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Semester 2 PM Exam 10 > Surgical Ankle Disorders > Flashcards

Surgical Ankle Disorders Flashcards

1
Q

What should PT do to ensure best success for patient

A

Communicate with surgeon
Dont be scared to call and clarify
Tem based care is key

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2
Q

Must understand ___

A

the cause of the symptom

Dont just focus on symptoms, identify the disease and then address

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3
Q

What is equinus

A

limitation of DF due to tight post muscle group

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4
Q

Compensations for equinus

A 
Forward torso lean
Pelvic rotation
Hip flexion
Knee hyperext
Knee flex
ER of leg
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5
Q

Clinical outcome with stretching for equinus

A

Statistically sig but not really clinically sig for overlying etiology of equinus - good for pain relief though

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6
Q

Plantar Fasciitis/Fasciosis - what is it

A

chronic pain on the plantar heel secondary to continued stretch/strain of fascia
Results in microtears and degeneration of ligament

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7
Q

Plantar Fasciitis/Fasciosis - heel spur

A

heel spur is not the problem

Not inflammatory for most part is degenerative process

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8
Q

Plantar Fasciitis/Fasciosis - why does it occur

A

Commonly from overpronation due to equinus

Cavus, forefoot valgus

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9
Q

Surgical intervention for fasciitis/Fasciosis

A

Rarely needed but could do a plantar fasciotomy or Gastroc recession

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10
Q

Conservative tx for plantar fasciitis/fasciosis

A

shoes, orthotics, stretching usually resolves problem

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11
Q

Complications with plantar fasciotomoy

A

Instability
Painful scar
Neuritis post op
Stress fracture of calcaneus

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12
Q

PT Rehab for plantar fasciotomy

A

Massage to break up scar
Strengthen intrinsic musculature
Stretch GS complex

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13
Q

PT rehab for gastroc recession

A

Early AROM
Strengthen GS complex
Gait training
Massage to break up scar

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14
Q

Post tibial tendinopathy

A

Chronic strain on post tibial tendon

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15
Q

PTT most commonly due to

A

equinus with overpronation resulting in chronic strain leading to degeneration of the tendon

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16
Q

Pathologic Flexible flat foor - primary

A

Ligament laxity
Abnormal STJ/MTJ axis relationship
Tight GS complex

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17
Q

Pathologic Flexible flat foot - secondary

A

PTT rupture
Midfoot dislocation or other trauma
Neuromuscular disease

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18
Q

More DF with ROM testing if

A

foot is pronation - leads to underdiagnosing equinus

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19
Q

Best way to measure DF for diagnosing equinus

A

Neutral/Supination

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20
Q

Pathological Rigid Flat foot - primary

A

tarsal coalition

Vertical talus

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21
Q

Pathological rigid flat foot - secondary

A

Degnerative arthritis
Post trauma
Peroneal spasm

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22
Q

Pediatric flat foot

A

Prior to age 6/7 is normal to have flat foot

Past this age though subluxation and deformity are strong indicators for pathologic protation –> which is progressive

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23
Q

Pathological pronation - Arch

A

Arc height is not primary determinant

Arch can be high, low or avg

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24
Q

Pathological Pronation - hallmarks of pathologic pronation

A 
Equinus
Progressive subluxation
Soft tssue degeneration
Postural symptoms
Joint degeneration
Caolition or congenital deformity
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25
Evans Calcaneal Osteotomy indications
Flexible pes valgus (progressive, painful) No DJD Younger patient
26
Medial calcaneal displacement osteotomy is used in who
slightly older patients wihtout degenerative changes
27
FDL tendon transfer
Can transfer for flexible PTTD | Lose one grade of strength
28
PT rehab with a tendon transfer - Goals
Strengthen Maintain/Inc ROM Dec edema Gait retraining
29
PT rehab with tendon transfer - Caution
Timing for tendon (4-6wks) and bone healing (6-8wks) Constant communication with surgeon Pain is guide initially
30
Achilles tendinopathy
Tendinosis proceeds rupture | Equinus is often present
31
Achilles tendinopathy - conservative tx
eccentric (alfredsons) works well for midsubstance tendinosis - NOT as well for insertion
32
Insertional Achilles tendinosis.tendinopathy - s/s
Thickening of tendon Edema Pain with first thing in am Pain with inc activity
33
Theories to explan degeneration of achilles tendon - mechanical
Stress to collagen fibrils causes direct damage and subsequent healing
34
Theories to explan degeneration of achilles tendon - vascular
not geographic ischemia | Neovascularization
35
Theories to explan degeneration of achilles tendon - Neural
alterations in neural homeostasis may lead to tendon pathology
36
Surgical intervention for tendinosis
Gastroc recession to correct biomechanicla fault Debridement Stimulate acute injury for body to response
37
Retrocalcaneal Exostosis - insertional achilles calcific tendinosis - what is it
calcification at achilles tendon insertion
38
Exostosis - insertional achilles calcific tendinosis s/s
``` Dull aching pain Tender at insertion Sharp/burning Achilles tendon thickening Pain with ROM and palpation Equinus ```
39
Exostosis - insertional achilles calcific tendinosis - surgical intervention
``` Incision Split achilles tendon longitudinally or remove it from calcaneus Resection of exostosis Remove bursa Debride tendon Address other pathology (equinus) Reattach tendon ```
40
Achilles tendon rupture - standard intervention for most patients
surgery | Multi strand or precutenous or dounble strand - multi strand is the best
41
PT rehab goals for Achilles tendon rupture
Early AROM to prevent atrophy
42
PT rehab cautions for Achilles tendon rupture
Incision problems if too much movement too early Risk of re-rupture Maintain some degree of strain relief with heel lift
43
Chronic ankle instability- acute sprain vs chronic
Acute - functional rehab for proprio and strength just as effective as surgery Chronic - rehab not as successful
44
Lateral Ankle Stabilization surgery
Anatomic (primary) repair is usually chosen because provides the most stability and maintains anatomy
45
Anatomic (primary) repair for lateral ankle stabilization
ATF and CF ligaments make and angle of 105 | Allows inc STJ motion, dec ant translocation of talus on tibia and talar lift
46
Secondary repair for lateral ankle stabilization
use peroneus brevis or allograft Utilized to recreate/reinforce the repair Creates stiff STJ
47
PT rehab for lateral ankle stabilization
proprioception strengthening/ROM edema mobilzation
48
PT rehab precautions for lateral ankle stabilization
make sure far eough post op to withstand rehab and not compromise healing/pull of ligament repair
49
Ankle unimalleolar fracture
fixate with screws | Evaluate deltoid
50
Ankle bimalleolar fracture
Surgery is best | Allows early AROM to dec atrophy
51
PT rehab for ankle fractures
``` Prevent adhesive capsulitis Edema control ROM - dec disuse atrophy, continue synovial fluid formation Strengthening Stability/proprioception ```
52
Calcaneal fractures
can lead to arthrosis | Restoration of height and width of calc is most important
53
Concerns with calcaneal fracture
compartment syndrome
54
Surgery for calcaneal fracture
ORIF Precutaneous pinning External fixation
55
Post op course for calcaneal fracture
``` Splint, NWB Suture removal at 3 wks CAM walker, NWB ROM start at 3 wks NWB for 9 weeks Full activity by 4.5 months best case ```
56
Complications with calcaneal fracture
``` Sural and tibial nerve entrapment Wound opens Arthritis Osteomyelitis Malunion Peroneal tendon impngement Ankle pain Exotoses Heel pad pain or atrophy ```
57
PT rehab for calcaneal fracture
Mobilize ankle and STJ Edema cotnrol Gait train Strengthen
58
Ankle OA/TAR - PT goals
Inc mobility Dec scarring/adhesions Gait train after TAR Balance/proprio
59
PT caution with TAR
CANT WB too early - subsidence or dislocation of device
60
Freibergs disease
lesser joint collapse of articular surface 2nd most common Young females Trauma, biomechanical, overuse, lack of artery
61
Sausage digit
swelling that persists beyond first 3-4 months Damage to lymphatics or venous system Infection
62
Indications for bunion surgery
symptoms that interfere with ADLs Severe or rapidly deforming in younger pts Skin breakdown and ulceration NOT cosmetic procedure

Semester 2 PM Exam 10 (3 decks)

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