Non-Surgical Ankle (only underlined info) Flashcards
Plantar Fasciitis
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
Plantar Fasciitis (cauvs/planus info)
Pes planus exerts passive stretch on fascia
pes cavus causes increased pressure under calcaneus
may be enthesopathy secondary to inflammatory arthorpathy
Signs/Symptoms of plantar fasciitis
post-static dyskinesia: morning pain upon arising after NWB = classic symptoms
Swelling rarely seen
NSADs ineffective
Treatment for plantar fasciitis
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
Lateral Ankle Sprains - ligaments involved
anterior talofibular
posterior talofibular
calcaneofibular
Lateral ankle sprains mechanism of injury
most common is landing on a plantarflexed and inverted foot
high ankle sprain
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)
high ankle sprain strongly suggests ____
syndesmotic rupture
very unstable ankle
Treatment for lateral ankle sprains
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!!!
Posterior Tibial Tendonitis
most common cause of medial ankle pain!!
most common etiology of PTT dysfunction is pronation
Signs/Symptoms of Posterior Tibial Tendonitis
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
Treatment of PTT
orthotics, richie brace, PT!
Achilles Tendionpathy
most pathologies occur 3-6cm above insertion of Achilles
area of poor vascular supply!
Detecting Achilles tendon rupture
Thompson test
little pain with dramatic increase in passive DF
Treatment for tendinopathy
no stretching until tendon pain decreases - eccentric stretching
Problematic fractures (3)
5th metabase
calcaneal joint depression
ankle (syndesmotic rupture)
5th Metabase
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
Jones fracture
reputation as a poor healer, but literature supports conservative or surgical care as successful for healing
Calcaneal joint depression fracture
at impact, posterior facet of calcaneus is driven plantarly into body of calcaneus by lateral talus
extremely poor outcome with or without surgery
Ankle Fractures
we always look for fibular fracture, but don’t forget about an associated medial malleolar fracture!
most common type of ankle fracture (75%)
involve a spiral oblique fracture of fibula starting at level of ankle joint
Most serious and longest healing ligament injury
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)
