Age Related Joint Changes, Nerve Conditions, and Functional Testing Flashcards
What is the MOST common foot jt. to experience age related joint changes?
1st MTP joint
When you load the 1st MTP joint in weight bearing what happens overall?
- 2x load of lesser toes
- 40-60% BW
- 1-2x BW with sports
Where is the foot most rigid in gait?
More rigid for propulsion with greatest forces from just before heel off to toe off
What is the etiology/ pathomechanics for age related joint changes in the foot?
- Longer 1st ray
- Excessive pronation
- Trauma
- Genetics
What symptoms will you see with age related joint changes at the foot?
- Gradual onset
- AM stiffness < 30 min after static positions
- Dorsal joint P!
- Possible antalgic and/or asymmetrical gait, particularly on inclines
What might you observe with age related joint changes in the foot?
- Hallux Valgus with possible excessive pronation leading to greater loading onto 1st ray
- Claw toe = MTP hyperext + IP flex
- Hammer toe = MTP hyperext vs. neutral + PIP flex + DIP hypertext vs. neutral
- Mallet toe = neutral MTP & PIP with flexed DIP
- Dorsal spur at 1st MTP
What gait observations might you see with age related joint changes at the foot?
- Antalgic and asymmetrical
- Possible hip ER and/or vertical limp or vaulting due to loss of motion at heel/toe off
- Excessive pronation and/or impaired LQ control
What will you see with ROM with age related joint changes in the foot?
- Capsular pattern of restriction for great toe is loss of ext > abd aka Hallux Limitus/Rigidus
- P! particularly into CPP of ext
- Need 65°hypertext for normal gait
What will you see with combined motions with age related joint changes in the foot?
Consistent block
What will you see with stress tests with age related joint changes in the foot?
Compression and distraction are possibly positive if symptomatic
What will you see with accessory motion testing with age related joint changes in the foot?
Hypomobility of 1st MTP, with DF and/ or sesamoid bones
Is POLICED helpful for age-related joint changes at the foot?
Yes
What should you do for your age related joint changes patient in regards to their footwear?
- Proper footwear including orthotics to unload involved cartilage and accommodate for deformities and impaired biomechanics
- Prevent and treat hallux valgus equal to sx
- Arch support
- Stiffer shoe with larger toe boxes
- Rocker bottom shoe
Should you provide you age related joint patient with an assistive device?
You can
Is manual therapy effective for age related joint changes at the foot?
- MOST effective early in disease progression and with younger individuals
- Applied to MTP, sesamoids, and ankle
What is MET used for with age related joint changes in the foot?
- Tissue integrity and mobility
- Address any impaired LQ control contributing to excessive pronation
Are injections helpful for age-related joint changes at the foot?
- Poor quality of evidence to use
- Fair quality of evidence to NOT use
What surgeries are done for age related joint changes at the foot?
- Past procedure involve- bone excision, and possibly arthrodesis aka fusion
- NEWER is a lapiplasty with a focus on 3-dimensional correction of dysfunction thru the mid-foot to better address the causative excessive pronation- better outcomes
What is mortons neuritis/ neuroma?
- Overview- compression of interdigital nerve(s)
- Acute- inflammatory = neuritis
- Chronic- fibrous cyst = neuroma
What is the etiology of mortons neuritis/ neuroma?
- Excessive pronation
- Small toe boxes with/without high heels
- Limited 1st MTP extension shifts load onto lateral foot
What is the pathomechanics of mortons neuritis/ neuroma?
Excessive pronation leading to excessive inter-metatarsal compression
What is another name for tarsal tunnel syndrome?
Posterior tibial neuralgia
What is tarsal tunnel syndrome?
Entrapment of tibial nerve at flexor retinaculum/ medial malleolus
What is the etiology/ pathomechanics of tarsal tunnel syndrome?
Excessive pronation leading to excessive tension and compression of the tibial nerve
Is POLICED helpful for nerve compressions?
- Yes to POLI (NO C) ED
- Because compression is most often the cause
Are JM, orthotics, and METs used with nerve compressions?
- Yes, to reduce compression by assisting with abnormal mechanics
- MET also helps to create neural motion/ flossing
