ankle/foot Dx (cuboid syndrome, lisfranc injuries, turf tos, foot orthroses, bone stress injuries, fractures, post traumatic osteoarthritis, end stage ankle arthritis, ankle/foot fx rules)

cuboid syndrome: source of persistent ____ pain

lateral midfoot

associated with lateral ankle sprain

cuboid syndrome

MOI cuboid syndrome - macrotrauma

• forceful ____ of ____ while calcaneus is ____

  • forceful reflexive contraction of ____

eversion, cuboid, inverted, fibularis longus

MOI cuboid syndrome - microtrauma

• ____ instability

• excessive ____

• _____

• training on ____

• obesity

• improper ____

midtarsal, pronation, overtraining, uneven, shoes

clinical presentation of cuboid syndrome

• diffuse ____ pain 

• ____ gait 

• ____/edema 

• pain with ____ and ____ 

• pain with resisted ____ 

• ____ and ____ tendon are TTP

lateral foot, antalgic, sulcus, jumping, landing, eversion, cuboid, fibularis longus 

Tx cuboid syndrome

• _____ and then:

  • avoid impact ___-___ days

  • taping to support _____ arch

• address ____ factors

cuboid whip, 3, 4, medial longitudinal, contributing

joints coined lisfranc joints

tarsometatarsal

what makes up tarsometatarsal joints

metatarsals, cuneiforms, cuboid

medial column of the foot =

1st metatarsal and medial cuneiform

middle column of the foot = 

2nd and 3rd metatarsals, middle and lateral cuneiforms 

lateral column of the foot =

4th and 5th metatarsals, cuboid

ligaments associated with lisfranc joints

intermetatarsal, dorsal/plantar tarsometatarsal, lisfranc

intermetatarsal ligaments

• ____

• not between ____ metatarsals

strongest, 1st and 2nd

dorsal/plantar tarsometatarsal 

• ____=weaker 

dorsal 

lisfranc ligaments connect ____ and ____ column

medial, middle

3 lisfranc ligaments

dorsal, plantar, interosseous

Dorsal Lisfranc ligament (DLL): connect ____ to _____

medial cuneiform, 2nd metatarsal

Plantar Lisfranc ligament (PLL): connect ____ to _____

medial cuneiform, 2nd and 3rd metatarsal

interosseous Lisfranc ligament: connect ____ to _____

medial cuneiform, 2nd metatarsal 

Lisfranc injury: ____ injury affecting the ____ joints

midfoot, tarsometatarsal

MOI Lisfranc injury

• high-energy ___

• ____ injuries

• hyper____ with ____ load

• forced ____ of forefoot with ____

trauma, athletic, PF, rotation or axial, ABD, rotation

clinical presentation of Lisfranc injury

• variable ____

• ____ eccymosis at ____

• ± feeling a ___

• ____ at midfoot

• dorsal ____/____ of metatarsal base

• decreased sensation in ____ n

• TTP of ___

• pain with activation of ____ and _____

• pain with passive ____ or ___

• ____ sign

WB, plantar, midfoot, pop, edema, sublux, dislocation, deep fibular, MTP, tib ant, tib post, ABD, pronation, piano key

need to get _____ imaging to reflect Lisfranc injury

WB 

imaging Lisfranc injury

• stage 1 = ____

• stage 2 = ____-____ mm

• stage 3 = ____ mm

no instability, 2, 5, 7

Tx Lisfranc injury

• stage 1 = non ____, initially ___ 6 wks

• stage 2 and 3 = likely ____

surgical, NWB, surgery

Tx after out of boot from Lisfranc injury

• ____/____/balance

• normalize ___

• ____ progression

• monitor signs of ____

ROM, strength, gait, RTS, overload

turf toe: _____ sprain of 1st MTP 

hyperext 

turf toe results in altered gait mechanics

• delayed ____ in mid-late stance

• altered ____

• progressive ____ laxity d/t excessive ____

re-supination, windlass, lig, pronation

clinical presentation of turf toe

• lots of ___

• swelling, ____, red 1st ____

• ____

• ____ gait (early ___, ____ force with push off)

pain, stiffness, MTP, TTP, antalgis, toe off, decreased

50% of athletes with turf toe have persistence symptoms ____yrs post injury

____ may result

5, hallux rigidus

Tx turf tow 

acute: 

• ____, NSAIDS 

• ____

• rom and ____ 

RTS = ____ deg great toe ext 

PRICE, taping,, strength, 90

goal of foot orthoses

• evenly distribute ____

• ____ stress on structures

• ____, ____ or ____ deformities

• increase ____

WB, decrease, prevent, correct, compensate, comfort

two approaches to foot orthoses

balanced foot, total contact

balanced foot approach to orthoses: ____ foot posture

correct

total contact approach to orthoses: brings ___ to ____

ground, foot

50% of athletic stress fx occur to ___

tibia

compression side of tibia stress fx =

posteromedial

tension side of tibia stress fx =

anterior

types of bone stress injuries

tibia, fibula, metatarsal, navicular

metatarsals most commonly injured by bone stress injuries

2nd and 3rd

stress fx to 5th metatarsal = ____

jones fx 

jones fx

• ____ healing

• ____ + ____ 6-8 wks

poor, immobilizer, NWB

ottawa foot rules

• Pain in the ____

AND (one of the following)

• Tender on palpation of ____

• Tender of palpation on _____

• Inability to WB ____ steps in the ER or immediately after

midfoot, navicular, base of metatarsal, 4

ottawa ankle rules

• Pain in _____

AND (one of the following) 

• Tender to palpation on posterior aspect or tip on _____

• Tender to palpation on posterior aspect or tip on _____

• Inability to WB ____ steps in the ER or immediately after 

malleolar zone, lateral malleolus, medial malleolus, 4

moi ankle/foot fx = ___

traumatic 

prognosis of ankle/foot fx

• ____ initial recovery

• incomplete at ____ mo post injury

rapid, 24

types of ankle/foot fx

unimalleolar, bimalleolar, trimalleolar, talar, calcaneal

most common ankle/foot fx =

unimalleolar

unimalleolar fx

• fx of ____

• fx below tibiotalar = ____ stable

lateral malleolus, more

bimalleolar fx 

• fx of ____ 

• MOI = severe ____/____/____ 

• ± ____ surgery 

medial and lateral malleolus, pronation, ABD, ER, ORIF 

trimalleolar fx

• fx to _____

• MOI = forceful ____ and severe ____

• requires ___

med/lat/ and posterior malleous, abd, er, ORIF

talar fx

• MOI = high energy ___ + ___ or excess ____

• nondisplaced = ____ surgery, NWB ___-___wks

• displaced = ____

axial load, PF, DF, no, 6, 8, ORIF

calcaneal fx

• MOI = ____

• conservatative tx = ___ outcomes

• long term risk for ____ atrophy

crush/compression, poor, fat pad

clinical presentation of post traumatic osteoarthritis 

• Hx ankle ___ with injury to ____/altered ___ 

• isolated ankle ___/____

• catching, ____, painful ___

• limited ____ 

• hypomobile with ____/____

trauma, articular cartilage, biomechanics, pain, stiffness, locking, giving way, rom, DF, PF 

conservatative tx of posttraumatic osteoarthritis

• pain ____

• activity ____

• shoe ____

• bracing

• rom

• strengthing (____ and ____)

• balance and ____

management, modification, modificaiton, PF, DF, proprioception

end stage ankle arthritis: 70% = ____

post traumatic

gold standard for surgical tx of end stage ankle arthritis

ankle arthrosesis

ankle arthrodesis

• retaining ____ sagittal plane motion

• 50% of ppl develop ___ in adjacent joints in ___ yrs

1/3, OA, 20

total ankle arthroplasty 

• ____ replaced 

• increased ___ and ___ rates 

• NWB ___ wks

• WBAT in boot ___-___wks

• ____% recovery expected in ___ mo

distal tib and talus, complications, re-op, 4, 4, 8, 75, 6

contraindications to total ankle arthroplasty 

• active ____

• _____

• significant peripheral ___

• peripheral ___ disease

• ____ neuropathy

infection, AVN, neuropathy, vascular, charcot

indications to total ankle arthroplasty 

• end stage ____

• no significant ___

• >____yrs old

• non____

• non____

arthritis, defomities, 55, smoker, diabetic