ankle and foot module 7 Flashcards
What is the MOI for capsular restriction?
post ankle immobilization: develops over time due to lack of movement through range
how do patients with a capsular restriction present?
capsular pattern presents during A/PROM assessment
complaint of stiffness
what is the definition of a capsular pattern?
a series of limitations of joint movement when the joint capsule is limiting structure… occurring only in synovial joints that are controlled by muscles and not in joints that depend primarily on ligamentous stability
what is the common restriction pattern at the talocrural joint?
PF is limited greater than DF
what is the common restriction patter at the subtalar joint?
limited varus/valgus PROM translation
what is the common restriction pattern at the transverse tarsal joint?
DF > PF > Add > medial rotation
what is the common restriction patter at the 1st MTP joint?
extension is limited greater than flexion
what is hallux abducto-valgus (HAV)?
inflamed and eventually thickened bursa inferior to MTP
tendinitis may develop in the flexor tendons of the great toe, with bunions, flexor and extensor tendons are misaligned creating more angular stress on the joint.
what deformities do we see because of HAV?
flattened transverse arch and a pronated foot
what are some signs and symptoms of HAV?
in the beginning of bunion formation there is tenderness swelling and enlargement of the joint
poorly fitting shoes increase the irritation and pain- as the inflammation continues, angulation of the toe progresses eventually leading to painful ambulation
what are some is hallux limitus?
stiff big toe or rigid first ray
arthritic degeneration of great toe
progression to bone spurs at first MTP joint
limited MTP joint mobility
bump or callus on MTP joint
altered mechanics during push-off phase of gait
what are some signs and symptoms of hallux limitus?
limited motion of MTP joint; decreased DF
pain, redness around joint
callus bunion on top of toe
feeling of hard-end during joint motion may indicate bone spur
what are some functional implications of hallux limitus?
pain with standing
pain in first metatarsal with walking
inability to wear high-heeled shoes that create extension at big toe
altered gait pattern and mechanical issues of the forefoot; increased supination and ER of foot for clearance; forefoot abduction with lateral whip
what are some differential diagnoses for hallux limitus?
hallux valgus
gout
osteochondrotic lesion of the 1st metatarsal head
sesamoiditis, turf toe
osteochondritis dissecans
metatarsalgia
metatarsal stress fracture
plantar fasciitis: patient may initially have more pain at medial arch due to altered mechanics
what is the treatment for Hallux deformities?
orthotics designed to reduce biomechanical forces leading to deformity
surgical realignment with bony osteotomy, debridement of joint, fusion of joints
what do are lesser toe deformities?
hammer toe
claw toe
mallet toe
what do lesser toe deformities result in?
corns, calluses, phalangeal joint pathology
what is the MOI for tarsal tunnel syndrome?
insidious, runners, RA
what are the signs and symptoms for tarsal tunnel syndrome?
difficulty localizing pain, diffuse burning, worse at night or when rest at the end of the day
what is tarsal tunnel syndrome?
compression of the posterior tibial nerve occurs proximally and therefore the whole foot can be affected. after the nerve passes distal to the tarsal tunnel one branch (calcaneal) continues to the heel, the other two (medial and lateral plantar nerves) continue on to the bottom of the foot
what is the MOI for distal tarsal tunnel syndrome?
> 9 months history of plantar fascia type pain that does not respond to typical treatment
what are the signs and symptoms for distal tarsal tunnel syndrome?
pain at medial calcaneal tubercle (similar to plantar fasciitis), decreased sensation at lateral heel
what are some special tests for distal tarsal syndrome?
unable to abduct the 5th digit
altered sensation
+ tinnels sign at baxters nerve = 1st branch off the lateral plantar nerve
what population do we typically see distal tarsal tunnel syndrome in?
40-50 year olds, long distance runners
what is the treatment for distal tarsal tunnel syndrome?
plantar fascia stretch, NSAIDs, orthodic (cupped heel with a relief channel for the nerve), no steoid injections
What is metatarsalgia (Morton’s neuroma)?
Growth of scar tissue from chronic irritation of compression
Most common area is between the third and fourth toes, but also can be in between the second and third toes
Involved a thickening of the tissues (neuroma) around one of the intermetatarsal plantar nerves
What is the MOI for metatarsalgia (Morton’s neuroma)?
Wearing high heels
Rock climbers with repetitive forefoot pressure
Higher risk for individuals with bunions and flat feet
What are some signs and symptoms for metatarsalgia (Morton’s neuroma)?
Burning pain in the ball of the foot
Numbness and tingling in the toes, especially between the third and fourth toes
Difficulty wearing/finding shoes, especially pointed ones
Limited motion of the MTP joint
What are some functional implications for metatarsalgia (Morton’s neuroma)?
Pain with standing
Pain with ambulation at the toe
Inability to wear regular shoes
Need to wear larger shoes with a larger toe box
Alteration of gait pattern and mechanical issues of the forefoot
Is the sural nerve sensory or motor?
Sensory
Where does the sural nerve cross?
Crosses the Achilles tendon form proximal-medial to distal-lateral. There exists a hot zone around a lateral border of the Achilles tendon approximately 9-12 cm proximal to the insertion of Achilles
If someone is experiencing pain on the outer border of their distal calf, lateral heel/foot what could it be?
The sural nerve
Where is pain for the deep fibular nerve?
Dorsal foot, pain/1st web space
Where is pain for the superficial fibular nerve?
Lateral lower leg, lateral border of foot
Where should we examine for peripheral nerve injuries?
Clear lumbar spine
Pain with palpación of entrapment
+ tinsels sign with tapping of nerve at entrapment
Pain with stretch, adverse neural tension
Quality of pain will often be burning
How do we conservatively treat peripheral nerve injuries?
Conservative treatment consists of orthotics, heel pads etc, cortisone injection, relative rest
How do we surgically treat peripheral nerve injuries?
Attempt to eliminate offending tissue
What are foot conditions related to diabetes mellitus?
Concurrent neurological and circulatory involvement
Sensory loss
Motor weakness leading to toe deformities, pes cavus foot type
Plantar metatarsal fat pads migrate distally, no longer protecting the met heads
How commonly do foot ulcers from excessive pressure develop?
Accounting for 20% of all diabetic hospitalizations and 5-70% of all non traumatic and amputations performed annually
What is Charcot joint?
Aka neuropathic joint
Refers to a progressive degenerative joint disorder when the patient has peripheral neuropathy and impaired proprioception. Most commonly occurs in the foot
What are some treatments of diabetic foot ulcers?
Prevent tissue ulceration through patient education
Protect plantar surface with full contact soft orthotics, accommodative padding
Custom shoes if necessary
Wound care
What are some signs of Charcot foot of tarsal bones?
A red, hot, swollen foot (without a foot ulcer) and increased skin temperature in the affected foot (compared with the other foot). Care need to be coordinated with physician
Why do patients with Charcot foot in the tarsal bones “offload”?
Helps prevent inflammation and stops the condition form getting worse and prevents deformity
What is a treatment for Charcot foot of the tarsal bones?
Protected weight-bearing (walking in a walking boot)- in later stages can prevent complications from the existing deformity and avoid new deformities
What is another treatment for Charcot foot of the tarsal bones?
Serial casting- stabilizes 8-12 weeks. Crutches, knee walker or a wheelchair are sued to avoid putting any weight on the affected foot. The cast is changed several times as the swelling in the foot goes down. The casting continues until the redness, swelling, and heat are resolved
