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ortho foot and ankle dysfunction pt 2 - Coggle Diagram
ortho foot and ankle dysfunction pt 2
neurodynamics and heel pain
-heel pain can stem from local entrapment of medial calcaneal branch of tibial nerve or nerve to abd DM
-hypothesized nerve sliding/gliding can promote healing/decrease adhesion
common cause of heel pain in children
severs disease aka calcaneal apophysitis
-related to activity
pain with running/jumping, tenderness to insertion
-decreased activity guided by symptoms
-foot taping
-immobilization if bad enough
-heel lift may decrease pull,
-heel cord flexibility
radiographic stress views used in diagnosis of ankle sprains
-anterior drawer and talar tilt for degree of ankle instability
->6 mm on invovled side or >3mm difference indicative of ATFL rupture (drawer)
->10mm in talar tilt indicates rupture of ATFL and CFL
-65% of ankle sprains involve ATFL, 20% combined ATFL/CFL
-no data on PTFL, but rare
-AITF 10%
-deltoid 3% (ant portion can be injured in grade 3 sprains during PF portion)
OAR
RTS criteria
-full A/PROM
-walking without limp
-strength is 90%
-ho testing 90% of uninvolved side
prevention of recurrent ankle sprains
-external support
-coordination/balance training
-strengthening muscles of entire LE
causes of chronic ankle pain after ankle sprain
tension neuropathy of superficial peroneal nerve
-nerve is stretched from inversion sprain
-localized pain to dorsum of foot
-compression where nerve exits deep fascia of ant compt
-reproduced with PF
anterior/lateral soft tissue impingement
-scarring of ATFL or hypertrophied synovial tissue entrapped during DF
-most severe in anterolateral gutter of ankle
-less common cause is talar impingement on AITFL due to increased ant glide of talus after severe ATFL sprain
cuboid subluxation
-fairly common
-most commonly subluxed in plantar direction
-weak peroneals as result of displaced bone
syndesmotic ankle sprain
-injury to AITF/PITFL and interosseous membrane
-aka high ankle sprain
-MOI is ER of tibia on planted foot
-tenderness/swelling over distal/ant leg
-swelling on both sides of ankle
-critical to rule out concurrent fibula fx
-refer to ortho surgeon
-longer disability than routine ankle sprain
shin splints
-spectrum
-many causes
most common cause
-complication of chronic, intensive, weight-bearing exercise or training
-common in military or athletic populations
-anterior stress syndrome or posterior medial stress syndrome
anterior tibial stress syndrome
-EMG showed during running TA muscle increased in activity and fired above fatigue threshold for 85% of the time
-posterior tibial stress
-soleus, FDL and deep crural fascia most frequently attach at this time
-stretching of these specific muscles
treatment
-rest for prolonged periods
-foot supports, improved shock absorption
sinus tarsi syndrome
-home to many structures
-tenderness indicates disruption of subtalar complex
-chronic ankle sprains common cause
-scarring and synovial inflammation indicated in arthroscopic reports
tarsal coalition
-fibrous or osseous bar abnormality
-most common in talocalcaneal and calcaneonavicular joints
-onset in teenage years
-slight trauma or growth-plate ossification may provoke pain
-common findings are loss of rearfoot motion, rigid pes planus
-MRI or CT may be needed to dx
-conservative Rx initially, followed by surgery if needed