This document provides an overview of a foot and ankle session. It discusses topics like imaging the foot and ankle, common injuries like lateral ankle sprains and their treatment, and case studies involving various foot and ankle conditions like plantar fasciitis, pes planus, and Achilles tendinopathy. Clinical tests and management strategies are described for different injuries and conditions.
Foot and ankle trauma, common pitfalls, imaging modalities and radiographic occult fractures. The concept of the PITFL or "pitiful injury" an easily overlooked ligamentous injury of the talocrural joint
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
Common Foot and Ankle Injuries: You Don’t Have to Suffer!Summit Health
Join us for a lecture on common foot and ankle injuries, diseases, and conditions, including skin lesions/soft tissue masses, fungal nails, plantar fasciitis, bursitis, hammertoes, bunions, tendonitis, ankle sprains, and arthritis. In addition to discussing causes, the lecture will focus on treatments that can help you get back on your feet!
Foot and ankle trauma, common pitfalls, imaging modalities and radiographic occult fractures. The concept of the PITFL or "pitiful injury" an easily overlooked ligamentous injury of the talocrural joint
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
Common Foot and Ankle Injuries: You Don’t Have to Suffer!Summit Health
Join us for a lecture on common foot and ankle injuries, diseases, and conditions, including skin lesions/soft tissue masses, fungal nails, plantar fasciitis, bursitis, hammertoes, bunions, tendonitis, ankle sprains, and arthritis. In addition to discussing causes, the lecture will focus on treatments that can help you get back on your feet!
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
Approach to Knee Pain I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
DR. GIRISH MOTWANI
Consultant Foot & Ankle surgeon (Paediatric & Adult)
1)Sushrut Hospital, Research Centre & PostGraduate Institute of Orthopaedics, Nagpur west
2)Aman hospital,Nagpur east
3)South point clinic, Nagpur south
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
Approach to Knee Pain I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
DR. GIRISH MOTWANI
Consultant Foot & Ankle surgeon (Paediatric & Adult)
1)Sushrut Hospital, Research Centre & PostGraduate Institute of Orthopaedics, Nagpur west
2)Aman hospital,Nagpur east
3)South point clinic, Nagpur south
Bryan English - classification of muscle injuries in sportMuscleTech Network
Bryan English
Medical Director Middlesbrough Football Club. Member of Technical Advisory Group in Sports Science. The English Institute of Sport
-
Terminology and classification of muscle injuries in sport: a Munich consensus statement
(6th MuscleTech Network Workshop)
14th October, Barcelona
The Battle Sport Traumatology 2023 Castrocaro Terme FC.pdfNicola Taddio
In this presentation the author analyzes the various problems relating to the functional and mechanical instability of the ankle which has suffered a lesion of the lateral ligaments, the complications, failures and short and long term outcomes in order to have a 360 degree vision of the problem , the possible solutions and the correct management to avoid them.
This talk looks a few common knee disorders including ACL tears, patellar tendinopathy,and Osteoarthrits and meniscal tears, and looks at Physiotherapy management and some of the associated evidence. The talk was a 30 minute for Doctors unfamiliar with management options and was semi-technical in nature. It provides several patient handouts for practitioners to use. Videos describing exercises were also included in the talk but not available in Slideshare.
This paper looks at some of the issue regarding computer workstation design and chair selection. It discusses some of the common musculoskeletal problems including carpal tunnel syndrome, neck, shoulder an low back problems caused by computer use.
Physiotherapist or Physical therapists are important health providers and can contribute to enhanced outcomes in many common musculoseletal disorders including osteoarthritis, ACL injuries, tendinopathies, such as rotator cuff disorders, tennis elbow and achilles tendinopathy and muscle tears
This is a staged protocol designed to guide the management of a simple muscle tear. These injuries are common in sport and are often poorly managed. Understanding how management fits in with the physiology of healing assists.
Muscle tears are extremely common and are often recurrent. They are not as simple as we used to think and the advent of better imaging has proven that the site, size and location of the tear, together with the presence or otherwise of the tendon is crucial information especially for elite or professional athletes, who need accurate information about return to play. Traditional treatments of electrotherapy are simply placebos. The challenge ahead is to optimise treatments for the various diagnostic categories.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. Foot and Ankle Session
Cameron Bulluss, Rob Dingle, Peter Enks, Pierre
Buchholz, Gavin Jackson – Advanced Physiotherapy
and Injury Prevention
www.advancedphysio.com.au
2. Preliminaries
Useful Resources and Acknowledgements
1. Atlas of Imaging in Sports Medicine (2nd ed.). Jock Anderson and
John W Read
2. Clinical Sports Medicine. Bruckner and Khan
3. American Academy of Orthopedic Surgeons Website.
www.aaos.org
4. Advanced Physiotherapy and Injury Prevention Website
www.advancedphysio.com.au, notes will be on website (show)
Acknowledgements – Isobel Green, Jess Fidler
Introduce Colleagues
Purpose of these talks: educate, meet, value add
Who we treat
4. When to Image
If it affects management
Diagnosis is uncertain
Demanding patient
To assist with determining prognosis
Red flags
Orange flags
Failed treatment
6. Red Flags
> 50 year old
Systemic symptoms
Significant morning stiffness
Known risk factors
Past history or family history
Noctural pain
7. Orange Flags
Disability disproportionate to mechanism
Failure to respond to conservative management
Multiple opinions
Anxious patient
Education
Significant trauma (fall over 1 metre)
IV drug use
Cord or cauda equina signs
History of use of oral corticosteroids
8. Grades of Injury – Muscle/Ligament
Ligament
Grade 1 Pathology = microscopic tearing (strain)
Clinical = Tenderness but no ligament laxity
MRI = normal ligament thickness but increased periligamentous
signal
Grade 2 Pathology = partial tear
Clinical = some ligamentous laxity but firm end-point
MRI = ligament thickening +- partial discontinuity, increased signal
Grade 3 Pathology = complete tear
Clinical = increased ligament laxity and no indentifiable end point
MRI = complete ligament discontinuity + oedema and
haemorrhage
9. Anatomy of the Foot and Ankle
Bones and Articulations
Inferior tibiofibular joint
Talocrural joint
Subtalar joint
Transverse tarsal (Choparts)
Intertarsal joints
Tarsometatarsal joint (Lisfranc)
13. Case Study 1
42 year old coal-miner, twisted ankle felt pop, swelled
immediately and unable to weight-bear, ED x-rays reported
as normal, placed in backslab at hospital, told to RICE and
presented to you 2 days post injury
14. Case Study 1
Probable diagnosis?
Clinical tests to confirm
diagnosis?
Further imaging required?
16. Lateral Ligament Sprain (16 -21% of all
athletic injuries)
- Biomechanics of injury
- Clinical Tests (ant. Drawer,
palpation, inversion, KTW)
- Time frame to recover
- Likleyhood of poor prognosis
- ? Refer on
17. Management of Lateral Ligament
Sprains - conservative
RICE
Place ligament in shortened position
Boot, brace, tape
Short period of reduced weight bearing
Then progressive exercise based rehabilitation
focusing on regaining movement, balance, strength and
proprioception
2-6 weeks to recover
80% recover structurally
Strap or brace for season
18. Conservative vs Surgical For Grade 3
Lateral Ligament Tears
Rehab 87% excellent or good outcomes
Surgery 60% excellent or good outcomes (Kaikkonen 1996)
19. Treatment of Choice for Lateral
Ligament Sprain
(BRITISH MEDICAL JOURNAL VOLUME 282/ 21 1981)Early functional treatment
with a short period of protection via boot, brace or tape followed by series of exercises
designed to gradually restore range of motion, strength, proprioception
The Journal of Bone and Joint Surgery VOL. 73-A, NO. 2, FEBRUARY 1991 Summary.
After a critical review of these twelve studies, it is not difficult to select functional
treatment as the treatment of choice for acute complete tears of the lateral ligaments of
the ankle
20. Complications Following Major Lateral
Ligament Tear
Location of osteochondral Study of 30 patients with
lesions grade 3 lateral ligament tears
The arthroscopic findings
in these were
chondral lesions in 20
patients,
traumatic synovitis in 19,
adhesions in nine and a
partial rupture of the
deltoid ligament in one.
21. ANKLE TAPING DEMONSTRATION
Also show walking boot, dorsiwedge splint
Discuss management high versus low grade injuries
22. Case Study 2
Soccer Player twisted ankle Possible diagnosis?
(external rotation). Clinical tests to confirm
Presented unable to diagnosis?
weightbear with swelling Further imaging required?
anterior ankle joint. ED
series x-rays – patient told
no fracture. Reports no
swelling lateral ankle but
swelling anteriorally
23. Case Study 2
Injury to inferior tibiofibular ligaments (high ankle sprain)
24. Injuries to the Inferior tibiofibular ligaments
(syndesmotic ligaments) 3-10% of ankle sprains
Biomechanics of injury, patient presentation, clinical testing
(ext rot, squeeze), investigations, show primal dvd
27. Management of Syndesmosis Injuries
AITFL – MRI and surgical referral if high grade
tear/instability
PITFL – does not cause diastasis and treated as per a typical
sprain
28. Case Study 3
51 year old female presents Probable diagnosis?
with heel pain that she has Clinical tests to confirm
had for several months. It is diagnosis?
worse in the morning, Further imaging required?
particularly with her first
step.
29. Case Study 3 - Plantar Fasciitis
Management options
Most common foot
problem Plantar fascia stretches
Heel cord stretches
Biomechanics
Night splint
Pathology
Orthotics
?Heel spur (FDB) Tape
Time frame to recover
?referral on
Imaging?
Clinical tests
30. Case Study 4
62 year old woman,
presents with medial foot
and ankle pain of insidious
onset. Claims that she
notices the arch of her foot
has gradually collapsed
over the last few years
Probable diagnosis?
34. Acquired Adult Flat foot
Referral on?
Clinical tests
Management
Likely time frame to recover?
Likelyhood of poor outcome?
35. Case Study 5
39 year old woman Probable diagnosis?
presents with pain over the Clinical tests to confirm
mid achilles tendon diagnosis?
following commencing Further imaging required?
boot camp training.
Referral on?
Impossible to run
comfortably now, but is Likely time frame to
able to walk except up hills recover?
Likelyhood of poor
outcome?
36. Case Study 5 Achilles Tendinopathy
Apart from disorders of the tendon sheath there are no
inflammatory changes in most tendon pathologies (excluding
tendon sheath)
Alfredson’s accidental discovery
37. Tendon Facts
Types of tendon Pathology (Cook and Purdham BMJ 2008)
normal,
proliferative
failed healing
degenerative
rupture
Tendon sheath
Insertional and non-insertional tendinopathies
These pathologies can co-exist
38. Tendon Facts
Most tendon pathologies we see in the non-athletic
population are degenerative tendinopathies
Most athletic tendinopathies are insertional
39. Aeitiology
Genetic factors (more type 3 collagen, blood group O,)
Hypermobility
Higher incidence in diabetics
Increased with increasing age
Related to waist girth (BMI>30 3times greater likelyhood of
rotator cuff surgery) - ? Effect of cytokinines, lipids on tendon
health
Hormonal (positive effects from HRT)
Seronegative and metabolic disorders
40. Tendon Facts
Degenerative tendon pathology is reversible
sometimes (Alfredson, Cook 2005,Silbernagle 2008)
41. What Works Best
Best evidence is for slow resistance exercises that have an
eccentric component and this can be enhanced with the
application of a GTN patch
Achilles – painfree 49% (78% with patch) (Murrell 2007)
Achilles -Mid substance 90 %, Insertional 30%
significant improvement with eccentric program (Alfredson
2008)
42. Why Does Exercise Work
Produces new collagen (but can take 100 days)
Destruction of neovessels and nerves
Normalisation of cells
Reduces thickness of tendon
Implications for impingement
43. Implications for Management
If patient presents with acute overload a period of rest is
important
If pain in a sedentary person or is chronic we can embark
immediately on a resistance exercise program
If there is a bursae associated with the tendon then ultrasound is
worthwhile and if the bursae is inflamed consider an injection
If the tendinopathy is insertional and you are prescribing exercises
don’t allow the tendon to stretch
Many of the traditional programs are not appropriate
Expect 6 -12 months in many cases
?GTN patches and other measures such as autologous blood,
polidocinol,
44. Case Study 6
15 year old boy, falls out of a Probable diagnosis?
roof at work and lands on Clinical tests to confirm
foot. Fracture to distal tibia diagnosis?
and fibula treated by cast Further imaging required?
immobilisation for 8 weeks.
After 6 weeks of physio and
exercises ankle movement is
good but complains of
persistent forefoot pain. He
reports that he is unable to
rise up on to his toes, xray
series of foot at initial
incident show no fracture .
45. Lisfranc Injury
Although not common early management is crucial to long
term outcome
Referral on?
Likely time frame to recover?
Likelyhood of poor outcome?
46.
47. Low Velocity Lisfranc Ligament Injuries
2 predominant mechansims
Forced hyperplantarflexion with fixed midfoot
Typically involves a strap (windsurfers, equestrian, wakeboarders etc)
Foot gets stuck in strap and patient has fallen backwards
Weightbearing on forefoot, axial loading
Contact sports where a player may fall on another players heel when
forefoot weightbearing.
Landing on the forefoot with force (landing from jump, parachuting)
48. Lisfranc Ligament Injury Clinical
Echymosis
Swelling
Often unable to weight-bear
Pain on passive inversion and eversion of forefoot
X-Rays often normal or reported as normal
MRI best test
Higher grade injuries need urgent orthopaedic referral
50. Metatarsalgia
The term metatarsalgia is often used to describe pain in the
distal forefoot, but does not define a specific diagnosis or
indicate a particular mode of treatment.