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83 Cards in this Set
- Front
- Back
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Footwear problems with plantar fasciitis
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Medial Midsole compressed, well-worn running shoes
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Strain to Plantar fasci is caused by
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Lack of DF
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Objective signs of Plantar Fasciitis - Palpation
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Palpation tender along plantar fascia, medial calcaneal tubercle
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Objective signs of Plantar Fasciitis - Flexibility Issues
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Decreased DF, Decreased Plantar flexor flexbility, Pain with toe extension
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Muscle Weakness with Plantar Fasciitis
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Tib Post
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Structural foot issues with Plantar Fasiciitis
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Excess pronation due to rearfoot varus, forefoot varus
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Differential Dx of plantar fasciitis
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Tarsal Tunnel Syndrome,
Bruised heel, Calcaneal Stress Fx |
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Tendinitis's that are Diff Dx of plantar fasciitis
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Tib post, Peroneus Longus
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Impairments with Plantar fasciitis
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Morning pain, pain with walking, increased pronation, decreased flexibility of PF, Pain with heel rasie
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What causes stress/strain to plantar fascia
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DF with toe extension
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Plantar fasciitis Tx - 1st 2 Weeks - What orthotics are appropriate?
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Orthotics= OTC, Heel Lift, Night Splint
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Night Splint function
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Keep foot in DF thru night to help maintain slight stretch on Plantar fascia
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Modalities for Plantar fasciitis Tx in the first two weeks
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Ice Massage, US, Soft Tissue Massage= Deep Friction Massage, Iontophoresis, Phonophoresis, NSAIDS, ECSWT
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What is ECSWT
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Extracorporeal Shockwave Therapy is a high intensity US and is done in MD office. It is similar to Deep friction massage
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When strengthening TA what postion does foot need to be in?
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PF so there is no stress on Plantar Fascia
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To minimize stress on plantar fascia when stretching PF - foot should be in this position
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No toe extension, decrease pressure on forefoot= NWB stretch, Maintain supination
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Mechanism for heel lift to help with plantar fasciitis
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Puts forefoot on a more PF position to help in gait when tibia is coming over foot (foot don't have to DF as much
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Aspects in pt history leading to idea of Tendinitis
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Overuse, Pain with activity and decreases with rest, NSAIDS help, Insidious Onset
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Pain with Active Contraction/Passive Stretch
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Tendinitis
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Pain increasing with Stance Phase
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Tendinitis of plantar flexor - but cannot indicate which one
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Where is Critical Zone of Avuscularity
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2-6 cm above calcaneus
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What is Critical Zone of Avascularity
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Decreased blood flow to achilles tendon. Classic area to look for tendinitis
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Insertional Tendinitis
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Is not common
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Paratendonitis
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Inflammation around paratendon
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Tendinosis
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Degeneration in the tendon
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A firm nodule is present with
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Tendinosis
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Modality commonly used with tendinosis
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US
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Longitudinal arch is supported by
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TA, TP, FHL, FDL, PL
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Diff Dx of Tendinitis
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Tarsal Tunnel Syndrome, Ostrigonum, Sever's Disease, Haglund's Deformity
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Ostrigonum
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Post lat tubercle of talus either breaks off or is congentially not there- is an accessory bone
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Ostrigonum
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Active or Passive PF causes posterior pain with this
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Sever's Disease
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Calcaneal apophysitis- growth plate is irritated and inflammed
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Haglund's Deformity
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Prominence of Post Superior calcaneal tuberocity
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Impairments with tendinitis
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Pain= pass stretch/ act contraction, pain with walk/run, decreased flexibility
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Eccentric Protocol is used for what
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Tendinitis at foot/ankle
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Eccentric Protocol
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Concentric contraction with heel raise of both legs, eccentric contraction of involved leg only with lowering of the foot
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Eccentric Protocol Dosage
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3 sets, 15 reps, 2x day, 7 days/wk, for 12 wks
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Key for Eccentric Protocol
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Add weight to cause pain and only stop if pain is debilitating
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Achilles Tendon Rupture Occurs in what group of people
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30-50 YO, Recreational Athlete
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Platelet Rich Plasma
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Plama spun from blood - rich in platelets, injected into area that needs to heal.
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What in PRP accelerates healing
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growth factors & cytokines attract macrophages & stem cells accelerate healing
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Why should AROM begin in Acute phase of Achilles Tendon Rupture
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Only in early motion. It increases blood flow, maintains mm strength, limits loss of motion
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Ankle position used for DF isometric exercise
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PF bc it decreases strain on the muscles
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Open pack postion of ankle
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PF and IN
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Ankle sprained with what position
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PF and IN
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Typical Ligaments injured in Ankle Sprain
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Ant. Talofib and CF ligaments
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Ligaments injured in high ankle sprain
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Post and Ant Tibiofibular Lig
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This lig is typically not sprained
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Deltoid
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Positive Tests for Ankle Sprain
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Ant Drawer, Talar Tilt
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Diagnosis for Ankle Sprain
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MOI, Swelling over lateral malleoulus and lat sinus tarsi
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Reason for ordering Stress X-Ray
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Pain with WB, 6" above med & lat malleoli, styloid of 5th, swelling occurs quickly, eccymosis
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Diff Diagnosis seen with Stress X-ray for Ankle Sprain
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Growth Plate Fracture at fibular head
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Grade I Sprain
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No Instability. Little bruise/swelling, 1 lig partially torn
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Grade II Sprain
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2 Lig partially torn, Swelling/bruising, + Ant Drawer/ Maybe + Talar Tilt
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Grade III Sprain
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Complete lig tear. + ant drawer/ + talar tilt. Lots of instability
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Osteochondritis Dissecans, Talar Tibial Impingement
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Diff Dx of Ankle Sprain
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Osteochondritis Dissecans
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cartilage lifted off bone. Happens in talus due to shearing or compressive forces
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Talar Tibial Impingement
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Spurs Develop anterior tibia
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Talar Tibial Impingement
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Impingement of Talus Anteriorly on tibia. Pain anterior and occurs with DF. Lat x-ray shows spur on ant tibia
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Trimalleolar Fracture
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Posterior Part Tibia Is Fractured
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Medial Tibial Stress Syndrome
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Shin Splints
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Shin Splints
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Stress Fx, myositis, periostitis, tendinitis, compartement syndrome, fasciitis, ischemic disorders
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Symptoms MTSS
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Hurt with stretch/ contraction. Pain with Pass DF/ Act PF. Hopping, run, walk all hurt
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Causes MTSS
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Change in training
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Pain location with MTSS
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medial distal 1/3 of tibia
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Gait Deviations with RA
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Collapsed arches & are rigid thus flat foot, No control over toes = significant degeneration at MTP jts. DF occurs at midfoot insead of ankle
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Hallux Abducto Valgus, Hammer Toe, Claw Toe, Hallux Rigidus
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Toe Problems with RA
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Hallux Abductor Valgus
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ABD toe at MTP jt
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Causes of Hallux abd Valgus
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Footwear (pointed toe shoes), Foot type (over pronated)
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Hammer Toe
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Normal MTP jt, toe is on the ground
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Claw Toe
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Flexion of IP joint, Extension of MTP
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Hallux Rigidus Causes
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RA, Gout, OA
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Forefoot Problems with RA
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Metatarsalgia, Morton's Neuroma
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Metatarsalgia
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Pain ball of foot
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Metatarsalgia Causes
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RA, Pes Cavus, decreased flexibility of platar flexors, tight fitting shoes, over pronating foot
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High arch in foot where pressure is created at met heads and heel
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Pes Cavus
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Morton's Neuroma Irritates Nerves between which toes
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3 and 4
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Morton's Neuroma Symptoms
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Stinging, Burning, Parathesia, numbness,
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Symptoms of Morton's Neuroma Relieved with
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rest/ staying off feet
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Symptoms of Morton's Neuroma Worse with
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Standing, walking
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Midfoot Problmes with RA
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Pes Planus
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Rearfoot Problems with RA
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Subtalar Pronation, Bursitis, tendinitis, bone spurs
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Types of Bursitis in Foot
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Superficial Calcaneal Bursa and Retrocalcaneal Bursa
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