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62 Cards in this Set

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  • Back
Pronated Foot: Etiology
- Foot positional deformities
- Function equinus (<10 degrees)
- Tibial torsion
- Genu valgus/varus
- Increased femoral rotation
- Obesity
Pronated Foot: Pathomechanics
- Peroneus longus can't stabilize 1st ray
- Inefficient cuboid pulley mechanism
- Tibialis posterior lengthens and becomes weak
- Peroneus longus becomes shortened
Pronated Foot: Hx
Pain
- Multiple sites
- Medial longitudinal arch
- Lateral tip of fibula
Worsens
- Prolonged standing
- Walking
Improves
- Rest
Pronated Foot: Onset
Overuse
- Excessive standing
- Changes in normal activity
- Increased training
- Improper footwear
Pronated Foot: PE
- Calcaneal eversion
- Medial bulge of talonavicular joint
- Low medial longitudinal arch
- Forefoot ABD
- Increased tibial IR
- Navicular drop > 10 mm
Pronated Foot: Possible Sequelae
- Achilles tendonitis
- Tibialis posterior tendonitis
- Posterior tibial nerve tension
- Anterior knee pain
Pronated Foot: Interventions
- Reduce stress: Orthosis, taping
- Shoe modification: Motion control, straight last
- Stretch gastroc/soleus
- Strengthen
Supinated Foot: Etiology
- Idiopathic pes cavus
- Clubfoot
- Neuromuscular disorders: Charcot-Marie-Tooth disease
Supinated Foot: PE
- Calcaneal inversion
- High medial longitudinal arch (pes cavus)
- Increase tibial ER
Supinated Foot: Interventions
- Soft shoe: Midsole, cushioned
- Orthosis
- Mobilization
- Stretching
Hallux Rigidus: Overview
- Progressive loss of big toe extension
- Ankylosis possible
- Etiology: Excessive pronation leads to 1st ray hypermobility, trauma, OA or RA
Hallux Rigidus: Hx & PE
- Pain: Walking, stairs, squatting
- Gait: Toe out, push off decreased
- Decreased ROM
Hallux Rigidus: Interventions
- Mobilization
- Orthosis
- Rocker-bottom shoes
Hallux Valgus: Overview
- Lateral deviation of big toe
- Only in populations that wear shoes
- Women to men 9:1
- Hallux valgus normal angle 5-10 degrees, pathological > 20
Hallux Valgus: Etiology
- Lateral subluxation of FHL
- Congenital
- Pronated foot
- Tight shoes
Bunion
- 'Bunch' or area of swelling or osteophyte
- With or without hallux valgus
- Treat the cause: Achilles stretching, orthosis, bunionectomy
Inversion Ankle Sprain: Overview
- 80-95% of all ankle sprains
- Mechanism: PF, INV, ADD, ATF
Inversion Ankle Sprain: Co-morbidities
- Avulsion fx of lateral malleolus
- Malleolar fx
- Peroneal nerve compromise
- Sinus tarsi syndrome
- Compression of medial ankle ligaments
- Jones fx
Inversion Ankle Sprain: Hx
- Turned ankle
- Pain with running only: Grade I
- Pain with walking & running: Grade II
Inversion Ankle Sprain: PE
- Swelling
- Ecchymosis = at least Grade II
- Limited ROM
- Positive anterior drawer
- Positive medial talar tilt
Eversion Ankle Sprain: Overview
- Avulsion of medial malleolus more common with eversion (Pott fx)
- Positive lateral talar tilt
Syndesmotic Ankle Sprain: Overview
- 'High ankle sprain'
- 10% of all ankle injuries
- Ligaments involved: Anterior & posterior inferior tibiofibular, transverse, interosseous membrane
Syndesmotic Ankle Sprain: MOI
- Forceful ER of foot
- Forceful eversion
- Forceful DF
Syndesmotic Ankle Sprain: PE
- Positive ER test and forced DF
- Palpation tender along interosseous
- Longer recovery expected
Ankle Sprains Grades of Injury
- Grade I: Minimal to no swelling, tender over ATF, return to full activity in 2 wks
- Grade II: Swelling, diffuse tenderness, slight laxity, return to full activity in 2-6 wks
- Grade III: Significant swelling, pain, ecchymosis, laxity, return to full activity > 6 wks
Chronic Ankle Sprains: Etiology
- 30%
- Recurrent ankle sprains
- Ligaments healed in lengthened position
- Peroneal muscle weakness
- Poor proprioception
Chronic Ankle Sprains: Hx
- Recurrent sprains
- Difficulty in cutting or jumping activities
- 'Giving way'
- Inability to run
Chronic Ankle Sprains: Interventions
- Taping or bracing
- Proprioceptive training
- Peroneal strengthening
Sinus Tarsi Syndrome: Overview
- Sequelae of inversion sprain
- Sprain of STJ
- Difficult to differentiate from ankle sprain
Sinus Tarsi Syndrome: Hx & PE
- Hx of inversion sprain
- Feeling of instability walking on uneven ground
- Pain over sinus tarsi
- Pain decreases with rest
Sinus Tarsi Syndrome: Interventions
- Steroid injections
- Address biomechanical deficits
- Surgical excision of tissue filling sinus tarsi
Cuboid Syndrome: Overview
- Subluxed cuboid from inversion/PF sprain
- Etiology: Midtarsal instability, pronated foot
- Professional ballet dancers
Cuboid Syndrome: Hx
- Previous inversion ankle sprain
- Localized pain: ATF and CF pain gradually subsides, calcaneocuboid joint pain unchanged or worsens
- Edema and ecchymosis
Cuboid Syndrome: PE
- Antalgic gait during push-off
- Distraction of calcaneocuboid joint (supination, ADD)
- Compression of calcaneocuboid joint (pronation, ABD)
- Joint play of calcaneocuboid joint
- Pain with resisted inversion and eversion
Cuboid Syndrome: Differential Dx
- Stress fx to cuboid
- Jones fx
- Tarsal coalition
- Fibularis tendonitis
- Sinus tarsi syndrome
- Extensor digitorum brevis tendonitis
Cuboid Syndrome: Interventions
- Modalities
- Arch taping
- Orthosis
- Cuboid whip HVT
Turf Toe: Overview
- Sprained plantar ligament of 1st MPT
Turf Toe: Hx & PE
- Onset: Forced DF of 1st MTP
- Pain and tenderness on plantar surface
- Toe-off reduced and painful
Turf Toe: Interventions
- RICE, especially rest
- Taping
- Grade II: Up to 2 wks off
- Grade III: Crutches and up to 6 wks off
Achilles Tendonitis: Overview
- 5-18% of running injuries
Achilles Tendonitis: Hx & PE
- High impact sports or shoe pressure
- Pain and tenderness of Achilles tendon: 2-6 cm superior to insertion, increases with WB
- Crepitus with AROM
- Excessive pronation
Achilles Tendonitis: Interventions
- RICE
- DFM
- Progressive stretching of Achilles tendon
- Eccentric loading of gastroc/soleus
- Heel lift (temporary)
Achilles Tendon Rupture
- Risk factors: Poor conditioning or flexibilty, advanced age, overexertion
- MOI: Sudden eccentric force, 'pop'
- Positive Thompson test or inability to PF
- Palpable defect
- Surgical repair
Retrocalcaneal Bursitis: Risk Factors
- Repetitive ankle use
- Excessive walking, running or jumping
- Shoes
Retrocalcaneal Bursitis: PE
- Increased inflammation on the skin over the calcaneus
- Increased symptoms while rising up on toes
Sever's Disease: Overview
- Children 8-15 yo
- Running and jumping activities
- Self-limiting disorder
- Stretching and activity reduction
Plantar Fasciitis: Overview
- Inflammation of the plantar aponeurosis
- Incidence > 2 million/yr
Plantar Fasciitis: Etiology
- Endurance sports: Prolonged standing or walking
- Excessive pronation
- Tight gastroc/soleus
- Obesity
- Footwear
- Nerve entrapment: Posterior tibial n.
Plantar Fasciitis: Hx
- Aching pain in plantar heel
- Worsens: First step in the morning, walking without footwear
Plantar Fasciitis: PE
- Pain with palpation over medial tubercle
- Pain with windlass mechanism
Plantar Fasciitis: Interventions
- Correct abnormal foot mechanics with orthoses
- Stretching: Gastroc/soleus, rolling pin
- IOP (analgesic injections)
- DFM
- Night splint
- Low-dye taping
Tibialis Posterior Tendonitis: Overview
- Tibialis posterior eccentrically controls STJ pronation
- Failure of midfoot 'locking' during push-off
- Endurance athletes with chronic pronation
Tibialis Posterior Tendonitis: PE
- Pain with PF and inversion
- Loss of inversion with toe raise
- Pain in arch or posterior to medial malleolus
Peroneal Tendonitis: Overview
- MOI: Forced inversion or chronic pronation
- Pain along peroneal muscle, especially posterior to lateral malleolus
- Pain with resisted foot eversion
Shinsplints: Overview
- Pain along the anterior or medial distal 2/3 of tibia
- Overuse of: Tibialis anterior, tibialis posterior, EDL or EDB
- Common early season condition
Shinsplints: Differential Dx
- Tibial stress fx
- Compartment syndrome
Sesamoiditis: Overview
- Inflammation of FHB surrounding sesamoids
- Pain and tenderness over sesamoids
- Pain with big toe extension
Peroneal Nerve Palsy: Overview
- Characterized by: Foot drop, decreased sensation
- Common causes: Trauma or injury to knee, fibular fx, tight plaster cast
- AFO
Tarsal Tunnel: Overview
- Region posterior to medial malleolus: Flexor retinaculum, calcaneus
- Tibial n.: Posterior tibial n., medial plantar n., lateral plantar n.
- Entrapment of tibial n. in tarsal tunnel
- Etiology: Excessive pronation, swelling, cyst, post-traumatic scarring
Tarsal Tunnel Syndrome: Hx & PE
- Plantar pain and paresthesia
- Positive tinel's sign
Tarsal Tunnel Syndrome: Interventions
- Modalities
- Steroid injection
- Correct abnormal foot mechanics
- Surgery
Morton's Neuroma: Overview
- More common in females
- Burning pain between metatarsal heads
- H/o chronic MTP extension
- Worsens: Tight-fitting shoes, high heels
- Better with rubbing forefoot