ankle ligament and tendon patho

-4 -perpendicular - parallel

Collagen producing phase -At max level at ____ weeks -Oriented _____ to the long axis -2 months ______ to the long axis

-eversion or eversion and dorsiflexion -May often be from someone hitting or falling on foot/leg

MOI for deltoid ligament sprain

5-6, 80

•Return to athletic activity (jogging, hopping in place, ) _____ months if strength is ___% of other LE.

-3, 1 -collagen -weak

Collagen producing phase 1. ~ 3 weeks Type ___ is being converted to Type ___ 2.By ~28 days all _____- is laid done 3.Still _____

-6-8 -WB -ice, elevation, compression -talocrural , subtalar and phalanges -joint mobilizations -talocrural, intrinsic foot -raises, wobble -squats, toe raises

Lisfranc Rehab •Typically in a cast _____ weeks, maybe in walking boot after casted •Once out of cast - Physician will determine ____ status. Progress WB accordingly •Control any swelling with ______, e-stim Interferential current •Start with A/PROM of the ______ •Gentle _____ •Strengthening of the muscles around the ____ joint and _____ muscle •Seated heel _____, toe raises, BAPS board, ___ board •Functional exercises _____, step up/downs, heel raises, ______

-Inversion of ankle/ inversion and plantarflexion of ankle

MOI for ATFL, PTFL, and CFL sprain

-Dorsiflexion, external rotation(abduction) and eversion -Often due to external force (someone falls on foot)

MOI for anterior/ posterior tibfib sprain

-usually plantarflexion and abduction, -axial loading to the foot with the foot in extreme dorsiflexion or equinus (plantarflexion) with MTP joint dorsiflexed --direct crushing blow in industrial accident

MOI for tarsometatarsal joint sprain

-months to years -organized and stronger

Remodeling phase 1.Last _____ 2.Collagen becomes ____ and _____

eccentric

achilles tendon rupture occurs with what kind of muscle contraction?

1 year- 18 months

full return to activity takes how long?

-ATFL -slight, localized -PWB to FWB -stretched -none

grade 1 ankle sprain: -involves the ____ ligament - _____ swelling -WB? -ligament damage? -instability?

-ATFL, CFL -moderate, localized - PWB with crutches -partially torn -none to slight

grade 2 ankle sprain: -involves the ____ ligament - _____ swelling -WB? -ligament damage? -instability?

- ATFL, PTFL, CFL -significant, diffuse -impossible without pain -complete tear -definite

grade 3 ankle sprain: -involves the ____ ligament - _____ swelling -WB? -ligament damage? -instability?

months to a year

how long does the remodeling phase last?

-Fibroblast -increase - 3, weak

inflammation phase: 1. ~2 days _______ proliferate and synthesize 2. ~4 days blood flow ______ 3. Type ______ collagen most dominate but very _____

-Deltoid -Fibula -Anterior -Heterotopic

injuries other than tibiofibular sprain -______ ligament sprain -_____ fracture - Maisonneuve fracture -______ impingement syndrome of the talocrural joint -______ ossification

tarsometatarsal joint and 1st metatarsophalangeal sprain

ligament injuries of the foot

ATFL, CFL, PTFL, anterior tibiofibular, and deltoid ligament sprain

ligament sprains of the ankle (5)

-medial cuneiform and base of 1st metatarsal -3 cuneiforms and bases of 2nd and 3rd Metatarsals -cuboid and base of 4th and 5th metatarsal

lisfranc injury: 1.Medial- between _____ 2.Intermediate- between all ______ 3.Lateral- between ______

-Strength -ROM -normal

non-surgical rehab Subacute (collagen producing phase) -______ - PRE's -_____ -Flexibility -Gait - ______

-Anti-inflammatory -ROM

non-surgical rehab: Acute stage (1-7 days) -_______- (maybe on NSAIDs , RICE) -______ - ABC's, Ankle pumps, etc...

-Function -sport, 80 -Balance -Bracing

non-surgical rehab: Remodeling phase (chronic instability) -_____ -Return to _____ - single limb hop for distance, star excursion balance test. Performance on functional test ~____% of the uninvolved limb -_____/ Proprioception -_____

-Anterior tibiofibular sprain / Syndesmosis injury -Fibula fracture - Maisonneuve fracture

other injuries on medial side of foot

-Walk 4 steps immediately after injury or in clinic -Localized tenderness malleolus, navicular, or 5th metatarsal

ottawa ankle rules:

proximal, watershed zone

palpable defect may be -2-6 cm _______ to insertion "______"

1. inflammation phase 2. collagen producing phase 3. remodeling phase

phases of ligament healing (3)

-bootwalker -6 -6-8 -8-12

rehab 4-8 weeks: -8 weeks transitioning out of the _____ to regular shoes (may place a small heel lift in shoes) -Stationary bike started a ____ weeks no resistance -Progressive resistance exercises can be started at _____ weeks -Full PROM and AROM in PF and DF by _____ wks

-conservative -boot, cast or brace -NWB to PWB -Heel lift -widening -6-8 -run, cut, jump -80

rehab for anterior/ posterior tibfib sprain •More ______ •Walking _____ •_____ with crutches •____ once WB •Surgical fixation if ______ of the ankle mortise -_____ weeks NWB or touch down WB •RTP - be able to _____ with limitations -LE strength ~____% compared to non-involved LE

-lateral malleolus -medial -ligament

signs and symptoms of ATFL, PTFL, and CFL sprain -Immediate swelling around ______. -Can invert far enough to impact the ______ side of ankle. -Point tender to the ______

-superior, between -ligament -pushing

signs and symptoms of anterior/ posterior tib fib sprain -Swelling located ______ to malleolus and _____ tib/fib -Point tender to the _____ -"Difficulty _____ off" or "lacking power"

-medial, inferior -inferior

signs and symptoms of deltoid ligament sprain -Immediate swelling _____ side of ankle _____ to malleolus -Point tender to the _____

thompson test

special test for achilles tendon rupture

talar tilt

special test for deltoid ligament sprain

-anterior drawer -talar tilt -figure 8 measurement

special tests for ATFL, PTFL, and CFL sprain (3)

-Cotton (shuck) test -Squeeze test -External rotation stress test

special tests for anterior/posterior tibfib sprain (3)

strength

surgery rehab Week 10-12 -usually return to sport if have normal ______ compared to other LE.

-strength -strengthening, balance

surgery rehab Week 6 -10: -Progress ____ in all directions -Begin weight bearing _____ and _____ exercises and progress as tolerated

-NWB, 4 -ROM, peroneal -adduction, inversion

surgery rehab of lateral ankle instability: •1-4 weeks -Will be in splint/short leg cast _____ or WBAT in cast for ____ weeks -Begin gentle ____ and isometric _____ strengthening -Avoid _____ and ______ until 6 weeks

-RICE, WB -activity levels, rest -gentle joint mobs -scrunches -hallux MTP DF and PF -PF and DF -supination and pronation -single -inserts

tape for turf toe: •Acute - _____ and gentle painfree ROM , May limit _____ •Reduce ______, increase ____ intervals and duration , avoid rigid playing surfaces •Could perform ______ •Towel _______, toe pick ups •Manual resistive _______ •Seated resisted ankle _____ and progress to standing •Seated ankle ______ progress to standing •Progress to _____ limb balance activities •Rigid shoe _____, removable walking cast,

•Lisfranc Injury

tarsometatarsal joint sprain is also called what?

-fibroblast -~7

tendon healing Inflammatory Phase -Inflammatory cells, ______ -____ days after injury

•Sharp pain, may hear pop

type of pain with achilles tendon rupture

-Tib/fib -Malleolus -5th -Peroneal -Deltoid -High ankle

what do you want to rule out with ankle injuries? 1._______ fracture 2._______ fracture 3.____ metatarsal fracture 4.______ muscle strain 5.______ ligament sprain 6._______ sprain

swelling

what is the figure 8 measurement for?

•Prevent hyperextension of 1st MTP joint -Tape, inserts, shoe change

what is the goal for turf toe rehab?

lateral ankle sprain

what is the primary diagnosis?

1st metatarsal sprain

what is turf toe?

2nd metatarsal, its good for stability but most likely to fracture

what metatarsal is restricted in movement with a tarsometarsal joint sprain?

yes, localized

will you have swelling with achilles tendon rupture?

-2-8 -15- 20, heel lift -after cast is removed -painfree, decreasing, inversion / eversion

•1-4 weeks -Casted in PF from ____ weeks - Post -op will be in a walking boot set in ____ degrees of plantar flexion, may also have a ______ in the boot. -Exercises generally started when? -AT 1 month progress slowly in _____ increments bring the foot toward neutral by _____ the heel lift and position of boot, initiate ____ AROM