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KIN 3160 > lower limb, ankle, & foot injuries > Flashcards

lower limb, ankle, & foot injuries Flashcards

1
Q

what should you look for in lower limb posture analysis (static)

A
  • look for symmetry
  • alignment: shoulders, ASIS, achilles, etc.
  • muscle contracture - tension through muscles
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2
Q

what should you look for in gait analysis (dynamic)?

A

look for functional work

  • how does the muscle look when you move
  • general stride length - symmetric
  • stride width
  • time spent on each leg
  • normal movement through each phase
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3
Q

coxa vara - def

A

deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees

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4
Q

coxa valga - def

A

deformity of the hip where the angle formed between the head and neck of the femur and its shaft is increased, usually above 135 degrees

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5
Q

at which angle does the head of the femur normally sit in the acetabulum?

A

typically between 125 and 140 degrees

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6
Q

femoral anteversion - def

A

inward twisting of the femur

-toed in position

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7
Q

femoral retroversion - def

A

femoral neck is rotated backward on the femoral shaft

-toed out position

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8
Q

femoral ante/retroversion can come from _____ or ____ rotation

A

hip, tibial

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9
Q

patella alta - def

A

unusually small knee cap (patella) that develops out of and above the joint

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10
Q

patella baja - def

A

abnormally low lying patella

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11
Q

genu recurvatum - def

A

deformity in the knee joint, so that the knee bends backwards
-aka hyperextension

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12
Q

internal tibial torsion -def

A

inward twisting of the tibia

-toed in position

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13
Q

external tibial torsion - def

A

outward twisting of the tibia

-toed out position

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14
Q

pes cavus - def

A

-abnormally high arch in the foot

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15
Q

pes planus - def

A

-collapsed arch of the foot

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16
Q

tibial contusion - etiology

A
  • prone to severe contusions due to lack of adipose and muscular padding
  • can palpate all along the anterior border
  • repetitive blows can result in periosteum damage
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17
Q

S&S of tibial contusion

A
  • hematoma

- inflammatory phase - POLICE

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18
Q

what are possible secondary conditions of tibial contusions?

A

-osteomyelitis, anterior compartment syndrome, tibial fracture

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19
Q

tibial contusion management

A

POLICE and protect upon RTP

Key: PREVENTION - or prevent re occurrence

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20
Q

gastroc contusion - S&S

A
  • hemorrhaging and muscle spasm quickly lead to a tender, firm mass that is easily palpable - similar to quad contusion
  • immediate pain and weakness (when contraction or pushing off during walk)
  • myositis ossificans - not as common in calf
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21
Q

gastroc contusion - management

A
  • POLICE - ice and compression with muscle stretch
  • gentle ROM and stretching exercises - minimize scar tissue
  • if it does not improve in 2-3 days - ultrasound may be used to assist in breaking up the hematoma
  • gentle massage to bring blood up towards body - gravity will pull it down; wrap distal to proximal, same with massage
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22
Q

compartment syndrome is usually involved in which compartments of the leg?

A

anterior and deep posterior

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23
Q

what are the 4 compartments of the leg and what are their functions

A

1) anterior: dorsiflexion
2) lateral: eversion
3) superficial posterior: plantar flexion - power muscles
4) deep posterior: plantar flexion and inversion

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24
Q

what are the 3 different types of compartment syndrome?

A

1) acute - from a direct blow
- intense swelling, distal pulse diminished, compromised vasculature and nerves, numbness and tingling
2) acute exertional - minimal to moderate activity
- build up of pressure
3) chronic - symptoms develop when activity stops

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25
Q

management of acute compartment syndrome

A
  • acute - ice and elevation
  • CONTRAINDICATIONS: compression - do not wrap
  • chronic - activity modification and stretching
  • fasciotomy in a medial emergency (Acute) or failed conservative treatment (Chronic)
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26
Q

why are eversion ankle sprains less common than inversion?

A

due to bony and ligamentous support on the medial side of the foot
-an avulsion fracture will often occur rather than a deltoid ligament sprain

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27
Q

which takes longer to heal? inversion or eversion ankle sprain?

A
  • eversion

- because of possible secondary avulsion fracture and the fact that it’s a larger and stronger ligament

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28
Q

grade ___ or ____ eversion ankle sprains produce significant ankle instability and weakness in the medial longitudinal arch

A

2, 3

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29
Q

management of eversion ankle sprain

A
  • POLICE
  • strength, balance/agility exercises
  • progress to functional movement, static is good but not relevant to sport
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30
Q

syndesmosis “high ankle” sprain - MOI

A
  • DF and external rotation
  • results in damage to anterior and/or posterior tibiofibular ligaments
  • interosseous membrane affected in more severe injuries
  • often misdiagnosed
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31
Q

S&S of high ankle sprain

A
  • severe and prolonged pain

- ankle and anterolateral leg, increased with passive external rotation and DF

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32
Q

what special test can be used to diagnose high ankle sprains?

A

Kileger’s and squeeze test

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33
Q

management of high ankle sprain

A
  • prolonged NWB with crutches or walking boot
  • delayed return to functional activities
  • NM control and proprioception important
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34
Q

ottawa ankle rules

A
  • clinically very difficult to differentiate a # from a severe sprain without an x-ray unless there is obvious deformity
  • ottawa rules introduced in 1992 to reduce the number of unnecessary xrays, while at the same time minimizing the number of #’s missed - have been validated; 97.8% sensitivity
  • ankle xray is only required if there is any pain in the malleolar zone and bone tenderness posterior edge or tip of LM and MM; inability to WB both immediately and in the ER
  • foot xray is required if there is any pain in the mid-foot zone and tenderness at the base of the 5th MT or navicular; inability to WB both immediately and in the ER
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35
Q

fractures of the tibia/fibula; transverse, linear, oblique, or spiral - MOI

A
  • direct blow or twisting with foot planted

- tibia most common at middle 1/3; fibular most common at distal 1/3

36
Q

avulsion fractures of the tibia/fibula - MOI

A
  • 2nd or 3rd degree inversion or eversion sprain

- medial or lateral malleolus

37
Q

cuboid subluxation is often a secondary condition to _______

A

inversion ankle sprains

38
Q

S&S of cuboid subluxation

A
  • pain on anterior/lateral ankle and along 4th and 5th MT
  • refers pain to heel (often confused with plantar fasciitis)
  • pain increases with standing after prolonged NWB period
  • pain due to stress on fibularis longus muscle when foot is pronated
39
Q

management of cuboid subluxation

A
  • manual manipulation offers immediate pain relief and able to RTP
  • tape or orthotic to minimize chance of recurrence
40
Q

Lisfranc injury - etiology

A

tarsometatarsal fracture/dislocation

  • dorsal displacement of the proximal end of the metatarsals
  • uncommon injury, but causes long-term disability
41
Q

Lisfranc injury - MOI

A
  • ankle locked in PF; forces hyper-plantar flexion of forefoot
  • dorsum of foot rolls forward with BW providing force to displace MTs dorsally
42
Q

S&S of Lisfranc injury

A
  • can be relatively subtle
  • pain and inability to FWB
  • swelling and tenderness over dorsum of foot
43
Q

management of Lisfranc injury

A
  • POLICE - splint and NWB with crutches
  • physician referral
  • assess for MT fractures and joint sprains
  • open reduction with internal fixation often required
44
Q

what is a potential complication of a Lisfranc injury?

A

metatarsalagia

45
Q

metatarsalagia - def

A
  • general term describing pain under the ball of the foot
  • commonly pain under 2nd or 3rd metatarsal head
  • flattened transverse arch and depressed MT heads
46
Q

there are many causes to metatarsalagia, but what are the common ones?

A
  • limited extensibility of the gastroc-soleus complex

- fallen metatarsal arch

47
Q

management of metatarsalagia

A
  • padding behind metatarsal heads to elevate depressed heads
  • stretching gastroc-soleus complex
  • strengthening tow flexors and intrinsic foot muscles
48
Q

intrinsic causes for metatarsalagia

A
  • excessive body weight
  • limited extensibility of G-S complex
  • fallen MT arch
  • valgus heel
  • pes planus or pes cavus
49
Q

extrinsic causes for metatarsalagia

A
  • narrow toe box
  • improperly placed shoe cleats
  • improper technique
  • landing incorrectly from a height
  • repetitive jumping or excessive running
  • running style puts undue pressure on forefoot
50
Q

morton’s neuroma - def

A
  • mass about the common plantar nerve sheath between the 3rd and 4th metatarsal heads
  • nerve is the thickest at the point where it divides into the 2 digital branches
51
Q

S&S of Morton’s neuroma

A
  • burning paresthesia and severe intermittent pain in forefoot and radiating to the toes
  • collapse of the transverse arch
  • hyperextension of toes on WB (squatting, stair climbing, running)
  • wearing shoes with narrow toe box or high heels

-pain becomes constant with prolonged nerve irritation

52
Q

management of Morton’s neuroma

A
  • teardop pad between 3rd and 4th MT head

- proper shoe selection

53
Q

turf tow (1st MTP joint sprain) - def

A

-hyper-extension of the great toe

54
Q

turf toe MOI

A
  • single trauma or repetitive overuse
  • artificial turf due to unyielding surface and more flexible shoes
  • jamming into the end of the toe box
55
Q

S&S of turf toe

A
  • significant pain and swelling around 1st MTP joint

- exacerbated with push off when walking, running, and jumping

56
Q

management of turf toe

A
  • POLICE and rest until pain free
  • shoes or insoles with support (steel) under forefoot
  • taping to prevent/limit MTP motion
57
Q

hammertoe - def

A
  • flexion contracture of the PIP joint

- proximal interphalangeal joint

58
Q

mallet toe - def

A
  • flexion contracture of the distal interphalangeal joint

- involves the flexor digitorum longus tendon

59
Q

claw toes - def

A
  • flexion contracture of the DIP with hyper-extension of the MP joint
  • caused by wearing shoes that are too short over a prolonged period of time
  • blistering, swelling, pain, callus formation, and occasionally infection
60
Q

subungual hematoma - MOI

A
  • direct blow - stepped on, dropping an object on or kicking another object
  • repetitive shearing force on toenail - long distance runner
61
Q

S&S of subungual hematoma

A
  • extreme pain bc blood accumulated in a confined space - gentle pressure on nail greatly exacerbates pain
  • area under toe nail assumes bluish-purple colour
62
Q

management - subungual hematoma

A
  • ice and elevation immediately to minimize bleeding
  • pressure can be released by drilling hole through nail
  • should be done by a physician in a sterile environment (high chance of infection)
63
Q

stress fractures - tibia and fibula - MOI

A
  • overuse stress condition, common in long distance runners
  • more common in lower 1/3 of leg
  • inexperienced and unconditioned athletes at risk
  • amenorrhea and nutritional deficiencies also affect bone structure
  • more likely in individuals with structural deformities in the foot

fibula - hypermobile or pronated foot
tibia - rigid pes cavus feet

64
Q

what are extrinsic factors that make someone susceptible to stress fractures in the tibia/fibula?

A

sudden changes in training habits, footwear, unforgiving hard training surfaces

65
Q

stress fractures - tibia/fibula: treatment

A

rest and reduce loading forces; identify and correct any training errors or bio mechanical issues; orthotics; gradual RTP

66
Q

fibularis subluxation/dislocation - MOI

A 
fibularis retinaculum (holds fibularis longus and brevis in place) torn allowing tendons to move out of the groove
-dynamic foot/ankle activities, direct blow to posterior lateral malleolus, severe inversion ankle sprain or forceful DF
67
Q

S&S of fibularis subluxation/dislocation

A
  • tendons snap out of groove
  • eversion replicates subluxation
  • ecchymosis, edema, tenderness, and crepitus
68
Q

management of fibularis subluxation/dislocation

A
  • conservative: compressing with padding, POLICE (5-6 weeks), gradual exercise progression (ROM, strength, and balance)
  • surgery if ocnservative management fails
69
Q

ankle tendinitis MOI

A

caused by excessive eccentric contraction

70
Q

anterior tibialis tendinitis

A

cause: running downhill

pain with resisted DF and or stretch

71
Q

posterior tibialis tendinitis

A

cause: hypermobility or pronated feet

pain with resisted inversion and PF

72
Q

fibularis tendinitis

A

cause: pes cavus foot

pain with PF (push off/rising on the ball of foot during activities)

73
Q

achilles tendon tendinitis

A

cause: uphill running and excessive jumping; decreased flexibility of gastroc/soleus
pain with toe raises

74
Q

management of ankle tendinitis

A
  • POLICE
  • correct biomechanics - foot positioning via shoes, orthotics, or taping
  • rest from aggravating activities
  • NSAIDs and analgesics as needed
  • stretching routine and warm up exercises
  • balance/neuromuscular control
  • progression of strengthening exercises - ECCENTRIC is key
75
Q

medial tibial stress syndrome S&S

A
  • aka shinsplints
  • pain along the posterior medial aspect of the lower tibia
  • originally thought to be posterior tibialis muscle causing myositis, fasciitis, and periostitis
  • now believed to be related to periostitis of hte soleus insertion along the medial tibia - sometimes see shin splints in tibialis anterior insertion point
76
Q

what are the causes of MTSS

A
  • foot alignment (pes planus or cavus foot; tight achilles tendon)
  • weak leg muscles; minimal support/cushioning from shoes, training errors (hard surfaces or overtraining). excessive weight, reduce bone mineral density
77
Q

when in pain present in different grades of MTSS?

A
  • grade 1: after activity
  • grade 2: before and after activity, but not affecting performance
  • grade 3: before, during, and after activity that affects performance
  • grade 4: so severe unable to perform activity
78
Q

management of MTSS

A
  • difficult due to multi factorial causes
  • physician referral to rule out: stress fracture or exertional compartment syndrome
  • ice for localized pain and inflammation
  • activity modification
  • correct biomechanics (shoes, orthotics, taping)
  • stretch gastroc/soleus
  • taping: arch support and or shin
79
Q

what are three different heel conditions?

A

1) apophysitis of the calcaneus - sever’s disease
2) retrocalcaneal bursitis
3) heel contusion

80
Q

apophysitis of the calcaneus

A
  • sever’s disease

- traction injury at the apophysis of the calcaneus where the Achilles tendon attaches

81
Q

retrocalcaneal bursitis

A
  • inflammation of the bursa between the Achilles tendon and calcaneous
  • Haglund’s deformity (pump bump) can cause ongoing inflammation of bursa
82
Q

heel contusion

A

-irritation of fat pad (inferior to calcaneus) due to impact

83
Q

talus fracture

A
  • compression fracture often associated with severe inversion ankle sprains
  • with DF = lateral dome fracture
  • with PF and external tibial rotation = medial dome fracture
  • pain with WB, catching/snapping, intermittent swelling and tender on palpation of joint line

-can be in the form of osteochondritis dissecans - displacement of osteochondral fragment on proximal aspect of talus

84
Q

calcaneal fracture

A

1) compression: associated with fall from a height or landing from a jump
2) stress: repetitive impact during heel strike in long distance runners
3) avulsion:
- anterior: calcaneal ligament - with inversion and PF
- calcaneal tuberosity: sudden contraction of the Achilles tendon

85
Q

what are two common metatarsal fractures?

A

1) Jones fracture

2) March fracture

86
Q

Jones fracture

A
  • fracture of the diaphysis of the base of the 5th MT
  • MOI: inversion with PF, direct force (stepped on), repetitive stress
  • immediate pain and swelling of 5th MT
  • high non-union rate
  • treatment is controversial - crutches with no immobilization vs internal fixation
87
Q

March fracture

A
  • stress fracture to the shaft of the 2nd MT
  • MOI: runners who suddenly increase mileage, run hills or harder surfaces
  • predisposing factors: forefoot varus, hallux valgus, flatfoot or short 1st MT (morton’s toe)

KIN 3160 (10 decks)

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