Msk System Ankle And Foot Injuries Alasky

Front 1

What injuries are most responsible for more time lost from playing than any other body part?

Back 1

Foot and Ankle Injuries

Front 2

Foot examination

Back 2

Calcaneus

Talar dome

Plantar fascia origin

Cuboid

Navicular

Talo-navicular

1st MTP

Sesamoids

Tendon insertions

Front 3

Ottawa Ankle Rules

Determine when images are needed in pts w/ankle trauma

Rules include images for:

Back 3

Bony tenderness of the posterior half of the lower 6 cm of the fibula or tibia

Inability to bear weight for 4 steps immediately after the injury or at evaluation

Navicular or base 5th metatarsal pain on exam

Front 4

Grade I Ankle Sprain?

Back 4

No ligament disruption

No laxity

Front 5

Grade II Ankle Sprain?

Back 5

Partial ligament disruption

Joint laxity w/endpoint

Front 6

Grade III Ankle Sprain?

Back 6

Complete ligament disruption

Joint laxity w/out endpoint

Front 7

Lateral Ankle Sprain

Back 7

Initial Tx - RICE

Early ROM exercises

Tx - Air casts and early mobilization are standard therapy/faster RTP and less swelling

Casts discouraged/functional Tx preferred

Front 8

Proprioception exercises

Back 8

Reduces incidence to normal in recurrent ankle sprain group

Front 9

Deltoid Ligament Sprain

Back 9

Always palpate prox fibula to r/o Maisonneuve rx

Walking ankle orthosis 1-2 wks prior to starting rehab

2-3 mo healing time

Front 10

Syndesmosis (high) Ankle Sprain

Back 10

Ant/Post Inferior and Transverse Tibiofibular Ligaments

Interosseous ligs

External rotation and hyperdorsiflexion mechanism

Little swelling 1-10% of ankle sprains

2-3 months to full return if evidence of diastasis

Front 11

Syndesmosis Injury Dx

Back 11

Widening of medial clear space >5mm medial talar facet and medial malleolus

Front 12

High Ankle Sprain Protocol

Back 12

Days 1-4: Non-wt bearing crutch

Days 4-5: Partial wt bearing

Days 6+: Full wt bearing and progressive rehab

Front 13

Transchondral Talar Dome Fractures

Back 13

6.5% of all sprains are assoc w/transchondral fx of talar dome

Associated w/lig instability

Stiffness, crepitus, Decreased ROM

Front 14

Transchondral Talar Dome Fx Tx

Back 14

Acute, nondisplaced - immobilize for 6 wks in cast or rigid brace. Afterwards rehab as per ankle sprain

Acute or chronic, displaced - surgical incision or ORIF (Open reduction internal fixation). Persistant pain may require osteochondral transplant

Chronic, nondisplaced-splint or cast for 4+ weeks, and reassess x-ray and symptoms. If symptoms persist sx.

In chronic cases always assess lig stability

Front 15

Tarsal Tunnel Syndrome

Back 15

Entrapment of tibial nerve

Burning pain on sole that radiates to toes

Front 16

Os trigonum

Back 16

The os trigonum is an extra (accessory) bone that sometimes develops behind the ankle bone (talus).

Front 17

Jones Fracture

Back 17

Fracture through metaphyseal - diaphyseal junction at base of 5th metatarsal

1.5 cm distal to tuberosity

Seen w/ lateral ankle sprain

Tx is short leg NWB cast 6-8 wks

Sx for those who fail conservative Tx

Front 18

Sever's Disease

KNOW!!!

Back 18

Insidious onset of heel pain often associated w/a growth spurt

10-12 yrs old

Unilateral usually

Positive calcaneal compression test

Deficit on dorsiflexion

Gait: increased pronation

Non-specific radiograph findings

Front 19

Sever's Tx

Back 19

Rest, Gastrocsoleus stretching, Dorsiflexion strengthening, heel cups, orthotics

Average return to sport: 2 months

Front 20

Preparticipation Physical Exam

Primary Objectives

Back 20

Detect conditions that may predispose the person to injury

Detect conditions that may be life threatening or debilitating

Meeting legal and insurance requirements

Also can determine general health, counsel re: health related issues and assess fitness level for specific sports

Front 21

Timing of preparticipation physical exam

Back 21

Preferably 6 wks prior to start of practices

allows for workup

Allows for adequate rehab of deficit or injury

Allows for conditioning for patients new to a sport or out of shape

Not too much time that new problems occur

Front 22

Most common cause of non-traumatic sudden death in an athlete

Back 22

1. Cardiac (80-95%)
2. Heat illness
3. Asthma

Front 23

Heat Illness

Back 23

Hx of previous problem

Assessment of other pre-disposing factors

SICKLE CELL TRAIT - risks for rhabdo and suudden death in heat or at altitude

Front 24

What is the most common injury in sports med?

Back 24

Recurrence of prior injury

Due to:

Inadeqeuate rehab
Lingering weakness or proprioception
Poor flexibility
Poor core strength

Front 25

PE Pupils/Vision

Back 25

Symmetry/Asymmetry (baseline if athlete has head injury later)

Vision should be 20/40 corrected

Front 26

PE Neck ROM

Back 26

Must be unrestricted

Downs pts must get cervical film for contact sports because of atlanto-axial instability

Front 27

PE Cardiovascular

Back 27

Supine and standing

Utilize Valsalva/squatting maneuvers

-functional murmurs (and aortic stenosis) should diminish w/change of position or decreased venous return as with valsalva
-pathologic murmurs due to ventricular septum thickness will be increased w/valsalva or decreased venous return

Pulses: radial and femoral (screen for coarctation), heart rhythm

Front 28

PE HTN

Back 28

PreHTN (90-95%) recheck in 6 months, ok to play

Stage 1 (95-99%) recheck in 2 additional visits - OK to play, but should not power lift, eval for LVH(if present needs Tx)

Stage II - (>99 %) (>160/100) immediate eval and tx - restricted until HTN controlled

Front 29

PE Abdomen

Back 29

Assess for organomegaly

Esp important w/history of mononucleosis and splenomegaly

Hernia check in males

Front 30

MSK PE

Back 30

2-3 min, focus on areas of prev injury

Front 31

Contraindications to play

Back 31

Carditis

Diarrhea

Fever