lower leg Flashcards
Anterior shin splints AKA
Lateral tibial stress syndrome
Posterior shin splints AKA
Medial tibial stress syndrome
Shin splint presentation
Achy pain on weight bearing, following running on hard surface or after break
Anterior muscles act as ___, posterior as ___
Shock absorbers, stabilizers
Pathognomonic for shin splints
Pain in middle or lower third of tibia. Non-responsiveness to Tx also clue
Shin splint management
Rest, ice, strapping, new shoes
Proximal, middle, and distal stress fractures are seen in ___, ___, ___
Military, dancers, runners (middle and distal)
Dreaded black line =
Middle shaft tibia fracture in dancers
Tibia stress fx management
Rest 5-7 weeks
Gradual return to impact
Achilles tendon can function with __% continuity
25%
Achilles tendinits cause
Jumping, running
Pump Bump AKA ___ results from ______
Hagland deformity, retrocalcaneal bursitis
Achilles tendinitis ddx
Reiters/ AS enthesopathy, Sever’s apophysitis
____ test for Achilles rupture AKA ___
Thompson, Simmond’s
Proximal tibia pain ddx (3)
Pes anserine bursitis, stress fx, tumor
MIddle and distal tibia pain ddx (3)
Stress fx, periostitis, shin splints
Calf muscle pain ddx (2)
Muscle tear, DVT
Achilles insertion pain ddx (4)
Retrocalcaneal bursitis, exostosis, tendinitis, swelling or hypertrophy
___ can initiate a DVT
Minor trauma in older patient
Neurogenic vs vascular claudication
Neuro- spinal stenosis, can walk/ ride farther before pain, typically in flexed position
Vascular- Blood vessel stenosis, common with atherosclerosis
Homan’s SIGN
Local swelling over biceps surae- indicates DVT
Tib/ fib local swelling
Stress fx
Close packed foot position
SUpination (phalanges- extension)
Supination involves
Adduction, plantarflexion, inversion
Pronation involves
Abduction, dorsiflexion, eversion
FPS aggravated by ___, plantar fasciitis by ___
Compression/ squeezing, stretching
Fat pad syndrome (foot) pain locates where
Middle of heel
__% of compartment syndrome is caused by tibial fx
45%
CS signs (3)
absence of distal pulse, paresis, hypoesthesia
Normal and CS pressures
10-12, 30
CS most commonly affects
Anterior compartment
6 P’s of acute extremity ischemia
Pain, paresthesia, pallor, pulselessness, paresis, poikilothermia (temp changes)
Acute CS management
Elevate limb TO LEVEL OF heart, no above
Release one side of cast if applicable
Commonly injured in lateral tibial plateau fx
Anterior tibial artery
Provides sensation to first dorsal web space
Deep peroneal nerve
Sensation to sole of foot
Posterior tibial nerve
Sensation to lateral foot and distal calf
Sural nerve
At risk for DVT
Females taking oral contraceptives
__% of DVTs are asymptomatic
50%
____ for diagnosis of DVT
Doppler ultrasound
Cellulitis causes (2)
Gram positive organisms, chronic venous thrombosis
Venous insufficiency presentation
Chronic lower leg swelling, itching, dull ache with standing, multiple varicosities
Venous insufficiency management
Supportive stockings, weight loss, reduce salt intake, avoid standing too long
Varicosities usually affect
Long saphenous vein
Bilateral leg edema, orthopnea
Congestive heart failure
Tarsal tunnel affects which nerve
Posterior tibial n
Predisposing factor in tarsal tunnel
Dropped longitudinal arch (foot everts, stresses area)
Nerve root test for tarsal tunnel
L4 (plantarflexion and inversion)
Passes through heads of gastroc, supplies dorsiflexors
Tibial n
Sensory branch of tibial n, supplies lateral foot and leg
Sural n
Sensory to plantar surface of medial 3.5 toes, motor for plantarflexion and and inversion
Medial plantar n (branch of post tibial)
Sensory to plantar surface of lateral 1.5 toes, motor to small muscles, culprit in Morton’s neuroma
Lateral plantar n (branch of post tibial)
Branch of tibial n, results in heel pain
Medial calcaneal n
Vulnerable to entrapment at fibular neck- lateral knee pain
Common peroneal n
Sensory to ant leg, dorsum of foot, part of 2-5th digits. Pain over lateral leg, ankle
Superficial pernoeal
Entrapped above ankle by extensor retinaculum, spurs, ganglia. Big toe pain and weakness on dorsiflexion and inversion
Deep peroneal n
Loss of sensation, burning pain over distal medial leg.
Saphenous n
