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PTA - Pathology > PTA135-Unit 3-2-Ankle, Foot, Toes > Flashcards

PTA135-Unit 3-2-Ankle, Foot, Toes Flashcards

1
Q

Describe 1st degree ligament sprain of the ankle

A
  • 1 ligament is completely torn

- anterior talofibular ligament (ATFL)

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2
Q

Describe 2nd degree ligament sprain of the ankle

A
  • 2 ligaments are completely torn

- ATFL and calcaneofibular ligament (CFL)

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3
Q

Describe 3rd degree ligament sprain of the ankle

A
  • 3 ligaments are completely torn

- ATFL, CFL and posterior talofibular ligament (PTFL)

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4
Q

State the most common MOI for sprains of the lateral aspect of the ankle

A

Inversion of the foot and ankle in a weight bearing position

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5
Q

discuss rehab following a lateral ankle sprain - Maximum Protection Phase

A
  • 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
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6
Q

discuss rehab following a lateral ankle sprain - Moderate Protection Phase

A
  • 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
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7
Q

discuss rehab following a lateral ankle sprain - Minimal Protection Phase

A
  • 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
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8
Q

What is the most common cause of Achilles Tendonitis?

A

overuse (injury from repetitive microtrauma and overloading of the tendon)

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9
Q

discuss rehab for Achilles Tendonitis

A
  • 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
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10
Q

discuss the medical management of an Achilles Tendon Rupture

A
  • 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
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11
Q

discuss the rehabilitation of an Achilles Tendon Rupture

A
  • 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
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12
Q

define Compartment Syndrome

A

a condition in which increased pressure within an enclosed space compromises the circulation of the tissue contained within that space

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13
Q

list the four compartments of the lower leg

A
  • anterior
  • lateral
  • superficial posterior
  • deep posterior
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14
Q

list the components of the Anterior Compartment

A
  • Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus, Peroneus Tertius
  • Deep Peroneal Nerve
  • Anterior Tibial Artery and Vein
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15
Q

list the components of the Lateral Compartment

A
  • Peroneus Longus, Peroneus Brevis

- Superficial Peroneal Nerve

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16
Q

list the components of the Superficial Posterior Compartment

A
  • Gastrocnemius, Soleus, Plantaris

- Sural Nerve

17
Q

list the components of the Deep Posterior Compartment

A
  • Tibialis Posterior, Flexor Hallucis Longus, Flexor Digitorum Longus, Popliteus
  • Tibial Nerve
  • Peroneal Artery and Vein, Posterior Tibial Artery and Vein
18
Q

discuss the medical management of Compartment Syndrome

A
  • 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
19
Q

discuss the conservative management of Compartment Syndrome

A
  • Relative rest
  • NSAIDs
  • Flexibility
  • Strengthening
  • Foot orthotic device as needed
20
Q

discuss the rehab of Compartment Syndrome

A

• 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)

21
Q

discuss the signs of Plantar Fasciitis

A

inflammation

22
Q

discuss the symptoms of Plantar Fasciitis

A
  • 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
23
Q

discuss the PT treatment for Plantar Fasciitis

A
  • 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
24
Q

discuss the medical treatment for Plantar Fasciitis

A
  • 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
25
Q

define Pes Planus

A

Dropped medial longitudinal arch of the foot, causing the medial border of the foot to touch the ground in a WB position

26
Q

discuss effects of Pes Planus on lower extremity

A

(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

27
Q

describe Morton’s Neuroma

A

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.

28
Q

describe Hallux Valgus

A

Lateral angulation of the great toe at the MTP joint, greater than 15 degrees; bunion

29
Q

describe Hammer Toe

A

MTP joint neutral/extended
PIP flexed
DIP flexed or extended

30
Q

describe Mallet Toe

A

MTP joint neutral/extended
PIP neutral/extended
DIP flexed

31
Q

describe Claw Toe

A

MTP hyperextended
PIP flexed
DIP flexed
(similar to hammer, but different)

32
Q

describe Medial Tibial Stress Syndrome

A
  • 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
33
Q

discuss rehab for Medial Tibial Stress Syndrome

A
  • 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
34
Q

describe Pott’s Fracture

A

3 parts:
• Fracture of fibula 2-3 inches above lateral malleolus
• Avulsion of medial malleolus
• Subluxation of talus laterally

35
Q

describe Pilon Fracture

A

Distal tibia compression fracture

tibia compressed into talus

PTA - Pathology (7 decks)

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