Ankle Pain
Common causes of medial ankle pain (2)
1. tibialis posterior tendinopathy
2. flexor hallucis longus tendinopathy
One way to help differentiate tarsal tunnel from typical S1 dermatomal irregularity is to perform this special test.
Tinel's or Kleiger's
NWB Calcaneal motion (give me the 3 for each one):
Supination: 1, 2, 3
Pronation: 1, 2, 3
Supination: calc ADD, inversion, PF
Pronation: calc ABD, eversion, DF
What is the advantage of including an aircast in the shoe immediately after an ankle sprain?
Faster WB & increase mvmt
BONUS: The one thing you CANNOT MISS when someone has calf pain is:
1. Mm strain
2. mm contusion
3. mm cramp
4. DOMS
BONUS: DVT
T/F: Tibialis Posterior tendinopathy is common in younger people v. older people.
False. More often in middle aged (women).
Common causes of lateral ankle pain (2).
1. peroneal tendinopathy
2. sinus tarsi syndrome
WB foot motion (give me 3 for each):
Supination: Calc (1), Talar (2), Talar (3)
Pronation: Calc (1), Talar (2), Talar (3)
Supination: Calc INV, talar ABD, DF
Pronation: Calc EV, talar ADD, PF
Your patient is a 16 y/o soccer player who just injured his ankle on the field. Do you want to perform special tests while he's down on the field or the next day after he's taken an advil for pain as this may skew your results?
Do it before the swelling sets in on the field!!
A score of ___ or more on the Wells Criteria for DVT indicates a 75% likelihood of having a DVT.
3
Resisted inversion or eversion will cause pain w/ tibialis posterior tendinopathy?
INversion
T/F: One of the clinical features of peroneal tendinopathy is painful passive eversion and resisted inversion.
False. Pain passive inversion (tendon on stretch) and resisted eversion (mm action).
If you lack DF ROM, there are 3 compensations you may demonstrate. Give me them.
1. overload arch
2. overload great toe
3. knee (shorter steps & greater vertical push-off v. AP)
Name the 4 components of the ankle sprain CPR that indicate a 95% success rate for rapid improvement w/ manual therapy and exercise.
1. sxs worse in evening
2. sxs worse in standing
3. navicular drop > or = 5mm
4. distal tibiofibular joint hypomobility
Which tissue has the smallest ability to respond/heal after an injury?
Cartilage
Which ligament holds up the talus?
Spring ligament.
A patient comes into your OP clinic with c/o pain on the top of her ankle when she's running the downhill portion of her hill workouts for cross country. You perform a shoe analysis and see that her Asics are tied pretty tightly, too. What is the primary muscle you believe she has tendinopathy of based on her presentation.
What's the difference in starting exercises with someone with an ATFL tear v. a syndesmotic tear (hint: think WB status).
Syndesmotic: NO WB (talus can start misaligning)
T/F: Medial ligamentous injuries have different rehab as lateral sprains and it takes longer for them to recover (could be 2x the amt of time).
False. Same rehab as lateral sprain but recovery is still 2x as long.
According to the visual analog scale of the pain monitoring model, what is considered an "acceptable range".
2-5
Which type of population is more susceptible for FHL tendinopathy?
Dancers - being on pointe bypasses other PFs
How can you distinguish posterior impingement from Achilles tendinopathy with testing (hint: not a special test)?
Forced PF (severe pain - compression btwn talus & tibia - reproduced for impingement, not for Achilles)
You have 30 seconds to read the prompt: 3 Patients with ankle sprains arrive to your OP clinic. It's your job to define which tear grade they are. Tell me the grade and which liggies are involved.
Pt 1: Walks in with crutches but tells you they can walk short distances without it. Tenderness around the anterior and slight lateral aspect of their foot.
Pt 2: Walks in with crutches, can't WB on foot w/o crutches. Whole ankle swollen and stiff.
Pt 3: Walks in with crutches in her hand but claims she only brought them cause the doc gave them to her. Slight swelling.
Pt 1: Grade II - ATFL/CFL
Pt 2: Grade III - ATFL/CFL/PTFL
Pt 3: Grade I - ATFL
Another clinic treated a patient for what appeared to be a typical lateral ankle sprain. They come to UDPT after their other discharge still w/ c/o pain. What other factors could contribute to persistent pain after a lateral ankle sprain (give me 2).
1. osteochondral lesion
2. avulsion fx of 5th met
3. peroneal tendon dislocation
4. Syndesmosis injury
5. synovitis
6. sinus tarsi syndrome
7. LIS FRANKKKK
MTSF: pain that increases w/ activity & can have pain at rest