Review Session

Question 1

What are the Ottawa ankle rules? (4)

Answer 1

1. Tenderness of the posterior edge of the lateral malleolus or medial malleolus
2. Pain at the base of the 5th metatarsal
3. Point tenderness at the navicular
4. Inability to bear weight both immediately and in the ED

Question 2

What imaging would you get if the Ottawa ankle rules are positive?

Answer 2

X rays

Question 3

Usually pronation or eversion/lateral rotation mechanism. Often a contact injury

Answer 3

Medial ankle sprain/deltoid ligament sprain

Question 4

This can come along with a medial ankle sprain. Often comes with a contact injury as body IR on a fixed foot.

Answer 4

Maisonneuve fx

Question 5

This will have a positive anterior drawer in ER, positive lateral tilt test, positive kleiger test

Answer 5

Deltoid ligament sprain

Question 6

This occurs when you have IR on a fixed dorsiflexed ankle. Will have diffuse pain anterolaterally or posteriormedially about the talocrural joint

Answer 6

High ankle sprain

Question 7

With this you will have tenderness to palpation of the anterior inferior tibiofibular ligament and syndesmosis, pain with DF. Will have a positive squeeze test.

Answer 7

High ankle sprain

Question 8

This is diagnosed with the reverse anterolateral drawer test or palpating the talus during the anterior drawer test

Answer 8

Lateral ankle sprain

Question 9

What are tx for lateral ankle sprains?

Answer 9

Prophylactic bracing, exercise, manual therapy to restore DF, NMR. Maybe NSAIDS, ice, diathermy, laser. NOT US!

Question 10

This is lateral midfoot pain due to a positional fault. Usually happens with a lateral ankle sprain. Pain with fibularis muscle testing, painful heel raise. How would you treat it?

Answer 10

Cuboid syndrome. Not a lot of research but likely tx with cuboid whip

Question 11

What does the lisfranc ligament connect?

Answer 11

It connect the medial cuneiform to the second metatarsal

Question 12

This is caused by ankle/foot supination on an axial loaded forefoot. Fall over fixed forefoot

Answer 12

Lisfranc injury

Question 13

This will have the gap sign (increased space between 1st and second toes). Swelling, ecchymosis, tenderness. Need to check pulse of dorsalis pedis and 1st webspace sensation. What will be seen on imaging?

Answer 13

Lisfranc injury will show fleck sign in imaging

Question 14

Will feel a pop in the back of the ankle, can usually feel a divot. Associated with high cholesterol, use of fluoroquinolones, statins, long term glucocorticoids.

Answer 14

Achilles rupture

Question 15

Can occur with a lateral sprain. Tenderness with palpation at lateral malleolus and pain with resisted PF+eversion

Answer 15

Fibularis tear

Question 16

This can occur with a lateral ankle sprain and has tenderness to palpation, along with pain with PF+eversion but has reports of popping and snapping. What is injured?

Answer 16

Fibularis subluxation due to a retinacular tear

Question 17

This is diagnosed with palpation, positive arc sign, positive royal London hospital test

Answer 17

Achilles tendinopathy

Question 18

How do you treat Achilles tendinopathy?

Answer 18

Ionto and stretching, primary tx is loading using the pain monitoring method

Question 19

This is commonly seen with obese middle age women, pain with WB and decreased medial arch

Answer 19

Tibialis posterior tendon dysfunction

Question 20

This is considered part of the progressive collapsing foot deformity and is diagnosed with the “too many toes sign”

Answer 20

Tibialis posterior tendon dysfunction

Question 21

What is Tibialis posterior tendon dysfunction treated with?

Answer 21

Anti inflammation, tib post and intrinsic strengthening, orthoses

Question 22

This affects with very active overweight children usually 8-15 yo, limited DF, pain with palpation distal to Achilles insertion, pain with passive DF.

Answer 22

Sever disease (calcaneal apophysitis)

Question 23

This is dx with squeeze test (squeeze calcaneous) and one leg heel stand

Answer 23

Sever disease

Question 24

What is sever disease treated with?

Answer 24

Stretching, orthoses, or heel cup/wedge, strengthen plantar flexors

Question 25

This looks like Achilles tendinopathy or sever’s but it doesn’t improve. What should we use to diagnose this?

Answer 25

Calcaneal stress fx; use a bone scan

Question 26

Pain at Achilles insertion, no thickening and can palpate boggy edema.

Answer 26

Retocalcaneal bursitis

Question 27

This is when a bone fragment (ossicle) that fails to fuse with the talus. It can cause pain due to overuse or trauma.

Answer 27

Os trigonum

Question 28

This presents with limited PF, pain at end range of plantar flexion. No pain with palpation of Achilles, calcaneous, or with passive DF. (Can be two diagnoses what are they)

Answer 28

Os trigonum and posterior ankle impingement

Question 29

What do you use to dx os trigonum?

Answer 29

X ray, CT, MRI

Question 30

This condition has pain at the distal 2/3 of the medial tibia that is worse with activity and relieved with rest. Pain will be reproduced if at least 5 consecutive cm of the posterior medial tibia

Answer 30

Medial tibial stress syndrome

Question 31

How do you treat medial tibial stress syndrome?

Answer 31

Load management and pain monitoring (<2/10). Can come from tight/strong PF

Question 32

This will have pain along medial tibia that worsens with activity and decrease with rest. Pain is reproduced with palpation over a small area of the tibia.

Answer 32

Tibial stress fx

Question 33

This condition presents with cramping, burning or paresthesia with exercise and the inability to reproduce symptoms with palpation of the tibia.

Answer 33

Chronic exertional compartment syndrome

Question 34

This has neurogenic complaints at night, later in the day, or with standing and walking.

Answer 34

Proximal tarsal tunnel

Question 35

Neurogenic symptoms such as medial arch, 1st, second, 3rd toe pain or dyesthesia (bad sensation)

Answer 35

Joggers foot

Question 36

This is chronic burning medial heel pain. This will have positive tinel sign, symptoms with DF EV and MTP extension.

Answer 36

Baxter neuropathy

Question 37

This happens between 3 and 4 digits but can also be between second and third digits. Patients report sharp shooting, burning? Cramping, tingling. Patients might report walking on a lump

Answer 37

Morton neuroma

Question 38

How do you stretch digital nerves?

Answer 38

Passively stretch all MTP into extension with ankle DF+eversion (this is called modified digital nerve stretch test)

Question 39

This condition occurs with first step or after prolonged activity. Positive windlass test.

Answer 39

Plantar fasciopathy or plantar heel pain.

Question 40

How do you tx plantarfasciopathy?

Answer 40

Stretching, manual therapy to improve Df, taping for short term relief, possible nightsplints, iontophoresis/phono, laser. NO US

Question 41

This dx comes with plantar heel pain with hx of corticosteroid injections. Negative windlass

Answer 41

Fat pad atrophy

Question 42

How do you tx fat pad atrophy?

Answer 42

Tape or add heel cushion to see if pain improve.