becomes entrapped beneath the flexor retinaculum
what is sural nerve entrapment
numbness along the dorsolateral aspect of the foot
what can cause sural nevre entrapment
Can be caused by multiple factors (tight gastroc, 5th meta #, cast, achilles repair)
