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57 Cards in this Set

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FIVE FUNCTIONS OF THE FOOT

-Load-Bearing (vertical and shear forces)
-Provides mechanical advantage for leg musculature (propulsion)
-Absorbs and dissipates shock forces
-Aids in control of balance (fall prevention)
-Protection as source of sensory information from the environment

During locomotion, the foot is in what line of defense for force absorption...

The first line of defense

What creates a force couple of the foot during gait?

The tibialis anterior and posterior by drawing the arch proximally & superiorly (supination of the foot)

Categorize the motions of pronation and supination

Composite motions since the talocrural, subtalar, midtarsal joints and the distal tibiofibular syndesmosis contribute to these motions

Describe the foot when in supination

plantarflexion + adduction + inversion


(ankle rolls away from center, heel turns towards center)

Describe the foot when in pronation

dorsiflexion + abduction + eversion


(heel rotates away from center, ankle rolls towards center)

Define Closed Kinetic Change

distal segment of
the extremity is met with considerable external resistance

Implications of Pronation

Pronation of foot & ankle complex

--> Internal rotation of the tibia

--> Internal rotation of the femur

Implications of Supination

Supination of foot & ankle complex

--> External rotation of the tibia

--> External rotation of the femur

What is Morton's Foot (Morton's Toe)?

-Shortened 1st MT (giving
the appearance of an
abnormally long 2nd toe)


-Increases weight bearing through the 2nd toe/MT


-10% of the pop

Symptoms of Plantar Fasciitis

pain at origin of PF


pain/stiffness when waking up



heel pain during/after activity



pain with passive ankle dorsiflexion


pain in DF with passive toe extension

Treatment of Plantar Fascitis

‐stretching of foot/gastroc‐soleus complex (5 min, 2‐3xday)
‐soft tissue release (massage, Graston, golf ball rolling, etc)
‐longitudinal arch taping
‐ice cup massage with foot on stretch (post exercise)
‐Rx NSAIDS



Hallux Rigidus

“Stiff great toe”



‐involves progressive
degeneration of first MTP joint’s
articular surfaces
‐often bilateral condition,
genetic disposition
‐may progress to ankylosed joint

Hallux Rigidus S/S

‐ limited DF of
MTP joint
‐pain and swelling during/after
activity
‐impacts gait (toe‐off)
‐exostosis development possible
on dorsal aspect of MTP joint
‐associations: Morton’s toe

Hallux Rigidus Tx

‐Passive ROM and joint mobilization techniques
‐Orthotics to unload first MTP joint (decrease hyperextension)
‐turf toe taping (limiting DF)
‐corticosteroid injection
‐surgical intervention (cheilectomy: removal of distal portion of MT and exostosis)

Define Hallux Valgus

progressive degeneration and
subluxation of the first MTP joint

‐characterized by MTP joint angle >
20deg abduction
‐”valgus deformity”
‐associated with a bunion (exostosis)
on medial aspect of the joint

Hallus Valgus TX

‐appropriate shoes
‐felt pad between 2nd/3rd phalanges
‐turf toe taping: reinforcing
adduction, preventing abduction
‐NSAIDs
‐surgical intervention: changing
shape of the foot‐

Define Turf Toe

Sprain of the 1st MTP joint

Turf Toe MOI

foot is planted and ankle forcibly dorsiflexed,
creating hyperextension of great toe
‐not limited to athletes participating on turf
‐can also involve forced valgus or varus of the 1st MTP joint

Turf Toe S/S

‐pain during toe‐off (push‐off) during gait or quick
stops
‐pain with palpation
‐limited ROM of MTP joint

Turf Toe TX

‐rest and NWB‐PWB in acute stages (cam walker)
‐RICE
‐turf toe taping/strap
‐firm (graphite/steel) shoe inserts or fabricated
orthoplast insert
‐NSAIDs

Where can stress fractures occur?

distal tibia, midshaft of tibia, distal fibula
= Overuse injury

Stress Fracture S/S

‐focal pain on bone
‐pain during activity and at rest
‐’night pain’
‐positive “bump test” or “squeeze test” (not always sensitive in early stages)

Stress Fracture TX

‐rest!
‐walking boot (PWB to NWB depending upon severity)
‐modified conditioning to maintain fitness (Swim Ex or UBE, progressing to biking)
‐bone stimulator

Lisfranc Injuries


-joint involved?


-type of injuries?


-fracture dislocation?


-

tarso-metatarsal joint


Sprain, dislocation, fracture-dislocation


T-MT joint can be dislocated w/o fx

Lisfranc MOI

high energy axial loading of foot while distal segment is fixed
(e.g. being stepped on back of heel with foot planted)

Lisfranc Injury S/S

range to from subtle to obvious (pain, swelling, deformity, ecchymosis
on plantar surface) of midfoot
‐acute mid‐foot injury with pain should have f/up to r/o Lisfranc injury
‐Lisfranc fx: 2% of all fx, but often misdiagnosed

Lisfranc Injury Tx

Conservative:
‐NWB (non‐displaced injury)
Operative:
‐open reduction & internal fixation
‐8 weeks NWB (cast/splint)
‐Arthrodesis (surgical joint fusion) for ligamentous injury‐ worse case
scenario

Medial Ankle Spains


prevented by?


ligaments affected?

static stabilizers and joint configuration prevent excessive ankle eversion



deltoid ligament sprain = 3-15%


can be associated with syndesmosis injuries or malleolar fractures

Medial Ankle Sprains S/S

‐TTP medial joint line
‐diffuse ecchymosis and edema/swelling on
medial aspect of ankle
‐pain or laxity w/ Eversion Talar tilt test

Medial Ankle Sprains R/O

‐medial malleolus fracture (‘knock‐off fx’)
‐bimalleolar fracture (‘Pott’s fx’)

Lateral Ankle Sprain MOI (most common)

‐typically result of excessive supination (can injure talocrural and subtalar joints)
‐pure inversion: rolling over the lateral surface of the foot, stepping on uneven surface (e.g. first base) with the
ankle dorsiflexed
‐contact with another player (congested playing spaces!)

Ligaments involved in lateral ankle sprains

Anterior talofibular ligament most often injured (taut during ankle supination)
Calcaneofibular ligament injured with more significant inversion
Posterior talofibular ligament more commonly injured with inversion in dorsiflexed ankle

Lateral Ankle Sprain S/S

‐popping sound at time of injury?
‐TTP sinus tarsi area and lateral ligament complex
‐diffuse ecchymosis and edema/swelling (increases
with the severity of injury)
‐pain or laxity with Anterior Drawer test, Talar Tilt test

Lateral Ankle Sprain R/O

‐fracture (fibula, tibia, talus)
‐avulsion fracture (styloid process 5th MT)

Mechanical Instability

gross laxity of the talocrural or subtalar joints with clinical examination

Functional Instability

Hx of repeated ankle sprains but normal findings during ligamentous stress tests

Maisonneuve Fracture

R/o fx of superior portion of fibula with ankle sprains

Morton's Neuroma

= Intermetatarsal neuroma
‐typically entrapment of the 3rd common digital (plantar) nerve, located
between 3rd and 4th MTs

MOI for Morton's Neuroma

prolonged pressure of nerve resulting in formation of fibrotic nodules and
edema around the nerve
‐contributors: excessive pronation, improperly fitted shoes (too
tight/pointed, high heels)
‐Women > Men
‐high re‐occurrence rate

S/S for Morton's Neuroma

‐pain in transverse (metatarsal) arch of foot, radiating to toes
‐numbness into the toes


‐increased pain/numbness when pressure is increased in forefoot (standing
on toes) or with tight shoes
‐positive: increase in symptoms with metatarsal compression, Mulder sign


Tx for Morton's Neuroma

metatarsal arch pad
low‐dye taping (widens MT arch)
Lidocaine injection (diagnostic)
corticosteroid injection
modification of footwear
surgical excision

Achilles Tendinopathy

‐AT poor vascularity “distal avascular zone”
tendon twists and inserts slightly medially
on axis of subtalar joint (on calcaneus)
=Common site for achilles pathology:
tendinosis, rupture

What is Partenon?

highly vascularized layer surrounding AT
‐susceptible to inflammation
‐forms adhesions to underlying tendon
paritendinitis-->tendinosis-->tendon rupture

Tendinosis

degeneration of tendon midsubstance (often ‘silent’)
‐microscopic tears and necrotic areas
(visible w/ diagnositc ultrasound or MRI)

Precipitating Factors for Achilles Tendinopathy

‐previous ankle sprain?
‐hyperpronation
‐tibial varum
‐calcaneovalgus
‐achilles tightness
‐hamstring tightness
+ training errors

S/S for achilles tendinopathy

‐burning pain during activity
‐TTP
‐palpable nodule
‐visible thickening
‐crepitis with active movement
-Visible thickening and limited ROM (DF):

Tx for achilles tendinopathy

Eccentric training!
Improve limited DF ROM through stretching and tissue and joint mobilization
Taping
Surgery?

Define Achilles Rupture

Achilles tendinosis or paratendinitis may lead to rupture, but not necessary as precipitating factor
More common in males > 30 yrs old, but any population susceptible


MOI: forceful contraction (landing from a jump, sudden changes in direction)

S/S of an Achilles Rupture

‐loud pop (gunshot) at time of injury
‐visible defect in tendon
‐absence of palpable in‐tact tendon
‐positive Thompson test
‐can actively plantar flex (why?)
‐may be able to walk but cannot perform a single leg heel raise
‐excessive edema/ecchymosis

Achilles Rupture Management

Conservative:
Immobilization (cast or night splint) 8 weeks
Surgery:
Outcomes are better with surgical reconstruction compared to conservative management
‐lower incidence of re‐rupture
‐faster return to pre‐injury activity

Chronic Onset of Exertional Compartment Syndrome

‐S/S during or after exercise
‐Increased fascia thickness inhibits venous outflow but
not arterial inflow
‐anterior, lateral, or posterior compartments
susceptible


Acute Onset of Exertional Compartment Syndrome

‐same s/s as chronic w/o prior symptoms or history of
traumatic injury

Exertional Compartment Syndrome S/S

‐pain localized in compartment
‐possible numbness into the toes and/or dorsal and lateral aspect of foot (anterior or lateral CS)
‐decreased strength of muscles associated with the compartment
‐pain with passive ROM (would stretching make them feel better at time of symptoms?)
‐possible visible swelling in compartment
‐reduced or absent pulse (dorsalis pedis) in advanced/extreme cases

When is fasciotomy required?

Resting pressure > 15mm Hg (compared bilaterally if a unilateral problem)
> 30mm Hg 1 min post exercise
> 20mm Hg 5 minutes post exercise
Pressure = difference between diasolitic BP and intercompartmental pressure

Define Traumatic Compartment Syndrome

Medical emergency!
MOI: direct blow to anterior or lateral compartments of the leg
‐more common in the anterior compartment
‐may be present with tibia or fibula fracture


S/S: related to the 5 P’s
pain, pallor (reddness), pulselessness,
paresthesia, paralysis

S/S for Traumatic Compartment Syndrome

‐visibly swollen compartment, skin may appear shiny
‐compartment hard to the touch and TTP
‐may have inability to dorsiflex ankle or extend toes
‐pain with passive ankle ROM (plantar flexion if anterior compartment)
‐extreme pain with walking
‐may present with drop‐foot (why?)
‐check integrity of dorsalis pedis pulse
*do not apply compression wrap with this type of injury