ANKLE/FOOT Flashcards
What are the three arches of the foot?
medial longitudinal
lateral longitudinal
transverse
What is the talometatarsal angle?
line along middle first metatarsal and line of talus on lateral foot
The talometatarsal angle is used to measure
pes cavus (high arch) and pes planus (low arch)
*determining flexible vs rigid arches requires comparing weight bearing and nonweight bearing
Achilles tendinopathy is defined as
painful overuse tendon condition
classified as tendinitis (overuse tendon injury with inflammation) OR tendinosis (tendon degeneration, no inflammatory cells)
Achilles tendinopathy is usually because of ____
excessive overuse
multifactorial causes
acute tendinopathy is usually caused by
trauma, muscle fatigue, excessive use
Primary site of achilles tendon injuries are proximal or distal to tendon insertion? Why?
just proximal to tendons insertion (2-6 cm)
*this is a region of hypovascularity, thus more easily injured
What is the physiological cause of achilles tendinopathy?
not clear/misunderstood. But mostly we know that tendon has failed to heal normally
What are the three muscles that are main stabilizers of the ankle?
fibularis long/brev, tib ant, tib post
What is responsible for pain present with tendinopathy?
increased neurovascularization and presence of increased neurotransmitters around tendon
Who most commonly gets achilles tendinopathy?
male teenage athletes (runners, jumpers)
11% runners, 9% dancers, 5% gymnasts
Achilles tendon injuries are usually due to ____ loading
excessive eccentric loading
*results from training errors, changes in training, increased distance, changes in terrain
What are foot/ankle related contributing factors to achilles tendinopathy?
PRONATION
pes planus (flat feet)
increased rearfoot mobility
weak calf muscles
poor footwear
changes in training program
What are systemic/medicinal/other contributing factors to achilles tendinopathy?
diabetes
obesity
steroid exposure (ligamentous laxity)
hypertension
quinolone antibiotics
What are common signs of achilles tendinopathy?
-pain at insertion site or just above (2-6 cm)
-swelling/thickening of tendon at site of injury
What 3 activities make achilles tendinopathy feel worse?
walking, running, jumping
What makes achilles tendinopathy feel better?
-rest
-NSAIDs (acute, not effective for chronic)
-heel lifts/walking cast boots to control pain with WB activities during acute phase
When do you consider achilles surgery for achilles tendinopathy?
when conservative treatment has failed
*for patients that undergo surgical repair, 75% have favorable outcomes, return to premorbid function.
Are NSAIDs helpful for chronic achilles tendinopathy?
No-found largely ineffective. Helpful for acute cases
Poor outcomes for achilles surgery are associated with what three factors?
age
intertendon lesions
partial tendon ruptures
How do you treat acute achilles tendinitis?
compression
cryotherapy
rest
heel wedge or walking boot
soft tissue mobilization
activity modification
How do you treat chronic achilles tendinopathies?
stretching
night splints
strengthening
orthotic therapy
biomechanical correction
sclerotic therapy
extracorporeal shockwave therapy (ESWT)
Besides stretching, night splints, and correcting abnormal foot mechanics, how do you rehab achilles tendinopathy? What kind of strengthening?
heavy-load eccentric strengthening/training program
What three abnormal foot mechanics predispose people to achilles tendinopathy?
excessive pronation
pes planus
excessive rearfoot motion