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Ortho-Ankle foot
Common disorders
| Question | Answer |
|---|---|
| These acccount for ¾ of all ankle injuries. | ankle sprains |
| What percentage of ankle sprains occur in basketball? | 45% |
| There are potential chronic symptoms with what percentage of all sprains? | > 40% |
| These are least stable in the “loose packed position” –PF with inversion injury. | Lateral ankle sprain |
| These ankle sprains are less common due to decreased eversion ROM and bony architecture. | Medial ankle sprain |
| This is also known as a “high ankle sprain”. | syndesmosis ankle sprain |
| Put these ligaments in order from most involved to least involved in a lateral ankle sprain...CF, ATF, PTF | ATF, CF, PTF |
| In lateral ankle sprains there is potential for what? | concomitant fracture |
| How many grades of ankle sprain are there? | 3 |
| Mild sx, likely continued running or playing...what grade of ankle sprain? | I |
| No functional loss/instability,...what grade of ankle sprain? | I |
| rare in PT clinic; typically self-treat...what grade of ankle sprain? | I |
| Moderate functional loss, may have “walked it off”, diffuse swelling/tenderness...what grade of ankle sprain? | II |
| What is the recovery time avg for grade II ankle sprain? | 20 days (range: 10-30 days) |
| most common in PT clinic...what grade of ankle sprain? | II |
| Unstable, multi-ligamentous sprain with anterior capsular involvement...what grade of ankle sprain? | III |
| Unable to fully bear weight, Diffuse edema/tenderness medially & laterally...what grade of ankle sprain? | III |
| Frequent concomitant fracture, Ortho intervention often required...what grade of ankle sprain? | III |
| What is the recovery time average for a grade III ankle sprain? | 40 days (range: 30-90 days) |
| What is the recovery time avg for grade I ankle sprain? | 8 days (range: 2-10 days) |
| ATFL involvement, slight & local edema and echymosis, full or partial WB, stretch/microtrauma ligament damage, no instability. | Grade I |
| What grade of ankle sprain does the following describe? ATFL & CFL involvement, moderate and local edema and echymosis, WB difficult with crutches, partial ligament tear, none or slight instability. | grade II |
| What grade of ankle sprain does the following describe? ATFL, CFL, PTFL involvement, significant and diffuse edema and echymosis, WB impossible initially, complete tear of ligament(s), definite instability. | grade III |
| What test is used to test the ATF? | anterior drawer |
| What test would you use to test the CF after an inversion sprain? | Talar tilt |
| What results in a positive talar tilt test? | laxity and/or pain |
| How do you perform the talar tilt test? | Grasp foot and stabilize tibia and fibula, then adduct and invert the calcaneus into varus |
| If your examination of a lateral ankle sprain results in a (+)anterior Drawer and a (-)Talar Tilt, what ligament is most involved? | Most likely isolated ATF injury (60-70% of all inversion injuries) |
| If your examination of a lateral ankle sprian results in both Anterior Drawer and Talar Tilt(+), what ligament(s) is/are most likely involved? | Most likely ATFL/CFL injury (accounts for 20% of inversion injuries) |
| If your examination of a lateral ankle sprain results in a (-)Anterior Drawer,(+)Talar Tilt, what ligament is most involved? | Most likely isolated CFL injury (10% of all inversion injuries) |
| Superficial peroneal/fibular nerve involvement 2º moderate or severe inversion or eversion sprain is called what? | Inversion Sprain Sequelae |
| What structures do you want to palpate during your exam of an inversion sprain?(3 things) | proximal fibula, navicualar, and base of 5th metatarsal. |
| What are the Ottawa ankle rules? | TTP along distal 6cm of tibia or tip of medial maleoli, TTP along distal 6cm of fibula or tip of lateral malleoli, cant bear weight for four steps immediately and in ER. |
| What are the Ottawa foot rules? | TTP on navicular, base of 5th metatarsal, inability to WB immediately and in ER four steps |
| What should be the aim of tx for a lateral ankle sprain? | initial pn and edema reduction, immobilization if severe instability, early mobilization and WB, strengthen ankle everters, ROM |
| Thrust and Non-thrust manipulation may improve ________ and ______ following acute ankle sprain | function and pain |
| ____________ focus may improve outcomes and reduce the occurrence of Chronic Ankle Instability. | neuromuscular |
| If a pt is having chronic medial ankle symptoms 2ºsevere INV sprain despite sound rehab program, what may be happening? | Posteromedial Ankle Impingement |
| What causes a posteromedial Ankle Impingement? | Usu inversion sprain...medial deltoid fibers impinged between medial talus & medial malleolus: fibrotic scar tissue & periosteal new bone may develop |
| This ankle sprain is much less frequent and is secondary to deltoid ligament strength. | Eversion Strength |
| What three things may predispose a person to an eversion sprain? | hypermobility, pronated foot, depressed medial longitudinal arch |
| Your pt presents with localized point tenderness and swelling over deltoid ligament, ROM/strength deficits per mechanism of injury and tissue involved, positive eversion (talar tilt) stress test...what is the problem? | eversion sprain |
| What occurs with injury to anterior tibio-fibular ligament and/or syndesmosis? | high ankle sprain |
| DF ROM frequently limited in rehab to avoid further stress on mortise/tibiofibular ligaments with what kind of sprain? | high ankle sprain |
| Typically, how long is recovery for a high ankle sprain? | average is 55 days, often requires > 6 months |
| Snapping/popping of peroneal or fibularis tendons over distal fibula is known as what? | peroneal subluxation |
| loose retinaculum or shallow retromalleolar (fibular) groove can cause what? | peroneal subluxation |
| Ankle DF while peroneals are contracting, or INV sprain when ankle PF <= 25 can lead to what? | peroneal subluxation |
| Peroneal subluxation often involves what kind of intervention? | surgery, short leg cast, air splint |
| These are symptoms of what: localized tenderness over superior articular talar surface, locking & occasional synovitis, Occasionally persistent pain despite unremarkable clinical exam & x-rays. | osteochondral lesion of the talar dome |
| These symptoms indicate what?...Tenderness at calcaneocuboid joint & along fibularis longus tendon, esp with pressure over fibularis groove on plantar surface of cuboid. | cuboid subluxation |
| What can cause the cuboid to sublux? | INV DF sprain(causes sudden stretch of the peroneus longus), Flexible pronated foot in conjunction with pull of fibularis longus tendon |
| What are some interventions for cuboid subluxation? | cuboid manip, motion control shoes/orthosis to control excessive pronation, cuboid plantar pad, low dye strapping. |
| Where would you expect to see tenderness with plantar fasciitis? | at the fascial insertion onto the medial tubercle of the calcaneus. |
| Increased symptoms with combined ankle DF and great toe/MTP joint extension indicate what? | plantar fasciitis |
| When are symptoms usu worse for pt's with plantar fasciitis? | during 1st steps after prolonged inactivity |
| What is the position of comfort for people with platar fasciitis? | slight PF |
| What are three examples of potential underlying causes of plantar fasciitis? | 1.pes planus with subsequent overstretch of fascia, 2.rigid cavus foot with tight fascia, 3.sudden increase in frequency, intensity, duration of activity. |
| Interventions for plantar fasciitis may include what? | gradual stretching of plantar fascia, gastroc soleus stretching, weight loss if indicated, surgery, ionotphoresis, ultrasound, shock wave therapy |
| This can be 2º age-related collagenous fat pad degeneration, or can result from calcaneal trauma with resultant bleeding into fad pad. | fat pad syndrome |
| What are some treatments for fat pad syndrome? | activity modification, cushioned heel pads or heel cups, fat pad containment taping, cushioned foot wear, cushioned semi-rigid orthosis |
| inflammation of the paratendon/outer layer of the tendon is achilles tendonitis or tendonosis? | tendonitis |
| involves loss of collagen continuity & intratendinous degeneration rather than inflammation...achillies tendonitis or tendonosis? | tendonosis |
| What is more common tendonosis or tendonitis? | tendonosis(according to the slides) |
| Tenderness 2-6 cm above calcaneal insertion, Crepitus, Pain with AROM PF or PROM DF, Pain with running or stair a/descent...are symptoms of what? | acute achilles tendonosis |
| Nodular swelling of the achilles tendon is a symptom of what? | chronic achilles tendonosis |
| What are some acute treatments for the achilles tendon? | rest/ice/analgesics or NSAIDS, stretching pn free ROM, bilateral heal lifts or orthosis |
| Treatment for chronic achilles symptoms should focus on restoration of _______ integrity rather than inflammation. | collegen |
| Footwear interventions for those with achilles problems should include what? | proper running shoe type for excessive pronators or supinators, frequent replacement of footwear, constant heal hight in all shoes throughout the day |
| Strengthening interventions for achilles should focus on what? | eccentric strengthening, and tendon loading to increase collegen |
Created by:
txst sum 2009
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