PTA135-Unit 3-2-Ankle, Foot, Toes Flashcards
Describe 1st degree ligament sprain of the ankle
- 1 ligament is completely torn
- anterior talofibular ligament (ATFL)
Describe 2nd degree ligament sprain of the ankle
- 2 ligaments are completely torn
- ATFL and calcaneofibular ligament (CFL)
Describe 3rd degree ligament sprain of the ankle
- 3 ligaments are completely torn
- ATFL, CFL and posterior talofibular ligament (PTFL)
State the most common MOI for sprains of the lateral aspect of the ankle
Inversion of the foot and ankle in a weight bearing position
discuss rehab following a lateral ankle sprain - Maximum Protection Phase
- RICE 3-5 times daily
- joint protection with brace, air sitrrup, taping in neutral or in DF with slight eversion
- WBAT
- AROM without pain, avoiding PF/inversion
- strengthening with isometrics and proximal PRE’s
- progress to WB without assistive device
discuss rehab following a lateral ankle sprain - Moderate Protection Phase
- begins when able to WB w/out assist; perform ROM/isometrics w/out increased pain
- RICE
- continue taping or bracing as needed
- WB exercise progression
- begin concentric/eccentric exercises
- stationary bike
- PF/inversion as pain allows
- calf and achilles stretches (to not lose flexibility)
- proprioceptive & balance exercises initiated
discuss rehab following a lateral ankle sprain - Minimal Protection Phase
- begins when pt can perform all resistive exercises and ambulate w/out pain or deviations and swelling is reduced
- continue progression of proprioception and neuromuscular activities
- return to functional activities - jogging, jumping, cutting exercises
- bracing during functional activities PRN
What is the most common cause of Achilles Tendonitis?
overuse (injury from repetitive microtrauma and overloading of the tendon)
discuss rehab for Achilles Tendonitis
- NSAIDs
- relative rest
- ice
- aerobic exercise - biking,swimming
- flexibility to increase DF
- strengthening - submaximal with limited ROM to begin, progress as symptoms allow
- eccentric exercises (in some studies)
- foot orthoses
- heel lift
- massage
- US/phonophoresis
- severe cases get immobilization for 10 days, then rehab progresses slowly
discuss the medical management of an Achilles Tendon Rupture
- surgery or cast immobilization
- with surgery, there is lower rate of re-rupture and greater return of strength, power, endurance
- rehab will be physician dependent
discuss the rehabilitation of an Achilles Tendon Rupture
- immobilization for up to 8 wks
- maximum protection phase for 6 more wks after immobilization
- aerobic exercise, strengthening of uninvolved leg, quads/hams of involved leg
- follow gradual process of regaining DF and PF ROM
- proprioception training, progression of strength
- when strength up to 70%, begin progressive jogging program
- in general, return to full activity in 6-9 months
define Compartment Syndrome
a condition in which increased pressure within an enclosed space compromises the circulation of the tissue contained within that space
list the four compartments of the lower leg
- anterior
- lateral
- superficial posterior
- deep posterior
list the components of the Anterior Compartment
- Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus, Peroneus Tertius
- Deep Peroneal Nerve
- Anterior Tibial Artery and Vein
list the components of the Lateral Compartment
- Peroneus Longus, Peroneus Brevis
- Superficial Peroneal Nerve
list the components of the Superficial Posterior Compartment
- Gastrocnemius, Soleus, Plantaris
- Sural Nerve
list the components of the Deep Posterior Compartment
- Tibialis Posterior, Flexor Hallucis Longus, Flexor Digitorum Longus, Popliteus
- Tibial Nerve
- Peroneal Artery and Vein, Posterior Tibial Artery and Vein
discuss the medical management of Compartment Syndrome
- Surgical fasciotomy (esp acute)
- Nerve and muscle ischemia lasting > 12 hours will produce severe and irreversible damage
- Pressure relieved with 4 hours usually avoids permanent damage
discuss the conservative management of Compartment Syndrome
- Relative rest
- NSAIDs
- Flexibility
- Strengthening
- Foot orthotic device as needed
discuss the rehab of Compartment Syndrome
• Referral for medical treatment if encountered in clinic
• Post surgery
o ice and elevation
o walking as tolerated
o A/PROM of ankle can begin 2 days post surgery
o Early ROM is important to avoid contractures
• Light resistance ankle motions once the pain and swelling are under control
• Avoid heavy resistance exercises that cause muscle hypertrophy (contraindicated after fasciotomy for acute compartment syndrome)
discuss the signs of Plantar Fasciitis
inflammation
discuss the symptoms of Plantar Fasciitis
- Pain and tenderness upon palpation along the medial border of the calcaneus or along entire fascia
- Increased pain with the foot in DF and toes extended
- Pain worse in the morning at first contact with floor
- Pain worse with first several steps after prolonged sitting
- Pain worse with prolonged weight bearing activity or exercise
discuss the PT treatment for Plantar Fasciitis
- Eliminate/modify causative factors
- Ice massage
- NSAIDs
- Night splints
- Arch taping, orthotics
- US, phonophoresis, iontophoresis
- Manual therapy
- Stretching of the calf and toe extensors
- Foot muscle strengthening
- Ankle strengthening
discuss the medical treatment for Plantar Fasciitis
- Steroid injections
- Extracorporeal shockwave therapy to break up adhesions, improve soft tissue extensibility
- Last resort is surgery – plantar fasciotomy or partial release and excision of bone spur if present
define Pes Planus
Dropped medial longitudinal arch of the foot, causing the medial border of the foot to touch the ground in a WB position
discuss effects of Pes Planus on lower extremity
(since foot is terminal component of weight bearing)
• Associated pain and discomfort may be experienced in other joints along the chain – knee, hip, back
• Because the foot is already pronated, the reduced normal motion from neutral to pronation is affected during the gait cycle
• Compensation from other joints leads to more pain
describe Morton’s Neuroma
An injury to the nerve between the toes, usually between third and fourth. Causes thickening and pain. Bones squeeze nerve between 3rd and 4th metatarsal heads.
describe Hallux Valgus
Lateral angulation of the great toe at the MTP joint, greater than 15 degrees; bunion
describe Hammer Toe
MTP joint neutral/extended
PIP flexed
DIP flexed or extended
describe Mallet Toe
MTP joint neutral/extended
PIP neutral/extended
DIP flexed
describe Claw Toe
MTP hyperextended
PIP flexed
DIP flexed
(similar to hammer, but different)
describe Medial Tibial Stress Syndrome
- Inflammation of the musculotendinous and periosteal interface
- Located at the posterior medial border of the tibia
- Medial origin of the soleus, posterior tibialis, flexor digitorum longus
- May be stress reaction rather than inflammation
discuss rehab for Medial Tibial Stress Syndrome
- Ice or ice massage
- NSAIDs
- Iontophoresis or phonophoresis
- Treatment directed towards impairments
- Orthotics to correct over pronation
- Stretching/strengthening of the lower extremity
- Relative/active rest for most cases – pool jogging, upper body exercises
describe Pott’s Fracture
3 parts:
• Fracture of fibula 2-3 inches above lateral malleolus
• Avulsion of medial malleolus
• Subluxation of talus laterally
describe Pilon Fracture
Distal tibia compression fracture
tibia compressed into talus
