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MSK 2 > Lower Leg > Flashcards

Lower Leg Flashcards

1
Q

unimalleolar fracture

A

medial OR lateral malleolus

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2
Q

Bimalleolar fracture

A

medial AND lateral malleolus

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3
Q

Trimalleolar fracture

A

both malleoli and posterior rim of tibia

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4
Q

Common MOI for distal tibia/fibula fractures

A

axial or rotational loading

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5
Q

Common MOI for calcaneus fractures

- What else can be injured during MOI

A

fall from height

- lumbar vertebra can also be injured/fractured after fall from height

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6
Q

Common MOI for talus fractures

A

forced ankle dorsiflexion

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7
Q

Forced _______ can cause avulsion fracture at navicular

A

eversion

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8
Q

Common MOI for metatarsal fractures

A

direct trauma - direct impact like dropping something heavy on the foot

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9
Q

Common MOI for phalangeal fractures

A

stubbing and direct trauma

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10
Q

pediatric physeal ankle fracture has worse prognosis if:

A
  • > 1 week prior to reduction
  • larger gap
  • gap >/= 3 mm for Types 1 and 2
  • younger patients
  • higher risk of physics arrest in types 3-5
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11
Q

Why are fat grafts used during physeal fractures? Which type?

A

to stop physeal arrest

- used during type 5 if recognized early

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12
Q

cast time after physeal fracture type 1 and 2 reduction

A

4-6 weeks

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13
Q

cast time after physeal fracture type 3 and 4 reduction

A
  • long leg NWB cast 1-4 weeks

- boot from week 5-8 (NWB for first 2 weeks)

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14
Q

How long is a patient NWB after type 3 or 4 physeal fracture reduction?

A

~6 weeks

- long leg NWB cast wk 1-4 the boot for weeks 5-8 w/ NWB for 2 weeks

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15
Q

With which physeal fracture is hardware typically removed after reduction?

A

If ORIF w/ Type 3 (> 2mm displacement)

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16
Q

What is Talipes Equinovarus?

A

clubfoot

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17
Q

characteristics of clubfoot. Who is more likely to get it?

A
  • plantarflexed heel
  • inversion STJ/varus rearfoot
  • metatarsal adduction/varus forefoot

males > females and common bilaterally

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18
Q

What is rearfoot varus? What motion is limited? Where is subtalar in relation to midline?

A
  • inversion of calcaneus
  • limited pronation (DF, abduction, eversion)
  • subtalar is farter from midline
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19
Q

What is rearfoot valgus? What motion is limited? Where is subtalar in relation to midline?

A
  • eversion of calcaneus
  • excessive pronation and limited supination (PF, adduction, inversion)
  • subtalar joint is closer to midline
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20
Q

What is forefoot varus? What muscles are typically weak and what motion does this cause at the knee?

A

Inversion of the forefoot
- big toe is higher off ground in subtalar neutral

PF are weak and causes knee valgus

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21
Q

What is forefoot valgus? What is it commonly found w/?

A

Eversion of the forefoot

  • pinky toe is higher than ground in subtalar neutral
  • commonly found w/ rearfoot varus
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22
Q

pes planus

A

flat foot

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23
Q

What is rigid/congenital pes planus?

A

arch stays flat in weight bearing and non-weight bearing

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24
Q

what is acquired/flexible pes planus? What is the cause?

A

arch returns in non weight bearing

- laxity of medial arch stabilizers (tib posterior)

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25
Q

pes cavus

A

longitudinal arches accentuated

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26
Q

hallux valgus

A
  • medial deviation of 1st metatarsal and lateral deviation of great toe
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27
Q

What gait deviations occur w/ hallux valgus?

A
  • collapse of medial arch
  • navicular drop
  • pronation during push-off = less rigid foot
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28
Q

hallux rigidus and its characteristics

A

arthropathy of great toe

  • pain
  • swelling
  • abnormal bone growth at dorsal aspect of 1st MTP
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29
Q

History and symptoms of hallux rigidus

A

History

  • arthropathy (RA, gout, etc.)
  • trauma to distal metatarsal
  • repetitive great toe extension

Symptoms

  • insidious onset, progressive
  • 1st MTP pain
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30
Q

What specific activities would be difficult w/ hallux rigidus?

A
  • walking up hill
  • stair ambulation
  • terminal stance - will have lift off instead of push off during gait
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31
Q

Physical exam of hallux rigidus

A
  • limited great toe extension ROM at MTP (hard end feel)
  • secondary gait alterations (limited terminal stance/push off)
  • abrasion of skin superficial to dorsal 1st MTP
  • swelling
  • palpable osteophyte complex/tenderness
32
Q

What is the most common ligament sprained during an inversion ankle sprain?

A

ATFL - anterior tibiofibular ligament

33
Q

What other injuries must be included in differential diagnosis during lateral ankle sprains?

A
  • avulsion fracture of 5th met styloid process (fibularis brevis)
  • osteochondral lesion
  • malleolar fracture
34
Q

History and Symptoms of lateral ankle sprain

A

History

  • 3rd decade of life (20s)
  • common running/athletes injury
  • MOI: forced ankle inversion

Symptoms

  • lateral ankle pain/swelling
  • painful w/ activities that place foot in supinated position
35
Q

Physical exam findings of lateral ankle sprain

A
  • antalgic gait (decreased stance time and decreased end ROM)
  • increased figure 8 measurement
  • local warmth/tenderness
  • pain w/ inversion ROM
36
Q

What special tests would be positive w/ lateral ankle sprains?

A
  • anterior drawer test
  • medial talar tilt stress test
  • reverse anteriolateral drawer test
37
Q

History and symptoms of medial ankle sprain

A

History
- MOI: forced ankle eversion

Symptoms

  • medial ankle pain/swelling
  • painful w/ activities that place foot in pronated position
38
Q

Physical exam findings of medial ankle sprain

A
  • antalgic gait
  • increased figure 8
  • warmth/tenderness distal to medial malleolus
  • pain w/ pronation/eversion ROM
39
Q

What special test would be positive for medial ankle sprain?

A

lateral talar tilt stress test

40
Q

What injury would you suspect if patient reports pain w/ activities that place foot in supinated position? Pronated position?

A

supinated foot - lateral ankle sprain

pronated foot - medial ankle sprain

41
Q

What ligament is typically involved in medial ankle sprains? Lateral ankle sprains?

A

medial - deltoid ligament

lateral - ATFL

42
Q

What is the concern w/ syndesmotic sprains?

A

chronic instability/degenerative arthropathy

43
Q

Common MOI for syndesmotic sprain

A
  • forced DF
  • forced eversion of talus
  • forced ER of talus

wedge of talus pushes apart the mallelous
- someone trying to turn quickly on a planted foot

44
Q

Symptoms of Syndesmotic sprain

A
  • pain in distal leg
  • aggravated w/ stair decent/walking up hill/ squatting
  • aggravated w/ DF/any motion where tibial advancement occurs
45
Q

Physical exam of syndesmotic sprain

A
  • early heel-off in stance phase (trying to avoid tibial advancement)
  • swelling/tenderness anterior tibiofibular joint
  • pain at end-range DF ROM
46
Q

What special tests would be positive for a syndesmotic sprain?

A
  • fibular translation test - excessive laxity
  • external rotation test
  • syndesmosis squeeze test
47
Q

History and symptoms of chronic ankle instability (CAI)

A

History

  • recurrent inversion sprains
  • fibular muscle weakness
  • impaired proprioception

Symptoms

  • often asymptomatic between ankle sprains
  • feelings of ankle giving away
  • ankle weakness
  • difficulty/inability to run (worse on un-even surfaces)
48
Q

Physical exam of chronic ankle instability (CAI)

A

diminished proprioceptive function of ankle

49
Q

What is the cause of anterior ankle impingement?

A

soft tissue or bony spur formation at the anterior talocrural joint

50
Q

History and symptoms of anterior ankle impingement

A

History
- recurrent/high trauma ankle sprains

Symptoms

  • anterior ankle pain
  • anterior ankle swelling
  • painful w/ activities that place foot in DF position
51
Q

Physical Exam findings of anterior ankle impingment

A
  • antalgic gait/early heel off
  • tenderness/palpable mass anterior tibiotalar joint
  • pain/limited end range DF (A/PROM)
52
Q

What special tests would be positive w/ anterior ankle impingement?

A

forced DF test

53
Q

fibulari longus/brevis tendinopathy history and symptoms

A

History

  • repeated inversion injuries
  • anatomic abnormalities

Symptoms

  • pain posterior to lateral malleolus
  • subluxation of fibularis tendons
54
Q

fibulari longus/brevis tendinopathy physical exam

A
  • swelling/bruising lateral ankle
  • pain w/ AROM < resistive testing ankle eversion and pronation
  • pain w/ end-range inversion/supination (A/PROM)
  • tenderness fibularis longus/brevis tendons
55
Q

tibialis posterior tendinopathy history and symptoms

A

History

  • insidious onset, progressive
  • concomitant (at the same time) deltoid ligament injury
  • sports that require quick directional change

Symptoms

  • pain near area of insertion at navicular
  • pain proximal to medial malleolus
56
Q

tibialis posterior tendinopathy physical exam

A
  • pronated foot/pes planus
  • navicular drop
  • tenderness/ swelling at navicular and proximal to medial malleolus
  • painful resisted inversion and PF
  • painful eversion and DF ROM
57
Q

Feiss angle of a patient w/ pes planus? pes cavus?

A

pes planus - < 130 deg

pes cavus - > 150 deg

58
Q

Achilles tendinopathy history and symptoms

A

History

  • common MOI: intesne eccentric loading on triceps surae
  • running injury

Symptoms

  • pain near achilles insertion
  • morning stiffness
59
Q

Achilles tendinopathy physical exam

A
  • tenderness/swelling/hypertrophy/palpable defect at achilles tendon
  • pain w/ DF ROM
  • Pain w/ AROM < resisted PF
60
Q

Physical exam of achilles tendon rupture

A
  • posterior calf tenderness/swelling/palpable defect
  • pain w/ DF ROM
  • weak/absent active/resisted PF
61
Q

What special test would be positive for achilles tendon rupture?

A

thompson test

62
Q

Risk factors for plantar faciitis

A
  • limited DF ROM

- high BMI in non-athletic populations

63
Q

Symptoms of plantar faciitis

A
  • plantar medial heel pain that is worse in morning and after prolonged w/b activity
  • pain w/ terminal stance
64
Q

plantar fasciitis physical exam

A
  • early heel off in stance
  • guarding of tricpes surae
  • swelling/tenderness origin of plantar fascia (heel spur)
  • pain w/ PROM DF of ankle and toes (windlass test)
65
Q

Metatarsalgia history and symptoms

A

History
- health condition that increase stress on the met head

Symptoms
- aggravated during prolonged weight bearing activities, mid terminal stance phases

66
Q

Physical exam findings of metatarsalgia

A
  • concomitant health conditions
  • antalgic gait/diminished push-off
  • observable calluses on plantar foot
  • tender plantar met heads
  • pain during mid and terminal stance
67
Q

History and symptoms of interdigital neuroma

A

History

  • insidious onset
  • DF injury of toes

Symptoms
- pain in area of met heads and corresponding web space

68
Q

Physical exam of interdigital neuroma

A
  • tenderness

- + foot squeeze test

69
Q

What nerve is entraped with tarsal tunnel syndrome?

A

posterior tibial nerve

- intrinsic muscles of plantar foot

70
Q

symptoms of tarsal tunnel syndrome

A
  • loss of plantar sensation
  • pain and paresthesia at the plantar foot
  • increasing intensity of symptoms w/ ankle DF activities
71
Q

physical exam findings of tarsal tunnel syndrome

A
  • antalgic gait
  • limited/painful squat
  • signs of invertor tendinopathy
  • diminished plantar foot sensation
  • weakness of intrinsic
  • limited ROM, painful DF and eversion
72
Q

Who is more likely to develop tarsal tunnel? What is the average age?

A

females have a greater incidence

average age of 47 yyears

73
Q

Anterior ankle impingement CPR requirements

A

5/6 of the following:

  • anteriolateral ankle joint tenderness
  • anteriolateral ankle joint swelling
  • pain w/ forced DF
  • pain w/ single-leg activities
  • pain w/ activites
  • absence of ankle instability
74
Q

What exercises can help with tib posterior tendinitis?

A

towel scrunches and marble pick ups w/ foot

75
Q

Interventions for plantar faciitis

A

manual joint mobs - anterior and posterior talocruel to increase DF ROM

triceps surae stretching

MSK 2 (8 decks)

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