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AT 500 > Lower Leg, Ankle and Foot Injuries > Flashcards

Lower Leg, Ankle and Foot Injuries Flashcards

1
Q

“Shin Splints”

A 
An umbrella term for a variety of lower leg pain.
Tibial Contusion
Medial Tibial Stress Syndrome
Tibial Periostitis
Tibial Stress Fracture
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2
Q

Tibial Contusion

A

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

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3
Q

Medial Tibial Stress Syndrome

A

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
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4
Q

MTSS Treament

A

Initially treat MTSS symptomatically
Address etiology
If symptoms persist R/O stress fracture.

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5
Q

Tibial Periostitis

A

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.

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6
Q

Tibial Stress Fracture

A 
Microscopic fractures in the bone
Results from repeated microtrauma
Presentation:
-Pain and tenderness to palpation
- Local are of swelling
- Gait disturbances (especially with activity)
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7
Q

Stress Fracture: Diagnosis (x-ray and bone scan)

A

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
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8
Q

Stress Fracture: Diagnosis (ct scan and MRI)

A

CT Scan:

  • Useful in differential diagnosis
  • Assists in identification of osteoid osteoma or osteomyolitis

MRI

  • High sensitivity
  • High specificity
  • Expensive
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9
Q

Tibial Stress Fracture

A

Tibial Shaft is the most common site for stress factures

Careful history and evaluation necessary for differential diagnosis.

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10
Q

Tibial Stress Fracture: Treatment

A 
RICE
NSAID's
Activity Reduction
Address contributing factors 
- Biomechanical causes
- Decreases in bone density
- Menstrual/hormonal disturbances
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11
Q

Compartment Syndrome Types

A

Acute Compartment Syndrome

Exert Ional (Chronic) Compartment Syndrome

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12
Q

Acute Compartment Syndrome

A 
Traumatic Injury
Caused by:
- Direct Trauma
- Complication after surgery
- Inappropriate immobilization
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13
Q

Acute Compartment Syndrome Signs and Symptoms

A 
Inappropriate complaints of pain
C/O dysthesia
Muscle may feel "tight of full"
Paralysis
A medical emergency
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14
Q

Exert Ional Compartment Syndrome (ECS)

A

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.

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15
Q

“Return to Play Criteria”

A

Non-tender to palpation
Full and painless range of motion
Equal strength bilaterally with both flexion and extension
Successful completion of functional performance Testing

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16
Q

Deep Venous Trombosis

A

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
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17
Q

DVT Presentation and Treatment

A

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)

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18
Q

Fibular Fracture

A

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
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19
Q

Ankle Sprain

A

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.
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20
Q

Ankle Sprain Treatment

A

Conservative Management

  • Rice
  • Activity Restriction
  • Graded return to activity
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21
Q

Syndesmotic Sprain

A

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.

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22
Q

Pott’s Fracture

A

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.

23
Q

Achillies Tendonitis/Tenosynovitis

A

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

24
Q

Achillies Tendonitis/Tenosynovitis

A

RICE
Activity Reduction
Prophylactic Taping
Graded return to activity

25
Q

Sever’s Disease

A

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.

26
Q

Achillies Tendon Rupture (Risk Factors and MOI)

A

Risk Factors

  • Poor conditioning/flexibility
  • Advanced age
  • Over-exertion

MOI: Sudden eccentric Force.

27
Q

Treatment and Presentation for Achillies Rupture

A 
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.

28
Q

Heel Contusion

A

MOI: Blunt trauma to the plantar surface.

Presentation

  • Tenderness o palpation
  • eccymosis
  • Gait Disturbances

R/O Fracture

Treatment:
RICE
Padding

29
Q

Plantar Fasciitis

A

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.
30
Q

Plantar Faciitis Presentation

A

Pain and tenderness over the medial calcaneal tuberosity.
Gait disturbances
“Movie Goer’s Sign”

31
Q

Treatment for Plantar Faciitis

A 
RICE
NSAID's
Address the cause:
-Training Errors
-Decreased Flexibility
32
Q

Heel Spur

A

Bony Protrusion anteriorly from calcaneus

Secondary to abnormal pull of plantar fascia

Treatment:
Orthotics
Padding
Surgical Removal

33
Q

Os Trigonum

A

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

34
Q

Sesamoiditis

A

Inflammation of the tendons and tissue surrounding the sesamoid bones of the foot.

Symptoms
_Pain and tenderness
-Pain with extension of the great toe.

35
Q

Sesamoiditis Treatment

A

RICE
Assess Shoe Wear
Address any biomechanical or aggravating activities
Surgery is very rare

36
Q

Tarsal Tunnel Syndrome

A

Entrapment of the tibia nerve in the tarsal tunnel.

Causes:
Biomechanical causes
Cyst
Post-Traumatic Scaring

37
Q

Tarsal Tunnel Treatment

A 
RICE for symptomatic relief
NSAID's
Steroid Injection
Address any biomechanical factors 
Surgery consist of cutting the lancinate ligament
38
Q

Sinus Tarsi Syndrome

A

Impingement of the structures within the sinus tarsi

Causes:
Cyst
Post-Traumatic Scarring
Complications following inversion sprains

39
Q

Sinus Tarsi Syndrome Clinical Presentation

A

Pain over lateral sinus tarsi, which decreases with rest

Perception of instability of rearfoot over uneven surfaces

40
Q

Sinus Tarsi Syndrome Clinical Presentation

A

Steroid Injections
Address biomechanical deficits
Surgical excision of tissue filling sinus tarsi

41
Q

Retrocalcaneal Bursitis

A

Inflammation of the retrocalcaneal bursa

Sympotoms:
Increased inflammation on the skin over the calcaneus
Icreased symptoms while rising up onto toes.

42
Q

Risk Factors of Retrocalcaneal Bursitis

A

Repetitive use of the ankle

Excessive walking, running or jumping

43
Q

Treatment of Retrocalcaneal Bursitis

A

RICE
NSAID’s
Rarely surgery may be required to excise bursa

44
Q

Callus

A

Caused by pressure and friction against the skin

45
Q

Callus Treatment

A

Padding
Modify Shoes
Shaving Callus

46
Q

Plantar Wart

A

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

47
Q

Plantar Wart Treatments

A

Cryosurgery
Prescription medication
Surgical Removal

48
Q

Jones Fracture

A

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

49
Q

Phalanx Fracture Management

A

RICE
Support padding for activity
ORIF may be required for bony displacement

50
Q

Hallux Valgus

A

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

51
Q

Hallux Valgus Is caused by?

A

Congenital
Atavistic TMT Joint
Shoe Wear.

52
Q

Bunion

A

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.

53
Q

Hallux Valgus Treatment

A

Pad and protect
Address biomechanical components
Surgery

AT 500 (4 decks)

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