Readings - Ankle Pain Flashcards
What is the most common cause of medial ankle pain
Tendinopathy
What is Tarsal tunnel syndrome and where does it cause pain
Compressed posterior tibial nerve
Medial ankle pain + sensory symptoms distally
Name a PROM for ankle or foot pain
Foot and ankle ability measure (FAAM)
What are the two common diagnosis for non-traumatic lateral ankle pain
- Perineal tendinopathy
2. Sinus Tarsi syndrome
What two foot biomechanical features may lead to perineal tendinopathy
- Excessive probation
2. Excessive eversion
What position should strengthening exercises be in for a perineal tendinopathy
resisted eversion in PF
What is sinus tarsi syndrome
An inflammation of the synovial tissue within the sinus tarsi (A tunnel between the talus and calcaneus)
List 4 causes of Sinus Tarsi Syndrome
- Chronic overuse secondary to poor biomechanics
- Repeated or singular inversion sprain
- Repeated forced eversion
- Chronic inflammatory conditions
How does Sinus Tarsi Syndrome respond in the morning and to exercise ?
AM - more severe
Diminishes with exercise
What type of surface is problematic for sinus Tarsi syndrome to walk on
Uneven ground
How will range present with sinus tarsi syndrome
Full range and pain free but a stiff STJ may be present
What passive movements or OPs will be painful in Sinus Tarsi Syndrome
Forced inversion and eversion
List 5 treatment options for sinus tarsi syndrome
- Relative rest
- Short term NSAIDS and ice
- Mobilisation of the STJ
- Correct footwear and biomechanics
- Proprioception and strength exercises
Pain over the anterior aspect of the ankle without an acute injury is usually due to what two injuries ?
- Tib. Ant. tendinopathy
2. Anterior impingement
What movement mechanics can be altered to help a Tib Ant tendinopathy and how does it help?
Reduce running stride length temporarily —> reduces the functional length of Tib ant and reduces pull on the tibia
What is posterior impingement
Impingement of bony or soft tissue structures between the posterior tibia and calcaneus in extremes of PF
Where do osteochondral lesions usually occur
Superomedial is more common
List 4 clinical signs of an osteochondral lesion
- Particular difficult WB
- Tender palpatinon of talar dome in 35 degrees PF
- May report locking or catching
- Reduced ROM
For anterior impingement, what strategy should be employed initially.
Give examples
- protect EOR DF
- heel lift, taping, orthotics, activity modification
Post navicular stress fracture, what ROM is important to increase ?
DF
Early exercise post Achilles repair ?
Isometric PF
3 Rx ideas for Calcaneal Apophysitis
- Heel wedge
- Address biomechanics
- Stretch Gastroc and Soleus
When are the special tests for the ankle more accurate
Greater than 5 days post injury
List 5 possible causes an ankle sprain may not be progressing
- Fractures
- Synovitis
- Sinus tarsi syndrome
- Anterior impingement
- Inadequate rehab
What 5 subjective reports may indicate an osteochondral lesion
- MOI with a compressive component to the medial aspect
- Ache
- Swelling
- Locking and catching
- Ongoing WB px
What 3 objective findings may indicate osteochondral lesion
- Persistence of joint effusion
- Tender on palpation with ankle in PF
- Continued loss or pain with DF
What functional difficult will be seen in a syndesmotic sprain
- difficulty taking load in DF
Biomechanical predisposing factors to sinus Tarsi syndrome ?
Foot pronation
How will ROM generally present in Sinus tarsi syndrome ?
- generally full ROM but pain on eversion over pressure
List 3 common findings in the assessment of a navicular stress fracture
- Poorly localised ache at mid foot and medial arch
- Reduced ankle DF
- Excessive pronation
