25_26- Foot/tibia disordera Flashcards
what is metatarsalgia
- sharp/aching/burning pain in forfoot
- worse when standing/walking/running
- a sharp/shooting pain that pt describes having a pebble in shoe
what is metatarsalgia
- sharp/aching/burning pain in forfoot
- worse when standing/walking/running
- a sharp/shooting pain that pt describes having a pebble in shoe
risk factors for metatarsalgia
- intense training (run)
- high arched feet/low arched
- tight pot compartment mm
- mortons/hammer toes
3 types of metatarsalgia
A. Impact pain
B. Stress fx
C. Mortons neuroma
mechanopathlogy of mortons neuroma
occurs as a result of compression of interdigital nerve against the distal end of the superficial transverse metatarsal lig during dorsiflex
mc loc of mortons neuroma
Mc occurs between 3rd and 4th metatarsals
2/3, 5/5 after
causes of mortons neuroma biomechanically
- overpronation results in loss of transverse arch which produces mechanical irritation to digital branches
- mc in women believed to be caused by high heal shoes
histopathological causes to mortons neuroma
- deg changes (mucoid degenerative) are notes
- mucoid deposition in confined space results in increased pressure
- leading to ischemic compression/demylenation.axonal damage
conservative tx to general metatarsalgia
- rest from aggravating activity
- stretch post compartment mm
- control over pro
- Stay away from positive heal
- orthotics (metatarsal pad)
risk factors of plantar facciitis
- obesity/reduced ankle dorsiflexion
- associated w tight achilles
- associated with pes plants and pet caves
characteristics of plantar fasciitis syndrome
- Am pain and stiffness
- medial heel pain w weight bearing
- w walking pain decreases but can reoccur later in day
Why shoudnt it be called plantar facciitis
its aponeurosis and histologically no inflammation
what does low arched foot cause in windlass effect
tension in plantar fascia has to be higher to get equal rot
plantar fasciitis pathology
- deteriorated collageen fibres, increased secretion of ground substance pros, fibroblast proliferation and neovascularization
- believed if you can prevent the neovascularization you will stop the infiltration of nerves that accompany the blood vessels and hence stop pain
foot orthosis an corticosteroid for plantar faccits
both can lead to decreased pain associated w plantar fasciitis
what actually is achilles tendinosis
no inflammation
-biopsy revealed disorganized and degenerate collagen fibres
mechanism of achilles tendinitis injury theories (4)
- soleus portion which wraps around gastro portion strangles the tendon and injuries it
- Poor blood supply prevents healing (then neovascularization occurs)
- Whipping action causes by overpronation/oversupination
- rapid eccentric action followed by rapid contraction action (toe off)
clinical causes of achileies tendinosis
- racing in heel less spikes/ low heeled shoes
- worn out runners
- excessive pronation
- take off supination
conservative approach to achileases tendinosis
- stop running (for at least 7-21 days)
- do other execises
- stretch
- strengthen
how should strengthen + stretch in achilles tendonopathy be done
- stretch should be done for 10-20mins per day
- very painful to begin with
- eccentric heel lowering to strengthen (concentrate on the eccentric portion, not on the heel raise)
grade 1 achilles tendonpathy
- rest one week before resuming normal schedule
- stretch calf 20 min/day
- add 7-15mm heel raise
- cross friction to tendon
grade 2 achilles rehab (running pain not affecting performance)
- approach as per grade 1
- reduce speed work, hill running, long runs and weekly distance
- orthotics
- cross-frriction
grade 3 achilles tendonopathy rehab (running pain affecting performance)
- approach as grade 1/2
- rest for 3 w
- after 3 w (resume jogging, cycle, or swim)
- resume serious running after injury reverts to grade 1
running shoe tx for achilles tendonopathy (4)
7-15mm heel raise on outside or inside
- ridgid heel counter
- vertical achilles pad
- rigid midsole material
primary postulated effect of foot orthoses on achilles tendinopathy
effect of foot orthoses on achilles tendinopathy relates to kinematic change and not distribution of plantar pressures, so we doubt this would have an sig effect
definition of medial tibial stress syndrome
pain along posteromedial border of tibia that occurs during exercise, excluding pain from ischemic origin or signs of stress fracture
role of tibia post (2)
- decelerate subtler jt pronation during stance phase (eccentric action)
- To return the subtler jt to neural after pronation (concentric action)
traction theory of medial tibial stress syndrome
tib post actively tractions the periosteum which leads to inflammation and eventual bone
tibial bowing theory of MTSS
ability of calf mm to cause repeated bending or bowing of the tibia, thereby causing a stress rxn and periosteal rxn
(military recruits w MTSS has a lower cross sectional cortical area compared w similar subjects)
risk factors of MTSS
- pronation
- navicular drop >6.8mm
- more rear/forfoot varus
- running < 8.5 y
