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PHTH 517 - Ortho Midterm LE > Other Ankle Disorders > Flashcards

Other Ankle Disorders Flashcards

1
Q

Heel pain is usually caused by?

A

Plantar fasciitis which is often associated with heel spurs

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2
Q

What are the causes of heel pain?

A

obseity (increased forces)
excessive walking/sports (muscle fatigue)
plantar fascia tightness
flattening of the arch

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3
Q

What are some treatments associated for heel pain?

A

Orthoses
PT
injection
NSAIDs
very rarely a surgical release in bad cases

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4
Q

What are the subjective findings that we get regarding plantar fascitis?

A

pain and tenderness on the inside of the heel
- happens during wb

in the morning or after being off your feet for a while and gets worse with activity

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5
Q

What are the objective findings for plantar fascitis?

A

pain during palpation at the
- inner edge of the fascia
- origin on the anterior edge of the calcaneus

firm pressure is needed to get the max tenderness

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6
Q

What is the typical prognosis regarding plantar fascitis?

A

~90% who go through treatment will get better in 12 months or so

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7
Q

What are the two bursae that accounts for bursitis in the foot?

A

retrocalcaneal and subcutaneous calcaneal bursa

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8
Q

What are the causes of retrocalcaneal bursitis?

A
  • constant trauma from shoes and sports
  • Gout, RA and ankylosing spondyloarthropathies
  • busal impingement
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9
Q

What structures usually impinge the bursa?

A

between the achilles tendon and BULGING posterior-superior aspect of the calcaneus

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10
Q

What is the subjective findings of a retrocalcaneal bursitis?

A

posterior ankle pain
pain with walking

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11
Q

What are the signs regarding retrocalcaneal bursitis?

A

tenderness
lump
inflammation

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12
Q

What is conservative measures regarding retrocalcaneal bursitis?

A

PT
taking account shoe wear
if so, injections:
- reduce swelling and inflammation
- paired wtih achilles tendon stretching

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13
Q

What is surgical measures regarding retrocalcaneal bursitis?

A

PUMP BUMP!!
- removing the calcaneal superoposterior prominence
- taking away the damanged buursa
- tendon debridement of the tendon insertion

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14
Q

A hallux valgus (or “bunion”) is caused by?

A

Big toe moving towards smaller toes but leaves big bump
- the bump is caused by the base of 1st MTP joint deviated laterally

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15
Q

What are some common aetiology regarding a bunion?

A

Familial
Inappropriate footwear, Toe box (small toe box)
Flatfeet
Long first ray
1st MTP being out of place from the joint articular surface
Metatarsus primus varus
Rheumatoid arthritis

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16
Q

What is metatarsus primus varus?

A

The 1st MT bone connecting the phalax to the big toe is rotated and angled away from the 2nd MT bone

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17
Q

What is the pathogenesis of a bunion?

A
  • weird angle between the big toe and 2nd toe around > 9 deg while the valgus angle of MTP joint is greater than 20 deg
  • forefoot fanning
  • joints are unsuitable = osteoarthritis
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18
Q

What are the signs of a bunion?

A
  • there is inflammation of overlying bursa and the skin
  • valgus and pronation deformity of the hallux
  • painful callus on the 2nd toe
  • thick skin over the MT heads
  • increased valgus angle at the big toe
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19
Q

Why is there a callus on the 2nd toe?

A

Second piggy is forced into hyperextension because of that stupid big toe

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20
Q

How are bunions managed?

A

again, look at the kinetic chain and the planes
- possible x-rays
- any devitations up the chain

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21
Q

What is the aim of a conservative treatment for bunions?

A

Relieve pressure over the bunion itself

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22
Q

What are the appropriate shoes for bunions?

A

fitted with low heel and stiff soled shoes
- wide, squared toe box
- more depth to account for DF second toe

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23
Q

What are other treatments for bunions?

A

Splint - splits the 1st and 2nd toe (a spacer)

Silicone bunion pad to take off the pressure

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24
Q

What are the acute pain management for bunions?

A
  • rest
  • moist heat pack
  • analgesics
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25
Q

What is the indications for surgical management for bunions?

A

was not able to handle the conservative management
bad deformity or bunion pain

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26
Q

What are the different categories of flat foot/pes planus?

A

Flexible (99%)
Rigid (1%)

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27
Q

How do we determine the type of pes planus?

A

Through the jack test or heel raise test

Check lab notes

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28
Q

Flexible planus foot is indicated by?

A

INTERNAL longitudinal arch
- GOING AWAY during WB
- BEING SEEN during NWB

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29
Q

What is indicated by the jack test and how is it performed?

A

By hyperextending the big toe = the internal longitudinal arch is present

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30
Q

What is indicated by the heel raise test and how is it performed?

A

Patient is in the natural stance then raise their heel

flexible planus = heel goes to varus (in)

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31
Q

What is the etiology of rigid pes planus?

A

vertical talus from birth
tarsal coalition

Tarsal coalition - abnormal connection of two or more bones in the foot

32
Q

What are the unsual connections of the tarsal coalition?

A

calcaneo-navicular
talocalcaneal
- can be bony, cartilagenous or fibrous

33
Q

What are the symptoms of rigid pes planus?

A

Foot pain
Hard time walking on uneven surfaces
foot fatigue
peroneal spasm

34
Q

What is the treatment for rigid pes planus?

A

4-6 weeks of cast immobilization
surgical:
- resection of connecting bar
- soft tissue interposition
- subtalar arthrodesis
- even triple arthrodesis

35
Q

What is the purpose of subtalar arthrodesis?

A

An operating designed to make the arch of the foot more stable but keeping some supination and pronation
- the joints involve are the: talonavicular and calcanocuboid

36
Q

Which metatarsals are most frequently injured?

A

The 2nd and 3rd piggies

37
Q

What is the common reasoning regarding MT stress fracture?

A

stress or fatigue fracture after cyclical submax loads
ex. running, bad shoes, jogging long distances after not doing so at all

38
Q

What are the subjective findings of MT stress fracture?

A

Pain and swelling on WB
Hx of sudden activity increase
running surface change
long walks

39
Q

What are the objective findings of MT stress fracture?

A
  • swelling
  • ecchymosis
  • tenderness over the fractured MT
    may not show up in imagining for 2-3 weeks
40
Q

What is Morton’s Neuroma?

A

tissues get thick around the nerves towards your toes (interdigital nerve entrapment)
- neuropathy

41
Q

What is the etiology of morton’s neuroma?

A

trauma
ischemia
entrapment

42
Q

What is the pathology of morton’s neuroma?

A

Not a true neuroma but rather a perineural fibrosis of the common digital nerve

43
Q

Where does the common digital nerve pass through?

A

Passes between the metatarsal heads
- 3rd and 4th

44
Q

What is the perineural fibrosis?

A

swelling and growth of tissues surrounding the nerves that pass between the bones of the foot

45
Q

What is the subjective findings seen in morton’s neuroma?

A
  • shooting/constant pain when walking
  • relieved by rest and taking shoes off
  • 3rd and 2nd cleft tenderness
  • click on MT squeeze test

cleft - butt crack of piggies

46
Q

What population does morton’s neuroma common in?

A

8-10x more in women than men

47
Q

What is the non-operative treatment for morton’s neuroma?

A

metatarsal pad
orthoses
injection
excision

48
Q

What is the recommended shoes for Morton’s Neuroma?

A

shoes with wide toe box
DO NOT WEAR:
- tight or pointed-toed shoes
- shoes with heels more than 2 inches high

49
Q

How is post-op Morton’s Neuroma handled?

A

compression dressing placed with a post-op shoe

50
Q

How does the dorsal approach affect treatment for Morton’s Neuroma?

A

Allows for immediate WB and suture removal after 2 weeks

51
Q

How does the plantar incision affect treatment for Morton’s Neuroma?

A

slows down WB and suture by adding 2 weeks
- normal shoe by 3-4 weeks
- return to sport in 4-6 weeks

52
Q

What is the cause of tarsal tunnel?

A

Posterior tib entrapment since it passes between the flexor retinaculum and medial malleolus
- can be acute or insidious

53
Q

How is tarsal tunnel diagnosed?

A

Patient reports of:
- poorly localized burning sensation or pain
- tingling at the medial plantar surface of the foot
- gets worse after movement
- worset at the end of the day

Paresthesia = tingling

54
Q

What are the objective findings of tarsal tunnel?

A
  • (+) tinel sign
  • pain with PROM DF and eversion
  • Decreased 2 point discrimination on plantar aspect of foot
  • Vagus or valgus deformity of the heel
  • Weak foot intrinsics w/ sustained PF of toes
55
Q

What is the treatment of tarsal tunnel?

A

local cortocisteroid injections
orthoses
making the foot intrinsics stronk = restore medial longitudinal arch

56
Q

What is the pathology of turf toe?

A

Sprain of the 1st MTP joint on big toe

57
Q

What is the mechanism of injury for turf toe?

A

Hyperextension and varus/valgus stress on the 1st MTP joint

58
Q

What are the subjective findings of turf toe?

A
  • red, swollen, stiff 1st MTP joint
  • joint can be tender on plantar and dorsal surface
  • gait can be limp and be unable to run or jump
  • hx of a single DF injury or multiple injuries to the great toe
59
Q

What are the objective findings of turf toe?

A

Depending on the grades of severity

60
Q

What is indicated for a grade 1 sprain for Turf Toe?

A

minor stretch injury to the soft tissue restraint
- little pain
- minor swelling
- minor disability

61
Q

What is indicated for a grade 2 sprain for Turf Toe?

A

partial tear of capsulo-ligamentous structures
- moderate pain
- swelling
- ecchymosis
- moderate disability

ecchymosis = discoloration

62
Q

What is indicated for a grade 3 sprain for Turf Toe?

A

complete tear of the plantar plate
- severe swelling
- pain
- ecchymosis
- can’t bear weight normally

63
Q

What are the basic treatment for turf toe?

A

R.I.C.E
NSAIDS
Toe taped for DF limit
- but also grade based

Guide: return to sport needs a DF of 90 degrees

64
Q

What is the timeline for grade 1 turf toe sprain?

A

return to sport as soon as sx allow

65
Q

What is the timeline for grade 2 turf toe sprain?

A

Need 3-14 days of rest

66
Q

What is the timeline for grade 3 turf toe sprain?

A

crutches for a few days and up to 6 weeks of rest from activity

67
Q

What is the specific treatment regarding grade 1 turf toe sprain?

A

can use narrow athletic tape to immobilize the big toe to restrict pain
- place a firm insert in the shoe to limit movement and promote healing

68
Q

What is the specific treatment regarding grade 2 turf toe sprain?

A

may need immobilizing the foot in a brace or walking boot
- allowing several weeks of rest

69
Q

What is the specific treatment regarding grade 3 turf toe sprain?

A

IT DEPENDS ON THE SEVERITY
- surgery may be needed if there is a fracture of a bone (!!!)
- damage to the cartilage (the tissue that lines the bones of the joints)
- complete tearing of the tendon
- excessive movement of the joint causes sublux

70
Q

What is a cuboid syndrome?

A

When the structures near the cuboid bone are injured = one of the bones is moved or out of place
- often misdiagnosed
- small valid and reliable diagnostic tests
- uncommon (< 3%) after lateral ankle sprain

structures = calcaneo-cuboid ligaments

71
Q

What is the importance of the cuboid?

A

The keystone of the lateral column of the foot:
- concave cuboid rest on the convex navicular and lateral cuneiform

72
Q

How does the cuboid connecting to the navicular important?

A

The only mid-tarsal that articulates with the navicular
- links the lateral column with the MLA of the foot

73
Q

Where does the peroneus longus pass through?

A

slings to the side and down into the fibrous-osseus tunnel in the plantar aspect of the cuboid

74
Q

What does the aetiology of cuboid syndrome?

A

Degree and direction of the force of the peroneus then SUDDEN inversion of the midfoot with it being unlocked
= medial and inferior glide of the cuboid
- cuboid will sublux to the middle and down into the plantar direction

tearing of the interosseous ligaments occurs

75
Q

What is the objective signs of cuboid syndrome?

A
  • pain over the cuboid
  • pain in toe-off
  • can’t do plyometrics
  • pain along the medial arch and/or length of 4th MT
  • palpate prominence on plantar lateral aspect of the foot
  • limited and painful on DF, INV and EV @ CC joint
  • painful dosal glides of cuboid
76
Q

What are the recommended treatment of cuboid syndrome?

A

Cuboid whips
cuboid squeeze
mobs with movement
Re-training of intrinsics of the foot = creating stable midfoot in closed chain
rehab of whole kinetic chain

77
Q

What is the subequent treatment after a cuboid whip?

A

Peroneal and gastroc stretching
intrinsic/extrinsic foot strengthening
neuro/proprioceptive control exercise

PHTH 517 - Ortho Midterm LE (10 decks)

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