Review Session Flashcards
What are the Ottawa ankle rules? (4)
- Tenderness of the posterior edge of the lateral malleolus or medial malleolus
- Pain at the base of the 5th metatarsal
- Point tenderness at the navicular
- Inability to bear weight both immediately and in the ED
What imaging would you get if the Ottawa ankle rules are positive?
X rays
Usually pronation or eversion/lateral rotation mechanism. Often a contact injury
Medial ankle sprain/deltoid ligament sprain
This can come along with a medial ankle sprain. Often comes with a contact injury as body IR on a fixed foot.
Maisonneuve fx
This will have a positive anterior drawer in ER, positive lateral tilt test, positive kleiger test
Deltoid ligament sprain
This occurs when you have IR on a fixed dorsiflexed ankle. Will have diffuse pain anterolaterally or posteriormedially about the talocrural joint
High ankle sprain
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.
High ankle sprain
This is diagnosed with the reverse anterolateral drawer test or palpating the talus during the anterior drawer test
Lateral ankle sprain
What are tx for lateral ankle sprains?
Prophylactic bracing, exercise, manual therapy to restore DF, NMR. Maybe NSAIDS, ice, diathermy, laser. NOT US!
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?
Cuboid syndrome. Not a lot of research but likely tx with cuboid whip
What does the lisfranc ligament connect?
It connect the medial cuneiform to the second metatarsal
This is caused by ankle/foot supination on an axial loaded forefoot. Fall over fixed forefoot
Lisfranc injury
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?
Lisfranc injury will show fleck sign in imaging
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.
Achilles rupture
Can occur with a lateral sprain. Tenderness with palpation at lateral malleolus and pain with resisted PF+eversion
Fibularis tear
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?
Fibularis subluxation due to a retinacular tear
This is diagnosed with palpation, positive arc sign, positive royal London hospital test
Achilles tendinopathy
How do you treat Achilles tendinopathy?
Ionto and stretching, primary tx is loading using the pain monitoring method
This is commonly seen with obese middle age women, pain with WB and decreased medial arch
Tibialis posterior tendon dysfunction
This is considered part of the progressive collapsing foot deformity and is diagnosed with the “too many toes sign”
Tibialis posterior tendon dysfunction
What is Tibialis posterior tendon dysfunction treated with?
Anti inflammation, tib post and intrinsic strengthening, orthoses
This affects with very active overweight children usually 8-15 yo, limited DF, pain with palpation distal to Achilles insertion, pain with passive DF.
Sever disease (calcaneal apophysitis)
This is dx with squeeze test (squeeze calcaneous) and one leg heel stand
Sever disease
What is sever disease treated with?
Stretching, orthoses, or heel cup/wedge, strengthen plantar flexors
This looks like Achilles tendinopathy or sever’s but it doesn’t improve. What should we use to diagnose this?
Calcaneal stress fx; use a bone scan
Pain at Achilles insertion, no thickening and can palpate boggy edema.
Retocalcaneal bursitis
This is when a bone fragment (ossicle) that fails to fuse with the talus. It can cause pain due to overuse or trauma.
Os trigonum
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)
Os trigonum and posterior ankle impingement
What do you use to dx os trigonum?
X ray, CT, MRI
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
Medial tibial stress syndrome
How do you treat medial tibial stress syndrome?
Load management and pain monitoring (<2/10). Can come from tight/strong PF
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.
Tibial stress fx
This condition presents with cramping, burning or paresthesia with exercise and the inability to reproduce symptoms with palpation of the tibia.
Chronic exertional compartment syndrome
This has neurogenic complaints at night, later in the day, or with standing and walking.
Proximal tarsal tunnel
Neurogenic symptoms such as medial arch, 1st, second, 3rd toe pain or dyesthesia (bad sensation)
Joggers foot
This is chronic burning medial heel pain. This will have positive tinel sign, symptoms with DF EV and MTP extension.
Baxter neuropathy
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
Morton neuroma
How do you stretch digital nerves?
Passively stretch all MTP into extension with ankle DF+eversion (this is called modified digital nerve stretch test)
This condition occurs with first step or after prolonged activity. Positive windlass test.
Plantar fasciopathy or plantar heel pain.
How do you tx plantarfasciopathy?
Stretching, manual therapy to improve Df, taping for short term relief, possible nightsplints, iontophoresis/phono, laser. NO US
This dx comes with plantar heel pain with hx of corticosteroid injections. Negative windlass
Fat pad atrophy
How do you tx fat pad atrophy?
Tape or add heel cushion to see if pain improve.
