Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
62 Cards in this Set
- Front
- 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 |
