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EPHE 344 > Lower Leg and Ankle > Flashcards

Lower Leg and Ankle Flashcards

1
Q

what are the most common injury in US collegiate sport (contribute to 15% of injuries reported)

A

lateral ankle sprain

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2
Q

ankle injuries are most common in ?

A

competition (game time) over practice

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3
Q

ankle injuries represent ? out of the reported 10000 exposures reported in US high school sport

A

5.23

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4
Q

2 contributing factors to ankle injuries

A

types of playing surfaces and conditions

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5
Q

neglecting injuries can result in

A

long term injuries

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6
Q

what bone translates all the forces of the foot

A

the talus

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7
Q

hyaline cartilage covering and no muscle attach to it (what bone)

A

the talus

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8
Q

what are the 3 main lateral collateral ligaments of the foot and what 2 usually get hurt in conjunction with each other

A

posterior talofibular ligament
calcaneofibular ligament *
anterior talofibular ligament *
*= usually get hurt in conjunction with one another

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9
Q

the deltoid ligament gives supports to what side of the ankle?

A

medial

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10
Q

why is it good to ice muscles?

A

the muscular compartments can swell and out pressure on the fascia

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11
Q

the ankle is what type of joint?

A

hinge joint

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12
Q

medial and lateral displacement of the ankle is prevented by?

A

the malleoli

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13
Q

what limits eversion and inversion at the subtalar joint

A

ligaments

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14
Q

the square shape of the talus is good for what?

A

adds to stability of the ankle

Mortise stabilized by bony configuration, passive & active structures

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15
Q

the ankle is most stable during? and least stable during?

A

dorsiflexion

plantar flexion

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16
Q

how many degrees of motion of dorsiflexion does the ankle have and how many in plantar flexion

A

10 degrees

50 degrees

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17
Q

normal gait requires what range of motion ?

A

10 degrees of dorsiflexion and 20 degrees of plantar flexion with the knee fully extended

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18
Q

normal ankle function is dependent on what?

A

the action of the rear foot and the subtalar joint

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19
Q

the ankle plays a critical link in what?

A

the kinetic chain

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20
Q

5 preventative measures to take for ankle and lower leg injuries

A
  • achilles tendon stretching
  • strength training
  • neuromuscular control training
  • footwear
  • preventative taping and orthosis
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21
Q

2 types of special testing for ankle and lower legs injuries

A
  • Percussion and compression tests for fracture

- Ottowa ankle rules

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22
Q

a tight heal cord may limit what?

A

dorsiflexion leading to increase chance of injury

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23
Q

Achilles tendon stretching techniques

A
  • routinely stretch before and after practice
  • stretching should be performed with knee extended and flexed 15-30 degrees (stretch the soleus when bent and gastroc when straight)
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24
Q

strength training techniques for injury prevention of lower lag and ankle

A
  • Static and dynamic joint stability is critical in preventing injury
  • While maintaining normal ROM, muscles and tendons surrounding joint must be kept strong
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25
Q

neuromuscular control techniques for injury prevention of lower leg and ankle

A
  • Can be enhanced by training in controlled activities

- Uneven surfaces, BAPS boards, rocker boards, BOSU

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26
Q

injury prevention technique for footwear

A

shoes should not be worn in activities they are not made for

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27
Q

preventative taping and orthosis techniques for injury prevention of lower leg and ankle (4)

A

-Tape can provide some prophylactic protection
– Improperly applied tape can disrupt normal biomechanical function and cause injury
– Lace-up braces have even been found to be superior to taping relative to prevention
– Bracing can impact ankle & knee biomechanics

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28
Q

a blow to the tibia, fibula or heel to create vibratory force that resonates w/in fracture (pressing)

A

percussion test

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29
Q

involves compression of tibia and fibula either above or below site of concern (can flick the bone)

A

compression test

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30
Q

what can also be used to create vibration at the site of an injury

A

tuning forks

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31
Q

Used for determining need for radiograph

A

ottawa ankle rules

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32
Q

according to the ottawa ankle rules, X rays a required if: (4)

A

-Pain in malleolar or midfoot area (on the bone itself)
– Tenderness over inferior or posterior pole of either malleoli
– Inability to bear weight (4 steps taken independently, even if limping) at time of injury and/or evaluation
– Tenderness along base of 5th metatarsal or navicular bone

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33
Q

for functional testing, while weight bearing the following should be performed (6)

A

-Walk on toes (plantar flexion)
– Walk on heels (dorsiflexion)
– Walk on lateral borders of feet (inversion)
– Walk on medial borders of feet (eversion)
– Hops on injured ankle
– Passive, active and resistive movements should be manually applied to determine joint integrity and muscle function

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34
Q

what ligament is most likely to be injured in an inversion ankle sprain (injured with inversion PF and IR)

A

anterior talofibular ligament

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35
Q

if the anterior talofibular ligament ruptures it can create what kind of ankle instability

A

rotary

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36
Q

what ligaments are more rare to injure during an inversion ankle sprain but may be injured if there is great impact with an upward force

A

posterior talofibular ligament and calcaneo fibular ligament

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37
Q

a great upward force on the foot may do what?

A

avulse the lateral malleolus (rip a bit of bone)

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38
Q
  • Occurs with inversion plantar flexion and adduction

- Causes stretching of the ATF ligament

A

grade 1 inversion sprain

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39
Q

Mild pain and disability; weight bearing is minimally impaired; point tenderness over ligaments and no laxity (what grade of inversion sprain)

A

grade 1 inversion sprain

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40
Q

management of grade 1 sprains

A

-RICE for 1-2 days; limited weight bearing initially and then aggressive rehab
– Tape may provide some additional support – Return to activity in 7-10 days

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41
Q

Moderate inversion force; increased disability/ increased days off
– Pop or snap; moderate pain; difficult to WB; tenderness and edema
(what grade of inversion sprain)

A

grade 2

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42
Q

management of grade 2 sprains

A

-RICE for at least first 72 hours; X-ray exam to rule out frature; crutches 5- 10 days, progressing to weight bearing
– Begin ROM exercises early with tape/brace
– Long term disability
- chronic instability;
- increased re- injury
– Rehab required to prevent re-injury

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43
Q

Relatively uncommon but is extremely disabling
– Caused by significant force (inversion) resulting in spontaneous subluxation and reduction
– Causes damage to the ATF/PTF/CF & capsule
– Is possible to tear the talus out of the joint

A

grade 3 inversion sprain

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44
Q

grade 3 inversion sprain causes damage to?

A

ATF/PTF/CF ligaments , and possibly tear the talus out of joint

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45
Q

Severe pain, swelling, hemarthrosis, discoloration – Unable to bear weight
(what grade of inversion sprain)

A

grade 3

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46
Q

management of grade 3 sprains

A

-RICE, X-ray (physician may apply dorsiflexion splint for 3-6 weeks)
– Crutches are provided after cast removal
– Isometrics in cast; ROM, and balance/ proprioception exercise once out
– Surgery may be warranted to stabilize ankle due to increased laxity and instability

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47
Q

what type of ankle sprain accounts for only 5-10% of sprains

A

eversion

48
Q

in an eversion sprain what gets damaged?

A

deltoid; possible fibular fracture

49
Q

-Ligament may impinge & be contused with inversion sprains
– Increased chance of injury with pronated, hypermobile foot
– Tearing medial structures
– Possibility of avulsion
(what type of sprain)

A

eversion

50
Q

an eversion sprain damages what side?

A

medial

51
Q

inversion grade 1 sprain causes stretching of what ligament

A

ATF

52
Q

increased pain; unable to bear weight; and pain with abduction and adduction (what type of sprain)

A

eversion

53
Q

with a grade 2 or 3 eversion sprain the increased instability may cause weakness where? and result in what?

A

in the medial longitudinal arch resulting in increased pronation or fallen arch

54
Q

how is eversion sprain tape job different than a inversion

A

just tape neutral, you don’t pull them inversion and you DON’T figure eight, you DO heel lock though

55
Q

syndesmotic sprain results in damage to what joint? and what ligaments

A

the distal tibiofibular joint, anterior/posterior tibiofibular ligaments

56
Q

syndesmotic sprain occurs from what?

A

increased dorsiflexion or excessive or forced external rotation or a driving force to the bottom of the foot

57
Q

Closed position – full dorsiflexion – Intermalleolar distance increases 1.5mm
(what sprain? )

A

syndesmotic

58
Q

-Can initially appear benign or assume ankle sprain
– Marked pain and tenderness over the anterior syndesmosis (anterolaterally)
-joint weakness
-inability to bear weight

A

syndesmotic sprain

59
Q

with a syndesmotic sprain you will experience pain in?

A

dorsiflexion and eversion (active passive and resistive)

60
Q

what type of sprain is also called a high ankle sprain

A

syndesmotic sprain

61
Q

management of of syndesmotic sprain (whats different than normal sprain management?)

A

difficult to treat and may take longer, immobilization may also last longer
- surgury may be required

62
Q

Number of mechanisms • Avulsion, bi-malleolar fractures

- increased swelling and pain and possible deformity

A

ankle fracture

63
Q

management of ankle fracture

A

RICE to edema & bleeding
– Walking cast or brace
– Immobilization lasting 6-8 weeks

64
Q

snowboarders ankle is caused from what

A

fracture of the lateral talar process

65
Q

greater odds of ankle injuries in what bone?

A

soft bone vs hard bone

66
Q

persistant lateral ankle pain is a sign of what?

A

snowboarders ankle (lateral talar process fracture)

67
Q

the achilles tendon is how long?

A

~ 15 cm

68
Q

the achilles tendon inserts where?

A

calcaneal tuberosity

69
Q

the achilles tendon spirals how many degrees? this results the gastroc fibers inserting ? and the soleal fibers inserting ?

A
  • 90 degrees
  • laterally
  • medially
70
Q

Common in sports and often occurs with sprains or excessive dorsiflexion

A

acute achilles strain

71
Q

sometimes you dont feel this injury right away (might just feel like you got kicked there)

A

acute achilles strain

72
Q

most severe achilles strain involves?

A

partial/complete avulsion or rupturing of the achilles

73
Q

management of acute achilles strain (4)

A

-Pressure and RICE should be applied
– After hemorrhaging has subsided an elastic wrap should continue to be applied
– Conservative treatment should be used as Achilles problems generally become chronic
– A heel lift should be used and stretching and strengthening should begin soon

74
Q

an inflammatory condition involving the tendon, sheath or paratenon

A

achilles tendinitis

75
Q

achilles tendinitis is referred to as ?

A

tenosynovitis

76
Q

Causes fibrosis and scaring that can restrict tendon motion in sheath
– May lead to tendinosis

A

achilles tendonitis

77
Q

typically does not present with inflammation, area has lost normal appearance, with cell disorganization/scarring and degeneration
-Tendon is overloaded due to extensive stress • Presents with gradual onset and worsens with continued use • Decreased flexibility exacerbates condition

A

achilles tendonitis

78
Q

a symptom of achilles tendonitis is generalized pain proximal to?

A

calcaneal insertion

79
Q

-Warm and painful with palpation, also presents with thickening
– May limit strength
– May progress to morning stiffness
-Crepitus with active PF & passive DF (can sometimes hear it)
– Chronic inflammation may lead to thickening

A

achilles tendonitis

80
Q

management of achilles tendonitis (4)

A

Resistant to quick resolution due to slow healing nature of tendon
– Must reduce stress on tendon, address structural faults (orthotics, mechanics, flexibility)
– Use anti-inflammatory modalities and medications
– Strengthening must progress slowly in order to not aggravate the tendon

81
Q

Occurs w/ sudden stop and go; forceful plantar flexion w/ knee moving into full extension
-generally has a history of chronic inflammation

A

achilles tendon rupture

82
Q

achilles tendon rupture is commonly seen in?

A

athletes >30 years old

83
Q 
Sudden snap (kick in the leg) w/ immediate pain which rapidly subsides 
– Point tenderness, swelling, discoloration; decreased ROM
A

achilles tendon rupture

84
Q

obvious indentation and positive thompson test

A

achilles tendon rupture

85
Q

an achilles tendon rupture occurs where?

A

2-6 cm proximal to the calcaneal insertion

86
Q

achilles tendon rupture management (4)

A

Usual management involves surgical repair
– Non-operative treatment: RICE, NSAID’s, & a non-weight bearing cast for 6 weeks, followed up by a walking cast for 2 weeks (75-90% return to normal function)
– Will never have full ROM
– Rehabilitation lasts about 6 months and consists of ROM, and wearing a 2cm heel lift in both shoes

87
Q

Susceptible to strain near musculotendinous attachment
– Caused by quick start or stop, jumping
– Muscular fatigues with fluid-electrolyte depletion & cramping

A

gastrocnemius strain

88
Q

Depending on grade, variable amount of swelling, pain, muscle disability
– May feel like being “hit in leg with a stick”
– Swelling, point tenderness and functional loss of strength

A

gastrocnemius strain

89
Q

management of gastrocnemius strain (3)

A

-RICE
– Grade 1 should apply gentle stretch after cooling
– Weight bearing as tolerated; use heel wedge to reduce calf stretching while walking

90
Q

Occurs in sports with dynamic forces being applied to the ankle

A

fibularis tendon sublaxation

91
Q

fibularis tendon sublaxation may be caused by a dramatic blow to the ? or moderate/severe ? ankle sprain resulting in tearing of ?

A

posterior lateral malleolus
inversion
fibularis retinaculum

92
Q

Complain of snapping in & out of groove with activity
– Resisted eversion replicates subluxation
– Recurrent pain, snapping and instability
– Present with ecchymosis, edema, tenderness, and crepitus over the tendon

A

fibularis tendon sublaxation

93
Q

management of fibularis tendon sublaxation (3)

A

-Compression with felt horseshoe
– RICE, NSAID’s and analgesics
– Rehab or surgery if conservative tx fail

94
Q

shin contusion results from ? affecting?

A

direct blow, periosteum

95
Q

Intense pain, rapidly forming hematoma w/ jelly like consistency

A

shin contusion

96
Q

management of shin contusion (4)

A

-RICE, NSAID’s and analgesics as needed
– Maintaining compression for hematoma
– Fit with doughnut pad and hard shell for protection
– If not managed appropriately may develop into osteomyelitis (deterioration of bone)

97
Q

muscle contusion of the lower leg is usually where ?

A

gastrocnemius

98
Q

-Bruise may develop, pain, weakness and partial loss of limb function
– Palpation will reveal hard, rigid, inflexible area due to internal bleeding and muscle guarding

A

muscle contusion

99
Q

management of muscle contusion

A

-Stretch to prevent spasm; apply cold compression and ice

– Wrap or tape will help to stabilize the area

100
Q

Occurs secondary to direct trauma • Medical emergency

A

acute compartment syndrome

101
Q

Acute exertional compartment syndrome evolves from?

A

acute compartment syndrome with minimal to moderate activity

102
Q

chronic compartment syndrome looks like?

A

symptoms arise consistently at certain point during activity

103
Q

-Complain of deep aching pain & tightness due to pressure and swelling
– Often bilateral
– Reduced circulation and sensation of foot occurs

A

compartment syndrome

104
Q

compartment syndrome often comes with reduced circulation and sensation of the?

A

foot

105
Q

compartment syndrome symptoms are relieved with?

A

cessation of exercise

activity related pain usually begins at a predictable time

106
Q

management of compartment syndrome (3)

A

-If severe acute or chronic case, may present as medical emergency that requires surgery to reduce pressure or release fascia
– Fasciotomy may be necessary if conservative measures fail
– RICE, NSAIDs and analgesics as needed

107
Q

pain in anterior portion of shin is a symptom of?

A

medial tibial stress syndrome

108
Q

Catch all for stress fractures, muscle strains, chronic anterior compartment syndrome

A

medial tibial stress syndrome

109
Q

medial tibial stress syndrome accounts for % of all running injuries, % of leg pain in athletes

A

10-15%, 60%

110
Q

-Caused by repetitive microtrauma
– Weak muscles, improper footwear, training errors, tight heel cord, hypermobile or pronated feet & forefoot dysfunction can contribute
– May also involve, stress fractures or exertional compartment syndrom

A

medial tibial stress syndrome

111
Q

4 grades of pain in MTSS (shin splints)

A

1) Pain after activity
2) Pain before and after activity and not affecting performance
3) Pain before, during and after activity, affecting performance
4) Pain so severe, performance is impossible

112
Q

there is increased pain of MTSS with active?

A

plantarflexion

113
Q

management of MTSS (shin splints) (6)

A

-Physician referral for X-rays and bone scan
– Activity modification
– Correction of abnormal biomechanics
– Ice massage to reduce pain and inflammation
– Flexibility program for gastroc-soleus complex
– Arch taping and or orthotics

114
Q

-Common overuse condition, particularly in those with structural and biomechanical insufficiencies
– Runners tends to develop in lower third of lower leg (dancers middle third)
– Often occur in unconditioned, non-experienced individuals
– Often training errors are involved
– Component of female athlete triad

A

stress fracture of the leg

115
Q

with a stress fracture of the leg, pain is more intense when?

A

after activity

116
Q

Point tenderness; difficult to discern bone and soft tissue pain – Bone scan results (stress fracture vs. periostitis)

A

stress fracture of the leg

117
Q

management of stress fracture of the leg (6)

A

-Discontinue stress inducing activity 14 days
– Use crutches for walking
– Weight bearing may return when pain subsides
– Cycling before running
– After pain free for 2 weeks patient can gradually return to running
– Biomechanics must be addressed

EPHE 344 (4 decks)

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