34_35- shoe fit/entrapment

Question 1

What time of day is most ideal for fitting shoes?

Answer 1

End of day (feet swell at the end of the day)

Question 2

Loose fitting shoes usually result in _____________ of toes

Answer 2

Clawing - because you are pushing your toes against the roof of the shoeq

Question 3

What part of an old shoe is most useful for assessing fit?

Answer 3

The liner/sole - can remove from shoe and check for how well the foot fits the shoe

Question 4

When you remove the liner from a shoe and have the patient stand on it, how much room should there be from the end of the longest toe to the end of the liner?

Answer 4

A finger’s width (1/4 - 1/2 inch)

Question 5

When and why should a shoehorn be used to put shoes on?

Answer 5

Always! Helps prevent breakdown of the heel counter. Pushing the foot over the counter will break it down in a matter of weeks

Question 6

True or false: You notice that the laces on your patient’s shoes are 4 finger widths apart. You should advise the patient that their shoes are too narrow.

Answer 6

True - should be 2 finger widths apart

Too close = shoe is too wide
Too far = shoe is to narrow

Question 7

A patient reports that their feet slip around in their shoes. To help reduce slippage, you advise them to (under/over) lace their shoes

Answer 7

Under

Question 8

One of your patients has diabetic feet. As part of the education component of treatment you advise them to do all of the following except:
A) Check their feet periodically for redness
B) Check the shoe each day to confirm no foreign object is in the shoe
C) Check the sensation in their feet at least once a week using a tuning fork to see if sensation has changed
D) Check that their toes are in straightOne of your patients has diabetic feet. As part of the education component of treatment you advise them to do all of the following except:
A) Check their feet periodically for redness
B) Check the shoe each day to confirm no foreign object is in the shoe
C) Check the sensation in their feet at least once a week using a tuning fork to see if sensation has changed
D) Check that their toes are in straight

Answer 8

C

Question 9

How long should the “break-in period” of shoes be? Are there any exceptions?

Answer 9

Break-in period should not be necessary if shoe fits well! Snug is ok, pinching is not.

Exception: if patient was in a cast, should wear shoes for 1/2 day for 2 days, then 3/4 day for 2 days, then full day

Question 10

How often should people replace their shoes if they are wearing them an average amount?

Answer 10

Once per year

If patient is >250lb, should replace every 6months

Question 11

How often should runners replace shoes?

Answer 11

Approx every 3-6months

Around 800km of use

Question 12

What are the contents of the Tarsal Tunnel?

Answer 12

Tib post, FDL, Post tib a, Tib n, FHL

Tom Dick And Not Harry

Question 13

The tibial nerve is bordered within the posterior tarsal tunnel by which 2 structures?

Answer 13

Post tib a.

FHL

Question 14

What makes up the roof of the tarsal tunnel?

Answer 14

Flexor retinaculum

Question 15

S&S of tarsal tunnel syndrome

Answer 15

Burning, tingling, numbness in heel, medial and lateral forefoot

Question 16

Tarsal tunnel syndrome tends to be aggravated by sitting or standing?

Answer 16

Standing - causes overpronation, leading to increased tautness of flexor retinaculum

Question 17

Which of the following muscles could entrap the lateral plantar nerve?
A. Abductor hallucis
B. Quadratus plantae
C. Flexor digitorum brevis
D. Flexor digitorum longus

Answer 17

A, B, and C

• Abductor hallucis (not in the diagram) resides over the lateral plantar nerve as it crosses over
• Lateral plantar nerve crosses from the medial to the lateral side of the foot, crossing over the quadratus plantae
• Flexor digitorum brevis resides over the lateral plantar nerve

Question 18

S&S of lateral plantar nerve entrapment

Answer 18

• Medial heel pain that comes on with brisk walking/joggging
• Burning & tingling in lateral aspect of forefoot
• Common in runners, ballerinas, gymnasts

Question 19

What is the etiology of lateral plantar nerve entrapment? How is it treated?

Answer 19

Hyperpronation and hypertrophy of AdH, QP, and FDB

Treated with orthotics to reduce overpronation

Question 20

Which muscles can compress the lateral or medial plantar nerve?
A. Flexor digitorum brevis
B. Abductor hallucis
C. Quadratus plantae

Answer 20

B

Medial plantar nerve resides over the tendons of FHL and FDL. AdH resides over the medial plantar nerve.

Question 21

What is “Jogger’s foot”? What are the S&S?

Answer 21

Medial plantar nerve entrapment

Tenderness and Tinel’s sign along AbH
Dysthesia along plantar aspect of 1st and 2nd toes

Question 22

What is the treatment for Joggers foot?

Answer 22

Removal of orthotic (if orthotic is problem - tends to compress medial aspect of arch)

Can also include NSAIDs or anti-inflammatory injections

Question 23

True or false: Anterior tarsal syndrome results from compression of medial branch of the deep fibular nerve

Answer 23

True

Question 24

Which of the following are potential points of entrapment of the deep fibular nerve in the anterior tarsal tunner?

A) EHB tendon
B) EHL tendon
C) Extensor retinaculum
D) Fib Tertius tendon

Answer 24

A, B, and C