Term
Initial treatment of an acute ACL injury includes:
Rest, Ice, NSAIDS, Narcotics and Crutches
(NWB – TT – PWB – FWB) until the patient is
able to ambulate without a limp
A knee immobilizer or range-of-motion brace
may be used for comfort when necessary until
acute pain subsides
Physical Therapy to begin early range-of-motion
exercises and initiate ACL rehab protocol
Full extension and flexion should be regained as
soon as pain and swelling permit; extension is
more important to achieve!
Bottom line – if a patient is unable to perform
rehab then ACL recon is not recommended
Definitive treatment of an ACL tear depends on
the patient's age, desired activity level, and any
associated injuries
Less active individuals can be treated with
physical therapy to reduce instability
ACL functional bracing may be helpful with
older or less active patients
For young, active patients, ACL reconstruction
offers the best chance for a successful return to
agility sports: B-PT-B OR HS grafts |
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Definition
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Term
| Isolated PCL injuries typically are treated with a structured program that initially concentrates on resolving swelling and restoring range of motion Once these goals have been achieved, progression to strengthening exercises can be initiated, with an emphasis on the quadriceps (short-arc terminal extension exercises from 30° of flexion to 0°) Functional bracing can be helpful when the patient returns to contact sports Failure of non-operative treatment typically manifests as recurrent instability and/or subsequent meniscal tears These patients require PCL reconstruction to restore functional stability After reconstructive procedures, instability is improved but translation usually remains increased relative to the normal |
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Definition
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Term
| Treatment of MCL Treatment of isolated MCL tears, even when complete, is usually non-operative Grade I sprains with no effusion likely will resolve within a couple of weeks Rest, ice, compression, and elevation (RICE), coupled with crutches and a short-term course of NSAIDs, usually are adequate With grade II sprains, use of a hinged brace and weight bearing as tolerated are appropriate For grade III injuries, use of a hinged brace with gradual return to full weight bearing over the course of 4 to 6 weeks is indicated Rehabilitation includes early range-of-motion exercises (including bicycling) and quadriceps and hamstring progressive resistance exercises Grade III injuries frequently require 3 to 4 months of protective bracing before the patient can return to unrestricted activity |
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Definition
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Term
| Absence of mechanical symptoms and particularly when a degenerative tear is present Initial treatment with rest, ice, compression, and elevation (RICE) Weight bearing as tolerated NSAIDS, Tylenol or ASA PT to regain range of motion and advance activities as tolerated Traumatic tears in younger patients should be evaluated and treated aggressively Sports activity should be restricted Surgical debridement or repair is indicated in younger patients with significant tears and in older patients who do not respond to nonoperative treatment Surgical meniscal graft is currently being explored both autologous and cadaver. |
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Definition
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Term
| Treatment 2 of 2 Non-operative treatment includes activity modifications to the point that symptoms are relieved—specifically, avoiding running and jumping activities and possibly a period of crutch ambulation Immobilization is reserved for refractory symptoms or noncompliant patients Surgical treatment is necessary after skeletal maturity and in children whose lesion has progressed to the stage that the articular cartilage has partially or totally separated If the cartilage is intact, lesion can be left alone. Microfracture Unstable lesions require temporary internal fixation to promote healing When the fragment is loose, treatment consists of removing the free fragment and debriding the articular surface defect |
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Definition
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Term
| Treatment 2 of 2 Operative management: Arthroscopy – debridement Mosiacplasty Cartilage transplantation HTO – Realignment procedure Arthroplasty – partial or total |
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Definition
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Term
| Most patients with a symptomatic bipartite patella will respond to a period of activity modifications This may require a period of protected weight bearing with crutches and a knee immobilizer Surgery to excise the superolateral fragment is rarely necessary because most patients respond to non-operative treatment |
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Definition
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Term
| Most patients respond a short-term course of NSAIDs, ice, and activity modifications Ultrasound and phonophoresis may help Patients with identifiable tightness should perform quadriceps, hamstring, or iliotibial band stretching/flexibility exercises to assist recovery Injection of a corticosteroid preparation is appropriate in recalcitrant cases Surgical treatment for bursitis of the knee is the exception rather than the rule |
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Definition
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Term
| Modify activity levels to a pain-free level PT with closed chain quadriceps strengthening and flexibility exercises Quadriceps exercises need to be individually modified as necessary to avoid causing knee pain Aggressive full-arc quadriceps exercises typically aggravate the symptoms Short-term intermittent use of Acetaminophen or NSAIDs Use of a simple knee sleeve with a patellar cutout or strap may help Weight loss is recommended when a patient is obese Corticosteroid injections – judicious use! |
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Definition
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Term
| Initial treatment of acute patellar subluxation/dislocation includes application of compressive dressing and protective splint with knee in extension (knee immobilizer or ROM brace locked in extension) Ice, analgesics, modified weight bearing When tenderness has resolved over the medial structures, ROM and strengthening exercises can begin Chronic recurrent maltracking or instability should include exercises emphasizing quadriceps strengthening and flexibility When non-surgical measures fail, proximal or distal realignment of the extensor mechanism may be indicated. Repair of MPFL |
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Definition
| Patellofemoral instability and malalignment |
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Term
| Treatment 2 of 3 NSAIDs can help control symptoms, but local injections of corticosteroids should not be used because these injections significantly increase the risk of rupture of the extensor mechanism The second phase of treatment focuses on regaining a pain-free range of motion, flexibility of the quadriceps and hamstrings, and strength Exercises focusing on pain-free quadriceps strengthening and flexibility should be initiated, often in conjunction with ultrasound and phonophoresis |
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Definition
| Patellar/quadriceps tendinitis |
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Term
| Surgical repair is the treatment of choice for a complete rupture of the quadriceps or patellar tendon and for a displaced fracture of the patella The uncommon partial tears of the tendons and non-displaced fractures can be treated by immobilization |
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Definition
| Quadriceps/patella tendon rupture |
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Term
| Initial management is aimed at decreasing inflammation and thickening of the plica NSAIDs or Tylenol Modification of activities An injection of local anesthetic and corticosteroid preparation into the plica can be both diagnostic and therapeutic Based on the physical examination, an appropriate flexibility and strengthening program should be initiated With persistent symptoms, and no other evidence of other intra-articular disorders, arthroscopic resection of the plica should be considered for recalcitrant cases |
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Definition
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Term
| With a deep posterior compartment syndrome, extension of the great toe will place the flexor hallucis longus on stretch Decreased sensation of the involved nerves is often present at onset of the syndrome, but paralysis and loss of dorsalis pedis and posterior tibial pulses are late findings A compartment syndrome = diastolic pressure minus the intracompartmental pressure is less than or equal to 30 mm Hg or an absolute pressure of 40mm hg or higher within the compartment |
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Definition
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Term
| Contusions are treated with minor analgesics, rest, ice, elevation, and range-of-motion, calf stretching, and strengthening exercises |
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Definition
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Term
| Ecchymosis can develop in the calf over 24 hours |
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Definition
| Medical Gastrocnemius tear |
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Term
| When diagnosed early, most patients with stress fractures of the tibia and fibula respond well to a period of rest Mild pain can be treated with activity modifications When significant pain occurs with walking, initial treatment is cast immobilization and limited weight bearing |
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Definition
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Term
| Non-operative treatment of exertional compartment syndromes requires discontinuing an activity or decreasing its intensity to an asymptomatic level Surgical treatment is fasciotomy of the involved compartment |
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Definition
| Exertional Compartment Syndrome |
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Term
| AP and lateral radiographs of the spine in patients with neurogenic claudication show degenerative changes MRI and CT can define the spinal pathology, although neither imaging study is necessary as a primary screening tool Doppler studies and arteriography will demonstrate vascular disease in patients with vascular claudication |
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Definition
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Term
| Treatment 2 of 2 Surgical repair is recommended for young, healthy, active patients Choosing non-operative or surgical treatment is based on the patient's level of activity, age, medical condition, and surgical risk When either treatment is delayed beyond a few days, Achilles tendon rupture becomes more complicated to treat because retraction of the proximal muscle widens the gap Whatever treatment modality is selected, stretching and strengthening exercises should be emphasized during the rehabilitation phase Six to nine months of rehabilitation |
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Definition
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Term
| Acute ankle sprains-treated according to the mnemonic RICE Rest-non-weight bearing or protected weight bearing based on resolution of symptoms Ice Compression (elastic wrap) Elevation Bracing Cast immobilization is reserved for patients with severe pain and swelling especially 1st time injuries After the acute phase, PT is helpful Range-of-motion exercises Strengthening exercises Proprioceptive training Chronic ankle sprains Operative reconstruction |
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Definition
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Term
| Treatment 2 of 2 Talonavicular and subtalar arthritis can be temporized with a medial longitudinal arch support or the more rigid UCBL (University of California Biomechanics Laboratory) orthoses Corticosteroid injections and NSAIDs can be helpful Predictable pain relief can be obtained with a subtalar arthrodesis Ankle motion is retained after a subtalar fusion Function is surprisingly good after an ankle fusion because midfoot dorsiflexion and plantar flexion increase Total ankle replacement remains an investigational technique |
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Definition
| Arthritis of the Foot/Ankle |
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Term
| Patients should be advised to select proper shoes with a soft upper and a roomy toe box A shoe repair shop can stretch the shoe over the bunionette A modified metatarsal pad also can help shift pressure off the fifth metatarsal head A medial longitudinal arch support can help a patient who has a flexible flatfoot This orthotic device rotates the forefoot slightly, which decreases direct pressure over the bunionette prominence With continued symptoms, surgical excision of the bunionette or realignment osteotomy of the fifth metatarsal may be require |
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Definition
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Term
| Treatment 3 of 3 For soft corns, a small amount of lamb's wool or a silicone spacer between the toes can wick away moisture and help cushion the area When non-operative measures fail, surgical treatment to remove the underlying bony prominences is indicated For Plantar Warts – typically treated with topical Salicytic Acid or Liquid Nitrogen When non-operative measures fail, surgical treatment is indicated |
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Definition
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Term
| Treatment 2 of 2 Treatment of a deep infection must be aggressive and prompt; the infection is often polymicrobial Skin swab cultures are inaccurate; bone biopsy provides more definitive cultures to direct antibiotic therapy Any abscess should be considered an emergency and drained surgically Osteomyelitis can be treated surgically with debridement of the affected bone Digit or ray (toe plus metatarsal) amputation is often needed to eradicate osteomyelitis of the toes or metatarsal heads In the initial stage of a Charcot joint, the foot and ankle need to be unweighted and stabilized, usually with a cast After the acute swelling and erythema have subsided, the patient can begin bearing weight with continued use of a cast or customized, clamshell short leg brace The patient must be advised that the period of immobilization can be lengthy, often up to 12 months, and that a permanent brace might be required for ambulation |
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Definition
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Term
| Stable fractures of the distal fibula can be treated with a weight-bearing cast or brace for 4 to 6 weeks Unstable but non-displaced fractures require a non-weight-bearing short or long leg cast and more prolonged immobilization Unstable, displaced fractures require either closed or open reduction In most cases, open reduction provides better restoration of joint function Osteochondral fragments should be removed Concomitant dislocation should be reduced as soon as possible to relieve pressure on the skin and neurovascular structures Open fractures require immediate surgical debridement |
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Definition
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Term
| Treatment 2 of 2 Fractures of the proximal fifth metatarsal may be easy or difficult to manage Avulsion fractures of the base of the fifth metatarsal (zone 1) or some proximal metaphyseal fractures (zone 2) do well with nonoperative treatment Immobilization with an air stirrup, wooden-soled shoes, or fracture brace is continued until symptoms subside Some acute fractures in zone 2 are more difficult to treat Most cases will heal with cast immobilization, but treatment of these injuries should start with non-weight-bearing ambulation in a short leg cast for 6 to 8 weeks Some patients, such as athletes, are better treated by early internal fixation Fractures in zone 3 often resemble a stress fracture with prodromal symptoms suddenly exacerbated by an inversion injury These need operative intervention to avoid problems of nonunion or delayed union |
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Definition
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Term
| Non-displaced injuries are treated by 6 to 8 weeks of non-weight-bearing cast immobilization, followed by use of a rigid arch support for 3 months A fracture or fracture-dislocation with any displacement requires surgical stabilization |
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Definition
| Fx-Dislocation of the midfoot |
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Term
| Immediate treatment consists of splinting with a well-padded posterior splint from the toe to the upper calf or Jones dressing The extremity should be elevated above the level of the heart and ice applied for 20 minutes every 1 to 2 hours Most of these fractures require surgical reduction and fixation to minimize later complications |
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Definition
| Fx of the Calcaneou/ Talus |
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Term
| Phalangeal fractures are treated by buddy taping the fractured toe to an adjacent toe, usually the toe medial to the fractured one A gauze pad can be placed between the toes to absorb moisture and prevent maceration of the skin from sweating Closed reduction under a digital block or open reduction and pinning is rarely necessary but should be considered for angulated fractures, cosmetically concerning toes, fractures involving the articular surface of the MP joints of all toes, or the great toe interphalangeal joint |
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Definition
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Term
| Treatment 2 of 2 Surgical treatment consists of either excision of the dorsal osteophytes or fusion of the joint (arthrodesis) Resection of the joint may be indicated in some patients |
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Definition
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Term
| Treatment 2 of 2 Physical therapy, splints, and bracing are not helpful No treatment is needed for asymptomatic hallux valgus, even if the deformity continues to progress Surgical consultation for disabling symptoms Indications for different procedures are based on the severity of the hallux valgus, the IM angle, and joint congruity |
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Definition
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Term
| Treatment 2 of 2 Stage II: Initial treatment should include foot soaks along with broad-spectrum oral antibiotics Partial excision of the nail under digital block should be performed when the patient has severe pain, when there is a risk of secondary infection to a prosthetic joint, or when a course of oral antibiotics fails to treat associated infection Partial nail excision is preferred; complete nail excision increases the risk of upward deformation of the nail bed (clubbing) An avulsed nail requires 3 to 4 months to regrow Stage III: Partial or complete nail plate excision with or without ablation of the germinal matrix of the nail is indicated |
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Definition
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Term
| Accommodative shoes, a metatarsal pad or an orthotic device is the key to treatment A thickened callus can be shaved Non-operative treatment usually is successful, but if these measures fail, surgery to realign the toes and/or metatarsal head can be considered |
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Definition
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Term
| Patients should be advised to wear a low-heeled, soft-soled shoe with a wide toe box Pain relief can be obtained using metatarsal pads to spread the metatarsal heads and take pressure off the nerve A lidocaine with corticosteroid injection just proximal to the metatarsal heads can be both diagnostic and therapeutic If symptoms persist, surgical excision of the neuroma or division of the transverse metatarsal ligament is indicated |
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Definition
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Term
| Treatment options include observation with periodic trimming of the thickened nail, removal of the nail, and/or medications Topical medications are less effective than oral agents because topical medications cannot penetrate the thickened nail Recently developed oral agents such as itraconazole, fluconazole, ketoconazole, and terbinafine have been shown to be effective in the treatment of onychomycosis |
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Definition
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Term
| Treatment 2 of 2 A night splint can be used as part of initial treatment; the night splint holds the ankle and foot in slight extension, which maintains the Achilles tendon and plantar fascia in a stretched position during sleep Contrast baths, ice, NSAIDs, and/or shoes with shock-absorbing soles also can be used to decrease inflammation in the painful heel If symptoms are unchanged after 8 weeks, injection of corticosteroid into the heel may be indicated – CAUTION! A formal physical therapy consultation may be necessary to help direct the patient's continued stretching program If symptoms persist, the use of a non-removable cast or custom orthotic device should be considered Extracorporal Shock Wave Therapy is a newer treatment available Surgical treatment typically consists of partial release of the plantar fascia |
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Definition
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Term
| Most lesions resolve spontaneously within 5 to 6 months, so aggressive treatment should be reserved for unusually large, painful, or persistent lesions Initial treatment commonly includes superficial paring, followed by the use of a keratolytic agent, such as salicylic acid in liquid or salve form (Mediplast) The lesion should then be covered with occlusive tape (Moleskin or Duct tape) to ensure that the medication stays within the desired area and debrides the necrotic layers of tissue upon removal of the tape |
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Definition
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Term
| A heel lift or open-back shoes will minimize pressure on the inflamed area Ice massage and contrast baths will decrease inflammation Achilles tendon stretching exercises should be used if an equinus contracture is present Casting for 4 to 6 weeks may alleviate symptoms Surgical intervention will remove the prominent bone and diseased tendon |
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Definition
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Term
| Tenosynovitis of the tendon without a flatfoot should be treated with a short leg cast or cast brace for 4 weeks, NSAIDs, and activity limitation After the cast is removed, a molded ankle-foot orthosis may be used as the tendinitis resolves An injection of corticosteroid may weaken the already pathologic tendon and is not recommended When non-operative treatment fails, surgical debridement of the tendon may be indicated |
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Definition
| Posterior Tibial tendon dysfunction |
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Term
| Medical management can improve symptoms and slow the progression of disease Disease-modifying agents (such as methotrexate) have been shown to decrease synovitis and slow progression of the disease Corticosteroid injections can be helpful for inflamed joints and significant tenosynovitis An extra-depth accommodative shoe with a molded insole and metatarsal bar often relieves metatarsalgia A UCBL (University of California Biomechanics Laboratory) orthosis can provide significant pain relief for a patient who has a flexible hindfoot deformity A molded ankle-foot orthosis can be used for more extensive disease involvement |
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Definition
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Term
| An acute sesamoid fracture is best treated with a stiff-soled shoe or a removable short leg fracture brace Patients may change to a stiff-soled shoe with a wide toe box as symptoms permit, usually about 4 weeks after the injury A J-shaped (dancer's) pad can help relieve pressure under the first metatarsal head once the fracture has healed and the patient begins to ambulate in everyday shoes |
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Definition
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Term
| Treatment 2 of 2 A plantar fibroma is best treated with shoe modifications and an orthotic device Surgical excision is indicated in patients with significant persistent symptoms or if the fibroma has increased significantly in siz |
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Definition
| Soft Tissue masses of the Foot and Ankle |
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Term
| Treatment for most patients is based on reduced activity and protective footwear For metatarsal stress fractures, a stiff-soled shoe, wooden-soled postoperative sandal, or removable short leg fracture brace shoe will be sufficient Most patients with calcaneal and fibula fractures will benefit from 2 to 4 weeks of immobilization in a short leg-walking cast |
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Definition
| Stress Fx of the Foot and Ankle |
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Term
| For patients with flatfeet and significant pronation, an orthotic device used to support the medial arch and decrease stretch along the tibial nerve may alleviate symptoms Review of the surgical results shows a lower success rate for tarsal tunnel release compared with that for carpal tunnel release |
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Definition
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Term
| Treatment 2 of 2 Over-the-counter, protective cushions are helpful for corns Commercially available straps to hold the toes in place can provide symptomatic relief In addition, the patient can tape the toe into flexion at the MP joint Surgical correction may be necessary for fixed deformities The goals of surgery are not cosmesis, but alignment of the toes to comfortably accommodate footwear Postoperatively, the toes tend to sit flat but do not have normal range of motion and tend to swell for several months |
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Definition
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Term
| Non-operative treatment with rest, ice, compression, and elevation usually is sufficient; early range of motion is started as symptoms allow Grade 3 injuries require protected weight bearing or immobilization for 1 to 2 weeks, with a 4 to 6 week period of rest from athletics; taping, orthotic devices, or a rocker bottom sole to restrict MP motion may decrease symptoms Surgical intervention is seldom necessary except in the case of displaced intra-articular or avulsion fractures |
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Definition
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