ATH301_CH9

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Author:
itzlinds
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244013
Filename:
ATH301_CH9
Updated:
2013-11-12 20:52:06
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ankle leg pathologies
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Description:
ankle and leg pathologies
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  1. the primary weight-bearing bone of the leg:
    the tibia

    provides attachment sites for muscles and tendons
  2. what are the 4 fnxs of the fibia:
    • serves as a site of muscular origin and attachments
    • serves as a site of ligaments attachments
    • provides lateral stability to the ankle mortise
    • serves as a pully to increase the efficiency of the muscles that run posteriorly to it
  3. the articulation formed by the distal articular surface of the tibia and its medial malleolus, and the fibula's lateral malleolus and the talus is called:
    ankle mortise
  4. the combination of dorsiflesion, abduction and eversion is called:

    a closed chain of this causes:
    pronation

    closed chain pronation causes: tibial rotation, knee flexion, and internal rotation of the femur at the hip
  5. a combination of plantarflexion, adduction, and inversion is called:

    a closed chain of this causes:
    supination

    closed chain supination causes: external tibial rotation, external rotation at the hip, and knee extension
  6. which nerve passes posterior to the fibular head:
    common peroneal nerve

    -the site is protected only by skin, making it vulnerable to injury

    -branches  to the superficial and deep peroneal nerve, the peroneus longus and brevis nerve, and eventally to the lateral and medial cutaneous nerve

    -trauma at this site causes weakness in plantarflexion, eversion, and dorsiflexion
  7. list the 4 related bony structures of the ankle:
    • calcaneal tubercle: insertion of teh achilles tendon
    • navicular bone: insertion of the tibialis posterior
    • cuboid:
    • 5th MT: attachment for peroneus brevis

    cuboid and 5th MT: provide passageway for the route of the peroneus longus
  8. the close-fitting articulation between the talus, tibia, and fibula is called the :

    list the 3 lateral ankle ligaments found at this joint:
    talocrural joint

    • 3 lateral ankle ligaments
    • anterior talofibular ligament (ATF)
    • calcaneofibular ligament (CF) ~ 70% of ankle sprains
    • posterior talofibular ligaments (PTF) ~ 50% ankle sprains
  9. the close-fitting articulation between the talus, tibia, and fibula is called the:

    list the 4 medial ankle ligments found at this joint:


    talocrural joint


    • 4 ligaments (the deltoid ligaments)
    • anterior tibiotalar
    • tibiocalcaneal
    • posterior tibiotalar
    • tibionavicular
  10. the intergrity of the ankle mortise relies on the fnxal relationship between the tibia and fibula; name the joint that is the union of the ankle mortise:

    list the 4 ligaments of this joint:


    distal tibiofibular syndesmosis

    • ligaments of the distal TF syndesmosis
    • anterior and posterior tibiofibular
    • crural interossesous
    • interosseous membrane
  11. list the structures within the anterior compartment:

    muscles:
    nerve:
    blood vessel:
    bone:
    • muscles
    • tibialia anterior
    • extensor hallucis longus (EHL)
    • extensor digitorum longus (EDL)
    • peroneus tertius

    • nerve: deep peroneal nerve
    • blood vessel: anterior tibial artery, dorsalis pedis artery
    • bone: tibia
  12. list the structures within the lateral compartment:

    muscles:
    nerve:
    bone:


    • muscles
    • peroneus longus
    • peroneus brevis

    • nerve: superficial peroneal nerve
    • bone: fibula
  13. list the structures of the superficical posterior compartment:

    muscles:
    nerve:
    blood vessel:


    • muscles
    • soleus
    • gastrocnemius
    • plantaris

    • nerve: tibial nerve
    • blood vessel: posterior tibial artery
  14. list the structures of the deep posterior compartment:

    muscles:
    blood vessles:


    • muscles
    • tibialis posterior
    • flexor digitorum longus
    • flexor hallucis longus

    blood vessels: peroneal vessels, posterior tibial
  15. list and describe the 2 major bursae of the leg/ankle:

    fxn:
    • subtendinous bursa: b/w achilles tendon and calcaneus
    • subcutaneous calcaneal bursa: b/w achilles tendon and the skin

    fxn: decrease friction
  16. list the innervation area of the following nerves:

    deep peroneal nerve:
    superficial peroneal nerve:
    sural nerve:
    saphenous nerve:
    • deep peroneal nerve: anterior compartment
    • superficial peroneal nerve: lateral compartment
    • sural nerve: posterior and lateral leg and lateral foot
    • saphenous nerve: skin on medial ankle and foot
  17. list the vasclar anantomy of the leg/ankle:
    • great and small saphenous veins: empties into the femoral vein
    • perforating veins: muscle contraction squeezes blood toward the heart

    for any distal trauma.. check for pulse: dorsalis pedis artery or capillary refill
  18. list and describe 2 things to consider in the past medical history in a clinical examination:
    • history of injury to involved or uninvolved extermity: previous injury may demonstrate excess laxity, decreased proprioception
    • review medical file for history
  19. list the 8  possible soft tissue traumas that may occur on the lateral side of the ankle:

    list the 7 bony traumas that may occur on the lateral side of the ankle:
     
    • lateral soft tissue trauma
    • lateral ankle ligament sprain
    • syndesmosis sprain
    • capsular impingment
    • subluxating peroneal tenonds
    • peroneal muscle strain
    • peroneal tendinopathy
    • interosseous membrane trauma
    • peroneal nerve trauma

    • bony lateral ankle trauma
    • lateral ligament avulsion from malleolus, talus, and/or calcaneus
    • lateral malleolus fx
    • fibular stress fx
    • frank fibular fx
    • 5 MT fx
    • peroneal tendon avulsion
    • arthritis
  20. list the 7 soft tissue traumas that may occur on the anterior ankle:

    list the 6 bony traumas that may occur on the anterior ankle:
    • soft tissue anterior ankle
    • extensor retinaculum sprain
    • syndesmosis sprain
    • tibialis anterior or long toe extensor strain
    • tibialis anterior/long toe extensor tendinopathy
    • anterior compartment syndrome
    • interosseous membrane trauma
    • anterior tibiofibular ligament sprain

    • bony anterior ankle trauma
    • tibial stress fx
    • frank tibial fx
    • talar fx
    • talar osteochondritis
    • arthritis
    • periostitis
  21. list the 5 soft tissues traumas that may occur on the medial ankle:

    list the 4 bony traumas that may occur on the medial ankle:
    • soft tissue medial ankle trauma
    • deltoid ligaments
    • capsular impingment
    • tibialis posterior strain
    • tibialis posterior tendinopathy
    • posterior tibal nerve compression (tarsal tunnel syndrome)

    • bony medial ankle trauma
    • medial ligament avulsion
    • medial malleolus avulsion
    • medial malleolus fx
    • arthritis
  22. list the 7 soft tissue traumas that may occur on the posterior ankle:

    list the 3 bony traumas at may occur on the posterior ankle:
    • posterior soft tissue trauma
    • triceps surae strain
    • achilles tendinopathy
    • achilles tendon rupture
    • subtendinous calcaneal bursitis
    • subcutaneous calcaneal bursitis
    • deep vein thrombophlebitis
    • posterior tibiofibular ligament sprain

    • bony posterior ankle trauma
    • calcaneal fx
    • arthritis
    • os trigonum trauma
  23. describe the history of the present condition:

    location of pain:
    onset:
    injury mechanism:
    type and severity of pain:
    pain pattern:
    changes in activity and conditioning regimen:
    • location of pain: evaluation should emphasize the suspected structures involved
    • onset: actue (sprain, strain, fx) or gradual (overuse)
    • injury mechanism: acute (MOI), chronic requires more in-depth questioning
    • type/severity of pain: burning-nerve involvemnt, sharp, localized pain involve bone structures
    • pain pattern: how are symptoms are aggravated by certain activites, change thru the day, beginning of activity...
    • changes in activity: to understand chronic, insidious conditions
  24. list the possible tissue damage that could occur on the lateral ankle as a result from an inversion MOI:

    list the possible tissue damage that could occur on the medial ankle as a result from and inversion MOI:
    • lateral ankle damage from inversion
    • anterior talofibular ligament
    • calcaneofibular ligament
    • posterior talofibular ligament
    • lateral capsule
    • peroneal tendons
    • lateral malleolus fx

    • medial ankle trauma from inversion
    • medial malleolus
    • deltoid ligaments
    • posterior tibial nerve
    • tibial artery
    • tibial vein
  25. list the possible tissue damage that could occur on the lateral ankle as a result from  an eversion MOI:

    list the possible tissue damage that couuld occur on the medial ankle as a result from an eversion MOI:
    • lateral ankle damage from eversion
    • lateral malleolus
    • lateral capsule

    • medial ankle trauma from eversion
    • deltoid ligament
    • tibials posterior
    • long toe flexor
    • posterior tibial nerve
    • tibial artery
  26. list the possible tissue damage to the anterior ankle that could occur as a result from plantarflexion:

    list the possible tissue damage to the posterior ankle that could occur as a result from dorsiflexion:
    • anterior ankle trauma from plantarflexion
    • anterior capsule
    • long toe extensors
    • tibilas anterior
    • extensor retinaculum

    • lateral ankle trauma from plantarflexion
    • anterior talofibular ligament

    • posterior ankle trauma from plantarflexion
    • posterior capsule
    • subteninous calcaneal bursa
    • subcutaneous calcaneal bursa
    • os trigonum
    • talus fx
  27. list the possible posterior ankle trauma that could occur as a result from dorsiflexion:

    list the possible lateral ankle trauma that coudl occur as a result from dorisflexion:

    list the possible anterior ankle trauma that could occur from dorsiflexion:
    • posterior ankle trauma from dorsiflexion
    • triceps surae
    • achilles tendon
    • tibialis posterior
    • flexor hallucis longus
    • flexor digitorum longus

    • lateral ankle trauma from dorsiflexion
    • posterior talofibular ligament
    • peroneal tendons

    • anterior ankle trauma from dorsiflexion
    • anterior capusle
    • syndesmosis
    • extensor retinaculum
    • anterior talu
  28. dorsiflexion ROM:
    plantarflexion ROM:
    inversion ROM:
    eversion ROM:
    • dorsiflexion ROM: 20
    • plantarflexion ROM: 50 degrees
    • inversion ROM: 20 degrees
    • eversion ROM: 5 degrees
  29. goniometry for ankle plantarflexion/dorsiflexion:

    patient postition:
    fulcrum:
    proximal arm:
    distal arm:
    • patien position: sitting knee flexed to 90, ankle in anatmoical position
    • fulcrum: axis centered on lateral malleolus
    • proximal arm: stationary arm is aligned with long axis of the fibula
    • distal arm: movement arm is parallel with bottom of the foot
  30. the anterior drawer test chekc the integrity of the:
    anterior talofibular ligament
  31. which test would you use to chekc the integrity fo teh calcaneofibular ligament:

    what does a positive test "look" like:
    what other ligaments does this test stress:
    • inversion ( talar tilt) stress test
    • posititve test:  the talus tilts or gaps excessively
    • other ligaments stressed: anterior and posterior talofibular ligaments
  32. what test would you use to check for the integrity of the deltoid ligament, especially the tibiocalcaneal ligament:

    what does a positive test "look" like:
    • eversion (talar tilt) stress test
    • postitive test: the talus tilts or gaps excessively
  33. this test will test for 2 trauma's, rotatary damage to the deltoid ligaments, or distal tibiofibular syndesmosis:

    what does a postive test look like for each:
    • external rotation test (kleiger's test)
    • positive deltoid ligament: medial joint pain, displacement of the talus away from the medial malleolus
    • positive syndesmosis: pain is described in the anterolateral ankle at the site of syndesmosis
  34. hypermobile medial glide is commonly assoicated with lateral ankle sprains, the amount of medial and lateral glide can be assesed with which joint play test:
    • subtalar joint play
    • positive test: increased or decreased medial or lateral translation of the talus relative to the opposite side
  35. this joint play test will identify the amount of anterior-posterior play in the distal tibiofibular syndesmosis:

    what does a positive test look like:
    • distal tibiofibular joint play test
    • positive test: pain arising from the syndesmosis or increased motion relative to the uninvolved side
  36. which common nerve, either its superficial or deep branches are prone to trauma:
    • peroneal nerve
  37. the presences of this pulse after LE fx or dislocation and in those individuals suspected of having an anterior compartment syndrome must be established in this artery:
    • dorsalis pedis artery
    • posterior tibial artery: swelling may mask the presences of this pulse
  38. what is the MOI for a lateral ankle sprain:
    what is the most common sprained ankle ligament in a lateral sprain:
    other symptoms in a lateral sprain:
    what are the characteristics of pain in a lateral sprain:
    • MOI: open-packed position - plantarflexion and calcaneal inversion ( supination) or talar rotation in any combination
    • most common: anterior talofibular (ATF)
    • other symptoms: associated "pop"
    • characteristics of pain: lateral aspect of the malleolus and sinus tarsi
  39. list the characteristics in examination findings or lateral ankle sprains:

    inspection:
    palpations:
    AROM:
    MMT:
    PROM:
    Joint stability:
    Joint play:
    Special tests:
    Functional assessment:
    • inspection: findings include swelling around lateral joint capsule, ecchymosis around lateral malleolus
    • palpation: pain along involved ligaments, sinus tarsi sensitive to touch, crepitus
    • AROM: pain lateral side during plantarflexion and inversion, pain medial indicates pinching of medial structurs
    • MMT: peroneals are weak, painful, extensor digitorum is weak and painful
    • PROM: inversion plantarflexion, inversion and neutral position, inversion and dorsiflexion are all painful
    • joint stability: positive inversion stress test, and anterior drawer test
    • Joint play: increased medial glide at subtalar joint
    • special tests: squeeze test to rule out fx
    • fxn assessment: shortened stance phase on involved side of gain, ankle maintained in resting position of slight plantarflexion
  40. list the characteristics in examination findings of a lateral ankle sprain:

    Joint stability:
    Joint play:
    Special tests:
    Functional assessment:
    • joint stability: positive inversion stress test, and anterior drawer test
    • Joint play: increased medial glide at subtalar joint
    • special tests: squeeze test to rule out fx
    • fxn assessment: shortened stance phase on involved side of gain, ankle maintained in resting position of slight plantarflexion
  41. list the characteristics in examination findings of a syndesmotic "high" ankle sprain:

    pain characteristics:
    other symptoms:
    MOI:
    • pain characteristics: anterior portion of the distal tibofibular syndesmosis
    • other symptoms: "feel shifting in plantarflexion"
    • MOI
    • external rotation of the talus within the ankle mortise and/or dorsiflexion
    • forced hyperdorsiflexion or hyperplantarflexion
    • internal rotaion of the talus
  42. list the characteristics in examination findings of a syndesmotic "high" ankle sprain:
    • joint play: anterior/posterior tibiofibular joint play test
    • special test: external rotation, dorsiflexion-compression test, squeeze test
    • fxn assessment: shortened swing on contralateral side to avoid full dorsiflexion in gain, toe gain on the involved side
    • differential diagnosis: lateral ankle sprain (mimics a lateral sprain, diagnosed when lateral ankle does not heal), fibular fx, deltoid sprain
  43. list the characteristics in examination findings of a syndesmotic "high" ankle sprain:

    inspection:
    palpation:
    AROM:
    MMT:
    PROM:
    • inspection: swelling over distal tibiofibular syndesmosis (in time swelling may 'seep down')
    • palpation: pain over tibiofibular syndesmosis, pain over anterior/posterior tibiofibular ligaments, palpate length of fibula to rule out fx
    • AROM: restricted dorsiflexion, eversion, end range of plantarflexion and inversion
    • MMT: anterior tibialis, posterior tibialis, are weak and painful
    • PROM: pain in dorsiflexion, eversion
    • stress test: not applicable
  44. list the characteristics in an examination findings of a medial ankle sprain:

    pain charcteristics:
    MOI:
    • Pain: medial border of the ankle, radiating from the medial malleolus
    • MOI: eversion and or rotation
  45. list the characteritics in an exmaination finding of a medial ankle sprain:

    inspection:
    palapation:
    AROM:
    MMT:
    PROM:
    • inspection: swelling around the medial joint capsule
    • palpation: pain around the deltoid ligaments, creptius at the site of ligamentous origin or insertion may indicate an avulsion fx
    • AROM
    • pain on the medial side of the ankle during plantarflexion indicates stretching of the anterior tibiotalar and or/ tibionavicular ligaments
    • pain durind dorsiflexion indicates trauma to the posteior tibiotalar ligament
    • lateral pain pain may indicate a pinching of the lateral ligaments and/or trauma to the lateral malleolus
    • MMT: posterior tibialis pain and weakness
    • PROM: motion produces pain along the ligaments, as described in the legamentous and capsular testing
  46. list the characteristics in examination findings of a medial ankle sprain

    stress test:
    joint play:
    special tests:
    fxn assessment:
    differential diagnosis:
    • stress test: eversion stress test
    • joint play: cotton test, talonavicular glide
    • special test: external rotation test, squeeze test to rule out a fx of distal fibula
    • fxn assesement
    • decreased strength or medial pain during most motions secondary to stretching the medial ligmaments
    • gait evaluation reveals shortened midstance phase and/or supinated gait as the pt avoids pronation
    • increased pain during midstance phase of gait
    • differential diagnosis
    • posterior tibialis strain
    • fibular fx
    • distal syndemosis sprain
    • medial malleolus fx
    • posterior tibialis neuropathy
  47. describe the patholgoies related to the ankle and leg. tibial shaft
    • may exhibit obvious gross deformity
    • significant force is required
    • inability to bear weight
  48. describe the patholgoies related to the ankle and leg. Fibula:

    types of forces that can cause fx:
    other structures that may be involved:
    Maisonneuve fx:
    Hugier fx:
    fxn assesment:
    • forces: inversion, eversion, rotational forces
    • structures involved: malleoli, interosseous membrane
    • maisonneuve fx: disruption of the interosseous membrane
    • Hugier fx: only the shaft of the fibula is fx'd
    • fxn assesment: capable of walking
  49. what is the fxn of the modified ottawa ankle rule:
    list the criteria for radiographic referal:
    what two zones should be considered for an ankle radiograph referal:
    what two zones should be considered for a foot radiograph referal:
    • fxn: ottawa ankle rule provides evaluative criteria to indentify when the patient should be referred for radiographs
    • criteria for referal:
    • the patients inability to walk 4 steps both immediately following the injury and at the time of examination

    • ankle radiograph referal:
    • posterior edge or tip of the lateral malleolus
    • posterior edge or tip of the medial malleolus

    • foot radiograph referal:
    • base of the 5th MT
    • Navicular
  50. describe the examinaition findings for achilles tendinopathy:

    onset:
    pain charactistics:
    other symptoms:
    MOI:
    predisposing conditions:
    • onset: insidious or the result of trauma of the achilles tendon
    • pain characteristics:  along the length of the achilles tendon, any where along the posterior side
    • other symptoms: may describe squeaking sensation

    • MOI
    • acute onset relating to a sudden, large increase in load or a blow to the achilles tendon
    • tendinosis results from reptitive stressors and subsequent local tissue degeneration
    • impoperly fitting shoe rubbing against the tendon may also activate the inflammatory repsonse

    • predisposing conditions:
    • tibial varum
    • calcaneal valgum
    • hyperpronation or other forms of foot rigidity
    • tightness of the triceps surae muscle group
    • risk increases with age, especially males
    • decreased strenght of the plantarflexion, increased dorsiflexion ROM
    • sudden chage in duration and/or intensity of training
    • ankle sprains or other foot/ankle pathologies resulting in toe-only gait and subsequent shortening of the achilles tendon
  51. describe the examination findings for achilles tendinopathy:

    inspection:
    palpation:
    AROM:
    MMT:
    PROM:
    • inspection:
    • possible visible edema along the lenght of the tendon
    • the tendon on the involved leg may appear thicker than on the opposite leg
    • pitted edema

    • palpation:
    • pain elicited during palpation of the tendon, especially 2 to 6 cm proximal to the tendon's insertion on the calcaneus;
    • creptius may be evident with active motion

    • AROM: pain and crepitus during plantarflexion and dorsiflexion
    • MMT: pain and decreased strength present during plantarflexion (gastrocnemius and soleus)
    • PROM: pain at end range of DF, resulting from stretching the tendon, DF may be decreased
  52. describe the examination finding for achilles tendinopathy:

    joint play:
    fxn assement:
    differential diagnosis:
    • joint play: hypomobile lateral glide of the talus
    • fxn assessment: decreased push off during gait
    • differential diagnosis: subcutaneous calcaneal bursitis; subtendinous calcaneal bursitis
  53. describe the examination finding for an achilles tendon rupture:

    onset:
    pain characteristics:
    other sypmtoms:
    mechanism:
    predisposing conditions:
    • onset: acute
    • pain characteristics: achilles tendon and/or lower portion of teh gastrocnemius
    • other symptoms: reports sensation of being kicked; audible "pop" may be described
    • MOI: forceful plantarflexion with eccentric loading, usually the result of eccentric loading or plyometric contraction of teh calf musculature
    • predisposing conditions
    • a possible relationship b/w a history achilles tendinits and rupture of the tendon
    • history of corticosteroid injections to the tendon
    • advancing age
    • male generd
  54. describe the examination findings for an achilles tendon rupture:

    inspection:
    palpation:
    AROM:
    MMT:
    PROM:
    • inspection:
    • a defect may be visible in the achilles tendon or at the musculotendinous junction, but rapid swelling may obsure this
    • discoloration may be present around the tendon
    • the patient is unable to bear weight on the involved extremity b/c of pain

    palpation: a palpable defect in the achilles tendon, although it may be quickly become obsucred by swelling; pain elicited along the tendon and lower gastrocnemius-soleus muscle group

    • AROM
    • plantarflexion may possibly still be present owing to the tibials posterior, plantaris, peroneals, and long toe flexors, although pt may complain of pain during this motion and during DF

    • MMT: weak or absent PF (gastrocnemius and/or soleus)
    • PROM: pain during DF; an empty end feel may be obtained secondary to pt apprehension
  55. describe the examinatin findings for an achilles tendon rupture:

    Special tests:
    fxn assesment:
    differential diagnosis:
    • special tests: thompson tests
    • fxn assesment: unable to perform a heel raise or push off during gait

    • differential diagnosis:
    • posterior tibial tendon rupture
    • plantaris tendon rupture
    • triceps surae strain
    • achilles tendinopathy
    • deep vein thrombosis
  56. what is the fxn of the thomposon test:
    describe the evaluative procedure:
    what does a positive test look like:
    • fxn: achilles tendon rupture, when the achilles tendon is intact, squeezing the calf muscle results in slight plantarflexion
    • evaluative procedure: the examiner squeezes the calf musclature while observing for plantarflexion of the foot
    • postivie test: when the calf is squeezed, the foot does not plantarflex
  57. what are the 4 classifications that the peroneal dislocations can fall into:
    • I. superior peroneal retinaculum is torn from its fibular insertion
    • II. superior retinaculum and fibrocartilaginous ridge are avulsed from the lateral fibula
    • III. superior retinaculum is torn from the lateral fibula, the fibrocartilaginous ridge is avulsed, and flake fxs occur on the lateral malleolus
    • IV. superior retinaculum is torn from its calcaneal insertion
  58. describe the examination findings for a subluxating peroneal tendon:

    onset:
    pain characteristics:
    other symptoms:
    MOI:
    onset: actue or insidious

    • pain characteristics:
    • behind the lateral malleolus in the area of the superior peroneal retinaculum
    • across the lateral malleolus
    • length of the peroneal tendons
    • rare case: site of the inferior peroneal retinaculum

    other symptoms: ankle instability accompained by snapping of the tendon is often reported

    • MOI
    • forceful dorsiflexion and eversion
    • plantarflexion and inversion
  59. describe the examination findings for a subluxating peroneal tendon:

    inspection:
    palpation:
    AROM:
    MMT:
    • inspection
    • swelling and ecchymosis may be isolated behind the lateral malleolus
    • tendons may be seen to sublux during eversion

    • palpation
    • tenderness behind the lateral malleolus, over the peroneal tendons, and perhaps the site of the inferior peroneal retinaculum
    • involvement of the peroneus longus may result in pain following the tendons course through the foot
    • palpate the area behind the lateral malleolus during peroneal MMT to idenitfy abnormal movement of the peroneal tendons

    AROM: the peroneal tendon may be seen, felt, or heard as it subluxates while the foot and ankle move from plantarflexion and inversion to dorsiflexion and eversion and back

    MMT: peroneals
  60. a periostitis at the posterior medial border of the tibial is called:

    what are are the causes 5 causes of this condition:
    a periostitis at the posterior medial border of the tibial is called: medial tibial stress syndrome

    • causes
    • repetitive overuse (running)
    • training errors (training on a hard surface, increasing load too quickly)
    • incorrect shoe wear
    • muscle fatigue (ankle is not conditioned; coach doesnt plan for rest properly)
    • biomechanical abnormalitites ( high/low arches, going thru growth spurts, a learned activity they dont know is wrong)
  61. describe the examination findings of a leg and ankle stress fx

    onset:
    pain characteristics:
    MOI:
    • onset: insidious or chronic, secondary to repetitive running and/or jumping
    • pain characteristics:
    • along the shaft of the tibia or fibula, localized during or after exericse,
    • may be described as a localize "ache" while at rest

    • MOI
    • sudden increase in the duratin, frequency, or intensity of exercise
    • change in a playing surface
    • change in shoe ware

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