Chapter 18 Special tests and Tarsal injuries

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Chapter 18 Special tests and Tarsal injuries
2013-10-05 12:29:47
Chapter 18 Special tests Tarsal injuries

Chapter 18 Special tests and Tarsal injuries
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  1. Etiology
    · Laterally from severe inversion/doriflexion
    · Medially from inversion/plantar flexion w/ external, tibial rotation

    Signs and Symptoms
    · history of ankle trauma
    · pain w/ weight bearing
    · ** intermittent swelling
    · ** catching/snapping
    · tender while palpate

    · xray for diagnosis
    · progressive weight bearing
    · ROM and strengthening
    · if surgery - return 6-8 mo
    Talus Fracture
  2. Etiology
    · jumping/ falling from a height
    · usually cause avulsion fracture (anteriorlly and posteriorlly)

    · immediate swelling/pain
    · cant weight bear

    · RICE immediately
    · x ray for diagnosis
    · non-displaced fracture- immobilization & early ROM

    Calcaneus Fracture
  3. Etiology
    · Repetitive trauma during heal strikes- in distance runners
    · In plantar-calcaneal area

    · Pain w/ weight bearing
    during heal strike
    · Pain continuous after exercise

    · 2-3 w rest/AROM
    · Non weight bearing cardio
    · Gradual return to activity
    Calcaneal Stress Fracture
  4. · Tap over posterior tibial nerve
    · Numbing in distal area indicates tarsal tunnel syndrome
    Tinel's Sign
  5. · Transverse pressure applied to head of metatarsals
    · burning/ sharp pain indicate neuroma or metatarsalgia
    Morton's Test
  6. · Tendon reflexes should elicit a response when gently tapped
    · Sensation can be tested by running hands over surfaces of foot and ankle
    Neurological Assessment
  7. Etiology
    · Traction injury of apophysis of calcaneus, where Achilles attaches
    · Over use injury in kids

    · Pain posteriorally at Achilles insertion

    · Rest, ice, stretching, NSAIDs

    · Heel lift
    Apophysitis of Calcaneus (Sever's Disease)
  8. Etiology
    · inflammation of bursa between Achilles and calcaneus
    · caused by rubbing of shoe's heel counter
    · may lead to exostosis (Haglund's deformity)

    · pain when palpate bursa just above and anterior insertion if Achilles

    · Swelling on both sides of heel cord

    · RICE and NSAIDs

    · ultrasound reduce inflammation
    · Stretching of Achilles
    · Heal lifts/ donut pads
    · shoes with wider heel contour
    Retrocalcaneal bursitis (Pump bump/ Bower's bump)
  9. Etiology
    · caused by sudden starts, stops, change in direction, irritation of fat pad
    · pain on lateral aspect  bc of heel strike pattern

    · Severe pain in heel- Can't weight bear

    · Warm and red

    · reduce weight bearing 24 hrs

    · RICE, NSAIDs
    · Use heel cup or doughnut pad
    Heel Contusion
  10. Etiology
    ·  any condition that compromises the tibialis posterio, felxor hallucis longus, flexor digitorum, tibial nerve, artery or vein
    · may result form previous fracture, tenosynovitis, acute trauma or excessive pronation

    · pain and paresthesis along medial and plantar aspect of foot

    · motor weakness- atrophy may occur
    · increased pain at night

    · NSAIDs, anti-inflam modalities
    · orthodics
    · possible surgery
    Tarsal Tunnel Syndrome
  11. Etiology
    · Pronation and trauma injury
    · Bc of stress on long peroneal muscle w/ foot in pronation
    · ususally confused with plantar fascitis

    · Displacement of cuboid- pain over 4th, 5th metatarsal and cuboid bone

    · may refer pain to heal when long weight bearing

    · move cuboid back to position

    · othodic to maintain position
    *** Cuboid Subluxation
  12. area behind medial malleous forming tunnel with osseous floor and composed of flexor retinaculum
    Tarsal Tunnel definition
  13. Etiology
    · occurs when the foot is already plantar flexed and rearfoot locked then forceful hyper plantar flexion resulting in dorsal displacement of metatarsal bases

    · pain and cant weight bear
    · swelling/ tenderness on dorsum
    · possible metatarsal fractures/sprains of 4th and 5th tarsometatarsal joints --> cause disruption of ligaments

    · recognition, realignment, maintaining stability

    · usually requires open reduction with fixation- leads to metarsaligia, decreased metarsophangeal joint ROM, long-term disability
    Tarsometatarsal Fracture Dislocation (Lisfranc Injury)