Term
Most common ankle injury
#1 risk for ankle sprain
Most common mechanism for ankle sprain
Problem with sprains |
|
Definition
Lateral ankle sprains are most common ankle injury
#1 risk factor for ankle sprain is hx of prior ankle sprain
Most ankle sprains result from an inversion injury b/c the lateral ligaments which support the ankle are weaker than the medial ligaments
Other significant injuries can be mistaken for an ankle sprain |
|
|
Term
| Two major foot joints and what they connect |
|
Definition
Mortise: the ankle joint; where talus (top bone of foot) meets tibia
Subtalar joint: where talus meets calcaneus (heel bone) |
|
|
Term
3 major lateral ankle ligaments
Which is involved in 85% of sprains? |
|
Definition
Anterior talofibular ligament (ATFL)
Posterior talofibular ligament (PTFL)
Calcaneofibular ligament (CFL)
ATFL |
|
|
Term
Major medial ligament
2 big jobs it does
Advantage of it |
|
Definition
Deltoid ligament
Provides medial stability: supports medial arch and prevents abduction and eversion
Is very tough and rarely gets injured |
|
|
Term
Describe where syndesmosis is
What it does (2)
AKA for sprain of this ligament |
|
Definition
Is ligament above ankle that connects tibia and fibula
Provides stability for mortise, ATFL, PTFL
Maintains relationship of distal tibia and fibula
High ankle sprain |
|
|
Term
| Key medial structures, with mnemonic |
|
Definition
Tibialis posterior
Flexor digitorum longus
Flexor halluces longer
Tom, Dick and Harry |
|
|
Term
| 3 important lower leg stabilizer tendons and where they are |
|
Definition
Tibialis anterior: anterior leg above ankle, in front of calf
Extensor tendons: over top of foot connected to toes
Peroneal tendons: lateral foot below maleolus |
|
|
Term
Define:
Pes planus
Pes cavus
Overpronation |
|
Definition
Flat feet
High arches
Pronation is the movement of the subtalar joint (between the talus and calcaneus) into eversion (turning the sole outwards), dorsi flexion (pointing the toes upwards) and abduction (pointing the toes out to the side). |
|
|
Term
| Ankle/foot issue only visible with walking |
|
Definition
|
|
Term
4 things to feel on palpation of medial ankle
3 things to feel on palpation of anterior ankle |
|
Definition
Medial malleolus
Deltoid ligament
Posterior tibial tendon
Navicular
Talar dome
Tibio-fibular ligament
Tibialis anterior |
|
|
Term
| 4 things or groups of things to feel when palpating lateral ankle |
|
Definition
Lateral malleolus and distal fibula
ATFL, PTFL, CFL
Peroneus longus/brevis
Base of fifth metatarsal |
|
|
Term
Describe dorsiflexion and plantarflexion
Define inversion and eversion |
|
Definition
Dorsiflexion: tilting foot up at ankle
Plantarflexion: tilting foot down at ankle
inversion: tilting foot inward at ankle
Eversion: tilting foot outward at ankle |
|
|
Term
How to do anterior drawer test of ankle
Describe finding |
|
Definition
When sitting, knee should be flexed over edge of table and the ankle should be allowed to fall into equinus. Examiner stabilizes distal part of leg w/ one hand and applies anterior force to the heel with the other hand, in attempt to subluxate the talus anteriorly from beneath the tibia.
Tests integrity of ATFL |
|
|
Term
Describe talar tilt
What the test is actually testing
What inversion tests
What eversion tests |
|
Definition
Foot is unsupported in 10 to 20 degrees of plantar flexion. Examiner stabilizes the medial aspect of the distal part of leg, just proximal to medial malleolus, with one hand & applies inversion force slowly to the hindfoot with the other hand. Lateral aspect of the talus should be palpated during inversion of hindfoot to determine if tilting is occurring at ankle joint
Tests the ligament that is being stretched
CFL and ATFL
Deltoid |
|
|
Term
| Describe external rotation stress test with finding |
|
Definition
| The examiner maintains ankle dorsiflexion and externally rotates the foot on a stabilized leg. A positive test occurs when pain in recreated in the area over the interosseous membrane (syndesmosis region). |
|
|
Term
| Describe squeeze test with finding |
|
Definition
| Squeeze is applied to the mid-point of the calf and pain reproduction located distally at the syndesmosis is considered a positive test. If the squeeze force is applied at the distal aspect of the tibiofibular joint a positive finding is indicated if pain is experienced at the syndesmosis upon release of the squeezing force. |
|
|
Term
| Describe side-to-side/ Cotton test with finding |
|
Definition
place examining hand under the plantar aspect of the foot/ankle, with your thumb under one malleolus and your middle finger under the other malleolus. Place a medial and lateral-directed force (not
inversion/eversion stress as in the talar tilt test) on the ankle. Assess if translation and assess quality of endpoint. There may be a few mm of motion with a syndesmosis sprain. |
|
|
Term
| Describe grades I-III ankle sprain according to four variables. |
|
Definition
Swelling: mild, moderate, severe
Ecchymosis: none, usually, certainly
Weight bearing: able to, partially able to, unable to
Stability: stable, slight instability, unstable |
|
|
Term
What is the most important part of ankle assessment?
In Grade III ankle sprains, what 2 tests will be positive |
|
Definition
Palpation
Anterior drawer and talar |
|
|
Term
| 2 times when Ottawa ankle rules don't apply |
|
Definition
Does not apply to children and adolescents
If syndesmosis injury is suspected |
|
|
Term
Ottawa ankle rules for ankle x-ray (2)
Ottawa ankle rules for foot x-ray (2) |
|
Definition
Unable to bear weight (limping counts)
Bone tenderness at posterior edge or tip of medial or lateral malleolus
Unable to bear weight (limping counts)
Bone tenderness at base of the fifth metatarsal or navicular |
|
|
Term
Where to find the fifth metatarsal
Where to find navicular bone |
|
Definition
Walk fingers down lateral foot; bony prominence two thirds back
In front of medial malleolus |
|
|
Term
MRI with ankles: general note
What helpful for
3 ankle things it can diagnose |
|
Definition
Not a first line study for acute sprain
Helpful for chronic ankle pain (sprain that does not heal)
Osteochondral injuries
Tendon injuries
Loose bodies |
|
|
Term
Use of CT in diagnosing ankle problems (3)
Use of US for same |
|
Definition
Can be used to diagnose bony injuries including talus, cuboid, navicular and calcaneus
Loose bodies
Subchondral cysts
Used to dx tendon injuries with a high degree of accuracy |
|
|
Term
| 3 phases of ankle sprain rehab |
|
Definition
Phase I: decrease pain and swelling
Phase II: stabilize the ankle joint
Phase III: return to activity |
|
|
Term
| 4 parts of phase I of ankle sprain rehab |
|
Definition
Protect the ankle from further injury w/ taping, brace, splint, cast
Rest, ice, compression, elevation
Weight bearing as tolerated
Work on ROM |
|
|
Term
3 parts of phase II of ankle sprain rehab
Describe phase III |
|
Definition
Increase strength and propioception
Continue icing
Fill weight bearing
Prepare to to return to full sports activity with sports specific training |
|
|
Term
What is the key to recovering from an ankle sprain?
What happens without it? |
|
Definition
|
|
Term
What causes plantar fasciitis
What injury is secondary to
Describe pain |
|
Definition
Caused by irritation and inflammation of the plantar fascia at its insertion site on the calcaneus (medially)
Injury is secondary to relative overuse
Plantar heel pain with weight-bearing. Greatest on rising from bed in the morning or when active after resting for a period of time. |
|
|
Term
What plantar fasciitis can result from
2 findings on examination of it
What xrays might show |
|
Definition
Can result from repetitive plantar flexion at the ankle and dorsiflexion of the forefoot (eg running)
1) Maximal tenderness over insertion site of plantar fascia on calcaneus
2) Stretching plantar fascia (passive dorsiflexion) reproduces pain
X rays may show bony spur at the fascia's calcaneal attachment site |
|
|
Term
Major treatment for plantar fasciitis
Drugs (2)
Exercise to help
3 devices to help
What to do for refractory cases |
|
Definition
Rest and LOTS of ice
NSAIDS
Corticosteroid injection (beware fat pad necrosis)
Stretching of fascia (formal PT or at home)
Arch supports and heel pads
Posterior night splint
Short leg cast or walker boot if severe
Surgery |
|
|
Term
What does the tibialis tendon support
Where is it found
What movements does it facilitate, and what does it control
In what circumstances is it prone to being overstressed |
|
Definition
Supports the medial arch
Lies posterior to the medial malleolus
Does plantarflexion and inversion of the foot; controls pronation
Prone to being overstressed with flat feet or repetitive over-pronation |
|
|
Term
2 common history points found with posterior tibialis tendonitis
3 exam findings found with posterior tibialis tendonitis |
|
Definition
1) Pain and tenderness along course of tendon
2) Posterior tibial nerve may also become irritated, creating neuro s/s
1) Peritendinous swelling or crepitation
2) Reproduction of pain w/ resisted inversion in plantar-flexed foot (this activates the tendon)
3) Rule out significant tendon tear by observing appropriate heel inversion on straight-leg toe raises |
|
|
Term
| 4 points for treatment of posterior tibialis tendonitis |
|
Definition
Rest, ice, NSAIDs and PT
Arch supports to orthotics, walker boot or short leg cast
Resistance exercises, correction of abnormal biomechanics
Graduate return to play |
|
|
Term
2 pain findings with peroneal tenderness
What causes
Treatment (several)
What to rule out, and when |
|
Definition
1) Pain and tenderness along the peroneal tendons (posterior lateral ankle) or its insertion site (base of 5th MT)
2) Pain w/ resisted eversion or passive inversion
From chronic overuse or sudden ankle dorsiflexion w/ inverted foot
NSAIDs, ice, rest, PT, correction of biomechanical factors
R/o a tear, esp in lateral ankle sprains or in elderly w/out prior injury |
|
|
Term
Describe Morton's neuroma
How created
Note re: trueness |
|
Definition
Irritation of the interdigital nerve b/w the metatarsal heads and beneath the overlying transverse ligament
Repetitive irritation creates scar tissue that organizes around the nerve, causing pain
Not a true neuroma |
|
|
Term
When Morton's neuroma often found
Where is most common |
|
Definition
Found with those wearing too narrow shoes, esp those with narrow toe boxes
B/w second and third or third and fourth metatarsal heads |
|
|
Term
Morton's neuroma:
Kind of pain it causes
Feeling it causes
Another feeling and where
Two things that aggravate it |
|
Definition
Plantar pain
Feeling of "walking on marble"
Numbness, tingling, burning pain in the web space
Symptoms aggravated by shoe wear: high heels, tight toe boxes |
|
|
Term
Morton's Neuroma:
1st clinical finding
What may be palpable
Name of test to reproduce symptoms, and how do it |
|
Definition
Tenderness in web space b/w the metatarsal heads
Nodule may be palpable
Squeeze test: compression of the forefoot reproduces symptoms |
|
|
Term
4 home treatments for Morton's neuroma
2 done by HCP |
|
Definition
Ice
NSAIDs
Metatarsal pad
Proper shoes
Corticosteroid injection
Surgery |
|
|
Term
Describe metatarsalgia
What most commonly affected by it, and where found
What causes it
What contributes to it |
|
Definition
Irritation of the metatarsalphalangeal (MTP) joint; this joint in the middle, b/w phalanges (toes) and metatarsals (middle foot)
2nd and 3rd joints most commonly involved
Due to repetitive trauma
Biomechanics and improper shoe wear contribute |
|
|
Term
Hx found w/ metatarsalgia
2 things found on exam
Home treatments
HCP treatment to consider |
|
Definition
Pain around MTP joint aggravated by forefoot wt bearing
1) Point of maximal tenderness over MTP joint
2) Pain created by passive flexion of the toe
Ice, NSAIDs, metatarsal pad, modify exercise
Consider corticosteroid injection |
|
|
Term
What foot stress fractures are secondary to
What can result from (2)
Bones most commonly affected (3) |
|
Definition
Secondary to overuse
Increasing physical activity level too quickly (eg marathon training)
Improper shoe wear
Metatarsals (most often 2nd or third)
Navicular bone
Calcaneus |
|
|
Term
Where maximal point of tenderness is in stress fracture, and where not
First diagnostic imaging note
Second diagnostic imaging note |
|
Definition
Maximal tenderness over the bone at the fracture site, not soft tissues or tendons
1) Xray often negative early on, but may see edema
2) MRI is best for visualizing; bone scan is sensitive but not specific |
|
|
Term
Why noticing foot stress fractures is important
Two interventions to help pain and heal
How long takes to heal, what required |
|
Definition
Is very common and easily overlooked
More supportive shoes or walking boots, no cast
normal after 4-6 weeks of rest |
|
|
Term
Define Achilles tendonitis
5 things that can cause
General cause |
|
Definition
Irritation of Achilles tendon
Jumping/running
Improper training
Malalignment of LE
Old worn shoes
Tight heel cords
Often results from overuse |
|
|
Term
First two findings with Achilles tendonitis
What can sometimes feel
2 things that cause pain w/ this condition |
|
Definition
+TTP on tendon (?) and edema
Sometimes can feel crepitus
Pain w/ restricted plantar flexion (contracts) or passive dorsiflexion (stretches) |
|
|
Term
| Test to differentiate Achilles tendonitis from tendon tear, and how to perform |
|
Definition
Thomson test:
To perform the Thompson test, the patient should lie face-down on the examination table. The feet extend farther than the end of the bed. The examiner then squeezes the calf muscle. This motion, in a normal patient, should cause the toes to point downward as the Achilles pulls the foot. In a patient with a ruptured Achilles tendon, the foot will not move. That is called a positive Thompson test. |
|
|
Term
| 5 tx for Achilles tendonitis |
|
Definition
PT
Ice
NSAIDs
Heel lifts or arch supports
New shoes |
|
|
Term
Which ligament is most commonly involved in lateral ankle sprains?
What are the Ottawa Ankle Rules used for?
Which condition causes pain that is greatest on rising from bed in the morning? |
|
Definition
ATFL
To decide whether or not to order an XR in an ankle sprain
Plantar fasciitis |
|
|
Term
Which condition is described as "walking on a marble"?
What subjective or objective finding in an ankle sprain would make you concerned about a sydesmotic injury? (3)
Which tendon is probably torn if Thomsons test does not elicit plantar flexion of the foot? |
|
Definition
Morton's neuroma
Unstable ankle joint, inability to bear weight, or positive syndesmotic tests
Achilles tendon |
|
|
Term
What abnormal biomechanics stress the posterior tibial tendon?
Which MTP joints are most commonly involved in metatarsalgia?
How long before a metatarsal stress fracture is seen on xray? |
|
Definition
Flat, pronated foot or repetitive dynamic over-pronation gait
Second and third MTP joints
2-3 wks |
|
|
