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MSK 3 Fall 2024 > Week 13 Ankle/Foot Common Conditions > Flashcards

Week 13 Ankle/Foot Common Conditions Flashcards

1
Q

Pes Planus (Flat foot)
Common Symptoms

A
  • usually incidental unless correlated with a clinical syndrome
  • may be due to subluxation of talus, traumatic deformities, ruptured plantar fascia, Charcot foot, neuromuscular imbalances `
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2
Q

Pes Planus (Flat foot)
Exam findings

A
  • Gastroc/soleus tightness
  • post tibial tendon dysfunction
  • Midfoot laxity/instability ( can no longer act as a strong lever during push off)
  • ABD of forefoot
  • ER of hindfoot
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3
Q

Pes Cavus (High Arch)
Common Symptoms

A
  • less common
  • may be due to neuromuscular problem
  • anything beyond 1 SD of the mean foot posture measure
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4
Q

Pes Cavus (High Arch)
Exam Findings

A
  • inverted hindfoot and midfoot
  • Forefoot in PF and ADD
  • High medial arch during weight bearing and inverted calcaneus
    (+) navicular drop
    (+)Too many toe signs
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5
Q

Pes Cavus (High Arch)
Interventions

A

Accommodate the rigid foot
- orthotics: shock absorption/distribution of pressure

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6
Q

Hallux Valgus (Bunions)
Common Symptoms

A
  • pain at 1st metatarsal with walking
  • pain with standing
  • parasthesia in 1st metatarsal
  • joint redness and pain
  • difficulty finding shoes with proper fit
  • inability to wear stiff shoes
  • more common in woman
  • contributing factors: pes planus, xs pronation, genu valgus, limited DF , arthritis, LLD, neuro conditions
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7
Q

Hallux Valgus (Bunions)
Exam findings

A
  • valgus deviation of great toe (lateral)
  • varus (medial) deviation of 1st metatarsal
  • > 15 degrees of deviation of hallux from 1st MTP
  • hypomobility of 2nd PIP
  • callus and blister formation around bunion (bump on medial side of great toe)
    Altered gait and mechanical issues of forefoot
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8
Q

Hallux Valgus (Bunions)
Intervention

A
  • correct forces acting on 1st MTP
  • strength
  • stretch
  • splinting
  • orthotics
  • toe spacers
  • address inflammation
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9
Q

Hammer Toe

A

Only 1-2 toes does not typically include MTP extension
- A hammertoe is curled due to a bend in the middle joint of the toe.

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10
Q

Claw Toe

A
  • Includes extension of MTP, flexion of all IP’s and often all toes, generally neuromuscular
  • metatarsalgia (pain in ball of foot)
  • corns due to increased pressure at dorsum of PIP, plantar to nail bed ( flex of PIP/DIP), dorsum of MTP (extension deformity of MTP)
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11
Q

Mallet Toe

A

Abnormal flexion of DIP
- may be isolated or 2 degrees to hammer toes
- most frequent at 2nd toe
- corns may develop plantar to nail bed

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12
Q

High Ankle Sprain
Common Symptoms

A
  • Syndesmotic sprain(tib/fib)
    MOI= ankle DF and ER of tibia on a planted foot also xs DF or Inversion
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13
Q

High Ankle Sprain
Exam Findings

A
  • pain due to= tib-fib loss of stability/ gapping with DF due to increased width of talar trochlea
  • Syndesmosis tenderness (over ATFL)
  • Unable to single leg hop (best indicator)
    (+) squeeze/ER (kleiger)
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14
Q

High Ankle Sprain
Intervention Phase 1

A

protection
- allow for healing and decrease inflammation
- immobilize
- AD to normalize gait
-PRICE
- pain free ROM
- Progress when pain/edema is controlled and normal gait

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15
Q

High Ankle Sprain
Intervention Phase 2

A
  • restore normal ROM
  • Improve strength
  • NM control
  • Joint mobs/stretching
  • progress when able to jog/hop

subacute

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16
Q

High Ankle Sprain
Intervention Phase 3

A

sport specific training
- Aggressive strength
- NM training
- Agility

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17
Q

Lateral ankle Sprain
Common Symptoms

A
  • ligaments involve: ATFL/CFL/PTFL
  • H/o previous ankle sprain
  • no use of external support, proper warm up, balance/proprioceptive training
  • Lack of normal DF
    MOI= Pf with inversion
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18
Q

Lateral Ankle Sprain
Exam Findings

A
  • Men= increase talar tilt
  • Woman = increased calcaneal eversion, increased tibial varum, participation in high risk sports

Sprain Vs. Fx (ottawa rule)
1. inability to bear weight ( can’t take more than 4 steps)
2. Medial/lateral malleolus point tenderness
3. 5MT base tenderness
4. Navicular tenderness

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19
Q

Lateral Ankle Sprain Intervention

A
  1. Phase 1= max protection
  2. Phase 2= weeks 1-2 progressive ROM and early strengthening
  3. Phase 3 weeks 2-3 progressive strengthening
  4. Weeks 3-6 advanced strengthening and return to sports
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20
Q

Recurrent Sprains/Chronic Instability
Common Symptoms

A

Functional Ankle Instability
- recurrent ankle sprains with absence of objective joint instability
- Due to mm weakness, altered mm recruitment patterns, decreased ankle ROM, balance problems, joint proprioception

Mechanical Ankle Instability
- recurrent ankle sprains with evidence of ankle ligament laxity
- Due to loss of ligament function leading to decreased strength, decreased ROM
- may loose bodies, chondral defects, anterior scar tissue

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21
Q

Recurrent Sprains/Chronic Instability
Exam Findings

A
  • difficulty running on uneven surfaces, cutting/jumping, feeling of giving way, recurrent pain and swelling tenderness, weakness
    (+) anterior drawer/talar tilt
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22
Q

Recurrent Sprains/Chronic Instability
Interventions

A
  • balance exercises
  • ankle supports
  • taping
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23
Q

Anterior Impingement Syndrome
Common Symptoms

A
  • anterior ankle pain worse with extreme DF
  • pain with squatting, climbing stairs, fast walking
  • may be caused by repeated microtrauma along anterior talocrural joint line, leading to scar tissue formation, and the synovitis or capsulitis of the CTR of the Tib-Fib joint capsule becomes impinged
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24
Q

Anterior Impingement Syndrome
Exam Findings

A
  • decreased DF
  • Pain with forced DF
  • TTP anterior ankle
  • No swelling
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25
Q

Anterior Impingement Syndrome
Interventions

A
  • activity modification
  • cryotherapy
  • NSAIDs
  • Stretch AT and strengthen DF
  • manual Therapy to increase DF
  • Surgery if conservative fails
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26
Q

OA
Common Symptoms

A

MOI= h/o recurrent ankle sprains or fx
1. Type 1= isolated ankle arthritis
2. Type 2= OA with intraarticular varus or valgus deformity or tight heel cord, or both
3. Type 3 = OA with hindfoot deformity, tibia malunion, midfoot abducts or adducts, supinated midfoot, PF 1st ray
4. Type 4= Types 1-3 + subtalar, calcaneal cuboid or talonavicular arthritis

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27
Q

OA
Exam Findings

A
  • decreased ROM
  • Ankle weakness
  • Impaired balance
  • varus/valgus hindfoot deformity
28
Q

OA
Interventions

A

Conservative:
- cane (decrease load)
- bracing/shoe inserts (rocker sole and SACH)
- Viscosupplementation

Surgery:
- Debridement
- Allograft transplantation
- Distraction arthroplasty
- Total ankle replacement/arthrodesis

29
Q

Plantar Fasciitis
Common Symptoms

A
  • gradual onset
  • pain with 1st step in the morning
  • Pain in the medial heel
  • Pain in calf/toes
  • worse with increased activity or after sitting
  • Treat more like an osis
    -Strongly influenced by activity rather than foot posture
    10 month clinical course
30
Q

Plantar Fasciitis
Exam Findings

A
  • TTP medial calcaneal tubercle
  • slight swelling
  • Achilles tightness
  • Decreased DF ROM
  • (+) windlass test

Predictors:
- age 45-64
- overweight
- bilateral DF limitations
- Occupation or activity that requires prolonged standing

31
Q

Plantar Fasciitis
Interventions

A
  • taping
  • education
  • orthotics
  • Stretching G-S, AT, Plantar fascia
  • splints
  • Manual Therapy
  • Modalities
32
Q

Lisfranc Injuries
Common Symptoms

A

MOI=longitudinal forces or axial load applied to a PF ankle and foot, direct crush
-thick ligament arising from medial aspect of 1st cuneiform and attaches to base of 2nd metatarsal

  1. Stage 1= no change in separation between 1st and 2nd metatarsal , no loss of medial longitudinal arch height
  2. Stage 2= 1mm-5mm separation no loss of arch
  3. Stage 3 = >5mm separation, with loss of arch
33
Q

Lisfranc Injuries
Exam Findings

A
  • depending on severity there is a spectrum of deformity, swelling, and medial foot pain
    (+) midfoot squeeze
34
Q

Lisfranc Injuries
Interventions

A
  1. Stage 1 Injuries:
    - immobilize x 6 weeks
    - if pain free, orthosis with return to function
    - if pain , weight bearing AFO for additional 4 weeks
  2. Stage 2 and 3 Injuries:
    - ORIF
    - NWB x8 weeks
    - PWB to FWB in 8-12 weeks
    - Custom medial arch support
  • differentiate between instability and sprain, instability usually requires surgery
35
Q

Sever Disease
Common Symptoms

A

MOI= traction force that AT pulling on the bone fragment before the calcaneus ossifies fully, overuse and microtrauma during sports that require repetitive loading ( running/soccer), overweight
- Calcaneal apophysitis
- inflammation of the 2 degree calcaneal ossification that is open in childhood
- Mainly boys 6-8 y.o

36
Q

Sever Disease
Exam findings

A
  • more common in pes cavus vs. pes planus
    -intermittent or continuous heel pain with weight bearing shortly after beginning new sport or season
  • may have malalignment
  • may have reduced flexibility in AT, plantar fascia, posterior tib, and peroneal tendons

(+) squeeze test

37
Q

Sever Disease
Interventions

A
  • rest
  • ice
  • heel lift
  • shoe inserts
  • stretch G-S and plantar fascia
  • Avoid barefoot walking
  • typically resolves in 2-4 weeks
38
Q

Hallux Rigidus/Limits
Common Symptoms

A
  • degenerative arthritis of 1st MTP (higher incidence in females)
  • lateral foot pain
  • stiffness
  • intermittent to constant pain
  • H/o injury to 1st MTP
  • pain when walking (push off) or running up hills
  • tingling or numbness (compression of cutaneous nerves)
39
Q

Hallux Rigidus/Limits
Exam Findings

A
  • limited 1st MTP DF
  • TTP1st MTP ( dorsal and lateral)
  • antalgic gait/compensated gait
40
Q

Hallux Rigidus/Limits
Interventions

A
  • taping 1st MTP to limit motion
  • joint mobs: distraction, extension
  • Foot wear mods: deep or wide toe box, stiff shoes with rocker bottoms, steel shank
  • in shoe orthotics that limit MTP movement
  • Surgery: removal of bone spurs (goal is to achieve 70 degrees of extension)
41
Q

Morton’s Neuroma
Common Symptom’s

A
  • Fibrosis and nerve degeneration of the common digital nerve, usually between 3rd and 4th metatarsals
  • mainly in women 45-50 y.o
  • sharp and burning intermitted pain and paresthesia with plantar pressure on the met heads, click with forefoot squeeze and push upward at site of compression
  • develops as a result of stress and irritation to nerve
  • worse with prolonged running, squatting, aggravated with narrow toe box and high heels
42
Q

Morton’s Neuroma
Exam Findings

A
  • rarely bilateral
  • may present with pes planus
  • may present with tight G-S
  • DF of metatarsals
    (+) morton’s
43
Q

Morton’s Neuroma
Interventions

A
  • steroid injection
  • soft soled shoes with wide toe boxes
  • elevated met head on medial side of neuroma to prevent compression
44
Q

Sesamoiditis
Common Symptoms

A

MOI= mechanical overload, trauma, repetitive high impact sports
- Avascular changes or inflammation of the sesamoids
- most often at medial/plantar at tibial sesamoid
- Exacerbated by weight bearing activities
- At flexor hallucis brevis

45
Q

Sesamoiditis
Exam Findings

A
  • Predisposing factors: pes cavus, PF 1st ray, ankle equinas
  • pain, tenderness and swelling under the sesamoid aggravated by movement of the great toe
46
Q

Sesamoiditis
Interventions

A

Conservative
- elevate proximally, unload, restrict forefoot loading
- Taping
- NSAIDs
- low heeled shoes with soft support proximal to met heads
- cortisone injections

Surgical
- sesamoidectomy

47
Q

Achille’s tendinopathy
Common Symptoms

A
  • overuse and overloading can lead to microtears and inflammation
  • May also include retrocalcaneal bursitis and or bone spurs (insertional AT–> poorer prognosis)
  • occurs at origin of AT and is associated with bursa and bone involvement
  • sedentary and overweight
48
Q

Achille’s Tendinopathy
Exam Findings

A
  • pain, increased temp, redness, swelling (2cm of insertion) tenderness, crepitus
  • non insertional ( away from insertion point)
49
Q

Achille’s Tendinopathy
Interventions

A
  • Eccentric training (G-S)
  • Load the AT to promote remodeling
50
Q

Achille’s Rupture
Common Symptoms

A
  • most often occur during sport activities in males 30-50 y.o
  • Sudden pain, inability to bear weight, weakness, especially in PF
51
Q

Achille’s Rupture
Exam Findings

A

(+) Thompson
- decreased ankle PF strength
- palpable gap (defect loss of contour)
- increased ankle DF with gentle manipulation

52
Q

Achille’s Rupture
Interventions

A
  • surgical
    -Nonsurgical if acute( weakly recommended)
53
Q

Posterior Tibial Tendon Dysfunction
Common Symptoms

A
  • Insidious onset
    -Swelling
  • Pain with standing, walking, running, stair climbing
  • Commonly associated with flat foot
  • Spring ligament may be injured
54
Q

Posterior Tibial Tendon Dysfunction
Exam findings

A
  • pain and weakness on MMT PF/Inversion
  • TTP along tendon at navicular and med malleolus
  • Unable to perform heel raise
  • G-S tightness
  • medial longitudinal arch height lowering
  • Decreased navicular height (midfoot instability)
  • hindfoot eversion
  • abnormal gait

(+) too many toe sign

55
Q

Posterior Tibial Tendon Dysfunction
Interventions

A
  • bracing
  • orthotics (custom hinged AFO)
  • exercise (concentric and eccentric)
  • Bilateral heel raises
56
Q

Medial Tibial Stress Syndrome (Shin Splints)
Common Symptoms

A
  • Associated with athletes who participate in intense, repetitive weight bearing activities
  • Tibial periosteum inflammation, secondary to bony weakness and local stress
  • Often bilateral and commonly located at distal 2/3rd of tib
57
Q

Medial Tibial Stress Syndrome (Shin Splints)
Exam findings

A
  • intrinsic risk factors: may have weakness of tib anterior, EDL, or EDB, poor biomechanics (xs or abnormal pronation), restricted ankle DF
  • pain during or after exercise, may last hours or days (diffuse 5cm pain at posteromedial border)
  • TTP
  • Risk factors: female, high BMI, sedentary, previous LE injury
58
Q

Medial Tibial Stress Syndrome (Shin Splints)
Interventions

A
  • rest/ice/NSAIDs
  • low load exercises
  • activity modification
  • strengthening (G-S, Core, foot inverison/eversion)
  • Footwear mods
  • Address proximal impairments
59
Q

Nerve Entrapment Injuries
Deep Peroneal N. L4-S2

A

MOI= blunt trauma

Location of Entrapment
- anterior compartment of the lower leg
- extensor retinaculum (anterior tarsal syndrome)

Signs/Symptoms
- motor loss, high steppage gait, and inability to control ankle movement
- sensory loss and possible pain referral in a small triangle area between the first and second toes
- pain with plantar flexion

60
Q

Nerve Entrapment Injuries
Superficial Peroneal Nerve L4-S2

A

MOI= ankle inversion

Location of Entrapment= near the head of fibula and lateral foot

Signs/symptoms
- loss of foot eversion and ankle stability
- sensory lateral side of the leg and dorsum of the foot
- symptoms increase with plantar flexion and inversion of the foot

61
Q

Nerve Entrapment Injuries
Tibial Nerve L4-S3

A

MOI= knee trauma, bow or dislocation or ankle sprain

Location of Entrapment=
- popliteal fossa
- tarsal tunnel: swelling from sprains
- deltoid ligament
- calcaneonavicular ligament (spring ligament)
- deep fascia of the abductor hallucis and the quadratus plantae

Risk Factors= valgus deformity

Signs/Symptoms= symptoms vary depending on location of nerve entrapment

62
Q

Nerve Entrapment Injuries
Tibial Nerve L4-S3 entrapment at Popliteal Fossa

A
  • inability to plantar flex and invert the foot
  • inability to flex abduct or adduct the toes
  • sensory loss on sole of the foot, lateral surface of the heel and plantar surfaces of the toes
63
Q

Nerve Entrapment Injuries
Tibial Nerve L4-S3 Entrapment at the Tarsal Tunnel and Deltoid Ligament

A
  • pain and paresthesia’s on the sole of the foot and medial side of the ankle distal to the medial malleolus
  • motor weakness in the terminal branches of the lateral and medial plantar nerve
  • Worse after activity, end of the day
  • can be similar to plantar fasciitis
64
Q

Nerve Entrapment Injuries
Tibial Nerve L4-S3 Entrapment at the Calcaneonavicular Ligament:

A
  • pain and paresthesias on the medial plantar nerve
  • arching in the arch
  • burning pain in the heel
  • altered sensation on the sole of the foot behind the hallux
65
Q

Nerve Entrapment Injuries
Tibial Nerve L4-S3 ENtrapment at the Deep Fascia of the Abductor Hallucis and Quadratus Plantae:

A
  • pain and paresthesias on the lateral nerve
  • dull and aching pain on the heel

MSK 3 Fall 2024 (8 decks)

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