Management of Foot and Ankle Pathology Flashcards
Which type of malleolar fracture will have weight bearing restrictions?
medial malleolus
What is important to remember about rehab of an ankle fracture?
if able to try to limit immobilization as early as possible to have better outcomes
Will pts still have issues 2 years after an ankle fracture?
most likely yes, pain stiffness and weakness
What can immobilization of the pt lead to after an ankle fracture?
CVD, cancer, DM, depression
What are main treatment principles for an ankle fracture?
once healed attack DF and weakness with stretching and Mobs
What are two common fractures to the 5th metatarsal?
Jones fx- base of 5th met peroneus brevis FX
stress fracture- proximal shaft of 5th- non union healing common
What is important to remember about healing of 5th met?
5th met gets poor blood supply
What is a Lover’s fracture?
calcanea fx from fall from height or MVA
if intra-articular likely healed with ORIF
What joint is key during rehab of a Lover’s fracture?
subtalar joint ROM is key
Can you treat pes planus by itself?
no, need to create with a clinical syndrome like plantar fasciitis, PFP, MTSS
What are most likely causes of hallux valgus?
due to abnormal mechanics over time
also a genetic link is cause of 60%
tx- address pathomechanics creating forces on 1st MTP
What is average hallux valgus degree?
15 degrees normal
mild 20-30
mod- 30-40
severe -over 40
What is claw toe?
abnromal flexion of IP joint with extension of MTP- affects all toes
What is hammer toe?
abnormal flexion of IP without extension of MTP- affects 1-2 toes
What is tx for claw and hammer toe?
if rigid needs surgery if not:
mobilize MTP into flexion and shoe with larger toe box
problems likely coming from up the chain
What is typical MOI for a syndesmotic ankle sprain?
rotation of talus that gaps the distal tib fib joint, DF of ankle and ER of tibia on planted foot
What motion should be avoided during rehab of high ankle sprain?
excessive DF as that will gap distal tib fib joint
What is most common risk factor associated with a lateral ankle sprain?
decreased ankle DF and muscle strength but remember ankle sprains are multi factorial
What are Ottawa rules for dx of an ankle fx?
bone tenderness at medial or lateral malleolus, talus, base of 5th met, navicular inability to bear weight
What are characteristics of a grade 2 lateral ankle sprain?
some loss of function, decreased motion, positive anterior drawer, neg talar tilt (CFL), swelling, bruising, point tenderness
What are characteristics of a grade 3 lateral ankle sprain?
significant loss of function inability to bear weight positive talar tilt and anterior drawer
extreme swelling, bruising, point tenderness
What is important to remember about any ligament in body but especially ankle ligs?
ligaments don’t have elasticity so if first injury isn’t resolved ligaments will becoming more lax and likely lead to another sprain
What are two types of ankle instability ?
- functional
2. mechanical
What is functional ankle instability?
recurrent ankle sprains or sensation that ankle is giving way, absence of objective joint instability
What is mechanical ankle instability?
evidence of ligamentous laxity
What is anterior impingement of ankle?
scar tissue along anterolateral TC joint line from repeated micro traumas results in pain with forced DF, squatting, stairs or fast walking
What percentages of adults will have ankle OA?
1-4% but most of them will be from post traumatic injuries
What is tx for ankle OA?
minimize impairments like strength and ROM, cane to unload jt (opposite side of impairment) , total ankle replacement
What is plantar fasciosis?
degenerative process with inflammation of plantar fascia
usually in 45-64 y.o
What are some anatomic/biomechanical risk factors for PF?
exccesive anteversion, pes planus, excessive pronation, limited DF, BMI over 30
Why will lack of DF increase risk for PF?
if they lack DF pt will toe out causing more pressure of fascia
What is PP for PF?
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
What is a windlass test?
lift big toe an arch must happen
What is Severs dz?
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
What is hallux limitus?
degenerative arthritis of 1st MTP, more common in females, accumulation of osteophytes
What is tx from hallux limitus?
distraction and extension mobs of 1st MTP , limit 1st MTP motion
What is a cheilectomy?
removal of bone spurs on 1st MTP for goal of 70 DF of 1st MTP
What is metatarsalagia?
forefoot pain associated with stress at metatarsal head region 1-3 from lack of DF causing more load at forefoot
What is morton neuroma?
nerve damage of common digital nerve between 3-4 met, women 45-50 from high high heels or narrowed toes, pain and paresthesia
What is best type of tx for morton neuroma?
steroid infection as it is more of a chemical instability
What is function of sesamoid bone in FHB?
absorb weight nearing forces, decrease friction, increase moment arm of FHB to PF toe
What is sesamoiditis?
avascular changes or inflammation without radiological evidence of fracture
likely to to lack of DF
What is a clinical pearl to differentiate between chills tendinitis and osis?
tendon enlargement will move with tendon but swelling will not
What are some intrinsic risk factors for ACT?
limited DF, foot pronation, obesity, HTN, DM
What is important to remember about eccentric exercises for achilles and anatomical location of osis?
mid substance osis- can do eccentrics past neutral
insertional- eccentrics only to neutral
Why is this true about insertional achilles -osis?
bc eccentrics past neutral will put an impingement force between tendon, bursa and bone in excessive DF
What is posterior tib tendon dysfunction?
excessive pronation or flat foot will cause a greater navicular drop which will result in pull on post tib.
Why is it important to catch PTTD early?
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)
What are 4 stages for PTTD?
- tender to palpation, pain with heel rise
- flexible flat foot posture
- non flexible foot posture- damaged to deltid ligs/joint contractures
- ankle OA- same as 3
What is preferred AFO for different stages of PTTD?
- solid AFO- for 3-4 limits PF
2. hinged AFO- stage 1-2 prevention of weakness
What tendon is commonly associated with lateral ankle sprains?
peroneal brevis and longus tendons (77% of sprains)
What is PP of fib tendon disorder?
pain on posterolateral region of foot, swelling, clicking eversion weakness pain with heel rise
Where does PB and PL attach?
PB- base of 5th met
PL- base of 1st MT
What is best method to see if a pt has a stress fx?
MRI
Where are pts most likely to have a stress fx?
- tibia- peak refract eversion during running puts stress on tibia
- calcaneus
- 5th met
What are 2 different forms of pathogenesis for Medial Tibial Stress syndrome?
- periostitis- traction on muscular origins (post tib and soleus), overuse causing muscle to pull away from bone
- periostalgia- chronic presentation as periosteum as detached from bone, adipose then forms between periosteum and underlying bone
What is PP of MTSS?
pain on palpation over distal 2/3 posterior medial tibia. vertical pain
What does MTSS not include?
stress fx and posterior compartment syndrome
What is important in prevention of MTSS?
increase strength of soles and control over pronation
promote adequate shock absorption, cross training for runners
What are tx principles for MTSS?
eccentric control of post tib, increase DF
