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Ortho LE and UE > the ankle > Flashcards

the ankle Flashcards

1
Q

what are the bones that are in the forefoot

A

14 bones of the toes and 5 metatarsals

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2
Q

what are the bones in the midfoot

A

navicular, cuboid and 3 cuneiform

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3
Q

is the purpose of the midfoot

A

to be very stable and support the capstone of the arch of the foot

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4
Q

what are the bones of the rearfoot

A

tibia, fibula, talus, and calcaneous

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5
Q

what are the ligaments on the medial side of the foot called and what motion do they resist

A

ankles eversion and rotation of the tibia

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6
Q

what are the ligaments on the lateral side of the ankle

A
  • ATFL
  • CFL
  • PTFL
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7
Q

what motion does the ATFL resist

A

inversion and planterflexion

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8
Q

what motion does the CFL resist

A

resist inversion

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9
Q

what motion does the PTFL resist

A

posterior motion of the talus

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10
Q

what is the purpose of the retinaculum of the foot and how to distinguish it from the extensor digit

A

purpose is to hold everything in place
contract the extensor digitorum tendon to eliminate contractile pain

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11
Q

what are the anterior muscles of the ankle

A
  • TA
  • ex hall longus
  • ex digit longus
  • peronenous tertius
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12
Q

what are the lateral muscles of the ankle and foot

A

fib long and brev

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13
Q

what are the posterior muscles of the ankle and foot

A
  • TP
  • flex digit long
  • flex hall long
  • gastroc
  • soleus
  • plantaris
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14
Q

what is the most frequently injured part of the foot in athletes

A

lateral ankle sprain

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15
Q

what lateral ankle ligament is the least elastic

A

ATFL

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16
Q

what is the sequence of lateral ankle sprains

A

ATFL, Anterolateral capsule, distal tib-fib, CFL, posterior talo fib ligament, and PTFL

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17
Q

what is osteochondritis of the talus

A

damage to the anterior lateral or poteriormedial domes of the talus due to a twisting injury

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18
Q

characteristics of instability

A

damaged ligaments, axis of rotation is shifted, discribed as a cluck, pathological/abnormal or pts.

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19
Q

characteristics of hypomobility

A

more “give” to the ligaments, axis of rotation increased but not shifted, discribed as a “click”

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20
Q

what is the MOA of a lateral ankle sprain

A

inversion and PF

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21
Q

what is a definition of a grade 1 lateral ankle sprain

A

less then 25% of the tissue is damaged, painful with a firm end feel

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22
Q

what is the definition of a grade 2 lateral ankle sprain

A

25-99% of the tissue is damaged
- very painful with soft and spongy end feel

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23
Q

what is the definition of a grade 3 lateral ankle sprain

A

100% of the tissue is damaged, not painful and no end feel

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24
Q

west point grading system location of tenderness

A

1: ATFL
2: ATFL and CFL
3: ATFL, CFL and PTFL

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25
Q

west point grading system edema and ecchymosis

A

1: slight and local
2: moderate and local
3: significant and diffuse

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26
Q

west point grading system wt bearing

A

1: full or partial
2: difficult without crutches
3: impossible without significant pain

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27
Q

west point grading system ligament damage

A

1: stretched
2: partial tear
3: complete tear

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28
Q

west point grading system instability

A

1: none
2: none or slight
3: definite

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29
Q

what is the MOA of the high ankle sprain

A

DF and inversion with external rotation of the talus - the domes of the talus is wider anterior then posterior forcing apart the mortise

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30
Q

what are the ligaments that get damaged in an high ankle sprain

A

1) interosseous ligament
2) anterior inferior tibiofibular ligament
3) posterior inferior tibiofibular ligament
4) transverse ligament
- sometimes the deltoid ligaments can also be impacted in a servere high ankle sprain

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31
Q

what is the MOA of a medial ankle sprain

A

DF and eversion

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32
Q

what is the treatment for acute stage ankle sprain

A

1 day - 4 days ; RICE, decrease effusion, early protected movement, WBAT, ankle pumps

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33
Q

what is the treatment for subacute ankle sprain

A

(4-14 days) - balance training and open chain resistive training

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34
Q

what is the treatment for advanced healing ankle sprain

A

(2-4 weeks) - enhance proprioception and RTS

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35
Q

what are the ottawa rules for the ankle

A

pain in a the malleolar zone and one of the following:
1) tenderness at the lateral mall
2) tenderness at the medial mall
3) inability to wt bear

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36
Q

what is the MOI of chronic ankle instability

A

repeated acute sprains leading a a decrease in joint proprioception

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37
Q

what is the presentation of chronic ankle instability

A

pain and instability lasting longer then 12 mouths from the initial injury

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38
Q

what are the S/S of chronic ankle instability

A
  • recurrent ankle sprains
  • frequent episodes of the ankle “giving way”
  • persistant s/s of pain, swelling, weakness, and diminished self-reported function
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39
Q

what are the quesionaires used to confirm chronic ankle instability

A

1) ankle instability index (5)
2) cumberland ankle instability (11)
3) identification of functional ankle instability (24)

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40
Q

what is the MOI for osteochondritis dissecans

A

twisting injury to the ankle that causes a fx to the joint surface

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41
Q

what is the subjective for osteochondritis dissecans

A

pain, swelling, and stiffness

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42
Q

what is the treatment of osteochondritis dissecans

A

undisplaced lesions are treated with RICE and immobilization; displaced lesion require arthroscopic removal and drilling

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43
Q

what is a type one osteochondritis dissecans of the talus grades

A

subcondral impaction: bone to bone

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44
Q

what is a type 2 osteochondritis dissecans of the talus grades

A

partly detached

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45
Q

what is a type 3 osteochondritis dissecans of the talus grades

A

non displaced free fragment

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46
Q

what is a type 4 osteochondritis dissecans of the talus grades

A

free fragment that has shifted out of place

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47
Q

what is the origin, insertion and action of the TP

A

o: posterior tibia
i: all the bones of the midfoot
a: PF and inversion ; stabilizes the medial longitudial arch

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48
Q

what is the orgin, insertion, and action of the fib brev

A

o:fibula and the interosseous membrane
i: base of the 5th
a: PF and eversion; provides stability

49
Q

what is the origin, insertion, and action of the fib long

A

o: fibular and interosseous membrane
i: base of the 1st meta
a: PF and eversion; maintains balance

50
Q

what are the 2 groups of patients that get tibialis posterior tendon issues

A

younger: patients with inflammatory arthropathy/ traumatic rupture
older: typically female pts with degenerative disorders

51
Q

what is the subjective for posterior tibial tendonitis

A
  • insideous onset of pain at one of the 3 locations
    1) distal to the medial malleolus/ area of the navicular
    2) proximal to the medial malleolus
    3) at the location of the origin (shin splints)
  • swelling to the medial ankle
52
Q

what is the objective for TP tendonitis

A
  • swelling and tenderness posterior and inferior to the medial malleolus, along the course of the posterior tib tendon, and to its insertion of the navicular
  • medial arch is decreased or completely flattened
  • heel shows increased valgus
  • pain with resisted ankle PF and inversion
53
Q

what is the treatment for tenosynovitis

A

RICE, short leg walking cast, orthoses, steroids, and synovectomy

54
Q

what is the management for an incomplete tear of the TP

A

repair with wither the FDL or FHL

55
Q

what is the management for a complete disruption of the TP

A

repair in traumatic young cases; tendon transfer with medial calcaneal displacement osteotomy (mobile hindfoot and subtalar triple arthrodesis ( fixed hind foot)

56
Q

what is peroneal tenosynovitis common in

A
  • high arch foot because of the increase in excursion or common inversion ankle injuries
57
Q

what are the symptoms of peroneal tendonitis

A

pain just behind the lateral malleolus. pain worsens with activity and eases with rest

58
Q

what are the treatment for peroneal tenonitis

A
  • non surgical
    rest, short leg walking cast, lateral heel wedge, NSAIDS, and cortisone injection
59
Q

what population group is achilles tendinitis most common in

A

adults in their 30s and 40s most commonly runners

60
Q

what are the 2 types of achilles tendinitis/ osis

A

1) noninsertional - occurs proximal to the retrocalcaneal bursa (generally responses well to non-operative tx
2) insertional- tenderness is located at the calcaneal tendon insertion (more difficult to treat)

61
Q

what is the subjective of achilles tendonitis

A
  • gradual onset of pain and swelling in the achilles tendon 2 to 3 cm proximal to the insertion of the tendon
  • pain increases with activity
  • some will present with pain and stiffness along the achilles tendon when rising in the morning or at the start of activity that improves as the activity progresses
62
Q

what are the objective findings of achilles tendonitis

A
  • tenderness and warmth to palpation along the tnedon
  • decrease AROM and PROM DF
  • gait deviations: premature toe of, ER
63
Q

what is the treatments for achilles tendonitis

A

12 week eccentric strengthening and correction of LE asymmetries for insertional do floor level eccentric to decrease pain

64
Q

treatment for type 1 achilles tendonitis

A

pain is experienced after activity; reduce pain by 25%

65
Q

treatment for type 2 achilles tendonitis

A

pain that occurs both during and after activity but does not affect performance; reduce activity by 50%

66
Q

treatment for type 3 achilles tendonitis

A

pain during and after activity that does impact performance; temporarily discontinue running

67
Q

non-insertional achilles how long until symptoms start to improve

A

3-6 mo
- 70% RTS in 3 mo

68
Q

what is the MOI of a achilles tendon rupture

A

loading on a DF ankle with knee extended, running backwards or repetitive microtrauma

69
Q

what systemic conditions can contribute to causing achillies tendon rupture

A

hyperthyroidism, gout or previous steriod injection

70
Q

what is the thompsons test

A

used to evaluate the integrity of the achillies tendon
positive with the absence of PF

71
Q

non operative achillies tendon rupture tx

A

older pts with minimally displaced ruptures and involves serial casting over 10-12 weeks

72
Q

operative achillies repair

A

indicated in younger pts with clinically displaced ruptures, delayed presentation (48-74 hours) followed by casting regime pt typically more satisfied if decide to do the operative treatment and lower risk of re-rupture

73
Q

when can AROM be initiated in post op achillies tendon repair

A

6 weeks

74
Q

when can pt discontinue functional brace post op achillies tendon repair

A

12 weeks

75
Q

what is the subjective of planter fascitis

A

hx of pain and tenderness on the plantar medial aspect of the heel, esprecially when wt bearing in the morning or after a prolonged period of non wt bearing. typically worsens with the start of activity

76
Q

what are the objective findings of planter fascitis

A

localized pain on palpation along the medial edge of the fascial or at the origin on the anterior edge of the calcaneus

77
Q

px for planter fasciitis

A

90% who undergo conservative tx improve within 12 mo

78
Q

what foot position is accociated with planter fasciitis

A

excessive pronation

79
Q

what are the causes of retrocalcaneal bursitis

A
  • repeative trauma from shoe wear and sports
  • Gout, RA and ankylosing sondyloarthropathies
  • bural impingement between the achillies tendon and an ecessively prominent poserior- superior aspect of the calcaneous
80
Q

what are the subjective findings of retrocalcaneal bursitis

A

posterior ankle pain and pain with walking

81
Q

what are the signs of retrocalcaneal bursitis

A

renderness, lump, and inflammation

82
Q

what is the conservative managment for retrocalcaneal bursitis

A

PT, appropriate shoe wear,a nd injection
goals: reduce swelling and inflammation and achillies tendon stretching

83
Q

what is the surgical intervation for retrocalcaneal bursitis

A

resection of haglund deformity (removal of the calcaneal superoposterior prominence), excision of the painful burse and debridement o the tendon insertion

84
Q

Hallux valgus definition

A

lateral deviation of the great toe 1st MTP joint: proximal phalanx deviated laterally ( 9 and 20 degrees)

85
Q

what is the etiology of hallux valgus

A
  • familial
  • inappropriate foot wear
  • flat feet
  • long first ray
  • incongrouous 1st MTP joint articular surface
  • metatarsus primus varus
  • RA
86
Q

what are the signs of hallux valgus

A
  • bunion
  • inflammed overlying bursa and skin
  • valgus and pronation deformity of hallux
  • painful callus and 2nd toe (2nd toe is forcesd into hyperextension and deviated great toe)
  • transfer metatarsalgia and thichened skin over the Met heads
87
Q

what is the conservative tx for hallux valgus

A
  • releive pressure over the painful bunion prominence
  • properlly fitted shoe with a wide toe box and low heels stiff soles
  • spacers
  • silicone bunion pad to alleviate direct pressure
88
Q

post op bunionectomy week 0-2

A

RICE, AROM at hip and knee

89
Q

post op bunionectomy week 2-6

A

ROM at non infused joints, heel touch WB in boot

90
Q

post op bunionectomy week 6-10

A

ROM 1st and 2nd MTP joints , can sleep without boot

91
Q

how to distinguish flexible or rigit pes planus

A

jack test and tiptoeing

92
Q

flexible pes planus

A

disappreance of the internal longitudinal arch when wt bearing and reappearance when not wt bearing

93
Q

postion the heel moves with doing the heel raise for a flexible planus foot

A

varus position

94
Q

what is the etiology of a rigid pes plantus

A

congenital vertical talus and tarsal coalition

95
Q

what is the tarsal coalition

A

calcaneo-navicular and talocalcaneal; can be bony, cartilagenous or fibrous

96
Q

what is the symptoms fo rigid pes plantus

A

foot pain, difficulty walking on uneven surfaces, foot fatigue and peroneal spasm

97
Q

what is the treatment for a rigid pes plantus

A

4-6 week cast immobilization

98
Q

what metatarsals are most commonly injured in a metatarsal stress fx

A

the second and the 3rd

99
Q

what is the MOI of a metatarsal stress fx

A

fx that develops after cyclical submaximal loading; running on hard surfaces,

100
Q

what is the subjective for metatarsal stress fx

A

pain and swelling on wt bearing
hx o sudden increase in activity, change of running surface and prolonged walking

101
Q

what is the objective of metatarsal stress fx

A
  • swelling, ecchymosis and tenderness over the fx met head
  • may not show on radiographs for 2-3 weeks
102
Q

what is Morton’s neuroma

A

mechanical entrapment neuropathy of the interdigital nerve; not a true nuropathy but rather a perineurial fibrosis of the common digital nerve as it passes between the met head

103
Q

what are the subjective findings of mortons neuroma

A
  • shooting and constant pain with walking
  • relieved with rest and removal of footwear
  • third and second cleft tenderness and palpable clikc on metatarsal squeeze test
  • more common in women then men
104
Q

what is the non operative treatment for mortons neuroma

A

metatarsal pad, orthoses injection and excision
- wear supportive shoes with a wide toe box (avoid pointed heels)

105
Q

dorsal approach post op mortons neuroma

A

allows for immediate wt bearing and suture removal after 2 weeks

106
Q

planter approach post op motons neuroma

A

delays wt bearing and suture removal at 4 weeks. transition to normal shoe by 3-4 weeks and RTS in 4-6 weeks

107
Q

what is tarsal tunnel

A

entrapment neuropathy of the tibial nerve as it passes between the flexor retinaculum and the medial malleolus

108
Q

subjective of tarsal tunnel

A
  • acute or insidious
  • poorly localized burning sensation or pain and paresthesia at the medial planter surface of the foot
  • worse after activity and worse at the end of the day
109
Q

objective of tarsal tunnel

A
  • positive tinel sign
  • pain with passive DF or eversion
  • decreased 2 point discrimination on the planter aspect of the foot
  • varus or valgus deformity of the heel
  • weakness of the foot intrinsics with sustain PF of the toes
110
Q

what is the tx for tarsal tunnel

A

steriod injections, othoses, strengthening of the foot intrinsics to restore the medial longitudinal arch

111
Q

what is turf toe

A
  • a sprain of the first MTP joint of the great toe
112
Q

what is the MOI of turf toe

A

hyperextension and varus/valgus stress of the first MTP joint

113
Q

what are the subjective findings of turf toe

A
  • complaints of red, swollen, stiff first MTP joint
  • joint may be tender on plantar and dorsal surface
  • may have a limp and may be unable to run or jump
  • hx of a single DF injury or multiple injuries to the great toe
114
Q

what are the objective findings (grades) of turf toe

A

1: minor stretch injury to the soft tissue restraints with little pain, swelling, or disability
2: partial tear of the capsuloligaments structures with moderate pain, swelling, ecchymosis and disability
3: complete tear of the plantar plate with severe swelling, pain, ecchymosis and inability to wt bear normally

115
Q

turf toe time line

A

grade 1: RTS as soon as symptoms allow
grade 2: 3-14 days of rest
grade 3: 6 weeks rest from sports
RTS: when toe can be DF to 90

116
Q

what is cuboid syndrome

A
  • disruption of the structural congruity of the calcaneo-cuboid joint complex
  • cuboid is the keystone of the lateral column of the foot (concave cuboid rest of the convex navicular and lateral cuneiform)
  • force of the fib longus with sudden inversion of the midfoot causes the cuboid to sublux medial and inferior
117
Q

what is the subjective of the cuboid syndrome

A

midfoot pain or tightness with prolonged activity

118
Q

what are the objective signs of cuboid syndrome

A
  • persistant and localized pain over the cuboid following an inversion sprain
  • pain with toe push off with walking
  • inability to preform plyos
  • pain radiating along the medial arch and length of the 4th met
  • palpable prominence on the planter lateral aspect of the foot
  • limited and painful DF, IN and EV localized to the CC joint
  • painful dorsal glides of the cuboid
119
Q

treatment for cuboid syndrome

A
  • cuboid whip HVLAT (grade 5 mob in the dorsal and lateral direction)
  • cuboid squeeze
  • mob with movement
  • intrinsic foot strengthening

Ortho LE and UE (7 decks)

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