Anatomy and Functions of Ankle and Foot
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Questions and Answers

What are the functions of the ankle and foot? (Select all that apply)

  • Absorb stress and shock (correct)
  • Play a role in absorbing heat
  • Facilitate side-to-side movement only
  • Provide a stable base of support in weight-bearing postures (correct)
  • How many bones are found in the foot?

    26 bones & 2 sesamoid bones

    The MCL (Deltoid ligament) controls lateral distraction forces on the ankle.

    False

    Ankle sprain involves stretching or tearing of ligaments in the __________.

    <p>ankle</p> Signup and view all the answers

    What is the purpose of the Anterior Drawer Test?

    <p>To assess the integrity of the ATFL (Anterior Talofibular Ligament).</p> Signup and view all the answers

    What is the purpose of the Talar Tilt Test?

    <p>To diagnose lateral ankle/CFL (Calcaneofibular Ligament) injuries or medial ankle/deltoid ligament complex injuries.</p> Signup and view all the answers

    What is the purpose of the Squeeze Test?

    <p>To diagnose syndesmotic injury.</p> Signup and view all the answers

    When performing the Anterior Drawer Test, the foot should be placed in which position?

    <p>Plantarflexion</p> Signup and view all the answers

    The Talar Tilt Test is used to diagnose syndesmotic injury.

    <p>False</p> Signup and view all the answers

    Define muscle spasm.

    <p>Muscle spasm is a sudden, involuntary contraction of one or more muscles that typically lasts for seconds or minutes.</p> Signup and view all the answers

    What are some factors that can contribute to muscle spasm?

    <p>All of the above</p> Signup and view all the answers

    Muscle cramps are painful, intense, and sustained muscle contractions.

    <p>True</p> Signup and view all the answers

    The primary cause of pain in muscle spasm is ____, which leads to the release of substances causing pain.

    <p>iskemia (lack of blood flow)</p> Signup and view all the answers

    Match the following modalities with their rehabilitation use:

    <p>NSAID and acetaminophen = Medications for pain relief Deep thermal therapy = Relaxation and tissue extensibility improvement Stretching exercise = Improving tissue extensibility and elongation of muscle crossing structures</p> Signup and view all the answers

    What is the neurotransmitter for skeletal muscles?

    <p>acetylcholine</p> Signup and view all the answers

    What is the receptor type found on skeletal muscle fibers?

    <p>Nicotinic receptor</p> Signup and view all the answers

    ATP is initially used for muscle contraction, and then ATP is generated by the muscle cell primarily from ________.

    <p>creatine phosphate, glucose, glycogen, and oxidative phosphorylation</p> Signup and view all the answers

    Low level laser therapy is known to disrupt the cycle at trigger points.

    <p>True</p> Signup and view all the answers

    What are the characteristics of latent MTPS?

    <p>No spontaneous pain, pain only with vigorous digital pressure, may cause different muscle activation pattern or weakness.</p> Signup and view all the answers

    What are the characteristics of active MTPS?

    <p>Manual patient cause pain, can cause autonomic phenomenon such as skin redness, sweating, goose pimpling, dizziness.</p> Signup and view all the answers

    According to Simon and Travell, what are the three characteristics of MTPS?

    <p>All of the above</p> Signup and view all the answers

    In MTPS, the abnormal release of acetylcholine can lead to taut band formation.

    <p>True</p> Signup and view all the answers

    Diagnosis of MTPS is often confirmed through physical examination findings such as ___, ___, and ___

    <p>trigger point, taut band, referred pain</p> Signup and view all the answers

    What are absolute contraindications for trigger point dry needling?

    <p>Needle phobia, conflicting beliefs, inability to consent, lymphedema</p> Signup and view all the answers

    What are relative contraindications for trigger point dry needling?

    <p>Abnormal bleeding, immunocompromised, vascular disease, pregnancy, epilepsy, psychological disorder, allergy to copper and nickel</p> Signup and view all the answers

    What is the recommended frequency range for ultrasound in trigger point injections?

    <p>0.8-1.0 MHz</p> Signup and view all the answers

    A latent trigger point causes spontaneous pain.

    <p>False</p> Signup and view all the answers

    ______ can bind to troponin, leading to the movement of tropomyosin and actin-myosin attachment.

    <p>Ca2+</p> Signup and view all the answers

    Study Notes

    Ankle Sprain

    Functions of Ankle and Foot

    • Stability: provide a stable base of support in various weight-bearing postures and act as a rigid lever for effective push-off during gait
    • Mobility: absorb stress and shock, and propel the body during walking
    • Protection: provide sensation to the sole of the foot

    Bones

    • 26 bones and 2 sesamoid bones divided into 3 functional segments:
      • Forefoot (anterior): 5 metatarsals, 14 phalanges
      • Midfoot (middle): navicular, cuboid, 3 cuneiform bones
      • Hindfoot (posterior): talus, calcaneus

    Joints

    • 25 component joints, including:
      • Proximal and distal tibiofibular joints
      • Ankle (talo-crural) joint
      • Talo-calcaneal (subtalar) joint
      • Talo-navicular joint
      • Calcaneo-cuboidal joint
      • Transverse tarsal joint
      • 5 tarso-metatarsal joints
      • 5 metatarso-phalangeal joints
      • 9 interphalangeal joints

    Ligaments

    • Medial collateral ligament (MCL):
      • Also known as deltoid ligament
      • Fan-shaped
      • Superficial and deep fibers from the borders of the tibial malleolus to the navicular, talus, and calcaneus
      • Extremely strong
      • Controls medial distraction forces on the ankle
    • Lateral collateral ligament (LCL):
      • Composed of 3 separate bands: anterior talofibular ligament, posterior talofibular ligament, and calcaneofibular ligament
      • Weaker and more susceptible to injury than MCL
      • Controls varus (lateral distraction) forces

    Definitions of Motion

    • Axis: through the fibular malleolus, body of the talus, and just below or through the tibial malleolus
    • Tibial torsion: more posterior position of the fibular malleolus due to normal torsion or twist in the distal tibia in relation to the proximal tibia

    Ankle Sprain

    • Involves stretching or tearing of ankle ligaments
    • 85% of ankle sprains occur on the lateral aspect, involving the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL)
    • 5-10% of ankle sprains are syndesmotic or high ankle sprains, involving the tear of the anterior distal tibiofibular ligament
    • 5% of ankle sprains occur on the medial aspect, involving the deltoid ligament

    Epidemiology

    • Ankle sprains are a common cause of morbidity in the general population and athletes
    • Peak incidence occurs between 15-24 years of age
    • Males are more commonly affected than females (incidence ratio 1.04)
    • However, a recent meta-analysis showed that females have a higher incidence rate than males (13.6 vs 6.94 per 1000 exposures)

    Mechanism of Injury

    • Strains occur depending on the mechanism of injury
    • Stress supination and inversion of the foot (most common) → tear of the lateral ankle structures (ATFL)
    • Stress eversion of the foot → tear of the medial ankle structures (deltoid ligament)
    • Stress dorsiflexion and external rotation of the foot → syndesmotic injury

    Grading

    • Grade I: partial tear of the ATFL, CFL, and posterior talofibular ligament (PTFL) intact
    • Grade II: complete tear of the ATFL, partial tear of the CFL, and PTFL intact
    • Grade III: complete tear of the ATFL, CFL, and PTFL

    Functional Limitations

    • Patients may experience difficulty walking due to pain and swelling
    • Proprioception and balance on the injured ankle may be impaired
    • Athletes may have difficulty returning to play until the swelling and pain have subsided, and rehabilitation is almost complete

    Symptoms

    • Patients report pain, swelling, and tenderness on the injured ligament
    • Some patients may report a "pop" sensation at the time of injury
    • Difficulty weight-bearing on the injured ankle during ambulation
    • Ecchymosis may occur within 24-48 hours

    Physical Examination

    • Look: edema and ecchymosis around the ankle
    • Feel: palpate the ATFL, CFL, and deltoid ligament
    • Move: assess range of motion (ROM) of the ankle joint

    Special Tests

    • Anterior Drawer Test: assesses the integrity of the ATFL
    • Talar Tilt Test: assesses the integrity of the CFL and deltoid ligament
    • Squeeze Test: diagnoses syndesmotic injury

    Imaging

    • X-ray: assesses for fractures and osteochondral lesions
    • MRI: assesses soft tissue injuries and osteochondral lesions
    • Ultrasound: assesses soft tissue injuries and subluxation of tendons

    Diagnosis

    • Differential diagnosis: fracture, osteochondral lesion, syndesmotic injury, and tendon subluxation

    Treatment

    • Conservative management: rehabilitation, bracing, and protection
    • Surgical management: may be necessary for grade III ankle sprains or those with osteochondral lesions

    Rehabilitation Protocol

    • Phase 1 (acute): 3-5 days, aims to protect the injured tissue, reduce pain and inflammation, and maintain functional range of motion
    • Phase 2 (subacute): 5-10 days, aims to improve strength, proprioception, and functional range of motion
    • Phase 3 (maturation): 10-14 days, aims to improve strength, power, and functional range of motion### Ankle Sprain Protocol
    • The ankle sprain protocol consists of three phases: acute, subacute, and mature phases.
    • During the acute phase, the goal is to reduce pain and inflammation, and to prevent further injury.
    • In the subacute phase, the goal is to improve range of motion (ROM), strength, and proprioception.
    • In the mature phase, the goal is to restore functional ability and prevent re-injury.

    Acute Phase

    • Lasts 0-3 days after injury
    • Goals:
      • Reduce pain and inflammation
      • Prevent further injury
      • Restore ROM and strength
    • Techniques:
      • Pulsed ultrasound to reduce pain and inflammation
      • Electric stimulation to minimize pain and muscle spasm
      • Cryotherapy to reduce pain and inflammation
      • Latihan ROM and strengthening exercises to improve ROM and strength
      • Technique of "flushing-type" massage to increase blood circulation

    Subacute Phase

    • Lasts 3-6 weeks after injury
    • Goals:
      • Improve ROM and strength
      • Increase proprioception and balance
      • Prevent re-injury
    • Techniques:
      • Continue latihan ROM and strengthening exercises
      • Add dynamic proprioception exercises with perturbation
      • Use taping or bracing for additional support
      • Stretching exercises to improve ROM

    Mature Phase

    • Lasts 6 weeks or more after injury
    • Goals:
      • Restore functional ability
      • Prevent re-injury
      • Improve proprioception and balance
    • Techniques:
      • Plyometric exercises to improve power and explosiveness
      • Dynamic proprioception exercises with perturbation
      • Aggressive stretching exercises to improve ROM
      • Combine soft tissue techniques, such as cross-fiber massage and myofascial release

    Criteria for Return to Activity

    • Pain-free during activity
    • No swelling
    • Full ROM
    • Full strength and endurance
    • Normal proprioception and balance
    • Patient feels psychologically ready

    Muscle Spasm

    • Definition: Involuntary muscle contraction that is painful and can be tender to the touch
    • Causes:
      • Overuse or fatigue
      • Muscle imbalance or poor posture
      • Dehydration or electrolyte imbalance
      • Medical conditions, such as multiple sclerosis
      • Medications, such as diuretics, statins, or beta-agonists
    • Symptoms:
      • Pain or stiffness
      • Muscle weakness or fatigue
      • Cramping or twitching
      • Numbness or tingling
    • Treatment:
      • Stretching and strengthening exercises
      • Modalities, such as heat or cold therapy
      • Medications, such as muscle relaxants or pain relievers
      • Manual therapy, such as massage or trigger point therapy

    Myofascial Trigger Point Syndrome

    • Definition: A condition characterized by pain and stiffness in a specific area of the muscle
    • Causes:
      • Muscle injury or overuse
      • Poor posture or biomechanics
      • Stress or anxiety
      • Hormonal changes
    • Symptoms:
      • Pain or stiffness
      • Limited range of motion
      • Weakness or fatigue
      • Numbness or tingling
    • Treatment:
      • Trigger point therapy
      • Stretching and strengthening exercises
      • Modalities, such as heat or cold therapy
      • Manual therapy, such as massage or joint mobilization### Myofascial Trigger Point Syndrome (MTPS)
    • MTPS is a condition of muscle pain or fascia, which can be acute or chronic, involving sensory, motor, or autonomic functions related to trigger points.
    • Diagnosis is based on anamnesis and physical examination.
    • Anamnesis typically includes complaints of pain, tenderness, and limited range of motion.
    • Physical examination includes inspection, palpation, and identification of trigger points and taut bands.

    Pathophysiology

    • Three key features of MTPS:
      • Release of acetylcholine, which leads to muscle contraction and pain.
      • Shortening of sarcomeres, which increases muscle tension.
      • Release of sensitizing substances, which causes pain.
    • These features interact in a positive feedback cycle, leading to increased pain and muscle tension.

    Vicious Cycle

    • Abnormal release of acetylcholine leads to increased muscle tension and pain.
    • Increased muscle tension and pain lead to the release of sensitizing substances, which further increases pain.
    • Pain leads to muscle contraction, which leads to the release of acetylcholine, and so on.

    Diagnosis

    • Diagnosis is based on five major criteria and at least one minor criterion.
    • Major criteria include:
      • Trigger point
      • Taut band
      • Pain on palpation
      • Referred pain
      • Limited range of motion
    • Minor criteria include:
      • Autonomic dysfunction
      • Muscle weakness

    Treatment

    • Manual therapy:
      • Stretching with intermittent cold
      • Deep pressure massage
      • Trigger point release
    • Modalities:
      • Ultrasound
      • Transcutaneous electrical nerve stimulation (TENS)
      • Low-level laser therapy (LLLT)
      • Radial shockwave therapy
    • Dry needling: a technique that uses a thin needle to stimulate trigger points, muscles, and connective tissue.

    Dry Needling

    • Indications: MTPS that is not responsive to conservative treatment.
    • Contraindications:
      • Absolute: patient has a bleeding disorder, is taking anticoagulant medication, or has a fear of needles.
      • Relative: patient has a compromised immune system, is pregnant, or has a psychological disorder.

    Injections

    • Injections can be used to treat MTPS that is not responsive to conservative treatment.
    • Types of injections:
      • Local anesthetics (e.g., lidocaine, procaine)
      • Corticosteroids
      • Other substances (e.g., botulinum toxin)

    Physical Examination

    • Posture evaluation
    • Measurement of range of motion
    • Muscle strength testing
    • Palpation:
      • Identification of trigger points and taut bands
      • Assessment of muscle tenderness and pain

    Spray and Stretch

    • A technique that uses a vapocoolant spray to anesthetize the skin and allow for deeper stretching.
    • Steps:
      • Identify the muscle with the trigger point
      • Position the patient in a comfortable position
      • Spray the vapocoolant at a 45-degree angle, moving the can 10 cm/sec
      • Stretch the muscle while the patient is relaxed

    Referred Pain

    • Pain felt at a distance from the actual trigger point
    • Examples:
      • Pain in the shoulder blade that originates from a trigger point in the neck
      • Pain in the leg that originates from a trigger point in the lower back

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    Ankle Sprain - Past Notes PDF

    Description

    Learn about the functions of ankle and foot, including stability, mobility, and protection, and explore the bones that make up this complex system.

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