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MS Test 3: Lower Quarter > Management of Foot and Ankle Pathology > Flashcards

Management of Foot and Ankle Pathology Flashcards

1
Q

Which type of malleolar fracture will have weight bearing restrictions?

A

medial malleolus

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2
Q

What is important to remember about rehab of an ankle fracture?

A

if able to try to limit immobilization as early as possible to have better outcomes

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3
Q

Will pts still have issues 2 years after an ankle fracture?

A

most likely yes, pain stiffness and weakness

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4
Q

What can immobilization of the pt lead to after an ankle fracture?

A

CVD, cancer, DM, depression

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5
Q

What are main treatment principles for an ankle fracture?

A

once healed attack DF and weakness with stretching and Mobs

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6
Q

What are two common fractures to the 5th metatarsal?

A

Jones fx- base of 5th met peroneus brevis FX

stress fracture- proximal shaft of 5th- non union healing common

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7
Q

What is important to remember about healing of 5th met?

A

5th met gets poor blood supply

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8
Q

What is a Lover’s fracture?

A

calcanea fx from fall from height or MVA

if intra-articular likely healed with ORIF

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9
Q

What joint is key during rehab of a Lover’s fracture?

A

subtalar joint ROM is key

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10
Q

Can you treat pes planus by itself?

A

no, need to create with a clinical syndrome like plantar fasciitis, PFP, MTSS

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11
Q

What are most likely causes of hallux valgus?

A

due to abnormal mechanics over time

also a genetic link is cause of 60%

tx- address pathomechanics creating forces on 1st MTP

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12
Q

What is average hallux valgus degree?

A

15 degrees normal

mild 20-30
mod- 30-40
severe -over 40

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13
Q

What is claw toe?

A

abnromal flexion of IP joint with extension of MTP- affects all toes

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14
Q

What is hammer toe?

A

abnormal flexion of IP without extension of MTP- affects 1-2 toes

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15
Q

What is tx for claw and hammer toe?

A

if rigid needs surgery if not:

mobilize MTP into flexion and shoe with larger toe box

problems likely coming from up the chain

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16
Q

What is typical MOI for a syndesmotic ankle sprain?

A

rotation of talus that gaps the distal tib fib joint, DF of ankle and ER of tibia on planted foot

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17
Q

What motion should be avoided during rehab of high ankle sprain?

A

excessive DF as that will gap distal tib fib joint

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18
Q

What is most common risk factor associated with a lateral ankle sprain?

A

decreased ankle DF and muscle strength but remember ankle sprains are multi factorial

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19
Q

What are Ottawa rules for dx of an ankle fx?

A

bone tenderness at medial or lateral malleolus, talus, base of 5th met, navicular inability to bear weight

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20
Q

What are characteristics of a grade 2 lateral ankle sprain?

A

some loss of function, decreased motion, positive anterior drawer, neg talar tilt (CFL), swelling, bruising, point tenderness

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21
Q

What are characteristics of a grade 3 lateral ankle sprain?

A

significant loss of function inability to bear weight positive talar tilt and anterior drawer
extreme swelling, bruising, point tenderness

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22
Q

What is important to remember about any ligament in body but especially ankle ligs?

A

ligaments don’t have elasticity so if first injury isn’t resolved ligaments will becoming more lax and likely lead to another sprain

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23
Q

What are two types of ankle instability ?

A
  1. functional

2. mechanical

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24
Q

What is functional ankle instability?

A

recurrent ankle sprains or sensation that ankle is giving way, absence of objective joint instability

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25
Q

What is mechanical ankle instability?

A

evidence of ligamentous laxity

26
Q

What is anterior impingement of ankle?

A

scar tissue along anterolateral TC joint line from repeated micro traumas results in pain with forced DF, squatting, stairs or fast walking

27
Q

What percentages of adults will have ankle OA?

A

1-4% but most of them will be from post traumatic injuries

28
Q

What is tx for ankle OA?

A

minimize impairments like strength and ROM, cane to unload jt (opposite side of impairment) , total ankle replacement

29
Q

What is plantar fasciosis?

A

degenerative process with inflammation of plantar fascia

usually in 45-64 y.o

30
Q

What are some anatomic/biomechanical risk factors for PF?

A

exccesive anteversion, pes planus, excessive pronation, limited DF, BMI over 30

31
Q

Why will lack of DF increase risk for PF?

A

if they lack DF pt will toe out causing more pressure of fascia

32
Q

What is PP for PF?

A

pain on medial calcaneal tubercle, 1st step pain in AM or after sitting, pain decreases with movement, limited ankle DF, positive windlass test and neg tarsal tunnel test

33
Q

What is a windlass test?

A

lift big toe an arch must happen

34
Q

What is Severs dz?

A

calcaneal apophysitis- traction from Achilles tendon, inflammation of growth plate common in boys 6-8 from high impact sports

tx: rest ice heel lift and stretching of gastroc

35
Q

What is hallux limitus?

A

degenerative arthritis of 1st MTP, more common in females, accumulation of osteophytes

36
Q

What is tx from hallux limitus?

A

distraction and extension mobs of 1st MTP , limit 1st MTP motion

37
Q

What is a cheilectomy?

A

removal of bone spurs on 1st MTP for goal of 70 DF of 1st MTP

38
Q

What is metatarsalagia?

A

forefoot pain associated with stress at metatarsal head region 1-3 from lack of DF causing more load at forefoot

39
Q

What is morton neuroma?

A

nerve damage of common digital nerve between 3-4 met, women 45-50 from high high heels or narrowed toes, pain and paresthesia

40
Q

What is best type of tx for morton neuroma?

A

steroid infection as it is more of a chemical instability

41
Q

What is function of sesamoid bone in FHB?

A

absorb weight nearing forces, decrease friction, increase moment arm of FHB to PF toe

42
Q

What is sesamoiditis?

A

avascular changes or inflammation without radiological evidence of fracture

likely to to lack of DF

43
Q

What is a clinical pearl to differentiate between chills tendinitis and osis?

A

tendon enlargement will move with tendon but swelling will not

44
Q

What are some intrinsic risk factors for ACT?

A

limited DF, foot pronation, obesity, HTN, DM

45
Q

What is important to remember about eccentric exercises for achilles and anatomical location of osis?

A

mid substance osis- can do eccentrics past neutral

insertional- eccentrics only to neutral

46
Q

Why is this true about insertional achilles -osis?

A

bc eccentrics past neutral will put an impingement force between tendon, bursa and bone in excessive DF

47
Q

What is posterior tib tendon dysfunction?

A

excessive pronation or flat foot will cause a greater navicular drop which will result in pull on post tib.

48
Q

Why is it important to catch PTTD early?

A

bc once you lose post tib you will lose a good amount of function as it is vital for gait

(controlling eccentric pronation of foot)

49
Q

What are 4 stages for PTTD?

A
  1. tender to palpation, pain with heel rise
  2. flexible flat foot posture
  3. non flexible foot posture- damaged to deltid ligs/joint contractures
  4. ankle OA- same as 3
50
Q

What is preferred AFO for different stages of PTTD?

A
  1. solid AFO- for 3-4 limits PF

2. hinged AFO- stage 1-2 prevention of weakness

51
Q

What tendon is commonly associated with lateral ankle sprains?

A

peroneal brevis and longus tendons (77% of sprains)

52
Q

What is PP of fib tendon disorder?

A

pain on posterolateral region of foot, swelling, clicking eversion weakness pain with heel rise

53
Q

Where does PB and PL attach?

A

PB- base of 5th met

PL- base of 1st MT

54
Q

What is best method to see if a pt has a stress fx?

A

MRI

55
Q

Where are pts most likely to have a stress fx?

A
  1. tibia- peak refract eversion during running puts stress on tibia
  2. calcaneus
  3. 5th met
56
Q

What are 2 different forms of pathogenesis for Medial Tibial Stress syndrome?

A
  1. periostitis- traction on muscular origins (post tib and soleus), overuse causing muscle to pull away from bone
  2. periostalgia- chronic presentation as periosteum as detached from bone, adipose then forms between periosteum and underlying bone
57
Q

What is PP of MTSS?

A

pain on palpation over distal 2/3 posterior medial tibia. vertical pain

58
Q

What does MTSS not include?

A

stress fx and posterior compartment syndrome

59
Q

What is important in prevention of MTSS?

A

increase strength of soles and control over pronation

promote adequate shock absorption, cross training for runners

60
Q

What are tx principles for MTSS?

A

eccentric control of post tib, increase DF

MS Test 3: Lower Quarter (10 decks)

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