Lower leg, foot and ankle Flashcards
1
Q
What are painful syndromes found at the ankle, foot and leg?
A
Ankle sprains Ankle fracture & dislocation Excessive pronation and supination Stress fractures Plantar fascitis Compartment syndrome Achilles tendonitis Achilles rupture
2
Q
What is the most common ankle sprain?
A
Inversion sprain
3
Q
What ligaments are injured in an inversion ankle sprain?
A
Lateral ligaments
- ATFL (weakest and most likely injured)
- PTFL (rarely injured)
- CFL (injured with greater inversion motion)
4
Q
What is also essential to take into consideration with an ankle sprain?
A
fracture
5
Q
What ligaments are damaged with a eversion sprain?
A
Deltoid ligament
6
Q
Rather than an eversion sprain what is more likely to happen?
A
An avulsion of the tibia before the deltoid tears
7
Q
Which sprain is worse eversion or inversion? which takes more recovery time?
A
Eversion more severe and longer recovery
8
Q
What is considered a high ankle sprain?
A
Syndesmotic sprain
9
Q
What ligaments are involved in a high ankle sprain?
A
Anterior and posterior tibiofibular ligaments
10
Q
Do high ankle sprain have a long or short recovery period?
A
longest
11
Q
What rehab do you do in the acute phase for an ankle sprains?
A
PRICE
injured ligaments must be held in a stable position to allow healing
NWB or PWB
PWB–> reduces muscle atrophy and improves circulation, prevents loss of proprioception, inhibits contracture development
12
Q
What does a ligament need to heel properly?
A
- stress
- early, limited stress AFTER the initial inflammatory response may promote faster healing and stronger healing
- facilitates proper collagen orientation
13
Q
During the acute phase of rehab strengthening should also be initiated at?
A
thigh, buttocks core strengthening and cardiorespiratory fitness
14
Q
What should be done in the early phase (acute) of ankle rehab?
A
ROM
- dorsiflexion and plantarflexion
* AAROM
* Stretching - Minimize eversion and inversion
* As pain decreases–> initiate inversion and eversion exercises
* BAPS or similar device to regain neuro control
15
Q
When can isometrics be initiated with ankle sprains?
A
Early- pain free, avoid compensation with tibial rotation
16
Q
Should dorsiflexion and plantar flexion be initiated before inversion and eversion isometrics?
A
yes, dorsiflexion and plantar flexion should be first
17
Q
What is the progression of strengthening in ankle sprains?
A
Weight bearing
-progress seated to standing
-balance
Activity specific
18
Q
What is tendinopathy?
A
Tendon injury that happens when the tendon becomes painful or torn
19
Q
What causes tendinopathy of the tibialis posterior and tibialis anterior?
A
Foot mechanics
Footwear
Changes in training
Requires complete lower extremity evaluation
20
Q
How long does it take acute tendinopathy to resolve?
A
about 2 weeks
21
Q
How long does it take to resolve chronic tendinopathy?
A
May take months
Tendon thickens and remodeling must occur
22
Q
What type of exercise progression for tendinopathy?
A
Pain free strengthening
Pain that does not resolve 24-48 hrs
-tast was too aggressive
23
Q
Ankle fractures and dislocations have a similar MOI to?
A
Ankle sprains
24
Q
Are dislocations common?
A
No, they are rare
usually require surgical intervention
25
Medial malleoli fractures may be accompanied by?
lateral ligament sprain
26
Lateral malleoli fractures may be accompanied by?
medial ligament sprain
27
What is a non displaced fracture?
nothing is out of place
28
How do you rehab a nondisplaced fracture?
PRICE
| Subacute--AAROM, AROM, isometrics, stretching, OKC
29
How to rehab a nondisplaced fracture in the repair phase?
CKC, balance exercise
| return to exercise activites
30
What is a displaced fracture?
Something is out of place
| Requires open reduction and internal fixation (surgical fixation and realignment)
31
Rehabilitation for displaced fractures?
NWB initially (follow surgical preferences)
-surgical healing about 6 weeks
Initiate stretching, AAROM, AROM (pain free)
Proximal strengthening and endurance
Progress to CKC, balance
32
When does excessive supination or pronation occur?
May occur as a compensation for an existing structural deformity
- subtalar or calcaneal varus
- excessive pronation to put foot on the ground
33
Forefoot varus is?
excessive pronation
34
Forefoot valgus is?
excessive supination
35
Excessive, delayed or prolonged pronation may cause?
Major cause of stress injuries during running
Compensatory STJ motion
-MTJ remains unlocked
-increased tibial rotation excursion
-will not allow foot to supinate in time to act as a rigid lever for push off (less power and efficiency)
36
Problems with excessive pronation?
Bunions
Stress fractures of 2nd MT
Tendonitis---->achilles, peroneal, tibialis post., ITB
37
Excessive supination at heel strike?
STJ will not allow MTJ to unlock
- foot remains too rigid
- can not absorb shock efficiently, limits tibial IR
38
Excessive supination injuries?
```
Tibial stress syndrome
MT stress fractures
Tendinitis-achilies, peroneal, ITB
Greater trochanteric bursitis
inversion ankle sprain
```
39
The cause of excessive foot pronation and supination is always the foot? (T/F)
FALSE
| but in order for the body to put the foot on the ground, excessive pronation or supination may occur
40
Genu varum
subtalar pronation to get the foot on the ground
41
Genu Valgus
subtalar pronation is forced because knee position
42
Ankle Joint Equinus
Loss of talocrural joint motion (loss of DF)
Compensation at MTJ
-increased pronation
-forefoot pain
-more often seen in folks with high arches
43
What is forefoot varus?
Medial MT heads inverted relative to the plane of the calcaneus
- -cause excessive pronation
- -In stance, foot must get to the floor, compensated with talus rolling down the calcaneus everting
44
What is forefoot valgus?
Lateral MT heads everted relation to the plane of the calcaneus
45
What is calcaneal varus?
STJ must pronate
46
First ray mobility resting postion?
Neutral or PF is most common
47
Is you lack great toe extension how do you compensate?
```
Forefoot abduction and ER at the hip (inefficient push off)
Short strides (reduced DF, early knee flexion, decreased hip extension)
```
48
Can you correct the faulty biomechanics that are due to the structural deformity?
Not necessarily
- orthodics
- appropriate footwear
- pt treatment
- educate
49
What is chronic exertional compartment sydrome?
Aching or burning pain in the affected limb (ant)
- usually the leg
- may have numbness or tingling
- weakness---anterior compartment will have drop foot
50
When does chronic exertional compartment syndrome start?
Begins at start of exercising
- worsens as exercise continues
- stops shortly after exercise stops
51
What causes chronic exertional compartment syndrome?
Inefficient or excessive exercise
Pressure builds and occludes blood flow and nerve signals
52
What occurs with chronic exertional compartment syndrome?
Tissues naturally swell with exercise or mild injury
- excess swelling due to overuse
- fascia can not explain to accommodate the volume
53
What is acute compartment syndrome?
Medical emergency
develops within hours of a reverse injury
-leg or forearm
54
How is a stress fracture to the navicular caused?
- Excessive pronation during running
| - Compensated calcaneal or forefoot varus (or both)
55
How is a stress fracture to the 2st MT caused?
- Excessive pronation (calcaneal varus or forefoot varus or both
- Training errors
- Inappropriate shoes
56
How is a stress fracture to the 5th MT caused?
- Overuse
- Acute inversion
- High velocity rotation (forefoot valgus or rigid, plantar flexion big toe)
57
How do you rehab stress fractures?
-Determine the precipitating cause and alleviating them
58
How do you rehab navicular and 5th MT fractures?
-May require NWB
59
How do you rehab 2nd MT fractures?
- Modified rest and WE TE’s
- Transition to full impact WB exercises
- pool running ->elliptical-> treadmill running-> overground running
60
What can heel pain be caused by?
- Spurs
- Plantar fascia irritation
- Bursitis
61
What does pain in the proximal arch and heel indicate?
-possible plantar fasciitis problem
62
What can cause plantar fasciitis?
- Subtalar joint pronation
- Lack of flexibility of arch
- Gastroc-soleus restrictions
- Shoe wear
- Over striding
63
Explain plantar fasciitis?
- Tension on the fascia
| - pronated foot more prone to problems
64
How do you rehab plantar fasciitis?
- Orthotics
- Proper footwear
- Taping
- Modalities
- Appropriate PT (flexibility and strengthening)
65
How is the success rate for total ankle replacement?
Very fucking low
66
What is arthrodesis?
- fusion of the tibiotalar joint
- used in severe OA
- fused at 0 deg DF
67
Who is achillies rupture common in?
younger than 50 active people
68
What do you do if you rupture the achillies tendon?
surgical intervention needed for higher level functioning
69
How do you know if someone is an over pronator based on their shoes?
they wear our the front under the 2nd MT head
70
How do you know if someone is a normal rear foot striker based on their shoes?
wear lateral edge of the heel
71
Is the runner placing exceptional torsion on the shoe through the midfoot? how do you know?
- put shoe on flat surface and push down on the toe box
| - veers medially or laterally indicated torsion with running
72
How do you fix torsion?
-may need a more stable shoe or orthotic
73
How do you know if someone needs new shoes?
- bend shoe in half
- if you can touch toe to heel, no longer has good structural integrity
- cushion property broken down
74
How do you check the structural stability of the shoe?
- bend shoe in figure 8 pattern
| - if it bends a lot the structural integrity is broken down
75
If someone pronates what type of shoes should they get?
- firmer shoe
| - rearfoot control
76
If someone supinates what type of shoes should they get?
adequate cushion and flexibility
77
What position does the foot function most efficiently in?
subtalar joint neutral
78
What do orthotics do?
- provide support so the foot does not move abnormally
| - create a biomechanically balanced kinetic chain
79
Describe biomechanical orthosis?
-hard or semi flexible capable of controlling movement related pathology by attemping to guide the foot into functiong at or near subtler joint neutral
80
Describe accommodative orthosis?
- allows foot to compensate (malformations)
| - medial or lateral wedge to accommodate deformity
81
How do you correct bad technique or compensation?
- what are they doing wrong?
- what do you want them to do?
- what needs to be done to correct what they are doing? (take pictures, new instructions, give them new pics)
82
What do you look specifically for the form of a patient?
- stabilization appropriate
- position of patient is appropriate
- resistance occurring in proper plane of motion
- change the resistance?
83
how do you document?
- what did the you or the patient do?
- how did you do it
- how many reps
- patient position
- equipment used
84
what is the purpose of self stretching?
to improve ROM
85
Techniques of self stretching?
- techniques (static or dynamic)
- position (supine, sidelying, standing)
- device (wall, cane, table)
- Dose (no convention or standard established in the literature)
- make sure you document
86
What is the purpose of isometric exercises?
- loss of strength occurs rapidly with disuse, immobilization, surgery
- minimize atrophy when movement is not possible
- dynamic strengthening not possible
- facilitate muscle firing
- require endurance (postural or joint stability)
- post-op surgical
- improve volitional muscle activation
87
Ways to strengthen the stupid foot?
- weights (cuff and elgin)
- therabands
- OKC
- CKC
88
what can you do for balance and proprioceptive training?
- firm
- foam
- BOSU
- rockerboard
- rollerboard
89
what do you do if a patient is doing an exercise with a theraband and they are doing it in the wrong plane?
you change the resistance
