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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
Q

Evans Calcaneal Osteotomy indications

A

Flexible pes valgus (progressive, painful)
No DJD
Younger patient

26
Q

Medial calcaneal displacement osteotomy is used in who

A

slightly older patients wihtout degenerative changes

27
Q

FDL tendon transfer

A

Can transfer for flexible PTTD

Lose one grade of strength

28
Q

PT rehab with a tendon transfer - Goals

A

Strengthen
Maintain/Inc ROM
Dec edema
Gait retraining

29
Q

PT rehab with tendon transfer - Caution

A

Timing for tendon (4-6wks) and bone healing (6-8wks)
Constant communication with surgeon
Pain is guide initially

30
Q

Achilles tendinopathy

A

Tendinosis proceeds rupture

Equinus is often present

31
Q

Achilles tendinopathy - conservative tx

A

eccentric (alfredsons) works well for midsubstance tendinosis - NOT as well for insertion

32
Q

Insertional Achilles tendinosis.tendinopathy - s/s

A

Thickening of tendon
Edema
Pain with first thing in am
Pain with inc activity

33
Q

Theories to explan degeneration of achilles tendon - mechanical

A

Stress to collagen fibrils causes direct damage and subsequent healing

34
Q

Theories to explan degeneration of achilles tendon - vascular

A

not geographic ischemia

Neovascularization

35
Q

Theories to explan degeneration of achilles tendon - Neural

A

alterations in neural homeostasis may lead to tendon pathology

36
Q

Surgical intervention for tendinosis

A

Gastroc recession to correct biomechanicla fault
Debridement
Stimulate acute injury for body to response

37
Q

Retrocalcaneal Exostosis - insertional achilles calcific tendinosis - what is it

A

calcification at achilles tendon insertion

38
Q

Exostosis - insertional achilles calcific tendinosis s/s

A 
Dull aching pain
Tender at insertion
Sharp/burning
Achilles tendon thickening 
Pain with ROM and palpation
Equinus
39
Q

Exostosis - insertional achilles calcific tendinosis - surgical intervention

A 
Incision 
Split achilles tendon longitudinally or remove it from calcaneus 
Resection of exostosis 
Remove bursa
Debride tendon
Address other pathology (equinus)
Reattach tendon
40
Q

Achilles tendon rupture - standard intervention for most patients

A

surgery

Multi strand or precutenous or dounble strand - multi strand is the best

41
Q

PT rehab goals for Achilles tendon rupture

A

Early AROM to prevent atrophy

42
Q

PT rehab cautions for Achilles tendon rupture

A

Incision problems if too much movement too early
Risk of re-rupture
Maintain some degree of strain relief with heel lift

43
Q

Chronic ankle instability- acute sprain vs chronic

A

Acute - functional rehab for proprio and strength just as effective as surgery
Chronic - rehab not as successful

44
Q

Lateral Ankle Stabilization surgery

A

Anatomic (primary) repair is usually chosen because provides the most stability and maintains anatomy

45
Q

Anatomic (primary) repair for lateral ankle stabilization

A

ATF and CF ligaments make and angle of 105

Allows inc STJ motion, dec ant translocation of talus on tibia and talar lift

46
Q

Secondary repair for lateral ankle stabilization

A

use peroneus brevis or allograft
Utilized to recreate/reinforce the repair
Creates stiff STJ

47
Q

PT rehab for lateral ankle stabilization

A

proprioception
strengthening/ROM
edema mobilzation

48
Q

PT rehab precautions for lateral ankle stabilization

A

make sure far eough post op to withstand rehab and not compromise healing/pull of ligament repair

49
Q

Ankle unimalleolar fracture

A

fixate with screws

Evaluate deltoid

50
Q

Ankle bimalleolar fracture

A

Surgery is best

Allows early AROM to dec atrophy

51
Q

PT rehab for ankle fractures

A 
Prevent adhesive capsulitis 
Edema control
ROM - dec disuse atrophy, continue synovial fluid formation
Strengthening 
Stability/proprioception
52
Q

Calcaneal fractures

A

can lead to arthrosis

Restoration of height and width of calc is most important

53
Q

Concerns with calcaneal fracture

A

compartment syndrome

54
Q

Surgery for calcaneal fracture

A

ORIF
Precutaneous pinning
External fixation

55
Q

Post op course for calcaneal fracture

A 
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
Q

Complications with calcaneal fracture

A 
Sural and tibial nerve entrapment
Wound opens
Arthritis
Osteomyelitis
Malunion
Peroneal tendon impngement 
Ankle pain
Exotoses
Heel pad pain or atrophy
57
Q

PT rehab for calcaneal fracture

A

Mobilize ankle and STJ
Edema cotnrol
Gait train
Strengthen

58
Q

Ankle OA/TAR - PT goals

A

Inc mobility
Dec scarring/adhesions
Gait train after TAR
Balance/proprio

59
Q

PT caution with TAR

A

CANT WB too early - subsidence or dislocation of device

60
Q

Freibergs disease

A

lesser joint collapse of articular surface
2nd most common
Young females
Trauma, biomechanical, overuse, lack of artery

61
Q

Sausage digit

A

swelling that persists beyond first 3-4 months
Damage to lymphatics or venous system
Infection

62
Q

Indications for bunion surgery

A

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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