Regional Foot Pain 2: Mid Foot

Front 1

What does the mid foot involve i.e bones

Back 1

• Cuboid, navicular, cuneiforms and surrounding tissue

Front 2

List 2 common, 2 less common and 1 not to be missed form of mid foot pain

Back 2

Common:

• Acquired adult flat foot deformity
• Tendinitis (Extensors and PT)
• Lis Franc #

Less Common:

• Stress fracture (cuneiform, cuboid, 2nd met base)
• Cuboid Syndrome

Not to be missed:

• Osteoid Osteoma (bone cancer)
• CRPS

Front 3

Difference between a sprain and a strain?

Back 3

• Sprain= ligaments and other soft tissues
• Strain= tendons

Front 4

Describe Adult acquired flat foot deformity?

also known as tibialis posterior dysfunction

Back 4

• Progressive flattening of the MLA
• presents as pain along tendon and progresses to deformity if not dealt with

Front 5

Most common aetiology of AAFFD and Dx

Back 5

• Tibialis posterior dysfunction- pain between M.mall and navicular, with be a lump of swelling on PT insertion and inability to complete single leg raise

Front 6

Tx of AAFFD

Back 6

• Physio
• Taping
• Orthoses
• Shoe wear modification i.e raised on effected side

Front 7

Describe Tendinitis/opathy of Extensors and Tibialis anterior, Dx and Rx

Back 7

• Caused by prolonged stretching of tendon
• most common in mid foot
• Dx palpation, passive and resisted motion
• Rx manage inflamation i.e NSAIDS, correct biomech abnormalities, concentric and eccentric exercises

Front 8

Describe Lis Franc #

Back 8

• **Injury, dislocation and # of 1 or more of the tarsal in relation to mid foot junction
• Generally traumatic

Front 9

3 classifications of Lis Franc Dislocation/#

Back 9

1. Homolateral: All 5 MT are displaced in same direction (car)
2. Isolated: 1 or 2 MT displaced from others
3. Divergent: MT are displaced in sagittal or frontal plane- some one way some another

Front 10

Describe a sprain and the 3 classifications?

Back 10

• Damage to 1 or more ligaments in a joint- sharp pain
• 1st degree: the fibres of the ligament stretched but intact (swollen)
• 2nd degree: partial tear
• 3rd degree: complete rupture of ligaments often involves avulsion fracture

Front 11

What is most common ankle sprain?

Back 11

Lateral ankle ligaments- inversion sprain

Order most likely to tear

1. anterior talo-fibular ligament
2. calcaneo-fibular ligament
3. posterior talo-fibular ligament

Front 12

Describe Medial ankle sprain

Back 12

• Caused by eversion sprain
• Frequently the spring ligament (above the PF) or deltoid
• Localised tenderness and limited MT ROM

Front 13

Rx for ankle sprains

Back 13

• Taping
• Orthoses
• NSAIDS
• CC.steroids

Front 14

Describe stress #

Back 14

• Trauma to the bone, overuse injury or pathological concerns
• Due to repetative loading/stress i.e jumping motion
• X-ray will show 'fluffing' around bone
• Insidious onset, painful overtime but decrease with rest
• Difficult to image

Front 15

2 most common mid foot bones to stress #

Back 15

• Navicular and MT

Front 16

Describe cuboid syndrome, symptoms, ass factors, Dx and Rx

Back 16

• Subluxation of cuboid (partial/incomplete dislocation)
• Slips out of original place
• Pain with L WB
• Ass with Peroneal tendinopathy, excessively pronated feet or lateral instability
• Dx Tell toe flat spot on plantar surface of foot
• Rx reduce subluxation, manage inflam

Front 17

Describe Kohlers Disease

Back 17

• Temporary avascular necrosis of the navicular bone- loses blood supply
• Gradual pain on M aspect of foot
• 3-7 year olds >boys

Front 18

Symptoms of Kohlers Disease

Back 18

• Painful limp
• shifting weight to lateral edge to relieve pressure on LA
• Pain and tenderness
• Swelling in navicular region
• Contraction of PT may be painful

Front 19

Pathogenesis of Kohlers Disease

Back 19

• Nav subject to repetitive compressive forces- risk factor for AVN
• Last bone in foot to ossify, more vulnerable to compressive damage

Front 20

Rx of Kohlers

Back 20

• Self limiting, prognosis is excellent
• Bone typically regains normal shape before foot completes growth
• Rx- cast (WB or NWB), rest , orthoses

Front 21

What is most common ankle sprain?

Back 21

Lateral ankle ligaments- inversion sprain

Order most likely to tear

1. anterior talo-fibular ligament
2. calcaneo-fibular ligament
3. posterior talo-fibular ligament