Ankle and Foot Conditions: Anatomy and Injuries PDF

ANKLE AND FOOT-COMMON CONDITIONS DPTV 755: Orthopaedic Assessment and Management I Observation Pes Cavus (Rigid Foot) Pes Planus (Mobile Foot) Causes: congenital, neurological Congenital, result of t...

ANKLE AND FOOT-COMMON CONDITIONS DPTV 755: Orthopaedic Assessment and Management I Observation Pes Cavus (Rigid Foot) Pes Planus (Mobile Foot) Causes: congenital, neurological Congenital, result of trauma, muscle dysfunction, or muscle imbalance weakness Medial longitudinal arch Rigid or Flexible accentuated Review classification system Table 13-6 and 13-7 (6th edition) 13-7 and 13-8 (7th edition) Observation Rearfoot Valgus Rearfoot Varus Calcaneal eversion in STJ neutral Calcaneal inversion in STJ neutral Excessive pronation and limited supination, Mildly rigid foot, leading to limited pronation possible genu Valgum, and pes planus (flat Pes cavus foot (high arch) foot) Observation Forefoot Valgus Forefoot Varus Fractures: Ottawa Rules for Ankle and Foot Figure 13-126 Magee, David. Orthopedic Physical Assessment, 6th Edition. W.B. Saunders Company, pg. 955 13.133 8th edition  Fractures Talar Dome Fractures Most common chondral fracture (also known as OCD). Present with persistent swelling, pain with walking, locking of the ankle, and crepitus, tends to present with as a “sprained ankle that did not heal”. Interventions vary from no intervention, casting, and possibly arthroscopy Pilon: axial compression force where tibia is driven down into talus, splitting and shattering distal end of tibia and completely disrupting the ankle joint Pott’s Fracture: Unimalleolar, Bimalleolar and Trimalleolar fractures: One, both or if involves the “post” malleolus (trimalleolar). Casting or surgery; trimalleolar treatment is ORIF (stabilize joint) Shibuya, N., Davis, M. L., & Jupiter, D. C. (2014). Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011). The Journal of Foot and Ankle Surgery, 53(5), 606-608. Fractures Calcaneus (~9% of fractures) Metatarsal Fractures (~12.5%) Lisfranc Injuries (~3% ) Phalangeal Fractures (~6%) Shibuya, et al (2014) Foot/Ankle Anatomy Lateral Collateral Ligaments Anterior Talofibular Ligament Calcaneofibular Ligament Posterior Talofibular Ligament Common Conditions of Foot-Ankle Complex Lateral Ankle Sprain Most common injury to the ankle. ATFL>CFL>PTFL. West Point Ankle Sprain Grading System (Table 13-1) Must rule out fracture (Ottawa Rules) Chronic Lateral Ankle Instability Prolonged dysfunction following Lateral Ankle Sprain 40% of individuals develop long-term ankle dysfunction after a lateral ankle sprain. (Hertel et al, 2006) Mechanical vs. Functional Ankle Instability Mechanical: Actual increase in ankle motion beyond its physiological limit Functional: Patient also reporting of instability or giving way Joints of Ankle Proximal Tibiofibular Joint Distal Tibiofibular Joint Syndesmosis Talocrural Joint Distal tibia, fibula and talus What are we looking at??????? Common Conditions of Foot-Ankle Complex Syndesmotic Ankle Injury Incidence: 10% of ankle sprains. Typically associated with collision sports and involves direct contact MOI:. forced dorsiflexion with ER of LE (foot typically planted) Differential Dx: fracture must be ruled out “High Ankle Sprain” Peroneal Subluxation Causes Grade: I: retinaculum torn from the fibula II: SPR is avulsed from the posterior aspect of the fibula III: Same as above with a flake of bone and cartilaginous rim IV: SPR elevated from the calcaneus Signs and symptoms Treatment Joints of the Ankle: Structure and Function Subtalar Joint Stability Primary Stabilizers Common Conditions of Foot-Ankle Complex Sinus Tarsi Syndrome Common after lateral ankle sprain or repetitive injury due to pronation Signs and Symptoms: Increased symptoms when walking/running on uneven ground localized swelling pain with local palpation pain with pronation Foot/Ankle Anatomy Medial Collateral Ligament Tibionavicular Ligament Tibiocalcaneal Ligament Tibiotalar Common Conditions of Foot-Ankle Complex Medial Ankle Sprain Eversion sprain Infrequent injury due to strength of deltoid ligament. MOI: plantarflexion and eversion Differential Dx: Fracture Posterior Tibialis dysfunction Tarsal tunnel syndrome FHL tendinopathy. Common Conditions of Foot-Ankle Complex Ankle Impingement Mechanical obstruction due to osteophytes or soft tissue structures Clinical Prediction Rule for Anterior Ankle Impingement. 1. Anterolateral ankle joint tenderness 2. Anterolateral ankle joint swelling 3. Pain on forced dorsiflexion 4. Pain on affected side with single leg squat 5. Pain with activities 6. Absence of ankle instability Five of six symptoms must be positive Observation- Common deformities, deviations and injuries Exostosis (Bone Spur) ▫ Abnormal bony outgrowth ▫ Increase in bone mass in response to overuse, trauma, or excessive pressure ▫ Common areas: Dorsal aspect of 1st TMT Tuberosity of 5th MT Calcaneus (Runner’s Bump) Insertion of plantar fascia Superior aspect of navicular Observation- Common deformities, deviations and injuries Hallux Valgus Bunionette (Tailor’s bunion) Observation- Common deformities, deviations and injuries Hallux Rigidis Turf toe Morton’s Foot Observation- Common deformities, deviations and injuries What do we see here????? https://www.youtube.com/watch?v=2VfFdvhUI9s&t=15s Common Conditions of Foot-Ankle Complex Achilles Injuries Tendinopathy: generic term for overuse injuries of Achilles tendon Tendinitis: insertional or midsubstance Tendinosis: chronic condition due to irregular fiber orientation, NO inflammation Achilles Tear https://www.youtube.com/watch?v=lYrA30qcvK4&t=52s Anatomy and Function of the Muscles Contents of the Tarsal Tunnel: TP, FHL and FDL are the primary supinators of the foot. Tibialis Posterior Physical Examination-Observation Medial Longitudinal Arch of the Foot Primary load bearing and shock absorbing structure of the foot Active Muscle Support Passive Support Physical Examination-Observation Lateral Longitudinal Arch Transverse Arch Common Conditions of Foot-Ankle Complex Plantar Fasciitis Insidious onset of heel pain ~10% of population at some point during lifetime Risk factors Obesity, prolonged weight bearing, and limited ankle DF Signs and Symptoms Typically localized to heel may radiate into medial longitudinal arch Pronation at late stage of gait Decreased muscle length in calf musculature Local tenderness at plantar surface of foot (insertion areas) Common Conditions of Foot-Ankle Complex Tarsal Tunnel Syndrome Figure 13-112 Common Conditions of Foot-Ankle Complex Medial Tibial Stress Syndrome (Shin Splints) Signs and Symptoms Dull, aching pain along the middle or distal posteriormedial tibia Causative Factors: Overuse or weakness of tibialis anterior and/or extensor digitorum longus, excessive or abnormal pronation, restricted ankle dorsiflexion, training errors, footwear Objective findings: Pain and point tenderness at the anteromedial aspect of the tibia, which is increased with active dorsiflexion and passive stretching into plantarflexion Pain is increased with activity and relieved with rest Common Conditions of Foot-Ankle Complex Compartment Syndrome Examination Firm and tense compartments on exam 5 Ps (for anterior compartment syndrome) Parasthesia- toes Paresis (foot drop) Pain- dorsal foot and ant tib Pallor- dorsal foot Pulseless – dorsal pedis pulse http://orthoinfo.aaos.org/topic.cfm?topic=a00204 Common Conditions of Foot-Ankle Complex Metatarsalgia Observation- Common deformities, deviations and injuries Morton’s Metatarsalgia (Interdigital Neuroma) ▫ Injury to a digital nerve Often the nerve between 3rd and 4th toes Intermittent pain, like a cramp, shooting up to the tip of the affected toe Palpation of plantar surface is painful Squeezing metatarsals together elicits pain (pressure on nerve) Anatomy and Function of the Muscles Nerve Injury Muscles Potential Clinical Name Involved Associated Deformity Deep Branch of Pretibial Muscle Plantar Flexion Drop-Foot Common Fibular Group Nerve Superficial Branch Fibularis Longus Inversion Pes Varus and Brevis Proximal Tibial Plantar Flexors DF/Eversion Pes Nerve and Invertors Calcaneovalgus Middle portion of Supinator Muscles Eversion Pes Valgus Tibial Nerve For each of the situations describes above, which structures would you expect to experience adaptive shortening?