Age Related Joint Changes, Nerve Conditions, and Functional Testing

Question 1

What is the MOST common foot jt. to experience age related joint changes?

Answer 1

1st MTP joint

Question 2

When you load the 1st MTP joint in weight bearing what happens overall?

Answer 2

• 2x load of lesser toes
• 40-60% BW
• 1-2x BW with sports

Question 3

Where is the foot most rigid in gait?

Answer 3

More rigid for propulsion with greatest forces from just before heel off to toe off

Question 4

What is the etiology/ pathomechanics for age related joint changes in the foot?

Answer 4

• Longer 1st ray
• Excessive pronation
• Trauma
• Genetics

Question 5

What symptoms will you see with age related joint changes at the foot?

Answer 5

• Gradual onset
• AM stiffness < 30 min after static positions
• Dorsal joint P!
• Possible antalgic and/or asymmetrical gait, particularly on inclines

Question 6

What might you observe with age related joint changes in the foot?

Answer 6

• 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

Question 7

What gait observations might you see with age related joint changes at the foot?

Answer 7

• 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

Question 8

What will you see with ROM with age related joint changes in the foot?

Answer 8

• 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

Question 9

What will you see with combined motions with age related joint changes in the foot?

Answer 9

Consistent block

Question 10

What will you see with stress tests with age related joint changes in the foot?

Answer 10

Compression and distraction are possibly positive if symptomatic

Question 11

What will you see with accessory motion testing with age related joint changes in the foot?

Answer 11

Hypomobility of 1st MTP, with DF and/ or sesamoid bones

Question 12

Is POLICED helpful for age-related joint changes at the foot?

Answer 12

Yes

Question 13

What should you do for your age related joint changes patient in regards to their footwear?

Answer 13

• 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

Question 14

Should you provide you age related joint patient with an assistive device?

Answer 14

You can

Question 15

Is manual therapy effective for age related joint changes at the foot?

Answer 15

• MOST effective early in disease progression and with younger individuals
• Applied to MTP, sesamoids, and ankle

Question 16

What is MET used for with age related joint changes in the foot?

Answer 16

• Tissue integrity and mobility
• Address any impaired LQ control contributing to excessive pronation

Question 17

Are injections helpful for age-related joint changes at the foot?

Answer 17

• Poor quality of evidence to use
• Fair quality of evidence to NOT use

Question 18

What surgeries are done for age related joint changes at the foot?

Answer 18

• 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

Question 19

What is mortons neuritis/ neuroma?

Answer 19

• Overview- compression of interdigital nerve(s)
• Acute- inflammatory = neuritis
• Chronic- fibrous cyst = neuroma

Question 20

What is the etiology of mortons neuritis/ neuroma?

Answer 20

• Excessive pronation
• Small toe boxes with/without high heels
• Limited 1st MTP extension shifts load onto lateral foot

Question 21

What is the pathomechanics of mortons neuritis/ neuroma?

Answer 21

Excessive pronation leading to excessive inter-metatarsal compression

Question 22

What is another name for tarsal tunnel syndrome?

Answer 22

Posterior tibial neuralgia

Question 23

What is tarsal tunnel syndrome?

Answer 23

Entrapment of tibial nerve at flexor retinaculum/ medial malleolus

Question 24

What is the etiology/ pathomechanics of tarsal tunnel syndrome?

Answer 24

Excessive pronation leading to excessive tension and compression of the tibial nerve

Question 25

Is POLICED helpful for nerve compressions?

Answer 25

• Yes to POLI (NO C) ED
• Because compression is most often the cause

Question 26

Are JM, orthotics, and METs used with nerve compressions?

Answer 26

• Yes, to reduce compression by assisting with abnormal mechanics
• MET also helps to create neural motion/ flossing