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Semester 2 PM Exam 10 > Nonsurgical Ankle Disorders > Flashcards

Nonsurgical Ankle Disorders Flashcards

1
Q

Plantar Fasciosis/itis

A

inflammation of the plantar fascia or chronic fibrosis

Usually near its insertion into plantar calcaneus

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2
Q

Plantar Fasciosis/itis may or may not be associated with

A

a heel spur - presence of spur is not significant and not associated with inc in symptoms

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3
Q

Plantar Fasciosis/itis - xrays

A

not indicated initially, only if pain does not decrease

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4
Q

Plantar fasciosis/itis - etiology of the spur

A

Uncertain
dystrophic calcification secondary to prolonged inflammation of fascial insertion
Dystrophic calcification in intrinsic mm origin
Chronci stress reaction (fracture?) at muscle origin

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5
Q

Plantar Faciosis/itis - Pes planus exerts

A

passive stretch on fascia

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6
Q

Plantar Fasciosis/itis - Pes cavus causes

A

increased pressure under the calcaneus

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7
Q

Plantar Fasciosis/itis - may have

A

concomitant bursitis, neuritis under heel

May be enthesopathy secondary to inflammatory arthropathy

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8
Q

s/s with Plantar Fasciosis/itis

A
  1. Post static dyskinesia (pain after NWB)
  2. Pain with palpation confined to medial plantar calcaneal tuberosity
  3. Swelling is rarely seen
  4. May feel better with heel elevated in shoe
  5. NSAIDs often ineffective
  6. Pain with passive DF
  7. Cushioning under heel is inaffective
  8. MRI, bone scan, ultrasound may confirm path when tx is ineffective
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9
Q

Tx for Plantar Fasciosis/itis

A

*Restore pressure under longitudinal arch with an arch support
1. Try Spenco 3/4 length arch cushion to start
Ice more effective than heat
2. Night splint
3. Strengthen arch
4. Massage arch

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10
Q

Tx for Plantar Fasciosis/itis - Spenco

A

Use the length arch cushion with extra arch support and heel accomodative pads fashioned from adhesive felt and attached at top of insert

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11
Q

Plantar Fasciosis/itis - Night splint

A

Ankle DF 5-10 degrees and toes DF 35 degrees with wedge

Works best when fascial pain is non-insertional

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12
Q

Plantar Fasciosis/itis - Stretching of gastroc-soleus and Achilles or just plantar fascia

A

RCT showed both relieve pain but just DF the digits (not the ankle) provided more sustained relief

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13
Q

Plantar Fasciosis/itis - stair exercise

A

Stand on a step at the bottom of the stairs and hold the handrail for balance
Slowly lower your heels as far as you can - 10 times

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14
Q

Lateral ankle sprains involve

A

3 lateral collateral ligaments
Anterior talofibular
Calcaneofibular
Posterior talofibular

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15
Q

ODonoghue or West Point classification of sprains

A 
1st = ligament is stretched with minimal fibrous disruptions
2nd = rupture of significant portion that leads to instability 
3rd = total ligamentous failure has occured
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16
Q

Mechanism of injury for lateral ankle sprain

A

Mos common is landing on a PF and inverted foot (talus post narrower part moves into wider part and is unstable)

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17
Q

Lateral ankle sprains - order

A

ATF > CF > PTF (rarely)

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18
Q

High ankle sprain

A

rupture of the anterior tib-fib ligament and syndesmosis occurs with ankle in DF and ER force is applied (lineman)

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19
Q

Anteriot Drawer - Positive test

A

4mm or more of anterior displacement compared to uninjured ankle

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20
Q

Stress Inversion test - positive test

A

CF ligament

6 degrees or more (btw ankle and tibia) varus tilt compared to uninjured ankle

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21
Q

High ankle sprain is of what and strongly suggests what

A

Ant Inf Tibial-Fibular ligament
Suggests syndesmosis rupture
VERY UNSTABLE

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22
Q

How to confirm a high ankle sprain

A

Produce pain with ER a PF foot or squeezing the distal tibia and fib together just above midcalf level

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23
Q

Stable vs. Unstable Grade 2 high ankle sprains

A

Positive ER test, Positive squeeze test, and pain with palpation of ant tib/fib lig and deltoid lig - if all these is as reliable as an arthroscopy - but if dont have all four doesnt mean you dont have it

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24
Q

Treatment ankle sprain - Grades and sport activity time lost

A

Grade 1 = 1-2 weeks lost from sport
Grade 2 = 2-6 weeks
Grade 3 = 4-26 weeks

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25
Q

Treatments for ankle sprain

A

NSAIDs for pain relief and limit swelling
Continue ice until sweling is gone or painfree WB
If pain with weight longer than 7 days consider BK walking cast or CAM walker with ACE wrap

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26
Q

Treatment for ankle sprain - ROM

A

Start ankle ROM exercises when NBW (write alphabet)

When ROM exercises are pain free start strengthening and stretching

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27
Q

Ankle Sprain - Isometric strengthening exercises are used for

A

rehabing the peroneals which often are weak after an ankle injury and can lead to instability

28
Q

Ankle sprain - stretching of the achilles tendon is necessary why

A

dec ankle joint DF places the narrow post talus further distally in wider ant ankle joint - most unstable position of the ankle
People with ankle sprains may have tight achilles so youd want to stretch it and make it more flexible to prevent further injury

29
Q

Isotonic strengthening - ankle sprain - used for

A

anterior msucle group

Isometric and then isotonic

30
Q

Ankle sprain - important to do proprioception because

A

residual instability may be a result of damage to the afferent nerve fibers in the capsule

31
Q

Proprioception exercises for people with ankle sprain

A

stand on injured foot, first with eyes open and then with eyes closed
Continue until patient can balance on one foot for one minute with eyes closed

32
Q

Ankle sprain - proprioception - you can also use a

A

BAPS board and have patient stand on one foot in center and rotate disk clockwise and then counterclockwise with eyes open and then with eyes closed

33
Q

Ankle sprain - return to full activities when?

A

when able to stand on toes of ankle for 20 seconds and hop on toes 10 times and can cut and run a figure of eight

34
Q

Ankle sprain - bracing

A

use bracing for at least 6 months

Nonbraced athletes have 3 times the risk of injury

35
Q

Ankle sprain - orthotics

A

especially USB insert, to limit varus deformities

36
Q

Ankle sprain - type of shoe

A

High topped laced athletic shoes

37
Q

Ankle sprain and taping

A

He doesnt recommend it - provides 10% inc in max resistance to inversion moments but after 40 min of exercise is not protecting anymore

38
Q

Ankle sprain - re eval

A

Consider re-eval with bone scan to rule out occult fracture if sx do not dec within 2 wks of initiating therapy

39
Q

Ankle sprain predicting chronic ankle instability

A

You can predict it after first ankle sprain by having them complete jumping and landing tasks within first 2 weeks of first time LAS

40
Q

Posterior Tibial Tendonitis

A

Most common cause of medial ankle pain, especially without identifiable trauma

41
Q

Most common etiology of PTT dysfunction is

A

pronation

42
Q

Other causes of PTT

A

obesity, inflammatory arthritis, oral or injectablle steroids

43
Q

S/S of PTT

A

Pain usually with noticeable swelling, along medial aspect of ankle and rearfoot
Noticeable flatfoot
Too many toes sign - due to increased forefoot abduction

44
Q

Treatment PTT

A

Base on stage of deformity

Usually all early or stage 1 deformities will respond to conservative care

45
Q

Treatment PTT - conservative care

A

Flexible foot
Mild weakness on single heel rise
Absence of too many toes sign
Stages 2 to 4 require surgery

46
Q

Orthotic for PTT

A

UCBL device
Best option might be a Richie brace though
Can consider an AFO but usually too bulky and bothersome for patient
PT is a must
Steroid injection into tendon body is contraindicated

47
Q

Achilles Tendinopathy - Most pathologies occur

A

3 to 6cm above the insertion of the achilles

48
Q

Achilles Tendinopathy - area of

A

Poor vascular supply (watershed area)

49
Q

Achilles tendinopathy can be

A

insertional or noninsertional

50
Q

Achilels tendinopathy - insertional is often associated with

A

calcification of tendon substance

51
Q

Etiology of achilles tendinopathy

A

Can be short gastroc-soleus
Excessive uphill running (passive DF stretching tendon)
Sport that involves more toe standing
Pronation or pes cavus foot
Too flat a shoe
Inflammatory arthropahty with enthesopathy

52
Q

Diagnostic imaging for achilles tendinopathy

A

MRI, ultrasound

53
Q

Other ways to diagnose an achilles tendinopathy - rupture

A

Thompsons test - but know that false pos can occur

Very little pain with dramatic inc in passive DF

54
Q

What can you see or feel with an achilles rupture

A

dell (feels like dead space) along the post aspect of the achilles where the rupture ocurrred

55
Q

Tx for tendinopathy

A 
RICE
Min of 3/8 inch heel lift
NO stretching until tendon pain eases (eccentric)
Topical diclofenac
Iontophoresis
NSAIDs
Orthotics
Cast immob
56
Q

Problematic fractures

A

5th metabase
calcaneal joint depression
Ankle syndesmotic rupture

57
Q

5th Metabase fracture - when confined to tuberosity

A

NWB, BK cast immob for 6 weeks

58
Q

5th metabase fracture - when somewhere btw 1.5 to 3cm from the tip of the tuberosity is called a

A

jones fracture and in an athlete surgery is accepted as tx of choice

59
Q

Jones frcture has a reputation as

A

a poor healer

literature says that conservative tx or surgical care is successful at healing though

60
Q

Calcaneal joint depression fracture - at impact what happens

A

the posterior facet of the calcaneus is driven plantarly into the body of the calcaneus by the lateral talus

61
Q

Calcaneal joint fracture outcome

A

extrememly poor with or without surgery

62
Q

Calcaneal joint fracture - ROM and WB

A

Early ROM and NWB
Boot in neutral position
Compression stocking

63
Q

Types of ankle fractures

A

Unimalleolar
Bimalleolar
Trimalleolar
Syndesmotic

64
Q

With an ankle fracture dont forget to look for

A

fibular fracture AND medial malleolar fracture

65
Q

Most common type of ankle fracture

A

Spiral oblique fracture of the fibula starting at level of ankle joint
75%

66
Q

Most serious and longest healing ligament injury involves what and is what

A

Ant-Inf tibial-fibular ligament and involves damage to the syndesmosis

67
Q

Ant Inf Tib Fib ligament injury with syndesmosis will have pain with

A

ER of the foot on passively PF ankle (Kleiger)
May have pain with squeeze
Only reliable detection of rupture is intra-operatively

Semester 2 PM Exam 10 (3 decks)

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