Non-Surgical Ankle (only underlined info)

Question 1

Plantar Fasciitis

Answer 1

inflammation of plantar fascia or chronic fibrosis
may or may not be associated with a heel spur - presence of spur is not significant and is not associated with increased symptoms!!!
Etiology of bone spur is unknown

Question 2

Plantar Fasciitis (cauvs/planus info)

Answer 2

Pes planus exerts passive stretch on fascia
pes cavus causes increased pressure under calcaneus
may be enthesopathy secondary to inflammatory arthorpathy

Question 3

Signs/Symptoms of plantar fasciitis

Answer 3

post-static dyskinesia: morning pain upon arising after NWB = classic symptoms
Swelling rarely seen
NSADs ineffective

Question 4

Treatment for plantar fasciitis

Answer 4

cushioning under heel often ineffective
Key is to restore pressure under longitudinal arch with arch support
night splint = DF 5-10 degrees (ankle) and toes DF at 35 degrees
Stretch gastroc/soleus and Achilles tendon and PF

Question 5

Lateral Ankle Sprains - ligaments involved

Answer 5

anterior talofibular
posterior talofibular
calcaneofibular

Question 6

Lateral ankle sprains mechanism of injury

Answer 6

most common is landing on a plantarflexed and inverted foot

Question 7

high ankle sprain

Answer 7

anterior tibiofibular ligament and syndesmosis with ankle in DF and ER force applied (lineman who has teammate land on back of ankle, IR ankle and foot is ER)

Question 8

high ankle sprain strongly suggests ____

Answer 8

syndesmotic rupture

very unstable ankle

Question 9

Treatment for lateral ankle sprains

Answer 9

isometric strengthing to rehab peroneals which are often weakened after ankle injury
stretch Achilles tendon
Isotonic strengthening of anterior muscle group (DF)
proprioception
brace for at least 6 months!!!

Question 10

Posterior Tibial Tendonitis

Answer 10

most common cause of medial ankle pain!!

most common etiology of PTT dysfunction is pronation

Question 11

Signs/Symptoms of Posterior Tibial Tendonitis

Answer 11

pain and swelling along medial aspect of ankle
noticeable flatfoot with loss of medial arch height
too many toes sign due to increased forefoot abduction

Question 12

Treatment of PTT

Answer 12

orthotics, richie brace, PT!

Question 13

Achilles Tendionpathy

Answer 13

most pathologies occur 3-6cm above insertion of Achilles

area of poor vascular supply!

Question 14

Detecting Achilles tendon rupture

Answer 14

Thompson test

little pain with dramatic increase in passive DF

Question 15

Treatment for tendinopathy

Answer 15

no stretching until tendon pain decreases - eccentric stretching

Question 16

Problematic fractures (3)

Answer 16

5th metabase
calcaneal joint depression
ankle (syndesmotic rupture)

Question 17

5th Metabase

Answer 17

if frx only on tuberosity, NWB BK case immobilization for 6 weeks
if frx is between 1.5 - 3cm from tip of tuberosity (Jones fracture) and in an athlete, surgery = treatment of choice

Question 18

Jones fracture

Answer 18

reputation as a poor healer, but literature supports conservative or surgical care as successful for healing

Question 19

Calcaneal joint depression fracture

Answer 19

at impact, posterior facet of calcaneus is driven plantarly into body of calcaneus by lateral talus
extremely poor outcome with or without surgery

Question 20

Ankle Fractures

Answer 20

we always look for fibular fracture, but don’t forget about an associated medial malleolar fracture!

Question 21

most common type of ankle fracture (75%)

Answer 21

involve a spiral oblique fracture of fibula starting at level of ankle joint

Question 22

Most serious and longest healing ligament injury

Answer 22

ligament = anterior-inferior tibial-fibular ligament
involves damage to syndesmosis
pain with ER of foot on passively PF ankle (Kleiger’s test)
pain with squeezing tibia and fibula together at midcalf (squeeze test)