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NMS3 Final
Ankle
| Question | Answer |
|---|---|
| What is pes Planus? describe it. | Flat foot. Loss of medial lonitudinal arch. |
| What is the exam findings for Pes Planus? | Lost of medial arch. Calcaneus has gone into eversion giving a prominent talus. medial shoe wearing. |
| What is Pes Cavus? Describe it. | High arch. Seen in northern europeans. Very rigid foot. |
| What is Hallux Valgus? Describe it? | Bunion. 1st MTP becomes valgus. Great toe rotates and shfit laterally. |
| What are the exam findings for Hallux Valgus? | Pain over the 1st MTP. Pressure over the skin by the shoe causes shear forces in the subcutaneous tissues. |
| What is treatment for Hallux Valgus? | Mobilization techinique of the 1st MTP. Toe spacer. Adjust foot/ankle. Education on proper footwear. Muscle strengthening coordination. Orthotics for hindfoot control. Treatment of any lower extrem. dysfunction. possible surgery. |
| What is a Hagland's Deformity? describe it? | Pump Bump. prominence of the posterior superior surface of the calcaneus. |
| What conditions can present as bursitis first before Hagland's Deformity? | Gout, RA, Calcific tendinitis, Osteomyelitis and Reiter's syndrome. |
| What are hammer toes? | Flexion contracture of PIP, Usually 2nd toe with DIP in flex/ext or hyperextention. Often bilateral and symmetrical. Often congenital but can be from wearing small shoes. |
| What is claw toe? | Hyperextension or dorsal subluxation at the MTP and flexion at both PIP and DIP joints. |
| What other condition might hammer toes be secondary to? | Hallux Valgus. |
| What other condition might claw toes be secondary to? | Pes Cavus |
| Where would callus form with claw toe? | Toes form callus or corns on the dorsum of the PIP joints and the plantar surface of the MTP joints. |
| What is mallet toe? | A flexion contracture of DIP joint |
| Where does a callus form with mallet toe? | Dorsum of DIP joint, and distal toe. |
| What Morton's Foot/Toe (Matatarsus Primus Atavicus)? | A congenitally short 1st metatarsal. |
| What might a morton's toe cause? | symptomatic flatfoot. |
| What % of ankle sprains are inversions? | 85-95 |
| What muscle imbalance contributes to most inversion ankle sprains? | Stronger plantar flexors than dorsi flexors. |
| What are differential diagnosis for ankle sprains? | AVN, Osteochondral fragments, fracture of 5th metatarsal shaft of styloid process, fracture of calcaneus, Talus, Tibia, fibula. Dislocation of talar or tarsometatarsal joints. |
| Key exam findings for ankle sprains? | Altered ROM, Pain tenderness over lateral ankle. Resisted motions that stress damaged areas may be weak (dorsiflexion) |
| What are the order ankle ligaments tear? | Anterior talofibular, Calcaneofibular, posterior talofibular. |
| What is indicative of a grade one ankle sprain? | No laxity/instability. Negative anterior drawer. Talar tilt negative. Single ligament involvement. Minimal swelling, No hemorrhage. Point tenderness. no or little limp. Minimal functional loss. recovery in 2-10 days. |
| What is indicative of a grade 2 ankle sprain? | Some laxity/instability. Anterior drawer may be positive. Talar tilt negative. Partial or complete tear of ant talofibular and possible calcaneofibular. Swelling. Hemorrhage. Limp. recovery 10-20 days. |
| what is indicative of a grade 3 ankle sprain? | Significant instability. Pos anterior drawer. Pos talar tilt. complete tear of Ant talofibular, calcaneofibular and anterior capsule. Swelling and Hemorrhage. Unable to bear weight fully. large loss of ROM. 30-90 days recovery. |
| IN the early phase of an ankle sprain, what is the suggested treatment? | PRICE. Ligaments maintained in stable position so healing can occur. Brace. Crutches. Minimize weight bearing. Isometric exercises. Ice especially in the first 48-72 hours. |
| IN the rehabilititaion phase of an ankle sprain what is the suggested treatment? | Pain is the guide to activity. swelling has maxed out and is starting to go down. Can start riding stationary bike. Isometric exercises with progression to isotonic exercises. Pain is the guide! |
| In phase 3 full function of an ankle sprain what is the suggest treatment? | Returning to normal activity when ROM is 80-90% when compared to non-injured leg. Runnign in pool. swimming. Full weight bearing when no limp. |
| What is plantar Fascitis? | overload injury to a tough longitudinal fibrous CT from the medial calcaneal tuberosity to the metarsal area. stepping on glass. pain decreases throughout day. |
| DDXs for Plantar fascitis? | Tarsal Tunnel syndrome. Positive Tinel's. Sacral radiculopathy. Seronegative spondylarthropathies, reiter's syndrome. |
| Key exam findings for Plantar Fascitis? | Tenderness at the medial calcaneal tubercle and over plantar fascia. DOsiflexion of great toe or ankle reproduces pain. Asses joint function and gait and structure. |
| What are contributing factors to Plantar Fascitis? | Middle aged or older. overweight. diabetes. excessive subtalar joint pronation. Pes Planus or Cavus. Limited dorsiflexion. over use. |
| How is Plantar Fascitis Managed? | Taping, gradual stretching, Myofascial release. Tennis ball. Ultrasound. Adjustments (navicular) Orthotics for pronation. |
| What is tarsal tunnel syndrome? | Compression of the posterior tibial nerve as it passes under the flexor retinaculum on the medial side of the ankle. |
| What is the etiology of tarsal tunnel syndrome? | Possible chronic inversion sprains causing tightness of the flexor retinaculum. Anything that causes swelling in the area. |
| What are signs and symptoms of tarsal tunnel syndrome? | Insidious increasing symptoms with activity. Decrease with rest. Aggravated by prolonged standing walking or running. May be constant pain or pain at night. Pain may radiate popliteal or sural regions. Pain, burning, numbness, pressure paresthesia. |
| What does the medial plantar branch of the posterior tibial nerve supply? | 1, 2, 3 toes and medial plantar surface. |
| What does the lateral plantar branch of the posterior tibial nerve supply? | 4, 5th toes and lateral plantar surface. |
| What does the medial calcaneal branch of the posterior tibial nerve supply? | over the heel. |
| What are the DDXs for tarsal tunnel syndrome? | Anterior trasal tunnel syndrome. Saphenous nerve syndrome. posterior tibialis tendinitis. |
| What are the key exam findings for tarsal tunnel syndrome? | Hypesthesia. Forced DF and eversion. Tinel's tap test positive. Abduction of toes may cause pain and paresthesias. |
| What are contributing factors for tarsal tunnel syndrome? | Overweight. Poor shoes. overuse. pregnancy. Systemic disease (diabetes, thyroid), excessive subtalar pronation. Hypertrophied abductor hallucis longus. Chronic inversion sprains, swelling trauma. |
| Treatment for tarsal tunnel syndrome... | RICE. Correct pronation. Adjust. |
| What is Morton's Neuroma? | perineruofibrosis on an interdigital nerve. 3-4th metatarsal most common. 4-5 least common. |
| Common symptoms/exam findings of Morton's Neuroma? | Localized tenderness between MT heads. Positive morton's sign. Hypesthesia in the web between teh affected matatarsals. Swelling if it's large. |
| DDX for Morton's Neuroma? | Stress fracture of MT, metatarsalgia, sesamoiditis. Tarsal Tunnel syndrome. |
| Contributing factors for Morton's Neuroma? | Overweight. Poor shoes. over use. preg. tubtalar joint pronation. |
| What is cuboid syndrome? | subluxation of the cuboid bone plantarward leading to pain witha ctivity or weight bearing. Paina nd perhaps slight indentation over the doral lateral midfoot. More common in pronated foot. |
| What are key exam findings for an achilles tendon over use injury? | Inability to perform heel raise maneuver. Weekness of plantarflexion against resistance. Painful passive dorsiflexion with knee extended (gastroc) and knee flexed (soleus) |
| What are key exam findings for an achilles tendon with rupture injury? | Postivie thompson test (25% inaccurate for complete tears). Visible/palpable defect in teh tendon. |
| What is Turf Toe? | Hyperextension injury of the 1st toe. Plantar capsule of MTP is sprained. Usually from kicking. |
| What do you need to rule out for turf toe? | Fracture of the toe. |
| What are shin splints? | anterior or posterior leg pain involving the middle or lower 3rd of the tibia. |
| Possible causes of shin splints? | Tendinitis, periostitis, muscle strain and interosseous membrane strain have all been implicated as possible causes> |
| DDXs for shin splints? | Tibial stress fracture and carpartment syndrome |
| Treatments for shin splints? | Adjustments. Activity modification, footwear, Nutrition. Sensorimotor training. Strengthening. Orthotics. |
| What is metatarsalgia? | Inflammation of the MT heads giving pain across the transverse arch of the foot. |
| Where might callus form with metatarsalgia? | across metatarsal heads possibly indicating loss of the arch. |
| What are possible causes of metatarsalgia? | Overweight. Repetitive activity. Hammer toes. Pes planus/cavus. Direct trauma(running). Tight shoes (compression). |
| What are exam findings for metatarsalgia? | Calluses or corns at metatarsal heads. Pes planus/cavus. Tender over metatarsals involved. Dropped metatarsal heads. Postive morton's test. Strunsky sign. metatarsal tap. |
| What are treatments for metatarsalgia? | Remove/modify activities and/or footwear. metatarsal pad proximal to heads. Adjust foot. Anti inflammatory treatments. |
| What causes acute compartment syndrome? | Due to a severe blow to the lower leg, often from a fracture. |
| Symptoms for acute compartment syndrome? | More severe than expected from trauma. can take up to 64 hours. Neurological dysfunction due to pressure on nerves. Edema sometimes. Muscles are stiff. |
| Risks of acute compartment syndrome? | If left untreated, muscle necrosis will occur leading to acute renal failure due to massive amounts of myoglobin in the urine. |
| Treatment for acute compartment syndrome? | Referral..Emergency surgery! |
| What is chronic exertional compartment syndrome? | Due to over use. May last weeks to months. OFten seen in runners. May be related to running on hard surfaces. |
| Symptoms of chronic exertional compartment syndrome? | Usually anterior and lateral compartments are effected so pain in these areas. Symptoms subside at rest. When active the patient may experience numbness and foot drop. |
| What are DDXs for chronic exertional compartment syndrome? | Stress fracture. Shin Splints, Tenosynovitis of anterior tibialis. |
| Treatment for chronic exertional compartment syndrome? | Stop activity, change activity, cross training, PRICE without compression. Light massage to drain. |
| what are the 3 arches in the foot? | Transverse arch. Lateral longitudinal arch, medial longitudinal arch. |
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