1. Ankle Sprains
    • lateral is the most common
    • Plantarfexion and inversion
    • grade 1-3
  2. Grade 1 ankle Sprain
    little to no trearing of ATF (anterior talofibular)
  3. Grade 2 Ankle Sprain
    anterior talofibular ligament complete tear and partial tear of calcaneofibular
  4. Grade 3 ankle sprain
    complete tear or anterior talofibular ligament and calcaneofibular with partial tear of posterior talofibular
  5. Special Tests for Ankle Sprain
    • Anterior Drawer - aft intergity
    • Talar Tilt Test - CF integrity
  6. History with ankle sprain
    • onset is usually a traumatic twisting injury
    • pt can identify specific event
    • may hear a pop or snap
  7. Signs and symptoms of a ankle sprain
    • antalgic gait
    • significant swelling - track with tape measure
    • Active movements gaurded and apprehensive - ROM limited (wont want to do platarflexion or inversion
    • Pt complains of unstable feeling
    • Tender with palpation
  8. How is an ankle sprain diagnosed
    • X-ray - rules out fracture, stress views may be needed
    • MRI
  9. Problems with an Ankle Sprain
    • Post traumatic edema
    • Pain with weight bearing
    • Instability or "giving way" of joint
    • tenderness with palpation of injured ligaments
  10. Goals of physical therapy with an ankle sprain
    • Joint protection - brace, tape, casting
    • Limit edema - cold and compression modalities
    • early protected weight bearing encouraged - use assistive device as long as gait pattern is altered and pt has pain
    • Begin AROM and progress
  11. Time frame with each stage
    • Grade 1 & 2 - 2 weeks to return to activity
    • Grade 3 - immoblize for 3 weeks in shortened position
    • Chronics may require surgery
    • Entire rehab process - 3 month
  12. Injury to High Ankle Sprain
    • Injury to tibulofibular ligaments
    • 10% of the time
  13. What is the cause of achilles tendinitis
    • overuse injury
    • common problem
    • repeated eccentric loading of tendon
    • Results in microtrauma and inflammation of the achilles tendon
  14. Contributing factors that lead to Achilles Tendinitis
    • Improper foot mechanics
    • Poor training
    • Inadequate conditioning techniques
    • tight posterior calf muscles
  15. Pt history with Achilles tendinitis
    • Gradual onset of symptoms
    • Insidious onset
    • Unaccustomed activity
    • mild symptoms - progress to severe complaints taht prevent activity
  16. Signs and Symptoms of Achilles Tendinitis
    • Dull aching pain in the area of the achilles tendon - proximal to insertaion into calcanus, pain at rest but most often with activity
    • Observable palpable edema and thickening of the tendon
    • Crepitus may be felt on repeated PF/DF
    • Pain with movement
  17. Diagnostics of Achilles Tendinitis
    • No routine tests - lateral x-rays may show changes or a loss of a distinct outline of the tendon
    • MRI - shows soft tissue changes
  18. Thompson Test
    check integrity of musculotendinous unit and rule out partial complete tear
  19. Homans Test
    Rules out DVT
  20. Acute management of Achillies Tendinitis
    • Modalties - US/phono/ionto, ice massage over tendon
    • NSAID's
    • Stop aggravating motions
    • May add felt heel lift to take stress off tendon
    • Pt edf for proper footwear, orthotics
  21. Subacute Management of Achilles tendinitis
    • Modalities - ice, cryo, us, ionto
    • AROM
    • Stretching - sustained
    • gentle passive stretch with knee extended and flexed, towel stretch as pain allows, standing heel cord stretches once towel stretch is ok, standing heel cord stretch once appropriate
    • Strengthening - initially limit ROM and do submaximal exericse -most full ROM strengthening and stretching exercises cause pain
    • Progress to threaband for plantarflexion eccentrics
  22. Return to function with Achilles Tendinitis
    • As symptoms resolve can add concentric exercises such as heel raises
    • Continue with general aerobic conditioing
    • Gradual return to sports
  23. Time Frame and Outcomes for Achilles Tendinitis
    • slow becuase tendon has low metabolic rate with prolongs healing 6-10weeks
    • can see cycle of heal and reinjury becuase of return to activity too soon
    • Need to educate patient
  24. Achilles Tendon Rupture
    • Tramatic injury - acceleration
    • 30-40 years old
    • 20:1 male to female
    • may see gap in tendon
    • Treated nonoperatively casted for 8 weeks
    • Suprgical repair is sometimes needed
  25. Compartment Syndrome
    • From sports or traume
    • Increased pressure in the fascial compartment
    • there are 4 compartments
  26. Acute Compartment Syndrome Presentation
    • Trauma will incrase pressure secondary to swelling/bleeding wihtin the fascial compartment
    • severe dull or sharp pain in the cmpartment
    • May see superficial contusion
    • Passive stretch increases symptoms
    • Parathesia foot - numb, irreversible nerve damge possible
  27. Chronic Compartment Syndrome Syndrome Presentation
    • Exertional compartment syndrome
    • Numbness
    • Pain - ischemic
    • See numbness foot and or anterior lateral leg depending on nerve involved
    • Mimics stress fracture
  28. Management of Acute Compartment Syndrome
    • Emergency fascial surgical release
    • Treat inlammation with meds, elevation, decrease weight bearing and modalities
    • ROM day 2-3 post-op
    • Gradual progressive weight bearing to FWB
  29. Time from for compartment syndrome
    6-8 weeks
  30. Plantar Fascitis
    • Chronic inflammation of the plantar fasica (aponeurosis) with or without an associated calcaneal heel spur
    • Repetitive cycle of microtraume leading to injury attemped repair and chronic inflammation
    • Inflammation is a reaction due to chronic traction on fasica at its insertion into the calcanues
  31. Pt history with Plantar Fascitis
    • gradual insidious onset of complaints
    • Occasionally complaint of acute onset of "strain" of the arch during vigorous activities
    • Symptoms progress if not treated
  32. Signs and Symptoms
    • Acute pain after prolonged sitting or with the initial weightbearing in the morning "physiologial creep" (facial in none weight bearing will shorten)
    • Pain localized at the proximal attachemnt of the fascia and may radiate along the length of the fascia distally - pain on palpation of the medial tubercle of the calcaneus
    • Heel pain with weight-bearing
  33. Conditions associated with Plantar Fascitis
    • Pes planus, pes cavus - flat foot or high arch
    • Obesity
    • Tight achilles tendon
    • Calcaneal valgus
  34. Diagnostics of Plantar fascitis
    Routine x-ray may reveal a dypertrophied spur formation at the medial calcaneal tubercle
  35. Management of Plantar Fascitis
    • NSAIDS
    • Modalities to decrease inflammation
    • Plastic heel cup, soft orthotic inserts
    • Arch taping or specific taping for plantar fascitis
    • May need night splints
    • Stretch fscia with roller
  36. Physical Therapy for Plantar Fascitis
    • may need night splints
    • Stretch fascia with roller
    • Specific stretching for heel sord toe, extension stretches
    • Steroid injections
    • May need surgery - fascial release
    • Pt ed
  37. Shin Splints/ MTSS
    • Shin Splints is not a specific diagnosis
    • Pain has many differnt origins
    • Better to describe pain by the location and etiology
    • Lower medial tibial pain resulting from periosititis
  38. Cause of Shin Spints
    • Abnormal biomechaniacal alignment
    • Poor condition
    • Improper training methods
  39. Differential diagnosis for Shin Splints
    • stress fractures of tibai and fibula
    • Ischemia disorders
    • Deep compartment syndrome
  40. Interventions
    • Pain management and edema control
    • Activity modification - orthotics, pt ed about proper training methods and prevention of reoccurrence
    • Stretching
    • Strengthening exercises
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