Ankle And Foot

Front 1

Retrocalcaneal and Calcaneal Bursitis: FAQ

Back 1

· Location-retro calcanealswelling will be deeper than calcaneal.

· Can be associated with anAchilles tendonopathy-microtrauma

· Increased in women and athletes

· Poor shoes-microtrauma

· Trauma- being kicked (soccer),hit with a hockey stick etc. Can be combined with tendon tears

· DDx- Achilles tendon syndromesand avulsion fractures.

Front 2

Retro calcaneal and Calcaneal Bursitis: Ex

Back 2

· Inflamed, swollen, tender

· Limp, decreased ROM (due topain)

· Influence of shoes

· Differentiate pain andswelling- inflammatory of the bursa with non-inflammatory tendon, orcombination of swelling between the structures. Can get an ultrasound to assessthe different layers of tissue

· Toygars Triangle- between the Achillestendon, calcaneus and leg bones

Front 3

Retro calcaneal and Calcaneal Bursitis: Tx

Back 3

· Aim is to ensure properfunction

· Muscle balance produced by thebursa-

· Adjustments- posterior tibia,superior or inferior tibia, calcaneus (drop piece, talus separation)/kineticchain adjustment (pelvis and hip)

· Ice/ice-massage, laser,ultrasound- anti-inflammatory

· Heel lifts, shoe changes-silicon based heel cups

· Exercise and ice (as apreventative measure)

· Nutrition

· Relative Rest

Front 4

Sever’sDisease (Traction Apophysitis): FAQ

Back 4

At the growth plate of the calcaneus-posterior calcaneus at the insertion of the Achilles tendon

8-10 years old, most common

Acute/Chronic/Acute exacerbation of achronic problemRadiographs- can show fragmentation at thesecondary growth center, this can be a normal variation

Front 5

Sever’s Disease (Traction Apophysitis): Ex

Back 5

· Pre-pubescent to adolescent(most common)

· Pain can be aggravated byshoes, running activities (track and filed, court sports) and standing on toes(dancing).

· Walking may be okay

· Static palpation- swollen ortender posterior calcaneus

· Muscle testing + (as well asstanding on toes)

· Diagnostic imaging can confirmdiagnosis, only send for radiographs if the child it not improving (x-ray,ultrasound)

Front 6

Sever’s Disease (Traction Apophysitis): Tx

Back 6

· Self-limiting- might flare upless often as they get older (teenage) depending if they rest or keep playinghigh level sports, pain won’t go away until they get fusion

· Curtail physicalactivity/relative rest

· Increase heel height-shoes/heel cup

· Kinetic chain function

· Muscle balancing

· Physiological therapeutics-ice, ice massage- can’t use ultrasound at a growth center (it creates motion ofsound waves throughout tissue causing the surfaces of the growth plate to heatup, this motion moves fluid and can decrease inflammation, this can be irritatingto the growth plate)

· Tape Achilles- strap across thecalcaneus from one side to the other

· Anti-inflammatory and nutrition

Front 7

Tarsal Tunnel Syndrome: FAQ

Back 7

· Most commonly caused byspraining an ankle (sport)-high leverage inversion sprains, flexor retinaculumdamage, bone will fracture before ligament tears.

· Structures of the tarsal tunnel

· Entrapment neuropathy,swelling, damage to the flexor retinaculum

· Valgus deformity- recurrenttrauma, post-traumatic scar or adhesions, venous engorgement

· Excessive pronation- may haveadapted as they have grown up

Front 8

Tarsal Tunnel Syndrome: Assessment

Back 8

· Parasthesia or pain on thebottom of the foot or toes

· May get pain referring up theback of the leg and into the medial compartment

· Trauma-inversion, eversionsprains

· Walking or stamping action canrelieve symptoms

· Claw toes

· Venous signs and symptoms

· Increased pronation assessmentTesting- Tinel’s, tourniquet test, sensory testing + (a pinwheel mightbe to over sensitive), weak toe flexion, atrophy (particularly if the tibialnerve has severe damage), nerve conduction

Front 9

Tarsal Tunnel Syndrome: Tx

Back 9

· Adjust- posterior calcaneus,mid-foot and forefoot subluxation, tib/fib, knee, hip, pelvis and spine(kinetic chain) and mobilizations

· Muscle balancing

· Re-renforce with exercise

· Drainage, soft tissue, TP/MFRintrinsic

· Nutrition- magnesium etc.

· Relative rest- relievestressors from the nervous system. Frequency, type, lower intensity/level. Workon them improving and getting progression