Lower extremiteis: diff di Flashcards
what is posterior tibialis tenosynovitis? pg. 96
an inflammation of the sheath that surrounds the posterior tibialis tendon
what is the most common cause of aquired pes planus? pg. 96
ruptured posterior tibialis
When does tarsal tunnel syndrome occur? pg 96
when the posterior tibial nerve is constricted beneath the tunnel roof formed by the flexor retinaculum
what is the most common finding of Achilles tendonitis? pg 97
malaligned calcaneous
what is the common etiology of achilles tendonitis?
chronic overuse injury
Achilles’ tendon pain is also referred to as what? pg 97
achillodynia
Achilles’ tendon pain is a significant source of disability for whom? pg 97
many people taking part in sports
what is the definition, etiology, signs/symptoms, and orthepedic tests of bursitis. pg 103
def: inflammation of the bursae
etiology: superficial bursa irritation by friction from shoe slippage and retrocalcaneal bursa irritation from calcaneal angulation
signs/symptoms: localized pain and swelling at superficial bursa or retrocalcaneal bursa
ortho tests: entire foot exam
what is an expected positive of bursitis? pg 103
may have palpable edema, pain, or tenderness
what is the most common finding with bursitis?
calcaneal subluxation
what is the definition, etiology, and S and S of hallux valgus? pg 105
def: lateral deviation of the great toe at the metatarophalangeal joint
etiology: obesity, misfitted shoes, trauma, heredity
SS: cosmetic deformity, swelling, calluses, disabling pain
What is the most common finding for a hallux valgus? pg 105
increased intermetatarsal angle
increased meatarsophalangeal angle
What degree is a congrous metatarsophalangeal (hallux valgus) joint? 106
20-30
what degree is a pathologic hallux valgus joint?
20-60
what degree is a normal metatarsophalangeal angle?
8-20 degrees
What degree is metatarsus primus varus?
increases intermetatarsal angle greater than 15 degrees
what is a bunionette or tailors bunion?
bunion on the 5th metatarsal
what is the most common toe involved toe involved in hammer toe, mallet toe, and claw toe?
the second toe
flexion deformities of the phalanges, phalangeal tippage, and painful calluses is indicative of what? pg 107
hammer toe, claw toe, and mallet toe
what is metatarsalgia? 109
inferior metatarsal head pain
burning and cramping in the inferior metatarsal head, which can be relieved by rest, and possibly accompanied by calluses can cause what?
metatarsalgia
what is the most common finding with metatarsalgia?
misaligned metatarsals
what is mortons neuroma? 110
forefoot interdigital pain. caused by pressure on plantar digital nerves. will have pain and palpable neuronal swelling and burning, or anesthesia exacerbated by usage and compression remitted by rest and massage.
what is an expected positive of mortons neuroma? 110
mortons test
what is the most common finding in mortons neuroma? 110
misaligned metatarsals
where is mortons neuroma most commonly located? second most common?
3rd and 4th metatarsal is most common, 2nd and 3rd is second most common
where is surgical treatment of mortons neuroma done? 110
excision of neuroma or swelling proximal to the site of distal nerve bifurcation
what is the definition, SS, and common findings of pes cavus? 112
def: high rigid longitudinal arch characterized by plantar flexion of forefoot on the hindfoot
SS: high rigid arch, clawing of toes, calluses on dorsum of toes
common findings: high arches
what is the etiology of pes cavus? 112
locking midtarsal joint linkage system, congential or idiopathic reduced normal tibial torsion, forefoot pronation and compensatory biomechanical secondary inversion of hindfoot
what is the definition of pes planus? 113
depression or loss of medial longitudinal arch. usually associated with calcaneal (valgus) eversion and forefoot abduction accompanied with hypertrophied fat pad
flexible pes planus
hereditary, tight Achilles’ tendon.
pain, burning, weight bearing collapses the arch. associated with genu valgum and internal tibial torsion
rigid pes planus
peroneal spasticity, usually secondary to hindfoot arthritis or tarsal coalation.
reduced hindfoot motion, irritation and resultant peroneal myospastic activity, painful limp
what are orthapedic tests performed for either pes planus or pes cavus?
medial and lateral stability tests, draw sign, mortons test, and strunskys test
an overstretching of the plantar fascia with possible fascial microtears and some inflammation can diagnose what?
plantar fascitis
what is the SS of plantar fascitis?
pain localized to the calcaneous (at the medial plantar tuberosity)
pes cavus and pes planus is the most common finding of what diagnosis?
plantar fascitis
calcaneal heal spur can be associated with inflammation of what?
plantar aponeurosis
plantar fascitis is easily misdiagnosed as what? 116
plantar bursitis, heel spur syndrome, calcaneal neuritis, or abductor hallicus myositis
increased forces over a period of time at a vector angle on a specific improperly weight-borne joint createing a periosteal interruption defines what?
stress fractures
an overuse injury, related to improper conditioning with localized tenderness is indicative to what?
stress fracture
what is an expected positive of a stress fracture?
tuning fork exam
treatment for a stress fracture?
rest, ice, elevation and bracing if necessary
What is the definition of tarsal tunnel syndrome?
posterior tibial nerve entrapment in the lacinate (retinaculuni) ligament
what are the SS of TTS?
burning, numbness and tingling in the sole of the foot, exacerbated by activity and may radiate into the tricep surae musculature
what is an expected positive of tarsal tunnel syndrome?
tinels tap over the posterior tibial nerve
what is the most common finding of tarsal tunnel syndrome? 122
misaligned calcaneus and talus
What are the borders of the tarsal tunnel?
flexor retinaculum (lacinate ligament)
medial malleolus
posterior aspect of talus
medial aspect of calcaneus
shin splints are most commonly caused by a subluxation of what bone?
talus
Surface irregularities and softening of the retropatellar articular cartilage indicates what?
chondromalacia patella
with progression of chondromalacia patella what happens?
the superficial layer of cartilage separates further form the deeper layer with the formation of a blister. This blister can rupture leading to ulceration and fragmentation of the articular cartilage. Finally, there is a complete loss of articular cartilage with exposure of bone in some areas. Gives appearance of crater around the rim of frayed cartilage.
What can predispose the knee to chondromalacia and ultimately osteoarthritic changes?
abnormal anatomic relationships between the patella and femoral condyles (pg. 222)
The eitiology: “may be latent from repeated microtrauma and become sympotmatic after a greater trauma; as well as, prolonged loading force on the cartilage which compresses the tissue and causes decreased elasticity with diminution of nutrition of cartilage” describes what?
chondromalacia patella
Signs and symptoms of chondromalacia patella are what?
anterior knee pain, audible retropatellar crepitis, reactive synovitis, increased Q angle, abnormal patellar position etc…
Expected positives of chondromalacia patella are what?
- apprehension test of patella: feels like patella will dislocate, patient pulls away by flexing quads
- clarkes patellar scrape test: retropatellar pain
- patella ballotment test: swollen joint, will have a floating sensation of the patella
- fouchets sign: point tenderness and pain along the patellar margin upon compression
- perkins sign: peripheral tenderness upon medial and lateral displacement f the patella
What radiology views are needed for chondromalacia patella?
Axial patella
A-P knee
Lateral knee
what are common findings of chondromalacia patella?
decreased joint space btwn femur and tibia, malposition of patella, and rotation of tibia
Is chondromalacia progressive?
yes. A “blister” or soft area forms initially. If the blister breaks, chunks erupt to produce an ulcer. as the knee cap slides laterally, the chunks are eroded to expose bone.
an increase in pressure within a myofacial compartment that compromises capillary flow, and subsequently, neuromuscular function is known as what?
exercise-induced compartment syndrome
What is the etiology of exercise-induced compartment syndrome?
excessively taught fascia! if muscle compartment cannot increase in volume then intracompartmental pressure rises and thus, the capillary blood flow to the muscle becomes compromised. Fluid will shift from vascular to interstitial space (further increasing pressure). ischemia will result and cause a temporary decrease in muscle and nerve function. may also cause inflammatory changes in muscle and fascia
