Lower Extremity Presentations/Questions
How long is a cast or boot needed after an achilles tendon surgery?
needed for 6-12 weeks.
What is medial tibial stress syndrome?
pain in the posteromedial tibial border during exercise, with pain on palpitation of the tibia over a length of at least 5 cm.
Symptoms of a MCL tear?
pain, swelling, instability and bruising.
What is the most common direction of direct impact to the hip which causes a hip fracture?
posterolateral impact
What common movement causes an achilles tendon injury?
quick speed changes, pivots, and sudden increase of force and stress on the tendon
Who are the people at higher risk for MTSS in terms of weight?
someone with a high BMI
What are the risk factors regarding sports associated with an achilles tendon strain?
sports that involve running, jumping and sudden starts and stops are more at risk.
What is a Grade 2 ACL injury?
stretched and possibly partially torn
The risk of re-tearing a previously repaired ACL is about ____% higher than the risk of tearing a normal ACL.
15%
At what point is the knee most susceptible to patella maltracking?
20-30 degree knee flexion
What % of people with plantar fasciitis will require surgery?
3-5%
How prevalent is medial tibial stress syndrome?
5% in overall active population, but very common in runners and military personnel.
What degree flexion is there the least stress on the patellofemoral joint?
60-90 degrees
After ACL reconstruction, % to % of athletes successfully return to sports.
65-88%
MCL tears acocunt for about ?% of all knee injuries.
7.9%
What percentage of Achilles tendon injuries occurs in recreational sports?
80%
What percentage of athletes suffer from an achilles tendon tear/rupture?
80%
What age category is at highest risk for a hip fracture?
85 years old and older. they have triple the incidence rate compared to people age 75-84.
The achilles tendon accounts for ?% of plantar flexion in the foot.
93%
What percentage of Grade 3 MCL tears are associated with ACL tears?
95%
Why are women more affected by patellofemoral syndrome than men?
Because they have a greater q angle
Which of the pairs listed include the primary forces that the MCL protects the knee against? A. Flexion and Extension B. Internal Rotation and Flexion C. External Rotation and Valgus D. Valgus and Internal Rotation
C. External Rotation and Valgus
What grade tears are the most common with MCL injuries?
Grade 1 & 2
Which grade of a MCL tear indicates a complete rupture of the ligament and leads to instability of the knee?
Grade 3
Tightness of plantar fascia can cause what to form on the calcaneus of the foot?
Heel spurs/bone spurs
What do you look for when examining for patellofemoral syndrome?
Hip and hamstring weakness and palpation for patellar misalignment
Explain how a direct knee-to-knee collision between two soccer players could lead to one of the players enduring an MCL injury?
If an oncoming player's knee collides with another player's knee, this would cause a lateral force to be applied to the second player's knee thus causing a valgus force which could lead to an MCL injury depending on the magnitude of the force applied by the oncoming player.
An increased or decreased hip internal rotation angle and navicular drop is what puts people at risk for a patellofemoral injury?
Increased
The greater the degree of knee flexion results in?
Increased contact area between the patella and intercondylar groove (up tp 90°)
Who are the people at higher risk for MTSS in terms of activity level?
Inexperienced runners are more likely to get MTSS
What are some of the complications of hip fractures?
Infections, muscle atrophy, increased dependency, immobility
What is plantar fasciitis?
Inflammation of the plantar fascia. It is one of the most common causes of heel/sole pain.
Where does the Achilles tendon connect?
It connects the calf muscles to the heel bone.
What is the second important biomechanical function of the patellofemoral joint?
It increases the area of contact between the femur and the patellar tendon which allows for greater distribution of compressive strength.
What is fascia?
It is dense, fibrous, unorganized tissues that doesn't fit into categories of a tendon, ligament or aponeurosis.
What is true about patellofemoral syndrome?
It is the abnormal motion of the patella in the trochlear groove and it's also caller runners knee.
Where is the plantar fascia located?
It runs from the heel to the toes on the bottom of the foot
What regions currently have the lowest incidence of hip fractures?
Latin America and Africa
What are some prevention methods for an achilles tendon tear?
Limit uphill running, wear shoes with good support, stretch calf muscles and vary exercises.
What is the largest and strongest tendon in the body?
The achilles tendon
What are the two most common tests used to determine if a patient has a patellofemoral injury?
The hip extension test and a patellar glide test
What 2 muscles stabilize the patella?
The patella is stabilized by the vastus medialis oblique (VMO) and the vastus lateralis (VL).
One of the nonsurgical treatment options for ACL tears is R.I.C.E., which stands for what?
Rest, Ice, Compression, Elevation
Where can fascia be found in the body?
Sheaths around blood vessels, organs, bones and cartiliage.
There is an increased risk of hip fracture depending on the orientation in which one falls. Which orientations have demonstrated an increased risk of fracture?
Sideways and forwards
Name one exercise that helps to prevent an ACL injury and explain why this helps.
Squats because having strength in your hips and thighs allows for more support for the knee
What is the achilles tendon?
a thick band of fibrous tissue, tendon, that is located at the back of the foot.
What is plantar fascia?
a think band of tissue that runs from the calcaneus to the phalanges on the plantar surface of the foot.
All of the following about the ACL are true except: a. An ACL injury is categorized into one of the four grades of sprains. b. The ACL provides rotational stability to the knee. c. An ACL rupture always requires surgery. d. The ACL prevents hyperextension of the knee. e. The ACL prevents the tibia from sliding out in front of the femur.
a. An ACL injury is categorized into one of the four grades of sprains.
What kinematic factor is NOT a compensatory response of plantar fasciitis pain? a. Greater total rear foot eversion b. Greater forefront plantar flexion c. Greater total sagittal plane forefront motion d. Decreased vertical ground reaction force at first contact
a. Greater total rear foot eversion
Where is the anterior cruciate ligament?
located between the femur and tibia at the knee joint on the lateral side.
What is a Grade 1 ACL injury?
mild damage; provides some stability
What is a Grade 1 strain of the achilles tendon?
mild strain with minor tear
What is a Grade 2 strain of the achilles tendon?
moderate strain with partial tear.
What are some of the mechanical factors for medial tibial stress syndrome?
- Navicular drop (foot pronation) - Ankle plantar flexion ROM - Hip external ROM
Treatments for PF:
- RICE (rest, ice, compression,elevation) - Shoe modifications - Devices - Physical therapy - Anti-inflammatory meds - Surgery
What are some forms of treatment of MTSS?
- Rest - Ice - anti-inflammatories - orthotics or shoe inserts
Who is more at risk for ACL injury?
- Women are more at risk - people who have previously torn their ACL
What are some ways to decrease the risk of MCL tearing?
- active and passive stretching - stretch the quads, hamstring and hip mobility
What are some of the treatments for a patellofemoral injury?
- anti-inflammatory drugs - tape and braces - foot orthotics - PT - Surgery
What are the best exercises to prescribe someone with MTSS?
- calf-raises - step ups - hip strengthening exercises
How does planar fascia occur?
- excessive running, walking or standing - being overweight - irregular gait or overpronation - wearing non-supportive shoes
What are some predispositions for patellofemoral injury?
- foot abnormalities - muscle tightness - muscle weakness - q-angle (the back of the knee angle) - patella maltracking
What are some of the mechanical factors for PF occuring?
- foot alignment/posture - foot and ankle ROM - tightness of calf muscles - muscle strength and endurance - BMI
What are the ligaments of the hip joint?
- iliofemoral - pubofemoral - ischiofemoral - transverse acetabular - Ligamentum capitis femoris
Why are women at greater risk for ACL tears?
- knee abduction movements - Joint laxity in the knee - ACL size - hormones
What are some ways to decrease PF prevelance?
- lower body stretching - supportive footwear - wearing a night splint - having a healthy diet and weight - resting after high-impact activities
What are the causes for patellofemoral injury?
- overuse injuries - muscular imbalance/weakness - secondary injury
What are the symptoms of patellofemoral syndorme?
- pain which can be retropatellar or peripatellar - crepitus, which is a grating or sensation produced by friction between bone and cartilage
What are some forms of treatment for a MCL tear/rupture?
- physical therapy - progressive strength training and ROM exercises - Grade 3 tears need surgery, especially if it is coupled with another ligament injury
What are some injury preventions for ACL tears?
- plyometrics - neuromuscular training - balance and stability training - strength and resistance training
What are some of the ways to prevent a hip fracture in the elderly?
- proper calcium intake - Vitamin D to aid in calcium absorption - hip protectors - mobility devices if they have trouble walking - exercise and physical activity
What are some of the symptoms of an achilles tendon injury?
- snapping or popping noise - pain when stretching the ankle or standing on your toes - tenderness, swelling and stiffness - Inability to walk
What are the symptoms of plantar fasciitis?
- stabbing or sharp pain on the bottom of the foot or on the heels - pain in the morning or at night after over-use
How is the ACL injured?
- sudden pivoting - landing wrong from a jump - receiving a direct blow to the knee -Lateral rotation, backwards displacement or sideways impact of the knee.
What are the main muscles in regards to MTSS?
- tibialis posterior - soleus - flexor digitorum longus
What are some surgical treatments for a hip fracture?
- using screws to stabilize the bone/joint - hip replacement
What are some of the causes for a MCL tear?
- valgus/external rotation/flexion - direct blow to the lower thigh or upper leg - extrinsic and intrinsic factors
How is medial tibial stress syndrome diagnosed?
- x-ray - ultrasound - computed tomography - bone scans
Approximately ?% of the US population experiences heel pain, which results in 1 million visits to medical professionals for treatment of PF per year.
10%
What percent of the US population experiences bouts of hell pain?
10%
How many ACL injuries occur every year in the US?
100,000-200,000
What is a hip protector?
A hip protector is a padded fabric worn by an individual. It is used to decrease the impact on the hip should the person fall.
A Grade III MCL tear is coupled in injury with this other knee ligament 95% of the time.
ACL
What is the most common tendon rupture in the lower extremity?
Achilles tendon rupture
What is the disadvantage of overusing bracing to treat patellofemoral syndrome?
Atrophy of quadriceps muscle because it is not doing as much work as it used to with support of the brace
Which of the structures listed is an attachment point for the deep MCL? A. Lateral Meniscus B. Medial Meniscus C. Patellar Tendon D. Head of fibula
B. Medial Meniscus
In a soccer game, which of the MCL injury causes listed below can NOT be attributed to an extrinsic factor? A. Collision with an oncoming player B. Being the victim of a slide tackle maneuver C. Landing from a jump D. Hitting the ground after a collision
C. Landing from a jump
Where do most noncontact ACL injuries occur?
Close to the femoral attachment site
_________ fibers are the principal fibers of the fascia.
Collagen fibers
Which of the following is NOT a function of the Achilles tendon? A. raise heel and lower forefoot B. helps with shock absorbance in the foot C. Important to run jump and walk D. allows lower leg to move relative to thigh
D. allows lower leg to move relative to thigh
Which of the following is NOT true regarding the Achilles tendon? A. largest and strongest tendon in human body B. has an insertion on the calcaneus C. attaches at the gastrocnemius and soleus D. connects tibia to the heel bone
D. connects tibia to the heel bone
An increased or decreased knee flexion angle and vertical ground-reaction force is what puts people at risk for a patellofemoral injury?
Decreased
How do most hip fractures occur?
Due to falling
How is the femur bone made during growth?
Endochondral ossification
What is the most common surgery to treat plantar fasciitis?
Endoscopic Plantar Fasciotomy (EPF). This is when a small incision is made on either side of the heel to relieve the tightness.
Which of the following categories of people is NOT more likely to get plantar fasciitis? A. Women B. Men C. Runners D. Overweight/Obese individuals E. Older than 65 F. Both a and e G. None of the above
F. Both a and e Women and people older than 65
T or F: MTSS can be diagnosed through x-rays.
False, it cannot
The anterior cruciate ligament connects to the ________ and the _________ bones in the knee joint.
Femur and tibia
Why are men more likely to tear their Achilles tendon?
Men tend have larger muscle fibers than women
What are the risk factors regarding age associated with plantar fasciitis?
More common in those ages 45-64
The most important and most common cause of patellofemoral syndrome is?
Muscle weakness/imbalance
What regions currently have the highest incidence of hip fractures?
Northern Europe and the US
Stacy had an ACL injury when she was young, which means she has a higher risk of developing _________ in the knee in her later years.
Osteoarthritis
What is peripatellar pain?
Pain that is around the knee
What is retropatellar pain?
Pain that is behind the kneecap/patella
What are the risk factors regarding weight associated with plantar fasciitis?
People with a higher BMI are more associated with PF
Name 3 important muscles groups to strength train to help reduce the risk of MCL tears.
Quads, hamstrings and hip flexors
What does conservative treatment mean? And what MCL tear grades receive it?
Range of motion exercises, Physical Therapy, progressive strength training. Grades 1 & 2 recieve it directly after diagnosis, grade 3 receives it later on in treatment.
What is the second surgical method that doctors use to fix an achilles tendon rupture?
There is a small incision made on the back of the lower leg. Then a series of needles with sutures attached through the skin and the achilles tendon are applied. They are then pulled out through the small incision and then the sutures are tied together.
What is the first surgical method that doctors use to fix an achilles tendon rupture?
There is an incision made on the back of the lower leg and the surgeon stitches the tendon together or if severe enough, it is reinforced with other tendons surrounding it.
What is a Grade 3 MCL tear?
This is a complete tear of the MCL and is usually coupled with other ligament injuries. 6+ weeks of recovery.
What is a Grade 2 MCL tear?
This is a partial tear of the MCL. 2-4 weeks of recovery.
What is a Grade 1 MCL tear?
This is a sprain to the MCL, aka stretch of the ligament. Athletes can return to play in about 1-3 weeks
What is one of the main reasons medial tibial stress syndrome is not a stress fracture?
This syndrome is a precursor to stress fractures
What is the first way to reduce the risk of MTSS?
To avoid sudden increase in exercise intensity
True or False: In general women are more susceptible to knee injuries than their male counterparts, however when it comes to MCL tears males take the lead in the category due to high impact sports and excessive valgus forces.
True
True or False: only 3-5% of patients with plantar fasciitis needs surgery.
True
True/False: Nearly three quarters of anterior cruciate ligament (ACL) injuries are non contact injuries.
True
What is the second way to reduce the risk of MTSS?
Use shock absorbing insoles and replace running shoes frequently
What are the risk factors regarding age associated with an achilles tendon strain?
Usually occurs in people ages 30-40 yrs. old
What are the two supplements recommended for bone health?
Vitamin D and calcium
Why is running in wet shoes bad for you and can increase risk of MTSS?
When shoes are wet, the ability to absorb shock is reduced and they are more likely to cause injury
Who is at greater risk for a hip fracture when looking at gender?
Women are more at risk, this might be due to higher prevalence of osteoporosis in women.
What are the risk factors regarding sex associated with plantar fasciitis?
Women are more likely to get PF than men
Who are the people at higher risk for MTSS in terms of gender?
Women are more prone than men
How is gender associated with risk for MCL injury?
Women are more susceptible to knee injuries than males, but males are more likely to tear their MCL due to the high impact sports they play
Which sex is more affected by patellofemoral syndrome?
Women, they are 2x more affected.
What is the third way to reduce the risk of MTSS?
Work on running form and try to run on softer surfaces like grass.
What is a hip fracture?
a break in the upper quarter of the femur bone
What is an intracapsular fracture?
a fracture at the head of the femur
What is an intertrochantic fracture?
a fracture further down the bone. It's found between the neck of the femur and lesser trochanter.
What is a subtrochanteric fracture?
a low distal fracture located below the lesser trochanter.
What is the most common first symptom to indicate an ACL injury?
a popping sound
Weakness in which muscles are primarily responsible for patellar maltracking? a. Vastus medialis oblique and vastus lateralis b. Gastrocnemius and vastus medialis oblique c. Gastrocnemius and vastus lateralis d. Semitendinosus and vastus lateralis
a. Vastus medialis oblique and vastus lateralis
Why does age have an influence on the likelihood of rupturing the Achilles tendon?
as age increases, there is a decrease in the blood supply to tendons
How long is the area of where medial tibial stress syndrome occurs?
at least 5 cm
Increased hip internal rotation during jumping can lead to all of the following EXCEPT... a. Inward turning of the knee b. Outward turning of the knee c. Increases torsion and twisting at the patellofemoral joint d. Produces compressive forces pushing on the patella laterally
b. Outward turning of the knee
Which of the following is NOT a mechanical factor of patellofemoral syndrome? a. Increase in navicular drop b. Increased hip internal rotation c. Decreased Q-angle d. Decrease in hip and knee musculature e. All of the above are mechanical factors
c. Decreased Q-angle
Which of the following should patellofemoral syndrome prevention exercises focus on? a. Stretching and strengthening of the quadriceps b. Stretching and strengthening of the hamstrings c. Stretching and strengthening of the quadriceps and hamstrings d. Only strengthening of quadriceps e. Only strengthening of the hamstrings
c. Stretching and strengthening of the quadriceps and hamstrings
What is another name for the Achilles tendon?
calcaneal tendon
What is a Grade 3 strain of the achilles tendon?
complete rupture and tear of the achilles tendon.
What is a Grade 3 ACL injury?
completely torn; provides no stability
What are the risk factors regarding obesity associated with an achilles tendon strain?
excess weight puts more strain on the tendon.
What does weakness in the VMO compared to the vastus lateralis (VL) lead to? a. Medial displacement of the patella b. Lateral displacement of the patella c. Articulating pressure on the medial facet d. Articulating pressure on the lateral facet e. Both a and c f. Both b and d
f. Both b and d Lateral displacement of the patella and articulating pressure on the lateral facet
What are the reasons for a hip fracture?
falling or a high impact collision, like in a car crash
What are two daily activities that put the most stress on the patellofemoral joint?
going up and down the steps, and squatting
What is patellofemoral syndorme?
it is abnormal motion of the patella in the trochlear groove, which in return, causes knee pain around the patella.
What are the risk factors regarding gender associated with an achilles tendon strain?
it is up to 5x more likely to happen to men than women
What is the first important biomechanical function of the patellofemoral joint?
it lengthens the lever arm of the quads which allows for increased mechanical advantage of the quads.
What mechanical things does the MCL do for the knee joint?
it limits valgus and external rotation.
What is the function of the ACL?
it provides rotational stability to the knee and prevents hyperextension of the knee.
What is the function of the achilles tendon?
it raises the heel and lowers the forefoot. It also helps with shock absorbance in the foot.
What is the medial collateral ligament (MCL)?
the major stabilizer ligament on the medial side of the knee.
What are the risk factors regarding steroid injections associated with an achilles tendon strain?
these injections can weaken nearby tendons while reducing inflammation.