MSK #8- Ankle and Foot Conditions Flashcards
Ligament Sprains: Where do most sprains occur?
- 95% on lateral side
- typically foot is plantarflexed and inverted at time of injury
Ligament Sprains: Risk factors for acute lateral sprain
- have Hx of previous ankle sprain
- do not use external support
- do not properly warm up before exercise or activities
- limited dorsiflexion
- do not engage in balance/proprioceptive activities where there was previous injury
Ligament Sprains: Risk factors for ankle instability
- have increased talar curvature
- not using external support
- did not engage in balance/proprioceptive activities where there was previous acute ankle sprain
Ligament Sprains: How many grades
3
Ligament Sprains: Grade 1
- no loss of function
- min tearing of ATFL
Ligament Sprains: Grade 2
- some loss of function
- partial disruption of ATFL and CFL
Ligament Sprains: Grade 3
- complete loss of function
- complete tear of ATFL and CFL
- partial tear of PTFL
Ligament Sprains: Diagnostic tests used
- MRI if necessary
Ligament Sprains: Special tests used
- anterior drawer test
- talar tilt test
Ligament Sprains: Meds used
- acetominophen for pain
- NSAIDs for pain and/or inflammation
Ligament Sprains: Modalities
- Cryotherapy: repeated intermittent application for pain and increasing ability for WB
- Diathermy: pulsating shortwave for reducing edema
- Estim: mod evidence for and against using it
- Low-Level Lasar Therapy: mod evidence for and against using it
- Ultrasound: No. Do NOT use it. Not even for like a second.
Ligament Sprains: self-report outcome measures
- LEFS
- FAAM
Ligament Sprains: Differential Diagnosis
- use Ottawa ankle rules (better sensitivity)
- use Bernese ankle rules
Ligament Sprains: Protected Motion and early WB
- advise use of external support to progressively WB on ankle
- Type of support and gait assistive device will depend on severity
- In severe injuries, semi-rigid bracing to below knee casting may be indicated
Ligament Sprains: Manual Therapy
- lymphatic drainage
- active and passive soft tissue and joint mobilizations
- anterior-to-posterior talar mobilization procedures
- all above completed w/in pain free ROM, to improve pain, reduce swelling, regain normal foot ankle mechanics, restore gait
- will progress to graded joint mobilizations and manips as needed to restore function
What is Achilles tendonosis/tendonopathy?
- degenerative condition of achilles tendon
- microtears of tendon
- tends to be overuse injury
- typically occurs in avascular zone of tendon
Achilles Tendonosis/Tendonopathy: special tests
- Royal London Hospital Test
- Positive Arc sign (high specificity)
- Thompson’s test (tests for rupture- so rule out and is a differential test?)
Achilles Tendonosis/Tendonopathy: Medications
- acetominophen
- NSAIDs
- corticosteroids
Achilles Tendonosis/Tendonopathy: Risk Factors
- abnormal DF ROM
- abnormal subtalar ROM
- decreased PF strength and flexibility
- increased foot pronation
- obesity
- hypertension
- hyperlipidemia
- diabetes
- training errors and/or faulty equipment (extrinsic factors)
Achilles Tendonosis/Tendonopathy: s/s
- localized pain
- feeling of stiffness at tendon after rest
- pain increases w/ activity
- muscle weakness
- swelling and thickening over tendon
- pain w/ single leg hop
Achilles Tendonosis/Tendonopathy: what to examine and
may reassess after interventions
- strength and ROM for PF, DF, and subtalar
- static arch height
- fore foot alignment
- pain w/ palpation
Achilles Tendonosis/Tendonopathy: exercise interventions
- strong evidence for eccentric exercise
- stretching to promote dorsiflexion ROM
Achilles Tendonosis/Tendonopathy: Modalities
- may use low-level laser for pain and stiffness
- iontophoresis w/ dexamethasone for pain
Achilles Tendonosis/Tendonopathy: Other interventions
- initially use RICE
- foot orthosis, possibly a heel lift and/or soft soled shoe
- manual therapy
- taping to reduce strain on Achilles tendon
***do not use heel lifts, and night splints are not that helpful especially when compared against eccentric exercise
Ankle/Foot fractures: what is a trimalleolar fracture
Fracture involving medial and lateral malleoli, and posterior tubercle of the distal tibia
***There is also a “uni” implicating one malleolus and “bi” implicating medial and lateral
Ankle/Foot fractures: Diagnostic tests used
plain film imaging
Ankle/Foot fractures: type of fracture occurring at the growth plate with highest complication rate
Type 3 and type 4 Salter Harris fractures
Ankle/Foot fractures: Medications
acetaminophen
NSAIDs
What is tarsal tunnel syndrome
entrapment of posterior tibial nerve or one of its branches w/in tarsal tunnel
Tarsal Tunnel Syndrome: cause
- over/excessive pronation
- overuse problems resulting in tendonitis of the long flexor and posterior tibialis tendon
- trauma may compromise space in the tarsal tunnel
Tarsal Tunnel Syndrome: symptoms
along medial ankle to the plantar surface of the foot
- pain
- numbness
- paresthsias
Tarsal Tunnel Syndrome: diagnostic tests
electrodiagnostic tests
Tarsal Tunnel Syndrome: special tests
Tinel’s sign at the tarsal tunnel
Tarsal Tunnel Syndrome: medications
- acetaminophen
- NSAIDs
- Neurontin for neuropathic pain
Tarsal Tunnel Syndrome: possible interventions
- foot orthoses to maintain neutral alignment of foot
- neurodynamic mobilization if abnormal neuro-tension
What is flexor hallucis tendonopathy
Identified as a tendonitis in the acute stage, or can be present as a chronic tendonosis. Commonly seen in ballet dancers
Flexor Hallucis Tendonopathy: medications
- Acetaminophen
- NSAIDs
- Corticosteroids
Flexor Hallucis Tendonopathy: treatment
refer to interventions for general bursitis, tendonitis, and tendonosis