Exam

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jessiekate22
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158136
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Exam
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2012-06-11 02:59:53
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Third Week
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2020
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  1. Ankle
    • - is the link between body and base of support- transmits WB forces
    • - allows leg to adapt to changes in ground contours and varying leg angles
    • - foot provides a stable platform of support and attenuates impact loading
    • - assists in efficient forward propulsion of body
  2. How many arches are in the foot?
    • - 3 to help with shock absorption
    • - transverse arch
    • - medial and lateral longitudinal arch
  3. What are the three sections of the foot?
    • - hnidfoot (talus, calcaneus)
    • - midfoot or midtarsal (navicular, cuneiforms, cuboid)
    • - Forefoot (rest of bones)

    Note the big toe is important for WB and push off
  4. Where is the talocrural jt and what does it involve?
    • - between the talus and tibiofuibular
    • - uniaxial/ hinge jt- very stable
    • - trochlear broader anteriorly- talus spreads mortise on DF (more stable)- most stable position (close pack)
    • - talus has superior convexity (dome) area pt get pain. Dome fractures don't show one xray
    • - slight medial rotation with internal rotation and inferior movement of lateral malleolus
  5. The foot and ankle
  6. Subtalar jt
    • - concave surface on posterior talus
    • - convex surface posterior calcaneus
    • - spring (calcaneonavivular) ligament
    • - talcocalcaneal ligament (lateral and medial interosseous ligaments)
  7. Tibiofibular jt
    • - also known as the crus
    • - distal syndesmosis has little movement
    • - tibiofibular ligaments (ant and posterior- deepen mortise)
    • Talofibular ligaments (ant and posterior)
    • - fibular malleolus more posterior and inferior
  8. At what jt does DF and PF occur?
    talocrural jt
  9. At what jt does in/eversion occur?
    • subtalar jt
    • (talus- calc, talus- navic)
  10. Where does pronation and supination of the foot occur?
    • - forefoot
    • - inversion = supination- adduction- PF
    • - eversion= pronation- abduction- DF
  11. What does pronation do in regards to the foot?
    - dampens impact loading on medial arch and increases mechanical efficiency of mm on heel lift
  12. biomechanics of the foot and ankle
    • - structural integrity depends on articular geometry and soft tisue suppor (static and dynamic stabilisers)
    • - tib posterior tendon (comes under foot), supports talocalcaneonavicular jt
    • - talus head can sag- calcaneus and foot laterally- medial rotation- pronation subtalar jt- supination forefoot
  13. What is the loose- packed position for the foot and ankle?
    • - talocrural: 10* PF, midway pro/supination
    • - subtalar jt- midway pro/supination
    • - distal tibiofibular: 10* PF
    • - Midtarsal: subalar jt pronation
  14. What is the closed pack position for the foot and ankle?
    • - talocrural: full DF
    • - subtalar: full supination
    • - distal tibiofibular: full DF
    • - midtarsal: subtalar jt supination
  15. What movement is more limited at each jt?
    • - talocrural: PF more than DF
    • - Subtalar: limited supination - fixed in full pronation
    • - Midtarsals: limitation of DF, PF, adduction, inversion
  16. What are some extrinsic ankle/ foot disorders
    • - referred ain from knee, hip, SIJ, radiculopathy, and somatic lumbar dysfunction/ arthritis
    • - vascular, neuroogical, metabolic and skin disorders
  17. Neurological: Spinal nerves
  18. What are some intrinsic ankle/ foot disorders
    • - peripheral nerve entrapment (tarsal tunnel syndrome)
    • - Achilles tentinopathy/ rupture
    • - ligament sprains/ rupture
    • - bone lesions (talotibial exostoses), (boney growth), osteochondral fracture)
    • - toe deformities
  19. What is tarsal tunnel syndrome?
    • - compression of posterior tibial nerve as it passes under flexor retinaculum
    • - tenosynovitis of posterior tibial tendon
    • - burning pain, p+ns, numbness in plantar aspect of toes, foo
    • - tender, tinel's sign (tap nerve to reproduce the pain) below medial malleolus
    • - trauma/ overuse
  20. How do you manage tarsal tunnel syndrome?
    • - orthotics
    • - local massage
    • - cortisone injection
    • - microsurgery to decompress nerve
  21. Achilles tendinopathy
    • - insertional/mid- substance
    • - active young to middle aged male
    • - ain made worse with activity
    • - oedematous, thich and tender
    • - pain and crepitus on movement
    • - inflam (very early stage) then a degenerative condition (failed healing process)
    • - rear foot abnormalities eg varus
    • - training errors eg sudden increase in intensity or frequency, hard surfaces
    • - footwear inadequate
  22. How do you manage achilles tendinopathy?
    • - reduce activity- gradual return
    • - orthotics
    • - NSAIDs
    • - ultrasound, ice, heat
    • - deep friction massage
    • - stretching of calf mm
    • - eccentric exercise helps teninopathy
    • - mobilise subtalar, ankle jts
    • - cortisone injection/ nitrate patch to increase blood supply
  23. Achilles tendon rupture
    • - usually at about 2-6cm above calc
    • - critical zone 0f circulation- poor circulation- local degeneration
    • - may occur with minial trauma
  24. What are the signs of an achilles tendon rupture?
    • - excessive passive DP
    • - visible, palpable gap in tendon
    • - marked swelling, bruising
    • - wekness on PF
    • - thompson test +ve
    • - Rx: surgery or immobilisation in PF
  25. Ankle sprain
    • - anterior talofibulular lig- forced inv, PF
    • - calcaneofibular lig- forced inversion
    • - posterior talofibular and medial lig- rarely
    • 1*= no instability
    • 2*= slight laxity
    • 3*= rupture
  26. What do you look for and ask pt when they have hurt their ankle
    • - history- mechanism, hear a snap
    • - pain, swelling, tenderness, bruising
    • - pain on stretch or compressing ligament
    • - stress test- ant draw etc
    • -stress x-rays
  27. How do you manage and ankle sprain?
    • - RICER 48hrs to decrease swelling and bleeding
    • - ROM exercise, gentle activity (no pain)
    • - NSAIDs
    • - EPA- electrotherapy
    • - resisted, isokinetic exercises
    • - proprioceptive re-education eg wobble board
    • - passive jt mobs
    • - stretches
    • - preventative bracing
    • - progressive functional exercise
  28. What is a potts fracture?
    • - fracture affecting one or more of the malleoli
    • - difficult to distingguish between severe strain and #
    • - tenderness over malleoli or insertion and inability to WB- need XR pin and plaster (ottowa rules)
    • - internal fixation, POP 6- 8 weeks
    • - will usually have a dislocation of the ankle
  29. Displacement of sesamoif bones
    - bunion
  30. Bone lesions: Talotibial exostoses
    • - boney out growths- talus and tibia due to sport
    • - push off running (ant), kicking football (posterior)
    • - locking if exostosis breaks off- foreign body
    • - pain at EROM and OP (DF- ant, PF- post)
    • - swollen and tender locally
  31. Bone lesions: osteochondral #
    • - inversion sprain in DF
    • - anterolateral # due to impingement against fibular malleolus
    • - presents as per sprain
    • - compression of jt while DF, PF painful
    • - tender superior talus
    • - suspect if sprain persists
    • - scan needed
  32. Toe deformities
  33. What is degenerative jt disease?
    • - is the result of the progressive breakdown of a jt surfaces
    • - infection, direct and indirect trauma to the articular cartilage and diseases of the jt can all lead to this.
    • - most common OA- break down of catilage not bone
  34. Aetiology?
    • - mutlple risk factors
    • - any event that chances the envt of the chondrocytes has the potential to cause OA
    • - described as primary or secondary
  35. What are the most common causes of secondary DJD?
    • - obesity
    • - abnormal contours of jt surfaces, particularly malunited (healing position being out eg ankle) #
    • - jt instability due to trauma or ligamentous laxity- changing the loading
    • - genetic or developmental abnormalities eg perthes (hip), SCFE (growth plate shifts in the hip)
    • - metabolic or endocrine disorders
    • - inflammatory diseases eg RA, gout
    • - Osteonecrosis- dead bone
    • - neuropathies, esp denervated jts and charcot's disease
  36. Epidemiology
    • - prevalence estimates ranging between 15% and 90%
    • - estimated > 3, 000, 000 aust effected
    • - between 70% and 90% of all people over 75 yrs have at least on involve jt
    • - prevalence and incidence of OA increases with age in males and females
    • - DJD has been sistenly shown to be associated with reduced quality of life, especially in terms of bodily ain and phsical functioning, than other conditions including cardiovascular, chronic respiratory and gastrointesinal disease
    • - females experience earlier and worse effects
    • SF36- quality of life qu
  37. Pathogenesis of DJD
    • - breakdown of the articular surface
    • - synovial irriation
    • - remodelling
    • - eburnation of bone and cyst formation
    • - disorganisation
  38. Radiological changes
    • - these reflect the pathological changes
    • - the jt space narrows
    • - the weight bearing surfaces become sclerotic (hardening of tissue)- white layer
    • - osteophytes from around the jt margins and cysts are seen in the subchondral bone
    • - the shape of the bone slowly alters
  39. What are the clincial presentation
    • - pain
    • - loss of movement
    • - altered function
    • - morning jt stiffness- goes away after 30 min
    • - crepitus- rough feeling
    • - nocturnal pain
  40. How do you manage degenerative joint disease
    • - weight control
    • - non steroidal anti- inflammatory drugs
    • -simple analgesics- reduces the pain
    • - steroid injections- opp shown to reduce pain- become more destructive in time
    • - operative treatment- debridement- clean the area up of the jt, arthrodesis- fuse the jt, osteotomy- reduce boney deformity- correct line of weight bearing
    • -arthroplasty- jt replacement
  41. How do physiotherapist managy DJD?
    • - edu
    • - modify activity
    • - appliances and aids
    • - modalities- provide relief
    • - manual therapy- treat minitations in jt range and relief
    • - exercise- resisted and aerobic- improve physical functioning
    • - prevent contractures in jt
  42. Guideline
  43. Exercise for DJD?
    • - strengthening- quads and add waste with hip and knee problems. As mm waste more pressure is put on the jt
    • - combined movement, strength, balance
    • - walking- safe and effective for knee OA
    • - cycling- no load or impact load
    • -hydrotherapy- unload jts

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