Shared Flashcard Set

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Cadogan ankle and foot
N/A
52
Nursing
Graduate
05/15/2013

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Cards

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
Overpronation
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
PT

Recurrent sprains
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
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