Ankle Sprains and Injuries Overview

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Questions and Answers

During a Thompson's test, what indicates a positive result?

Absence of plantar flexion (correct)

Pain in the calf muscle

Limited ankle dorsiflexion

Plantar flexion occurs

Which of the following tests is specifically used to assess for tarsal tunnel syndrome?

Tinel's Sign Test (correct)

Thompson's Test

Navicular Drop Test

Anterior Drawer Test

What does a positive Anterior Drawer Test indicate?

A torn Achilles tendon

A pinched nerve in the tarsal tunnel

A dislocated ankle

A sprained ankle (correct)

Which of these statements accurately describes the navicular drop test?

The test measures the degree of arch collapse in the foot. (C) Signup and view all the answers

A patient presents with a suspected Achilles tendon rupture. Which test would be most appropriate to confirm the diagnosis?

Thompson's Test (C) Signup and view all the answers

A third-degree ankle sprain involves ruptures of which ligaments?

Anterior Talofibular (ATF), Calcaneofibular, and Posterior Talofibular ligaments (C) Signup and view all the answers

Which of the following is NOT a risk factor for lateral ankle sprains?

Increased eccentric ankle inversion strength (D) Signup and view all the answers

Medial ankle sprains account for approximately what percentage of all ankle sprains?

2% (A) Signup and view all the answers

Which of the following best describes the cause of a high ankle sprain?

Excessive dorsiflexion or rotation while weight-bearing (A) Signup and view all the answers

What is a common characteristic of Medial Tibial Stress Syndrome (MTSS)?

Pain over the distal and medial third of the tibia (C) Signup and view all the answers

Which of the following is a contributing factor to Achilles tendinitis?

Limited stretching of the gastrocnemius (A) Signup and view all the answers

What is the term used to describe the death of bone tissue due to lack of blood flow?

Avascular Necrosis (AVN) (C) Signup and view all the answers

Which grade of MTSS is associated with constant pain?

Grade 4 (A) Signup and view all the answers

What can be a treatment option for Morton's neuroma?

Surgical removal (C) Signup and view all the answers

What is a common symptom of tarsal tunnel syndrome?

Intermittent burning pain (C) Signup and view all the answers

Which factors contribute to plantar fasciitis?

Excessive pronation (B) Signup and view all the answers

What is the primary characteristic of hallux valgus?

Lateral angulation of the great toe (A) Signup and view all the answers

What does acute compartment syndrome typically result from?

Fractures or crush injuries (C) Signup and view all the answers

The classic signs of compartment syndrome are referred to as the 5 P's. Which of the following is NOT one of them?

Pronation (D) Signup and view all the answers

What is Sever's disease commonly associated with?

Growth spurts in children (D) Signup and view all the answers

What can cause chronic compartment syndrome?

Muscular overuse and repetitive activities (A) Signup and view all the answers

Which compartment of the leg is primarily responsible for dorsiflexion?

Anterior compartment (D) Signup and view all the answers

What is a common treatment for plantar flexion contracture?

Active and passive stretching (A) Signup and view all the answers

What diagnostic test evaluates the position of the navicular tuberosity?

Feiss line test (A) Signup and view all the answers

What type of joint replacement is often necessary due to osteoarthritis in the 1st MTP joint?

Hemi-titanium joint replacement (A) Signup and view all the answers

Which muscle is included in the superficial posterior compartment of the leg?

Soleus (B) Signup and view all the answers

What is the primary purpose of the squeeze test when diagnosing Morton's neuroma?

Evaluate a possible nerve compression (D) Signup and view all the answers

Study Notes

Ankle Sprains and Injuries - Types and Risk Factors

Ankle sprains are categorized by severity of ligament damage:
- 1st degree: Rupture of the Anterior Talofibular (ATF) ligament.
- 2nd degree: Ruptures of ATF and Calcaneofibular ligaments.
- 3rd degree: Ruptures of ATF, Calcaneofibular, and Posterior Talofibular ligaments.
Risk factors for lateral ankle sprains include:
- Reduced ankle dorsiflexion range of motion.
- Decreased eccentric ankle inversion strength.
- Proprioception deficits.

Associated Injuries and Treatment

Lateral ankle injuries may also cause:
- Avulsion of Peroneus Brevis muscle.
- Fractures:
  - 5th metatarsal fractures (healing influenced by location).
  - Medial malleolus fractures.
  - Talar and calcaneus fractures (often due to falls).
Fracture treatment may involve casting or internal fixation.

Medial and High Ankle Sprains

Medial ankle sprains:
- Involve the Deltoid ligament.
- Account for 2% of ankle sprains.
- Have a significantly longer healing time (often twice as long as lateral sprains).
High ankle sprains:
- Syndesmosis injuries above the ankle joint.
- Usually caused by excessive dorsiflexion or rotation while bearing weight.

Avascular Necrosis (AVN): Bone tissue death due to lack of blood flow; can affect the foot and ankle.
Medial Tibial Stress Syndrome (MTSS) "Shin Splints":
- Pain on distal and medial third of tibia.
- Contributing factors include:
  - Increased pronation.
  - Increased body mass index (BMI).
  - Limited dorsiflexion range of motion.
  - Weakness in posterior tibialis and toe flexors.
- Grades of MTSS (severity): 1 (pain after activity), 2 (pain during/after), 3 (pain before/during/after), 4 (constant pain).

Tendon and Nerve Conditions

Achilles Tendinitis:
- Contributing factors:
  - Limited gastrocnemius stretching.
  - Overtraining.
  - Rigid foot structure (leading to compensatory pronation).
  - Weak calf muscles.
- Treatment: Heel lifts/wedges, stretching (focus on eccentric exercises during subacute phase).
Morton's Neuroma: Enlarged, painful nerve between 3rd and 4th metatarsal heads.
- Diagnosis: Squeeze test.
- Treatment: Wider/softer footwear, or surgery if needed.

Plantar Fasciitis: Inflammation at the medial calcaneal tubercle due to repetitive stress on plantar fascia.
- Contributing factors:
  - Excessive pronation.
  - Obesity.
  - Tightness in the gastrocnemius/soleus complex.
- Treatment: RICE, anti-inflammatories, heel cups, walking boots, night splints, foot intrinsic stretching.
Heel Spurs: Bony protrusions on anterior edge of medial calcaneal tubercle; often associated with plantar fasciitis.
- Treatment similar to plantar fasciitis.
- Can occur without symptoms.

Hallux Valgus and Tarsal Tunnel Syndrome

Hallux Valgus: Lateral angulation of great toe at 1st metatarsophalangeal joint.
- Treatment: Bunionectomy with osteotomy, toe spacers, stretching, orthotics.
Tarsal Tunnel Syndrome: Entrapment neuropathy of posterior tibial nerve behind medial malleolus.
- Common cause: Overpronation.
- Symptoms: Intermittent burning pain, tingling, and numbness in medial foot.
- Treatment: Orthotics, ice, ultrasound, phonophoresis/iontophoresis, surgery (flexor retinaculum release - potential for flexor tendon inflammation).

Compartment Syndrome

Acute vs. Chronic Compartment Syndrome:
- Acute: Sudden compression of nerves, blood vessels, and muscles; medical emergency. Causes include fractures, casts, crush injuries, burns, or hemorrhage.
- Chronic: Muscular overuse/repetitive activities; dull, aching pain during/after exercise (not an emergency, but potential long-term damage).
Five P's of Compartment Syndrome:
- Pain: Severe and disproportionate to injury.
- Paresthesia: Tingling/numbness.
- Pallor: Pale skin.
- Pulselessness: Weak or absent pulse.
- Paralysis: Loss of function.
Four Compartments of the Leg:
- Anterior, Lateral, Superficial posterior, Deep posterior.
- Each contains specific muscles and nerves.

Common Foot and Ankle Conditions

Sever's Disease: Pain at Achilles tendon insertion, often in children experiencing growth spurts; similar mechanism to Osgood-Schlatter disease.
- Treatment: Rest, bilateral heel lifts.
Plantar Flexion Contracture: Tight gastrocnemius/soleus muscles; limit ankle dorsiflexion.
- Causes: Spasticity (closed head injury, spinal cord injury, cerebral palsy).
- Consequences: Increased ankle sprains, pronation deformities, plantar fasciitis.
- Treatment: Active/assisted/passive stretching, ensuring foot supination.
Pes Planus (Flatfoot): Low medial longitudinal arch; overpronation.
- Symptoms: Foot pain (especially after prolonged standing/activity).

Surgical Interventions

Total Ankle Arthroplasty: Replace ankle joint with prosthesis for full range of motion.
Joint Replacement of 1st MTP Joint: Replace damaged joint due to OA/RA.
- Options: Hemi-titanium (one surface), total replacement.
- Concerns: Potential long-term failure due to bone size.

Diagnostic Tests and Assessments

Forefoot Varus Measurement: Assess forefoot varus position.
Feiss Line Test: Evaluates navicular tuberosity position relative to line drawn from medial malleolus to first MTP joint; identifies structural/functional pes planus.
Thompson's Test: Assess Achilles tendon rupture (absence of plantar flexion = positive).
Anterior Drawer Test: Assess ankle instability (excessive motion = positive, ATFL disruption).
Tinel's Sign Test: Assess for tarsal tunnel syndrome (tingling/pain = positive).

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Description

Explore the various types of ankle sprains and their risk factors in this comprehensive quiz. Learn about associated injuries, treatment options, and the distinctions between lateral, medial, and high ankle sprains. Test your understanding of ankle ligament damage and rehabilitation strategies.