Chapter 18 Flashcards
Specific Injuries: Plantar Fasciitis
- tension in plantar fascia during extension of toes and depression of longitudinal arch
- can occur with pes caves or pes planus
How many bones are in the foot?
26
Special Tests: Mortons Test
- foot neutral, transverse compression applied to heads of metatarsals
- may cause sharp pain in forefoot
- +’ve = may indicate presence of metatarsalgia or a neuroma
Special Tests: Mulder’s Sign
- pt seated, examiner squeezes metatarsal heads together with one hand while thumb and index finger of other hand apply pressure to interspace btwn heads of 3rd and 4th metatarsal heads
- +’ve = click or pain radiating in the toes
Special Tests: Tinel’s Sign Test
- tapping over posterior tibial nerve produces tingling distal to that area
- tests for tarsal tunnel syndrome
- +’ve = numbness, tingling, paresthesia
Special Tests:Dorsiflexion-Eversion Test
- another test for tarsal tunnel syndrome
- ankle passively and maximally everted and dorsiflexed
- all of metatarsophalangeal joins maximally dorsiflexed and held in this position for 5-10 seconds
- tests for entrapment of tibial nerve passing through tunnel on medial side of ankle
- +’ve = pain or numbness in tarsal tunnel or on plantar surface of foot
Specific Injuries: Bunions (Hallux Valgus Deformities) and Bunionettes (Tailor’s Bunions)
- one of the most frequent painful deformities
- head of 1st metatarsal
- caused by pointed shoes, too narrow or too short shoes
- bursa becomes inflamed and thickens
- tendinitis may develop in flexor tendon of 1st toe
Specific Injuries: Bunions (Hallux Valgus Deformities) and Bunionettes (Tailor’s Bunions) - Managemet
- correct fitting shoes with wide toe box
- felt or sponge donut
Specific Injuries: Bunions (Hallux Valgus Deformities) and Bunionettes (Tailor’s Bunions) - Signs and Symptoms
- tenderness
- swelling
- enlargement of joint
- poorly fitting shoes increases irritation and pain
- painful ambulation over time
Specific Injuries: Calcaneal Stress Fractures
Among the most common stress fractures in lower extremity Occurs with repetitive impact during heel strike and is most prevalent among distance runners
Sudden or gradual onset, initially hurting in plantar-calcanea area with activity and eventually hurts during rest
Specific Injuries: Calcaneal Stress Fractures - Signs and Symptoms
WB increases pain
C/o pain continue after exercise stops
fracture may fail to appear during XR
Specific Injuries: Cuboid Subluxation Syndrome
- pronation and trauma reported to be prominent causes
- sometimes confused with plantar fasciitis
- accompanied by lateral ankle sprain
Specific Injuries: Cuboid Subluxation Syndrome - Management
- Manipulating to restore cuboid to natural position
- orthotic for support
Specific Injuries: Cuboid Subluxation Syndrome - Signs and Symptoms
- pain along fourth and fifth metatarsal and over the cuboid
- refers pain to the heel and is often associated with plantar fasciitis
- pain increased when patient stands for a long NWB period
Specific Injuries: Fracture of Calcaneus
most often occurs from landing after jump or fall from a height
Signs and Symptoms
- immediate swelling and pain and an inability to WB
Management
- POLICE
-XR
- immobilization and early stage ROM
Specific Injuries: Fractures of the Talus
Signs and Symptoms
- Hx of repeated ankle trauma
- pain on WB c/o catching and snapping along with intermittent swelling
- talar dome TOP over anteromedial or anterolateral joint line
Management
- XR or MRI
- immobilization with NWM
- concentrate on strengthening and regaining full ROM in ankle
Specific Injuries: Great Toe Hyperextension (Turf Toe)
- results in a sprain of the first metatarsophalangeal joint
- from single trauma or repetitive overuse
- typically occurs on synthetic turf
Specific Injuries: Great Toe Hyperextension (Turf Toe) - Management
- thin, flat piece of thermoplastic placed under shoe insole or molded to foot
- taping toe to prevent DF
Specific Injuries: Great Toe Hyperextension (Turf Toe) - Signs and Symptoms
- significant pain and swelling around metatarsophalangeal joint of great toe
- pain exacerbated when patient tries to push off foot in walking
Specific Injuries: Hallux Rigidus
- painful condition caused by proliferation of bony spurs on dorsal aspect of first MTP joint
- impingement and a loss of active and passive DF
Specific Injuries: Hallux Rigidus - Management
- stiffer shoe with larger toe box
- surgically removing piece of bone
Specific Injuries: Hallux Rigidus - Signs and Symptoms
- great toe unable to DF
- forced DF increases pain
- walking becomes awkward b/c WB is on lateral aspect of foot