Orthopedic Management of the Foot and Ankle PP Flashcards
Injuries to lateral ligament complex
What 3 ligaments make up the lateral ligament complex of the ankle?
MOST OFTEN SPRAINED
- ANTERIOR TALOFIBULAR LIG(inversion ankle sprain)
next most often
- FIBULOCALCANEAL LIG
- POSTERIOR TALOFIBULAR LIG
Most common injury –
Approximately 95% of all ankle sprains
Injury does not require high forces to occur
WHAT SHOULD YOU AVOID?
shank pg233 17-1
inversion sprain
MOI: avoid pf inver and add of the foot and akle
the leach class what 3 degrees
first degree- rupture of anteriro talofib
second degree - two are rupture anterior talofib and fibulocalcaneal
third degree- all 3 torn anteriro talofib,anterior talofib and fibulocalcaneal
s/s inversion sprain
depends on the severity of the sprain
swelling pain lof cardinal signs
Scarify
Scratching or cracking the hard outer coat of a seed to help it germinate. Can also be done with acid.
Understands how environmental print, pictures, and symbols contribute to literacy development
Reading environmental print assesses the students ability to read commonplace or “highly frequent” print accessible in their local and daily environment, such as signs in the school like STOP, EXIT, or NO SMOKING. Environmental print information can be used to assess the access a child has had or the attention given to printed language in the environment. It encourages beginning readers to develop and “I can read!” attitude. The purpose of reading environmental print is to give children an experience that allows them to read familiar print drawn from the world around them that they are likely to have seen. It not only brings the outside world of print closer to the classroom but also build children’s confidence in their ultimate ability to learn to read.
grade three precautions with surgery
KC 875 box 22.2
“activity-related precautions to reduce the risk of re-injury after lateral ligament reconstruciton of the ankle”
- modify activities to low-impact
- minimized or avoid participation in high impact
- involve activities that associate with high risk ankle injuries
- particiapate in pre-season injury prevention
- wear prescribe orthodics
- tape ankle or insert slight lateral lift in the shoe
name 2 Ankle tests and what they test for.
- Talor Tilt
- Testing for ligament resistance to inversion stress
- Anterior Drawer
- Assess integrity of anterior talofibular ligament
Treatment:
for ankle sprain
include ROM
- RICE
- Clinically, what education should be provided to the patient to ensure pt safety re: icing at home?
- Limit movement/immobilization
- Limit weight bearing with gradual increase
- Avoid inversion with inversion sprains
ROM
- Strength-iso at ankle can strengthen above injury
- What type of exercises should be utilized in the acute stage?
- Progress weight bearing
- Progress to concentric and eccentric contractions and proprioception exercises
Clinically, remember that once a patient can bear weight on the ankle without crutches, demonstrates controlled swelling and can complete ROM and isometrics without excessive c/o pain, begin progressing to more challenging activities
Provide examples:
- wobble board
- bosu
- airX
- square pad
MOI: fo Achilles Tendinitis
Achilles Tendinitis
Intrinsic:
Extrinsic:
Achilles Tendinitis s/s
Signs & Symptoms
Pain
Swelling
Crepitus
What is crepitus? crunchy
Achilles Tendinitis:Treatment
Physical agents for inflammation/NSAIDS
Decrease stress
What could you do to improve aerobic endurance while avoiding stress? UBE
Progressive exercises as injury healing and pt pain tolerance allows: ROM,
If physician prescribes a rigid cast immobilization for a 10 day period, rehab progresses at a slower rate following removal of cast
rehab process is a lot slower do to cast
MOI: complete tear of tendon caused by sudden forceful PF
What type of impairments and functional limitations may be present?
suden forceful PF
Special Test for PTs to complete for achilles rupture
Thompson Test
like homens - no motion probably a rupture
Achilles Tendon Rupture 877 comp w/ repair kc
coventional tx 878
Whats the tx
Surgery to sew tendon back together, immobilize, then rehab to increase range, strength and more advance function
Conservative: Immobilize for as long as 8 weeks
Not typically very successful
General program suggestions for Achilles Tendon Rupture
General program suggestions:
Regain full ROM initially once immobilization has ended
Pt may be using heel-lift 3-4 weeks following immobilization
*If tendon is stressed too much, it could re-rupture
General program suggestions (cont’d):
Progressive exercises with latex band
Proprioception exercises
CKC exercises
Weight bearing PF is appropriate to begin once pt has completed ROM and strengthening exercises without complication
precautions and guidelines 881 kc
fix slide
Compartment Syndromes
Two types
Acute- serious with fluid build up after trauma
Chronic- exersional after working out
Inflammation of plantar aponeurosis
Heel spurs may be involved
because of pull Wolfs law may cause a heel spur
Plantar Fasciitis
Plantar Fasciitis
Signs & Symptoms
- pain in the moring
- pain in heel from spur
- tightness
- tends to warm up during day
Plantar Fasciitis
Treatment
Control inflammation
What types of modalities may be used? US, ICE
Deep massage
Basic strengthening of foot muscles
How can we strengthen the foot muscles? marble pick up or toe crunches
Orthotics
What types of exercises may be appropriate for a patient suffering from plantar fasciitis?
Consider what motion(s) would put the most stress on the plantar fascia?
DF
Morton’s Neuroma
What does neur- mean?
What does –oma mean?
Nerve
tumor
Morton’s Neuroma:Signs and Symptoms
- burning
- cramping
- catching sensation
- usually unilateral
- 15% of pt have bilateral
Morton’s Neuroma
Special Tests completed by the PT
Mortons test
Squeeze MT heads together for 1-2 minutes
Tingling, pain, etc indicative of neuroma
If positive, symptoms are relieved once pressure is taken away
Morton’s Neuroma: conservative tx
MT pad; change of footwear to wider, softer shoe; corticosteroid injections; avoid high heal wear
Treatment:Surgical Excision Post-op Rehab
- Early ROM to avoid stiffness and fibrosis
- Compression bandages for inflammation and pain
- Modalities
- Progress to strengthening
Lateral or valgus deviation of great toe
MOI
Genetic bony structure + improper footwear
15% or less is normal
Hallux Valgus
Hallux Valgus: tx conservative
Change footwear, orthotics, modify activity temporarily (bike instead of run), strengthen foot muscles
Hallux Valgus: Surgical
Bunionectomy
- Post-op
- Pads and special shoe to position toe in correct alignment
- Modalities for inflammation and pain
name3 Toe Deformities?
mrs t says know them
- Mallet toes
- Hammer toes
- Claw toes
mallet toes
Hammer toes
claw
flexed DIP
like butiners
THe claw
plesase look at
- ankle fx
- stress fx
- medial tibial stress syndrome
- arch deformities
- TAA
How would these toe deformities affect gait?
How would they affect balance?
What types of exercises may assist the patient?
effects hip knee and back
what combined motions cause supination?
plantar flexion, inversion, and ADD
what combined motion cause pronation?
dorsi, eversion, and ABD
What ligament is most affected by medial or eversion ankle sprains?
deltiod ligament
Most commonly ankle sprains occur with the foot in an ___________ or ____________ position before the injury.
unloaded or NWB
what motions should you avoid during the MAX-protection phase of an inversion ankle sprain?
PF, inversion
what is the MOI of a lateral ankle sprain?
___________ instibility is defined as laxity of the ankle ligaments.
Mechanical
___________ instability refers to a subjective feeling of giving way without affecting ligament laxity.
Functional
what injury of the ankle is the Thompson test for
ruptured achilles
what motions do you want to avoid in max protection phase of mechanical ankle ligament instability
excessive PF and inversion
complete rupture of the achilles tendon can occur with sudden _______________ contraction of the gastroc-soleus.
eccentric-concentric
approx _______ of achilles tendon ruptures are secondary to degenerative changes in the tendon
50%
what test is used for a ruptured achilles tendon
thompson test
surgical repaired achilles tendon have a much lower rate of rerupture (than non operative approch) and there is a significant increase in the ultimate recovery of muscle strenght, power and endurance
polo :)
what motion needs to be avoided with pt’s that have an achilles rupture?
DF
acute compartment syndome is treated with a surgical procedure called what?
fasciotomy
if you have a pt with an ankel fracture that was repaired with an ORIF and they are experiencing increased pain, swelling, crepitus(that was not already present), and motion what is this a sign of and what should you do?
sign of possible hardware loosening, notify PT immediately
there are certain stress fractures that pose a greater risk of delayed union, nonunion and displacement than others. these tend to be termed “at risk” stress fractures, where are the locations
5th metatarsal, navicular, sesamoid, and inraarticular fractures
which “at risk” stress fracture is described as “no-man’s-land”?
5th metatarsal at the base or proximal diaphysis
when can closed-chain activities be added to an intervention for a stress fracture pt?
when radiographic confirmation by a physician documents stable bone healing.
