Lower Leg, Ankle and Foot Injuries Flashcards
“Shin Splints”
An umbrella term for a variety of lower leg pain. Tibial Contusion Medial Tibial Stress Syndrome Tibial Periostitis Tibial Stress Fracture
Tibial Contusion
Results from a direct contact with the tibia.
- Presentation
- Pain tenderness to palpation
- Local area of swelling
- Area of eccymosis
- Gait Disturbances
X-Ray to R/O (rule out) a fracture.
Treat conservatively with RICE
Medial Tibial Stress Syndrome
Medial Tibial Stress Syndrome (MTSS) is a general term used to describe a number of disorders including tendonitis in the following muscles:
- Tibialis Posterior
- Flexor Hallucis Longus
- Flexor Digitorum
Presentation:
- Pain and tenderness to palpation
- Local are of swelling
- Gait disturbances
MTSS Treament
Initially treat MTSS symptomatically
Address etiology
If symptoms persist R/O stress fracture.
Tibial Periostitis
Irritation of the periosteum of the tibia
Diagnosis is based on palpation
“Periostitis” is actual inflammation along the lining of the bone.
Presentation:
- Pain and tenderness to palpation
- Local area of swelling
- Gait disturbances
Treat initially symptomatically as well as with a reduction in weight bearing activity.
Graded return to activity.
Tibial Stress Fracture
Microscopic fractures in the bone Results from repeated microtrauma Presentation: -Pain and tenderness to palpation - Local are of swelling - Gait disturbances (especially with activity)
Stress Fracture: Diagnosis (x-ray and bone scan)
Plain x-rays are often inconclusive
- Low sensitivity (doesn’t always pick up fractures)
- High specificity (you know its a fracture)
Bone Scan
- High sensitivity (high metabolism or actual fracture)
- Low Specificity
Stress Fracture: Diagnosis (ct scan and MRI)
CT Scan:
- Useful in differential diagnosis
- Assists in identification of osteoid osteoma or osteomyolitis
MRI
- High sensitivity
- High specificity
- Expensive
Tibial Stress Fracture
Tibial Shaft is the most common site for stress factures
Careful history and evaluation necessary for differential diagnosis.
Tibial Stress Fracture: Treatment
RICE NSAID's Activity Reduction Address contributing factors - Biomechanical causes - Decreases in bone density - Menstrual/hormonal disturbances
Compartment Syndrome Types
Acute Compartment Syndrome
Exert Ional (Chronic) Compartment Syndrome
Acute Compartment Syndrome
Traumatic Injury Caused by: - Direct Trauma - Complication after surgery - Inappropriate immobilization
Acute Compartment Syndrome Signs and Symptoms
Inappropriate complaints of pain C/O dysthesia Muscle may feel "tight of full" Paralysis A medical emergency
Exert Ional Compartment Syndrome (ECS)
CC of lower leg pain and dysthesia (aching or cramping pain) during or immediately following activity.
Diagnosed with measurement of intramuscular pressure
- 80% involve the anterior and the deep posterior compartment
Treatment
Conservative management includes edema reduction and assessment of biomechanical causes
Surgical intervention: Fasciotomy.
“Return to Play Criteria”
Non-tender to palpation
Full and painless range of motion
Equal strength bilaterally with both flexion and extension
Successful completion of functional performance Testing
Deep Venous Trombosis
A term used to describe a clot formation in the deep veins of the leg.
Considered a serious condition because of the treat of an embolism (esp. pulmonary embolism)
Risk Factors Age Obesity Surgery Trauma Immobilization/Bed Rest
DVT Presentation and Treatment
Presentation
- Diffuse swelling throughout the lower leg
- Diffuse Discoloration (Redness)
- Generalized complaints of pain
Treatment
- Edema Reduction (elevation)
- Immediate Medical Referral*
- Anticoagulant medication
Return to play requires clearance from a physician.
Homan’s Sign is a DVT test (DON’T DO)
Fibular Fracture
MOI: Typically traumatic in nature
Presentation
- Local pain and tenderness along the lateral lower leg
- Local area of edema
- Deformity (maybe)
- Positive compression test/heel tap test
Ankle Sprain
Presentation
- local pain and tenderness along the lateral lower leg (could be medial if inversion vs. eversion)
- local area of edema (especially near the lateral malleolus
- Gait disturbances
Clinical Evaluation
- Anterior Drawer
- Talar Tilt Test.
Ankle Sprain Treatment
Conservative Management
- Rice
- Activity Restriction
- Graded return to activity
Syndesmotic Sprain
Injury tothe distal tibiofibular ligament
MOI: Similar to “inversion sprain”
Clinical Evaluation
-Overpressure with end range dorsiflexion
External rotation Test
Squeeze Test
Prognosis: Extended rehab timeline.
Pott’s Fracture
Avulsion fracture of the medial malleolus of the tibia with rupture of internal lateral ligaments
MOI: Displacement of the lower leg laterally and posteriorly while the foot is fixed.
Achillies Tendonitis/Tenosynovitis
Inflammation of the achillies tendon.
Typically an “overuse” injury.
Presentation
- Pain and tenderness in Achillies Tendon
- Increased complaints with weight bearing
Gait Deviations
Crepitus with AROM
Achillies Tendonitis/Tenosynovitis
RICE
Activity Reduction
Prophylactic Taping
Graded return to activity
Sever’s Disease
Apophysitis of the Achillies Tendon
Affects the Calcanue-s in growing children ( years)
Associated with running and jumping activities.
self Limiting disorder.
Treated with activity reduction and bracing.
Achillies Tendon Rupture (Risk Factors and MOI)
Risk Factors
- Poor conditioning/flexibility
- Advanced age
- Over-exertion
MOI: Sudden eccentric Force.
Treatment and Presentation for Achillies Rupture
Presentation: HPI: "Sudden pop" "severe" comlaints of pain. Significant gait disturbances Palpable defect Inability to plantar flex the foot
Clinical Evaluation
Tompson Test
Surgical Repair is required.
Heel Contusion
MOI: Blunt trauma to the plantar surface.
Presentation
- Tenderness o palpation
- eccymosis
- Gait Disturbances
R/O Fracture
Treatment:
RICE
Padding
Plantar Fasciitis
Inflammaroty condition of the plantar fascia
Irritation at the insertion to the medial calcaneal tuberosity
Number of biomechanical risk factors such as:
- leg length discrepancy
- excessive pronation
- “tightness” in triceps surae muscle group.
Plantar Faciitis Presentation
Pain and tenderness over the medial calcaneal tuberosity.
Gait disturbances
“Movie Goer’s Sign”
Treatment for Plantar Faciitis
RICE NSAID's Address the cause: -Training Errors -Decreased Flexibility
Heel Spur
Bony Protrusion anteriorly from calcaneus
Secondary to abnormal pull of plantar fascia
Treatment:
Orthotics
Padding
Surgical Removal
Os Trigonum
Accessory Ossification Center
Located in the posterior border of the talus
May lead to:
- Talar compression syndrome
- Tarsal tunnel syndrome
Signs And Symptoms may be simliar to Achillies Tendonitis
Sesamoiditis
Inflammation of the tendons and tissue surrounding the sesamoid bones of the foot.
Symptoms
_Pain and tenderness
-Pain with extension of the great toe.
Sesamoiditis Treatment
RICE
Assess Shoe Wear
Address any biomechanical or aggravating activities
Surgery is very rare
Tarsal Tunnel Syndrome
Entrapment of the tibia nerve in the tarsal tunnel.
Causes:
Biomechanical causes
Cyst
Post-Traumatic Scaring
Tarsal Tunnel Treatment
RICE for symptomatic relief NSAID's Steroid Injection Address any biomechanical factors Surgery consist of cutting the lancinate ligament
Sinus Tarsi Syndrome
Impingement of the structures within the sinus tarsi
Causes:
Cyst
Post-Traumatic Scarring
Complications following inversion sprains
Sinus Tarsi Syndrome Clinical Presentation
Pain over lateral sinus tarsi, which decreases with rest
Perception of instability of rearfoot over uneven surfaces
Sinus Tarsi Syndrome Clinical Presentation
Steroid Injections
Address biomechanical deficits
Surgical excision of tissue filling sinus tarsi
Retrocalcaneal Bursitis
Inflammation of the retrocalcaneal bursa
Sympotoms:
Increased inflammation on the skin over the calcaneus
Icreased symptoms while rising up onto toes.
Risk Factors of Retrocalcaneal Bursitis
Repetitive use of the ankle
Excessive walking, running or jumping
Treatment of Retrocalcaneal Bursitis
RICE
NSAID’s
Rarely surgery may be required to excise bursa
Callus
Caused by pressure and friction against the skin
Callus Treatment
Padding
Modify Shoes
Shaving Callus
Plantar Wart
A Infection caused by a virus which can invade your skin through small cuts or breaks.
They appear as a spongy type tissue with tiny reddish brown or black spots
Plantar Wart Treatments
Cryosurgery
Prescription medication
Surgical Removal
Jones Fracture
Jones Fractures occur in the small area of the fifth metatarsal that receives less blood and is therefore more prone to injury.
Stress Fx -occurs more distally on the head of the metatarsal.
Jones Fx - occur in the middle area of the head
Avulsion Fx - Occurs at the distal end of the head
Phalanx Fracture Management
RICE
Support padding for activity
ORIF may be required for bony displacement
Hallux Valgus
Deviation of the great toe toward the fibular border of the foot.
Hallux Valgus angle
-Normal 5-10*
-Pathologic > or = to 20*
This in not the same as a Bunion
Hallux Valgus Is caused by?
Congenital
Atavistic TMT Joint
Shoe Wear.
Bunion
A Bunion is not synonymous with hallux valgus.
Bunion is derived from the same root as “bun” or “bunch”, and means an area of swelling.
In connection with the foot, bunion usually erfers to the prominant medial portion of the first metatarsal head and especially to the bursa or a bursa plus osteophyte over it, when this exist. A bursa and/or osteophyte may or may not accompany hallux valgus.
Hallux Valgus Treatment
Pad and protect
Address biomechanical components
Surgery
