Ankle/Foot Muscle Performance Deficits Flashcards
What will you typically hear in the Hx of those patients with this impairment?
- Insidious onset
- Localized pain and swelling
- Pain worse at the beginning and end of physical activity
- Morning stiffness and pain (Worse after activity)
- Relief when stopping painful activity
What is Achilles Tendinopathy?
This is activity-limiting pain located at midportion or insertion of achilles tendon
- Those with midportion achilles pain present with Sx with pain localized between 2-6cm from calcaneal insertion
- Those with Insertional achilles pain present with Sx with pain located within 2cm of insertion
What are the Risk Factors of Achilles Tendinopathy?
- 30-50 years old
- Male
- Sport-specific activities (Rock climbing, soccer, running)
Others:
- Obesity, rigid footwear, prior injury, decreased PF strength, history of fluroquinolones
With the DD of Achilles Tendinopathy, what are Red Flags to look out for?
- Compartment Syndrome
- Deep Vein Thrombosis
- Vascular Insufficiency/Claudication
With the DD of Achilles Tendinopathy, what are the Neuromusculoskeletal Disorders that should be considered?
- Acute Achilles Rupture
-Sensation of “pop” at time of injury
-(+) Thomas Test - Plantar fasciitis
- Lumbar Radiculopathy
- Retrocalcaneal bursitis
With Achilles Tendinopathy, what are Key Objective Findings during the Physical Examination?
- (+) Palpation
-This will help with the Midportion vs. Insertional - (+) Arc Test
- (+) Royal London Hospital Test
- Insertional Tendinopathy may present with Haglund’s deformity
What is the Prognosis for those with Achilles Tendinopathy?
- For Runners:
-Mean time = 82 days of recovery
-May be longer with worse initial Sx - For Elite Male soccer players
-Mean 23 missed days
-Has high recurrence rate
What is Tibialis Posterior Tendinopathy?
A continuum of disorders due to dysfunction of posterior tibialis muscle-tendon unit
- Dutton Def.: A complex disorder of the hind foot, beginning with synovitis, followed by tendinosis, which can potentially culminate in a rupture
What are the Risk Factors for Tibialis Posterior Tendinopathy?
- Middle-aged female (< 40)
- Obesity
- HTN
- DM
- History of steriod use
- Prior trauma
What is the DD for Posterior Tibialis Tendinopathy?
- Lumbar Radiculopathy
- Tarsal Tunnel Syndrome
- Medial Tibial Stress Syndrome
- Flexor Hallucis Longus Tendinopaty
- Medial Ankle Sprain
What is Stage 1 of Tibialis Posterior Tendinopathy?
Weakness, mild swelling, medial ankle/foot pain
What is Stage 2 of Tibialis Posterior Tendinopathy?
Tibialis Posterior Degeneration resulting in lengthening
- Impingement of lateral structures (subtalar joint or calcaneofibular ligament)
- Rearfoot valgus/forefoor abduction {which are associated with an abnormal pronated foot posture}
What is Stage 3 of Tibialis Posterior Tendinopathy?
- Severe medial and lateral pain
- Rearfoot and forefoot abnormal postures become rigid
What is Stage 4 of Tibialis Posterior Tendinopathy?
- Posterior Tibialis Tendon rupture
With Tibialis Posterior Tendinopathy, what is Progressive Collapsing Foot Deformity?
- Progressive loss of Medial Longitudinal arch
-Flexible -> Rigid - Causes Pes Planus
-Abnormal pronated foot posture - Due to Excessive medial ankle/foot tensile loading
With Tibialis Posterior Tendinopathy, what is the Etiology of Progressive Collapsing Foot Deformity?
- Posterior tibialis tendon rupture
- Arthritic changes
- Neuromuscular dysfunction
- Post-traumatic changes
With Tibialis Posterior Tendinopathy, what will you find in the physical examination?
- (+) Muscle performance test and measures
- Single limb heel raise
- P! with palpation at:
-Distal to medial malleolus
-Proximal to medial malleolus
-At muscuolotendinous proximal or distal attachent - Limited DF w/ A/PROM
- Limited talocrural joint
- Outcomes
-Foot Posture Index > 4
What is Medial Tibial Stress Syndrome?
Aka Shin Spints
Posteromedial Tibial Pain that aggravated by activity
- Mostly affects running athletes
What are the two Etiologies liked to the development of Medial Tibial Stress Syndrome?
(Shin Splints)
- Fasciotomy of the insertion sites for muscles like:
-Tibialis Anterior
-Soleus
-Deep Plantar Flexor Muscles - Bony stress injury due to injury of bone formation and resoption of the tibial complex due to repetitive microtrauma
What are the Risk factors for Medial Tibial Stress Syndrome?
Shin splints
- Females
- Obesity
- Abnormal Pronation foot posture
- Greater than normal Hip ER and ankle PF
- Small Q-angle
With Medial Tibial Stress Syndrome, what Differential Diagnosis should we consider?
Red Flags
- Compartment Syndrome
Neuromusculoskeletal Conditions
- Lumbar Radiculopathy
- Tarsal Tunnel Syndrome
- Tendinopathy/Muscle strain
-Tib anterior/posterior, flexor digitorum longus, flexor hallucis longus
With Medial Tibial Stress Syndrome, what would we find in the physical examination?
- Localized pain
-Distal 1/3 of tibia - AROM and Mid-range isometric testing
-DF combined w/ inversion = Tib. Anterior
-PF combined w/ eversion = Deep plantar flexor muscles - Limited ankle DF
-AROM, PROM, and joint mobility testing
Patients with Muscle Performance Deficits, what can be done in terms of interventions during the Acute/Protective Phase?
- Reduce loading
-Limit participation in Agg activities
-Boots, rigid taping, orthotic/wedges - Treat pain and Sx
-Iontophoresis w/ dexamthasone (More for Midportion achilles tendinopathy) - Normalize surrounding mobility and muscle performance (Above and below)
