Lower Leg conditions Flashcards
What is the most commonly fractured long bone in the body?
tibia
What is the MOI of fibular fractures?
Trauma in combo with tibial Fx
What is the presentation of tibial Fx?
pain, swelling, possible deformity
What is the presentation of fibula Fx?
TTP and pain with ambulation
How long is rehab for a non-displaced tibial Fx?
10-13 weeks
How long is rehab for a displaced tibial Fx?
16-26 weeks
How long is rehab for a fibula Fx?
4-6 weeks
What is the common location on the tibia that tibial STRESS Fx occur?
mid-anterior aspect (jumping) and posteromedial aspect of the tibial shaft
What is the MOI of tibial/fibular stress Fx?
- repetitive loading during training that the bone cannot adapt to
- WB training
What is the presentation of an anterior tibial stress Fx?
- activity relieved with rest
- anterior pain
What is the presentation of a posteromedial tibial stress Fx?
- pain over the distal 1/3
- gradual symptom onset
- TTP
What is the presentation of a fibular stress Fx?
- pain/TTP on the distal 1/3 of the bone
What are rehab concerns for tibial and fibular stress Fx?
- stop activity IMMEDIATELY
- pt education on rest and stress significance
- maintain CV fitness with stationary cycling and water walking
- address footwear
- address imbalances
What type of tibial stress Fx take longer to heal and has a high prevalence of continued issues?
Mid-anterior tibial stress Fx
- short leg cast for 6-8 weeks
- surgery
definition: increased pressure within a fixed osteofascial compartment causes compression of muscular and neurovascular structures within the compartment
compartment syndrome
What happens to venous and arterial flow with compartment syndrome?
They stop (venous then arterial)
What is the presentation of acute compartment syndrome?
- deep aching pain
- tightness
- swelling of involved compartment
- reduction on foot pulses
- sesnory change with involved nerve
What are aggs for acute compartment syndrome?
Passive stretching of involved muscles
What confirms a Dx for compartment syndrome?
intracompartmental pressure
What is the definitive treatment for acute compartment syndrome and acute exertional compartment syndrome?
emergency fasciotomy
What type of compartment syndrome occurs without any precipitating trauma and evolves with minimal to moderate activity?
Acute exertional compartment syndrome
What type of compartment syndrome Is activity-related in that the symptoms arise rather consistently at a certain point in the activity?
chronic compartment syndrome
What is the presentation of chronic compartment syndrome?
- sensation of pain and tightness
- swelling of affected compartment that resolves with stopping activity
What compartments most commonly have chronic compartment syndrome?
Anterior and deep posterior
Do males or females respond better to fasciotomies to treat compartment syndrome?
males
Anterior compartment fasciotomy patients may not return to full activity until ___-___ weeks after surgery
8-12 weeks
Deep posterior compartment fasciotomy patients may not return to full activity until ___-___ weeks after surgery
3-4 weeks
What is the most common muscle strain in the lower leg?
Gastrocnemius
What is the typical patient presentation with a gastrocnemius muscle strain?
- feel/hear a pop
- pain
- may not be able to walk due to DF stretch and no push-off
- TTP/divot may be present if there’s a rupture
definition: a condition that involves increasing pain about the distal two-thirds of the posterior medial aspect of the tibia.
Medial tibial stress syndrome (Shin splints)
What is the presentation of medial tibial stress syndrome?
- diffuse pain on the distal medial tibia and surrounding soft tissues
- excessive PRON
- tender
- may ONLY hurt after a workout
- pain with daily ambulation
- morning pain and stiffness
What is the MOI of medial tibial stress syndrome?
greater tensile loads
- excessive/rapid PRON
- PRON at wrong time in stance phase
- rearfoot and forefoot varus
- overuse of PF
How long should a person with medial tibial stress syndrome not run or jump?
7-10 days
definition: inflammatory condition that involves the Achilles tendon and/or its tendon sheath
achilles tendinitis
What is the typical presentation of achilles tendinitis?
- pain and stiffness
- agg with uphill running/hill workouts/interval training
- reduced gastroc and soleus flexibility
- muscle testing can be WNL but can present with pain
- gradual onset
- stiffness and discomfort with gait after prolonged sleeping and sitting
- excessive compensatory PRON
What is the largest tendon in the body?
achilles
What does the achilles tendon do?
transmits force from gastroc and soleus to the calcaneus
Tension through the achilles tendon in terminal stance is ____% of body weight
250%
Where is the typical location of an achilles tendon rupture?
2-6 cm proximal to the calcaneal insertion (avascular site)
What is the typical presentation of an achilles tendon rupture?
- popping
- PF is painful and limited
- palpable defect
(+) thompson
What are the MOIs for achilles tendon ruptures?
- sudden, forceful PF of the ankle (jumping/running)
- associated compensatory PRON for STJ
- inflexibile gastroc-soleus complex
- fatigue
Those with an achilles tendon rupture should be immobile for the first __–___ weeks post-op
6-8 weeks
definition: is a disc-shaped sac that lies between the Achilles tendon and the superior tuberosity of the calcaneus
retrocalcaneal bursa
What is the presentation of retrocalcaneal bursitis?
- gradual onset
- pain with AROM/PROM of ankle DF
- RELIEF with PF
- painful during gait due to DF in the midstance of gait and muscle activity of the PFs during push-off
What causes retrocalcaneal bursitis?
- loading the foot and ankle in repeated DF
- structural abnormalities
