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34 Cards in this Set
- Front
- Back
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Adventitial bursae
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-fluid filled sacs of connective tissue form to cushion the structures from trauma
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Lateral mortise ligaments
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-posterior talofibular
-calcaenofibular ligament -anterior talofibular ligament- most common torn with an inversion |
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medial ligament
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-deltoid ligament--> big
-more stability |
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nerves in foot
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-lay on top of the tendons
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achilles tendon
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-strongest tendon in body
-made by 3 muscles |
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accessory ossicles
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-extra muscle in the foot
-ex. sessemoid |
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pes planus (flatfoot)
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1. congenital flexible
-common -usually nonpathologic -usually bilat and asym -return of arch with NWB -nml ROM -tx if symptomatic: longitudinal arch support, stretching exercise 2. congenital fixed -tx: orthotics, shoe modification |
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Pes Cavus
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-etiology: NM/muscular disorder, congenital, trauma related
-non surgical tx: soft sole shoes, extra deep shoes if claw toe, orthotics -surgical tx: correct deformity |
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when is it important to examine the shoes of pts
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1. Diabetic pts
2. Pediatrics |
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deformities of lesser toes
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-etiology: long term improper shoe wear, neuro disorders, trauma
-presentaiton: 1. pain 2. deformity 3. difficulty with shoe wear 4. calus. contractious, ulceration 5. disability |
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Hallux valgus
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-bunion
-lateral deviation of the proximal phalynx of the great toe on the metatarsal head leading to painful prominence of the medial aspect of the joint -causes: improper shoe wear (F>M) -present: 1. pain 2. swelling 3. deformity 4. numbness/paresthesias 5. toe overlap 6. callous |
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hallux valgus dx and tx
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-Dx: clinical pres, xrays
-Tx: pt education, shoe modification, surgery |
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Ankle sprain
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-most common ankle injury
-forceful stretching/tearing of ankle ligaments -lateral sprain >>>medial sprain -ant talofibular lig #1 -local tenderness, pain with motion -variable swelling, ecchymosis -in stability -ant drawer test, talar tilt test |
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anterior drawer test for ankle instability
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With the patient’s tibia stabilized, grasp the calcaneus and pull forward to demonstrate anterior instability of the talus in the ankle mortise.
There will be asymmemtrical or excessive motion with chronic ankle ligament laxity and severe ankle ligament tears. |
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Varus Stress Test for Ankle
Aka Talar Tilt Test |
-With the tibia stabilized, grasp the calcaneus and talus and invert the hindfoot.
-There will be excessive or asymmetrical motion with chronic ankle ligament laxity and acute severe ligament tears. |
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classification of ankle sprains
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-slide 39
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ankle sprains tx
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-P protection
-R rest -I ice -C compression -E elevation -crutches, NSAIDs, splint -<1% require surgery -refer chronic, unstable, “high sprain”, positive x-ray |
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Stress fxs
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-pathological fx
-95% in lower extremities -F>M -prolonged and repeated loading -?improper training, change in training, underlying bone dz -pain with activity, local tenderness and swelling -common in athletes, kids growing fast -most common in metatarsals -Dx: xray, +/- abnormalities, bone scan, MRI |
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stress fx tx/prognosis
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-ice, elevation and NSAIDs
-activity avoidance -protection -cross training -?eating disorder/amenorrhea -modify risk factors -refer if not healing or persistent pain |
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Acute achilles tendon rupture
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-cause: direct trauma, sudden force applied to tendon, gradual intrinsic degeneration
-acute calf pain, "pop" and/or swelling -palpable defect -weak painful active plantar flexion -positive thompson fest |
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achilles tendon rupture dx, tx
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-radiographic findings: may show tendon rupture, +/- calcaneal avulsion, MRI more helpful
-tailor tx to pt -casting in "gravity" plantar flexion x 4-6 wks -heel lifts -PT -surgical approximation of tendon |
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PLantar fasciitis
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-painful feel syndrome
-#1 cause of heel pain in adults -inflamm or plantar fascia insertion microtearing -?repetitive strain, error in training, pes planus risk factors -commonly bilateral -localized sharp knifelike heel pain -pain with first AM steps and wt bearing exercise -point tenderness medial plantar surface of heel -xray poor clinical/prognostic indicator |
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plantar fasciitis tx
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-slow healing process
-conservative tx 90-95% successful: taping, orthoses, stretching exercises, ice -nt splints -extracorporeal shockwave therapy -local steroid injections if resistant -surgical release or spur excision |
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Morton's neuroma cause
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-interdigital neuroma
-entrapment, degeneration and constant traction on digital nerves between metatarsal heads -F>M -middle aged -#1 site at 3rd/4th MT interspace -unilateral |
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mortons neuroma clinical presentaiton
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-burning pain beneath MT heads or base of toes
-+/- pain radiation -point tenderness b/t MT heads +/- dysesthesias -+compression test -+/- palpable neuroma -xray not helpful |
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mortons neuroma tx
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-conservative: shoe modifications, orthoses, 30% success rate
-steroid injections -surgical neuroma transection: 80% success rate, sensory loss in 60% |
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Ingrown toenail (onychocryptosis)
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Patho:
1.nail edge/cuticle border pierces adjacent skin 2. soft tissue irritation 3. local edema and tenderness 4. cellulitis 5. small abscess formation |
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ingrown toenail tx
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-warm water soaks
-cotton packs -abx -proper toenail care -surgical |
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common ankle and foot fxs
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Malleolar fractures
Pilon fractures Lisfranc fracture dislocations Calcaneal fractures Jones fractures Toe fractures |
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tx goals of fxs
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1. obtain anatomic reduction
2. maintain anatomic reduction 3. pre-injury level of function with painless ankle mobility -classifications: extent of injury and tx plans |
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bimalleolar fx
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-avulsion fx of lateral malleolus and shear fx of medial malleolus caused by medial rotation of talus. Tibiofibular ligaments intact
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injury to tarsometatarsal joint complex
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-Lisfranc joint
-homolateral dislocation: all 5 metatarsals displaced in same direction -isolated dislocation: 1 or 2 metatarsals displaced -divergent dislocation: 1st metatarsal displaced medially, others superolaterally |
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Jones fx
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-5th metatarsal fx
-usually ends up being a surgical fx |
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when to refer pts with foot fxs
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1. displaced fxs
2. calcaneal fxs 3. open fxs 4. jones fx |
