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53 Cards in this Set
- Front
- Back
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possible conditions involving contractile lesions
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-muscle strain (1st, 2nd, 3rd degree)
-contusion -tendinopathy -partial rupture or complete rupture -avulsion/avulsion fracture |
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tendinitis
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-inflammation of the tendon's substance
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tendinosis
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-degenerative condition related to aging, microtrauma, vascular compromise
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paratenonitis
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-inflammation of the tendon's outer layer
-does not directly affect tendon |
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contractile structures commonly affected about the foot/ankle
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-tibialis anterior
-tibialis posterior -fibularis longus |
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possible locations of compartment syndromes
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-anterior compartment
-deep superficial compartment -lateral compartment |
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principles for managing muscle strains and tendinitis
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-relative rest/activity modification
-address inflammation -address biomechanics -address strength/length issues -gradual return to aggravating activity |
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signs/ symptoms of paratenonitis
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-gradual onset of pain, swelling, increased temperature
-pain will progress from pain after exercise -> pain during exercise --> pain at rest -there will be pain w/ resisted PF, stretching and palpation |
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treatment of paratenonitis
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-rest
-ice -stretching -modalities -heel lift -steroid injection |
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achilles tendinitis/tendinosis
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-can follow chronic paratenonitis
-can occur w/ overuse, aging, vascular compromise -can lead to full rupture |
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signs/symptoms of achilles tendinitis/tendinosis
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-same as paratenonitis
-palpable nodules in the tendon -possible palpable defects (if partial tear) |
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conservative treatment of achilles tendinitis/tendonisi
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-same as paratenonitis
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surgical treatment of achilles tendinits/tendonosis
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-may be necessary if conservative care fails
-excision/debridement of damaged tendon/sheath -may augment tendon w/ plantaris tendon if damage is severe |
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full thickness rupture of the Achilles tendon
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-commonly occurs in sedentary, middle aged males who engage in occasional bursts of strenuous activity
-often occurs w/ strong eccentric muscle contraction -most common site is 2-6 cm proximal to calcaneus |
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signs and symptoms of full thickness achilles rupture
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-relatively painless
-no active PF |
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non-surgical treatment of full thickness rupture
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-must be done acutely (<3 weeks post injury)
-can only be done if ends of tendon approximate w/ passive PF -immobilization in short leg cast in PF -recast every 2 weeks, gradually decreasing PF angle to neutral by 6-8 weeks -higher rate of re-rupture/worse functional outcome than surgical repair |
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surgical repair of full thickness rupture
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-acute conditions (ideally w/in 1 week post injury)
-end-to-end approximation w/ sutures -cast or boot may be worn initially |
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grade 1 ligament sprain (general grading scheme)
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-overstretch
-still stable -no actual tearing |
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grade 2 ligament sprain (general grading scheme)
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-partial tear
-mild to moderate instability |
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grade 3 ligament sprain (general grading scheme)
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-rupture
-significant instability |
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grade 1 lateral ankle sprain
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-overstretch of the ATFL
-mild local edema -no instability -full or partial WBing |
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grade II lateral ankle sprain
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-usually partial tear of ATFL
-overstretch of CFL -moderate local edema -slight or no instability -difficult WBing (probably needs crutches) |
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grade III lateral ankle sprain
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-complete tear of ATFL
-possible or complete tear of CFL -overstretch of PTFL -significant diffuse edema -unstable -very painful WBing (probably cannot bear weight...need crutches) |
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intervention for grade 1 and grade 2 lateral ankle sprains (Acute)
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-PRICE
-decrease WB -brace or tape -early ROM -friction massage, if tolerated -modalities |
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intervention for grade 1/2 lateral ankle sprains after acute stage
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-strengthening
-proprioception -activity-specific training |
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non-surgical intervention for grade 3 lateral ankle sprains
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-PRICE
-functional bracking -may cast 4-6 weeks in slight DF -post immobilization = same rehab as grade 1 and 2 |
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surgical intervention for grade 3 lateral ankle sprains
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-uncommon
-may be seen in elite athletes -no long term differences compared to conservative managment |
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chronic ankle instability
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-persists > 6 months
- 20-40% of ankle injuries develop chronic instability -proprioceptive deficits are a likely factor |
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signs and symptoms of chronic ankle instability
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-repetitive sprains or functional instability
-may be a feeling of instability rather than a mechanical instability |
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treatment of chronic ankle instability
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-may be non-surgical or surgical
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plantar fasciitis
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-inflammation of plantar fascia @ calcaneal origin
-etiology is not well known (trauma? obesity? overuse?) -often related to overpronation |
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signs/symptoms of plantar fasciitis
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-point tenderness @ anterior/medial plantar surface of calcaneal tuberosity
-stretching pain w/ first steps of AM -pain @ EOD |
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conservative treatment of plantar fasciitis
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-anti-inflammatory measures
-stretching of Achilles tendon and plantar fascia -address biomechanics -heel cup |
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more aggressive treatments of plantar fasciitis include
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-night splinting
-casting -surgical release |
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tarsal tunnel syndrome
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-entrapment of tibial nerve posterior to the medial malleolus (under flexor retinaculum)
-often related to overpronation (overstretch of nerve, inflammation w/in tunnel) |
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signs/symptoms of tarsal tunnel syndrome
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-intermittent burning/tingling of medial foot
-positive Tinel's sign -EMG/NCV changes |
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treatment of tarsal tunnel syndrome
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-treat inflammation
-address biomechanics -surgical release |
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posterior tibial tendon dysfunction
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-pain and shape changes w/ palpation of tendon
-pes planus/overpronation -weakness w/ PF and inversion -inability to do a single leg heel raise -may have limited DF ROM |
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F/A problems w/ RA
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-16% have F/A involvement @ diagnosis
-nearly all have F/A involvement @ some time -synovitis of MTP's, talonavicular, subtalar -talocrural jt (ankle joint proper) is least involved jt -overpronation common -antalgic gait, soft tissue swelling, ROM loss are common during exacerbations |
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foot deformities associated w/ RA
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-hallux valgus
-hammer toes -claw toes -hallux rigidus |
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Hallus Valgus
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-"bunion" deformity
-abnormal prominence of medial surface of 1st MT head -lateral displacement of great toe |
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signs and symptoms of hallux valgus
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-may be assymptomatic
-may have pain in 1st MTP |
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treatment of hallux valgus
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-NSAIDS
-footwear/orthotics -surgical realignment if severe |
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hammer toes
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-MTP extension
-PIP flexion -DIP jt is still flat/straight -common in 2nd toe |
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claw toes
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-MTP hyperextension
-flexion of both IP's -intrinsic muscle weakness and/or other foot deformities may be the cause |
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hallux rigidus
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-hypomobility of the 1st MTP
-bony ridge may form on the dorsal surface of the MTP joint limiting extension -osteophytes/bony ridges on dorsal surface -becomes painful during gait -can have surgical procedure to shave down osteophytes |
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management of F/A in RA
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-proper medical management of disease
-careful footwear selection -foot orthoses (Semi-rigid, total contact) -AFO's in severe cases -ther ex to address intrinsic muscle weakness, ROM losses |
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malleolar fractures
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-usually involves medial and/or lateral malleoli
-can also be lateral malleolus fx and deltoid ligament avulsion -heals in 10-20 weeks -may require immobilization of ORIF depending upon amount of displacement |
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trimalleoloar fracture
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-involves medial and lateral malleoli and posterior tip of the tibia
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boot top fracture
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-fractures of the tibia and fibula proximal to the malleoli
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pilon fracture
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-distal tibia fracture in addition to malleolar fracture
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lisfranc's fracture
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-fracture/dislocation involving base of metatarsals and TMT joints
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Jones fracture
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-avulsion fracture @ base of 5th MT
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