Ankle & Foot Dysfunctions (Lecture 2) Flashcards
Where is the sesamoid bone?
Plantar surface of distal part of 1st Metatarsal
Explain the windlas effect?
With toe extension the plantar fascia is pulled taut (makes it more rigid and larger)
What happens to the medial longitudinal arch in great toe extension?
The fascia tightens and causes the metatarsal heads to be depressed and the longitudinal arch to rise (windlass effect)
* causes the metatarsal heads to drop down which increases the distance of the bottom of the metatarsal from the navicular - which in turn increases the angle between the two which creates a larger arch (do it yourself)
What does plantar fascitis feel like?
First few steps feel like a sharp pain in the heel and then the fascia starts to loosen up
KNOW: hindfoot excessive motion (going into excessive proantion / supination) may cause plantar fascitis
Excessive loading can cause this
Heel spur
reptitive loading
High BMI
Limited ankle DF (makes the foot cominsate w/ that. excessive motion)
Where does the plantar fascia insert?
Medial tuberical of the calcenous (where pain is often felt)
What time of day is plantar fascitits pain felt?
In the AM
KNOW: More likely to get plantar fascitis if they have pes cavus or pes planus (note this is basically the same as them having increased supination or pronation as stated before)
Why would someone w/ plantar fascitits have pain w/ toe extension?
Windlas effect
Because as the toes are put into extension the plantar fascia is stretched
which 2 muscles being tight could lead to plantar fascitits? Why?
Gastroc / Soleus
Decreases foot DF which leads to needing more mobility at the foot which irritates that plantar fascia
KNOW: someone w/ plantar fascitits might have decreased intrinsic foot muscle strength thats causing that plantar fascia to have to compinsate causing their pain
What phase of gait would someone w/ plantar fascitits avoid? Why?
What position of gait might be early?
Heel strike
because thats where the pain is coming from
may also have decreased stance time on that limb
They would also have early toe off because they don’t want to stretch that plantar fascia (so their weight wouldnt be forward yet and those toes come off before that plantar fascia is taut)
Does surgery work well for plantar fascitits pts?
No
(they do a plantar fascia release but it is often not effective)
What 4 things do we do to treat plantar fascitits?
1) Stretching –> however, we don’t actually change the tissue but we get those psycological effects (neurlogic response which reduces pain)
2) Massage
3) Shoe modification
4) Strengthening
can also do taping / dry needling
there is a strong link between plantar fascities and ____
posterior tibia tendinopathies (often dry needle here)
Achilies tendinopathy also affects
What is a midportion achilies tendinopathies?
Just distal to the mid portion of the gastric
What is insertional achillies tendonpathy?
2-6 cm proximal to the achilies insertion on the calcaneous
KNOW: A midportion achilies tendonopathy is going to be treated more like a muscular issue than a tendonis issus (muscleular loading mechancis)
A proximal tendonpathy is treated more like a tendon issue (tendon loading mechanis)
Where does the achillies tendon insert?
Posterior gastroc
Pt has posterior foot pain, what kind of tendonpathy is most likely
Achilies tendonpathy