Week 2 [not including lab] Flashcards
What joint type is the talocrural joint?
hinge joint and synovial joint
- plantarflexion and dorsiflexion
- synovial joint
How many degrees of dorsiflexion is needed for walking and running?
walking: 10 degrees
running: 20-30 degrees
What joints is responsible for foot eversion and inversion?
- subtalar joint ( between talus and calcaneus)
- intertarsal joints
Describe the mortise and tenon diagram and how it relates to the foot
joint type seen in woodworking
- in foot, talus is tenon, tibia and fibula are mortise
What movement do syndesmosis joints allow for?
although they move very little, they allow for dorsiflexion
In what position is the ankle joint more stable? Why?
dorsiflexion
- when we dorsiflex our ankle when we dorsiflex the talus glides posterior and it comes into contact with a narrow part of the bottom of the tibia and fibula
- “when we plantar flex the talus glides anterior. narrow posterior part of the talus is in contact with the wide posterior portion of the tibia and fibula. bones are “loose” and the talus can move around a lot in the distal tibia and fibula
- ankle sprains typically occur when plantar flexed
because the talus has room to move around so it’s easier to collapse into plantar flexion
What are the 3 ligaments on the lateral side of the foot
- anterior talofibular
- calcaneofibular
- posterior talofibular
What ligament is on the dorsal side of the foot?
deltoid ligament
Define: AITFL
Anterior tibiofibular ligament
List all the muscles responsible for ankle plantarflexion (8)
- Gastrocnemius
- Soleus
- Flexor digitorum longus
- Flexor hallucis longus
- Peroneus longus
- Peroneus brevis
- Plantaris
- Tibalis posterior
List all the muscles responsible for ankle dorsiflexion (3)
- Tibialis anterior
- Extensor digitorum longus
- Extensor hallucis longus
List all the muscles responsible for ankle inversion (4)
- Tibialis posterior
- Tibialis anterior
- Flexor digitorum longus
- Flexor hallucis longus
List all the muscles responsible for ankle eversion (3)
- Peroneus longus
- Peroneus brevis
- Extensor digitorum longus
Define: proprioception (kinesthesia)
- what is it mediated by?
- gives information on what?
- relies on what other systems?
sense of self movement and body position
- mediated by mechanosensory neurons in muscles, tendons and joints which gives information on limb velocity, limb movement, and load on limbs
- also relies on vision and hearing (vistibular system)
What are the 3 basic types of proprioceptor neurons in vertebrates and where are they located?
- muscle spindles found in skeletal muscle fibres
- Golgi tendon organs at interface of muscles and tendons
- mechanoreceptors found in joint capsule surrounding synovial joints
tendinopathy
- define: tendonitis, tendinosis or tenosynovitis
- Hx (history)
- Ssx (symptoms)
- Tx (treatment)
- tendonitis: acute inflammation of the tendon
- tendinosis: degenerative changes (neovascularization) of the tendon that causes tendon pain
- tenosynovitis: inflammation of the tendon sheath
- Hx (history): acute strain or overuse
- Ssx (symptoms): tenderness, crepitus, swelling, pain
- Tx (treatment): complete tendon rest, NSAID, physiotherapy & ROM exercises, tape, slow return to exercise
Define: crepitus
grinding, creaking, cracking, grating, crunching, or popping that occurs when moving a joint
How common is an ankle sprain an inversion ankle sprain?
85%
1st degree sprain
- Ssx
- Tx
- partial tear of ligaments
SSx: - Mild tenderness, pain, swelling
- no snap, no limp, no increased laxity
Tx:
- P.OL.I.C.E.
- Reduce predisposing factors
2nd degree sprain
- Ssx
- Tx
- Incomplete tear of ligament(s) Ssx: - snap/pop - pain, tenderness - swelling, bruising - limp - resists inversion (if an inversion sprain) - increased laxity (has end point) Tx: - P.O.L.I.C.E. - 2 days of absolute rest - Xray if needed - air cast, tape, or plaster cast - NSAID - Physiotherapy - rehabilitation exercises indefinitely
3rd degree sprain
- Ssx
- Tx
- complete rupture of ligaments
Ssx - snap/pop
- pain, tenderness
- swelling, bruising
- limp
- resists inversion (if an inversion sprain)
- increased laxity (has end point)
^ everything for 2nd degree but more severe - positive anterior drawer test for inversion sprain
- increased laxity, no firm end point on talar tilt test
- higher risk of fracture or dislocation
Tx - stabilize (NPO); get medical attention
- x-ray, may need surgery, cast
- physiotherapy and rehabilitation as for 2nd degree sprains
Define: high ankle sprain
- give Ssx (where tenderness, where swelling, observations of gait, positive what test?)
- Tx
Definition: forced dorsiflexion with external rotation
- may destabilize mortise; AITFL damage
Ssx
- Tenderness between distal tibia & fibulae
- Anterior ankle swelling
- Patient walks on toes to avoid painful dorsiflexion
- Positive side to side Talar tilt test (widened mortise)
Tx
- same as inversion/eversion ankle sprain but with an extended period of immobilizaiton
- May require surgical fixation in which there is widening of the ankle mortise greater than 2mm or joint incongruity on standard or stress radiographs
What are some complications with sprains?
- high chance of reoccurrence
- chronic instability
- chance of fracture
- dislocation
What are some ways to assess proprioception (4)?
- joint position matching
- field sobriety test
- romberg test
- Y test or Star Excursion Balance Test (SEBT)
Define: Star Excursion Balance Test (SEBT)
Dynamic balance test, requires strength, flexibility and proprioception
Fracture
- evidence
- Tx
- Hx of severe trauma
- Deformity
- Bony tenderness
- Crepitus
Tx - Stabilize & transport if suspicious
- X-ray
- may need surgery
- Cast
- Physiotherapy and rehabilitation
What are the Ottawa Ankle Rules?
An ankle x-ray is needed if pain is in the malleolar area AND 1 of:
- pain over distal 6cm inferior or posterior pole of med or lat malleolus
- Inability to weight bear at all at time of injury
- Inability to weight bear 4 steps at time of examination (i.e. in hospital)
Foot x-ray needed if pain in midfoot area AND 1 of:
- Inability to bear weight at all at time of injury
- Inability to weight bear 4 steps at time of examination (i.e. in hospital)
- tenderness along base of 5th metatarsal or navicular bone
What are some things you’d do for ankle rehab
- Activity Modification/Controlled Weight Bearing
- ROM
- strengthening
- balance/proprioception
- running progression
- return to sport
What are some keys to strengthening the ankles
- isometric exercises in all 4 movements
- isotonic exercises in plantarflexion and dorsiflexion
- add resistance to inversion and eversion exercises
- lighter resistance and higher reps
What are some keys to balance/propioception rehab for the ankles
- seated rocker board for plantarflexion/dorsiflexion then after pain free inversion and eversion
- single leg balancing eyes open then eyes closed
- Double and single leg exercises on Rocker board, BOSU, mini trampoline, eyes open, eyes closed, perturbations
What are some keys to return to sport
- walking drills
- jogging drills
- running drills
- non-contact drills
- contact drills
- return to play
Criteria for return to sport?
- full pain free ROM
- normal strength
- normal proprioceptive function
- injured ligament healed
How can taping an ankle help?
- tape provides pressure on ankle joint that stimulates muscle contraction a bit sooner than it would
- Provides effective injury prevention in athletes with previous ankle injury, but not in uninjured players
- Benefit most through proprioceptive stimulated
Fill in the blank: _____ of patients who sustain an ankle sprain develop chronic ankle instability that results in recurring injury to that ankle and later develops traumatic arthritis
74%
Of the 3 lateral ligaments, which is the weakest?
Anterior talofibular ligament is the weakest of all 3 lateral ligaments
Anterior talofibular ligament function
stop forward subluxation of the talus
A complete rupture of the anterior talofibular ligament causes what?
Complete rupture allows talus to rotate about its longitudinal axis in the transverse plane creating rotary ankle instability
True or false: Generalized joint laxity and anatomical foot type are not risk factors for ankle sprains
true!
Define: hemarthrosis
bleeding into joint spaces
Define: mechanical instability
laxity that physically allows for movement beyond the physiologic limit of the ankle’s range of motion
Define: functional instability
subjective feeling that the ankle is unstable as a result of recurrent ankle sprains; attributed to proprioceptive and/or neuromuscular deficits that negatively impact postural control and thus stability and balance
What causes an ankle fracture?
forceful abduction
Define: avulsion fracture
chip of bone is pulled off by ligament resistance (common in grade 2 or 3 eversion or inversion sprains)
Define: bimalleolar fracture
both the medial malleolus of the distal tibia and the lateral malleolus of the distal fibula are fractured
Define: Osteochondritis Dissecans
- where does it occur
- symptoms and signs
- management
- joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow
- Can occur in the superior medial articular surface of the talar dome
- Symptoms and signs: pain and effusion with signs of progressing atrophy. Joint may catch, lock, or give way, particularly if fragment is detached
- Management: x ray diagnosis; immobilize ankle and delay weight bearing until evidence of healing; if fragment is displaced, surgery is recommended to excise the fragment and minimize the risk of non-union
Define: trochlea
talar dome (dorsal side of talar)
What is the largest foot bone?
calcaneus
Define: plafond
distal articulating surface of the tibia (ceiling in french_
Why is inversion ankle sprains more common than eversion?
- fibula blocks and prevents the talus from going into eversion
- strong ligaments on the medial side of the ankle
List what to do for an ankle assessment
- ask history of current injury
- ask past history relevant of injury to the area
- compare with uninjured extremity
- Inspection/Observation
- Range of motion(ROM)
- Ligament test
- Functional/Special tests
- Palpation
Describe the anterior drawer test
stabilize distal tibia and fibula
grab heel and pull foot anterior
test if you can clear talus over the distal tibia (significant ankle sprains may make this possible)
Describe the talar tilt test
tilt talus into inversion or eversion to stress ligaments
- test for increased laxity
Why are eversion sprains typically worse than inversion sprains?
- avulsion fracture of the tibia possible
- usually severity of injury is worse and time to heal is thus longer
- X ray likely to rule out fracture
- Grade 2 or more eversion sprain can cause significant joint instability and also lead to a fallen arch
