Readings - Ankle Pain

Question 1

What is the most common cause of medial ankle pain

Answer 1

Tendinopathy

Question 2

What is Tarsal tunnel syndrome and where does it cause pain

Answer 2

Compressed posterior tibial nerve

Medial ankle pain + sensory symptoms distally

Question 3

Name a PROM for ankle or foot pain

Answer 3

Foot and ankle ability measure (FAAM)

Question 4

What are the two common diagnosis for non-traumatic lateral ankle pain

Answer 4

1. Perineal tendinopathy

2. Sinus Tarsi syndrome

Question 5

What two foot biomechanical features may lead to perineal tendinopathy

Answer 5

1. Excessive probation

2. Excessive eversion

Question 6

What position should strengthening exercises be in for a perineal tendinopathy

Answer 6

resisted eversion in PF

Question 7

What is sinus tarsi syndrome

Answer 7

An inflammation of the synovial tissue within the sinus tarsi (A tunnel between the talus and calcaneus)

Question 8

List 4 causes of Sinus Tarsi Syndrome

Answer 8

1. Chronic overuse secondary to poor biomechanics
2. Repeated or singular inversion sprain
3. Repeated forced eversion
4. Chronic inflammatory conditions

Question 9

How does Sinus Tarsi Syndrome respond in the morning and to exercise ?

Answer 9

AM - more severe

Diminishes with exercise

Question 10

What type of surface is problematic for sinus Tarsi syndrome to walk on

Answer 10

Uneven ground

Question 11

How will range present with sinus tarsi syndrome

Answer 11

Full range and pain free but a stiff STJ may be present

Question 12

What passive movements or OPs will be painful in Sinus Tarsi Syndrome

Answer 12

Forced inversion and eversion

Question 13

List 5 treatment options for sinus tarsi syndrome

Answer 13

1. Relative rest
2. Short term NSAIDS and ice
3. Mobilisation of the STJ
4. Correct footwear and biomechanics
5. Proprioception and strength exercises

Question 14

Pain over the anterior aspect of the ankle without an acute injury is usually due to what two injuries ?

Answer 14

1. Tib. Ant. tendinopathy

2. Anterior impingement

Question 15

What movement mechanics can be altered to help a Tib Ant tendinopathy and how does it help?

Answer 15

Reduce running stride length temporarily —> reduces the functional length of Tib ant and reduces pull on the tibia

Question 16

What is posterior impingement

Answer 16

Impingement of bony or soft tissue structures between the posterior tibia and calcaneus in extremes of PF

Question 17

Where do osteochondral lesions usually occur

Answer 17

Superomedial is more common

Question 18

List 4 clinical signs of an osteochondral lesion

Answer 18

1. Particular difficult WB
2. Tender palpatinon of talar dome in 35 degrees PF
3. May report locking or catching
4. Reduced ROM

Question 19

For anterior impingement, what strategy should be employed initially.
Give examples

Answer 19

• protect EOR DF

- heel lift, taping, orthotics, activity modification

Question 20

Post navicular stress fracture, what ROM is important to increase ?

Answer 20

DF

Question 21

Early exercise post Achilles repair ?

Answer 21

Isometric PF

Question 22

3 Rx ideas for Calcaneal Apophysitis

Answer 22

1. Heel wedge
2. Address biomechanics
3. Stretch Gastroc and Soleus

Question 23

When are the special tests for the ankle more accurate

Answer 23

Greater than 5 days post injury

Question 24

List 5 possible causes an ankle sprain may not be progressing

Answer 24

1. Fractures
2. Synovitis
3. Sinus tarsi syndrome
4. Anterior impingement
5. Inadequate rehab

Question 25

What 5 subjective reports may indicate an osteochondral lesion

Answer 25

1. MOI with a compressive component to the medial aspect
2. Ache
3. Swelling
4. Locking and catching
5. Ongoing WB px

Question 26

What 3 objective findings may indicate osteochondral lesion

Answer 26

1. Persistence of joint effusion
2. Tender on palpation with ankle in PF
3. Continued loss or pain with DF

Question 27

What functional difficult will be seen in a syndesmotic sprain

Answer 27

• difficulty taking load in DF

Question 28

Biomechanical predisposing factors to sinus Tarsi syndrome ?

Answer 28

Foot pronation

Question 29

How will ROM generally present in Sinus tarsi syndrome ?

Answer 29

• generally full ROM but pain on eversion over pressure

Question 30

List 3 common findings in the assessment of a navicular stress fracture

Answer 30

1. Poorly localised ache at mid foot and medial arch
2. Reduced ankle DF
3. Excessive pronation