SHANKMAN CHP 17 ANKLE, FOOT, TOES pg 232 Flashcards
defintion:
a calcaneus fracture that heals in a varus positon locks the subtalar joint in inversion, crating a rigid transverse tarsal joint
calcanueus fracture
definition
rupture results in planovalgus, or flatfoot
posterior tibialis tendon
definition
ligaments responsible for maintaing stability of the distal tibiofibular articulation
syndesmosis
definition
tests integrity of both anterior talofibular ligament and calcaneofibular ligament. both must be dirupted to be postive.
Talar tilt test
definition
no muscle attachmetn origin or insertion. has a tenuous blood supply
Talus
definition
passes behind the medial malleolus
tibial nerve
chronic instablility may follow an inverison ankle sprain. Name the two types of instablilties associated with chronic ankle sprains.
mechanical and functional
pg 238
Name the 3 major ligaments that represent the lateral ligament comlex of the ankle.
FAP
Anterio Talofibular
Posterio talofibular
Fibulocalcaneal
PG 233
NAME the 3 distinct types of lesser toe deformities
- Hammer toe
- Mallet toes
- claw toes
pg 254
toe deformity characterized by deformity of the mtatarsophalangeal joint proximal interphalangeal joint, and distal interphalangeal joint
the MTP joint is either in neutral postion or extension. the PIP jt is held in flexion with the DIP jt in either flexion or extension
HAMMER TOE
toe deformity characterized by a neutral MTP jt, a neutral PIP jt, and a flexed DIP jt
bending at the DIP
Mallet toe
toe deformity often associated with neuromuscular disease and are similar in appearance to hammer toes.
distinguished by MTP hyperextension, PIP flexion, and DIP flexion. Usually results from simultaneous contraction of the extensors and flexors.
Claw toes
TRUE/FALSE
during the early recovery (acute phase) period of an inversion ankle sprain, it is imperative to instruct the pt to write the alphabet with the injured ankle
FALSE
TRUE OR FALSE
Complete deltoid ligament sprains occur in combination with ankle fractures.
TRUE
TRUE OR FALSE
Mechanical instability may require surgery to stabilize the ankle.
TRUE
TRUE OR FALSE
. Treatment for a ruptured Achilles tendon is always with surgery.
FALSE
TRUE OF FALSE
The loss of strength is less if the ruptured Achilles tendon is treated nonsurgically.
FALSE
TRUE OR FALSE
The initial management of pilon fractures usually involves an open reduction with internal fixation procedure, external fixator, or skeletal traction.
TRUE
TRUE OR FALSE
In severe cases of plantar fasciitis, the physician may inject a local corticosteroid to reduce pain and swelling.
TRUE
TRUE OR FALSE
n cases of plantar fasciitis where all conservative measures fail to bring significant results, the physician may elect to perform a fasciotomy or excision of a calcaneal exostosis.
TRUE
TRUE OR FALSE
Treatment of Morton neuroma is always with surgical excision.
FALSE
TRUE OR FALSE
The removal of tight shoes may significantly reduce painful symptoms associated with hallux valgus.
TRUE
TRUE OR FALSE
Lesser toe deformities are characterized as either rigid or flexible.
TRUE
What percentage of all ankle sprains occurs to the lateral ligament complex?
A. 50%
B. 65%
C. 95%
D. 85%
C. 95%
What is the primary mechanism of injury (MOI) to the lateral ligament complex of the ankle?
A. Eversion and plantar flexion
B. Plantar flexion, adduction, and eversion
C. Inversion, plantar flexion, and adduction
D. Dorsiflexion, abduction, and eversion
- C. Inversion, plantar flexion, and adduction
The anterior drawer test is used to clinically examine which ligaments of the ankle?
A. Posterior talofibular
B. Anterior talofibular
C. Fibulocalcaneal
D. Deltoid
E. All of the above
B. Anterior talofibular
Which of the following represents potential pathologies that may be seen in conjunction with an inversion ankle sprain that is produced by inversion plantar flexion and adduction?
A. Subluxing peroneal tendons
B. Fracture of the base of the fifth metatarsal
C. Malleolar fractures
D. Sprains of the midfoot
E. All of the above
E. All of the above
Using the injury classification model described by Leach, which of the following describes a second-degree lateral ligament complex sprain of the ankle?
A. The anterior talofibular ligament is completely torn.
B. The anterior talofibular ligament and fibulocalcaneal ligaments are completely torn.
C. All three ligaments are partially torn.
D. The anterior talofibular and fibulocalcaneal ligaments are partially torn.
B. The anterior talofibular ligament and fibulocalcaneal ligaments are completely torn.
classification of sprains
single ligament is completel torn
First degree sprain
classification of sprain
double ligament rupture. Both the Anterior talofibular ligaments and fibulocalcaneal ligaments are completely torn.
second -degree sprain
classificatin of sprain
all three lateral ankle ligaments (ATF, posteror talofibular, and fibulocalcaneal) are completely torn
third - degree
initial management of acute inversion ankle sprians calls for what
RICE
Clinically the most effetive means to reduce swelling are what
Elevation and compression
Protecting the torn ligaments from unwante stress is the cornerstone of what protection phase?
maximum
PTs IE outline for the clinical assessmetn of inversion ankle sprain includes:
- History
- Observation
- Palpation
- ROM
- Strength
- Clinical stabiltiy tests
TRUE OR FALSE
an AROM program must be used cautiously during the max -protect phase
true
what type of exerxises are initiated as soon as the pts pain tolerance allows.
Isometric strengthing exercises
DF and eversion 2 to 3 sets of 10
holding for 10 secs
When does the Moderate phase begin?
- once the pt can bear weight on the injured limb without crutches
- perform all ROM and isometric exercises without undue complaints of pain
- control the swelling
In the moderate protection phase of lat ankle sprian what can you graudally add in as pain allows.
- inversion and PF
- stationary bicycling w/ seat height lowered(encourage more neutral ankle)
- proprioception exercises
- balancing on injured limb(balance board, mini tramp)
When can the minimum protection phase begin?
- Once the pt can perform all resistive exercises (ankle weights, thera-band, and manual resistance)
- ambulate without pain or limping
- swellin is reduced
Does removal of all supportive devices imply minimum protection phase?
no
maturatin of the injured ligaments can take as long as 6-12 months.
- threfore it is critical to encourage pt compliance with the use of either tape or a semirigid brace during all running activities
Depending on the physician’s choice tx, a grade III sprain can be tx by either of what 2 ways?
- surgically
- early controlled motion and superviese PT
Fractures of the medial or lateral malleolus may cause disruption of what ligament?
Deltoid ligament
name the 7 parts to
Phase I: Max-protection phase
- RICE
- EGS-electrical galvanic stim
- WBAT
- joint protection (plastic, hinged orthosis, tape, air cast, semirigid braces)
- AROM- (DF and eversion)
- isometric exercises
- general fitness exercises
Name the 9 parts to
Mod protection phase
- RICE
- FWB
- concentri and eccentric contractoer
- continued joint protection
- heel cord stretching
- stationary cycling
- proprioception exercises
- general fitness exercises
- avoidance of unwanted stresses(inv, PF)
name the 8 parts to
Min protection phase
- joint protection during activities
- running
- jumping
- plyometrics
- proprioception exercises
- general fitness
- isotonic ex
- isokinetic ex
When the ankle is forced into DF or rotation with the foot in a Weight bearing position,where does the injury commonly occur?
ankle SYNDESMOSIS
definition
laxity of the ankle ligaments
Mechanical instabliltiy
With mechanical insablilties surgery may be necessary to stabliize the ankle joint.
procedures are common reconstructive surgical procedures used to help stabilize what ligaments
the lateral ligament complex of the ankle
In general, the peronues brevis
T/F
the healing time for ligaments is slightly longer and more tenuous than that for muscle and tendon reconstruction?
True
when subluxation of the peroneal tendons occurs what is happening?
/
the peroneal tendons normally dislocate anteriorly over the lateral malleolus with ankle DF
An overuse injury resulting from repetitive microtrauma and accumulative overloading ofthe tendon
Achililes Tendinopathy
Complete ruptures of the achilles tendon can occur with sudden what?
eccentric-concetric contraction of the gastroc and soleus
What test
- the pt lies prone with feet extending off end of table. the entire lower leg is exposed from knee to toe. the belly of the calf uninvolved lim is grasped and squeezed so that the foot PF.
- If the achilles tendon is ruptured on the involved limb when the calf is squeezed what indicates a positive thomas test?
no PF motion results
pg 243
Generally most pts after an achilles tendon rupture are able to return to full activiry after how long?
6-9 months
after an achilles tendon rupture and immobilization strength training can usually begin as early as?
2-4 weeks
pg 245
Surgical complication following achilles tendon repair or reconstruction include what?
- sural nerve dysfunction
- infection
- skin sensitivity
- adhesions
- rerupture
- tendon necrosis
definition
either acute or chronic elevated tissue pressure within a closed fascial space, resulting in occlusion of vessels and compromised neuromuscular function
Compartment syndromes of the lower leg
Acute compartment syndromes of the leg are most commonly associated with what?
And considered a medical emergency
- tibial fractures
- direct trauma to the area
- muscle rupture
- muscle hypertrophy
- circumferential burns
chronic compartment syndromes are also referred t as?
exertional compartment syndrome
or
exercise-induced compartment syndrome
Clinical symptoms of acute compartment syndrome include what?
- pain
- palpable swelling or tenderness
- paresthesias
- skin may be warm, shiny, and tense
- passive stretching may produce severe pain
- what is the most widely acceptedclassificatin of ankle fx called?
- and another type is called?
- Lauge-Hansen classifitcation
- AO
ankle fractures include
- lateral malleolar fx
- medial malleolar fx
- bimalleolar fx
- trimalleolar fx
Many ankle fx are repaired with what?
ORIF
after an ankle fx. when is a walking cast applied?
when the pt can acheive full PF and DF
after a cast removal following an ORIF procedure for a medial malleolar fx. When should the PTA recongnize when to stop tx and inform PT?
- increase swelling
- c/o crepitus when strengthening exercises were increased
- stressing inversion of the ankle
What is a pilon fx
Distal tibia comression fx- occurs as a result of veritcal or axial loads that drive, or compress, the tibia into the talus.
intraarticular depression fx that usually caused by falls from a height and resul in compression of the calcaneus from the talus
Calcaneal fx
name the 7 common patterns of calcaneal fx
- vertical fx of the calcaneal tuberosity
- horizontal fx
- fractures of the sustentaculum tali
- anterior calcaneal fx
- fracture of the body of the calcaneus without involvement of the subtalar jt
- calcaneal fx with lateral fisplacemtn and involvement of the subtalar jt
- central calcanues crushing fx
what are the types of fractures of the Talus?
TYPE I- talar neck fx without displacement
TYPE II- talar fx with subtalar subluxation (evidence of avascualr necrois is as high as 50%)
TYPE III-talar fx with subtalar subluxation ( incidnec of avascular necrosis is as high as 85%)
TYPE IV- talar head dislocates from the navicular in assoc… with a type III injury
A partial or complete fx of bone caused by unrelenting stress and force that do not allow for osteoblastic repair of bone and in turn cause accelerated bone resorption
stress fx
musculoskeletal overuse injuries of the lower leg involving the distal third of the posterior medial border of the tibia have historically been referred to as what?
shin splints
WHAT SYNDROME ? pain over the distal and middle thirds of the tibia along the posterior medial border.
Can include
- stress fx of fibula and tibia
- ischemic disorders
- deep compartment syndromes of the lower leg
medial tibial stress syndrome
chronic inflammation of the plantar aponeurosis with or without an associated calcaneal heel spur?
plantar fasciitis (heel spur syndrome)
Pts with plantar fasciitis frequently complain of what?
- pain along the medial border of calcaneus on plantar surface
- pain is worse in the morning
- palpation reveals tenderness at the medial tuberosity
- DF may provoke pain
radiating pain thru the toes and proximally to the dorsal or plantar surface of the foot
morton neuroma
where does a mortons neuroma usually occur
- 3-4 interspace
- less frequently the 2-3 interspace
A lateral or valgus deviation of the great toe with both soft tissue and bony deformity. Can be exacerbated by improper footwear.(narrow toe box)
Hallux Valugs
