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
Specific Injuries: Heel Contusion
activities demanding a sudden stop and go, change from horizontal to vertical movement, likely to cause heel contusions
Specific Injuries: Heel Contusion - Management
- no WB for 24hrs
- POLICE
- heel cup or donut
- wear shock absorbent footwear
Specific Injuries: Heel Contusion - Signs and Symptoms
- c/o severe pain in the heel and unable to WB
- warmth and redness over the area
Specific Injuries: Jones Fracture
- most common to shaft at the base of the 5th metatarsal
Specific Injuries: Jones Fracture - Management
- crutches with no immobilization
- gradually progressing to FWB
Specific Injuries: Jones Fracture - Signs and Symptoms
- immediate swelling and pain over 5th metatarsal
- slow healing
Specific Injuries: Metatarsal Stress Fracture
- most common involves second metatarsal and referred to as march fracture
- occurs in runner who has suddenly changed patterns of training
Specific Injuries: Metatarsal Stress Fracture - Management
- bone scan to detect
- 2-4 days partial WB followed by 2 weeks rest
- orthotic correcting excessive pronation
Specific Injuries: Metatarsal Stress Fracture - Signs and Symptoms
- dull pain begining over 2-3 weeks during tendon
- progresses to pain at rest
- initially diffuse pain then localizes to fracture site
Specific Injuries: Metatarsalgia
- pain in the ball of the foot
- more common with pain under second and sometimes third metatarsal head
- heavy callus forms in painful area
Specific Injuries: Metatarsalgia - Signs and Symptoms & Management
- pain
- apply a pad to elevate depressed metatarsal heads
- removal of callus buildup
- static stretching
- strengthening of flexor and intrinsic muscles and achilles tendon
Specific Injuries: Mortons Neuroma
- mass that occurs about the nerve sheath of the common plantar nerve
- occurs btwn metatarsal heads
- btwn 3rd and 4th metatarsal heads where nerve is thickest
- can occur btwn any
Specific Injuries: Morton’s Neuroma - Management
- teardrop shaped pad between heads of third and fourth metatarsals
- shoe selection
Specific Injuries: Morton’s Neuroma - Signs and Symptoms
- burning paresthesia
- severe intermittent pain in forefoot, localized to third webspace and radiating to toes
- toe hyperextension can increase symptoms
Specific Injuries: Morton’s Toe
- abnormally short first metatarsal, second toe appears to be longer
- more WB on second toe b/c first is too short
- not an “injury”
Specific Injuries: Morton’s Toe - Management
- no symptoms - do nothing
- pain - orthotic with medial wedge
Specific Injuries: Morton’s Toe - Signs and Symptoms
- stress fracture to second toe
- pain in both 1st and 2nd toe during and after activity
- may be an area of point tenderness
- callus under second metatarsal head
Specific Injuries: Plantar Fasciitis - Management
- extended period of tx
- orthotics with extra deep heel cup
- taping
- night splint
- achilles stretching
- exercises that stretch the plantar fascia (rolling with tennis ball)
- exercises increasing DF of great toe
Specific Injuries: Plantar Fasciitis - Signs and Symptoms
- c/o pain in the anterior medial heel
- pain moved into central portion of plantar fascia
- pain increased when patient wakes up or bears after sitting for a long period of time
Specific Injuries: Retrocalcaneal Bursitis
- Caused by inflammation of bursa lying just above and ant to achilles insertion
- Occurs from pressure and rubbing of heel counter of shoe
- Chronic, developing gradually over a long period of time, may take days-months to resolve
Specific Injuries: Retrocalcaneal Bursitis - Management
- POLICE
- U/S to reduce inflammation
- Achilles tendon stretching
- Heel lift
- Donut heel pad
- larger shoes with wider heel counter
Specific Injuries: Retrocalcaneal Bursitis - Signs and Symptoms
- pain elicited by palmation of bursa just about and ant to achilles insertion
- likely swelling on both side of heel cord
- body callus may begin to form
Specific Injuries: Sesamoiditis
- two sesamoid bones lie within the flexor hallicus brevis and adductor tendons of the great toe
- repetitive hyperextension of the great toe, resulting in inflammation
- most common in dancing and basketball
Specific Injuries: Sesamoiditis - Management
- treated with a variety of orthotic devices
- metatarsal pads
- Arch support
- Metatarsal bar
- Decreased activity
Specific Injuries: Sesamoiditis - Signs and Symptoms
- c/o pain under the great toe, during push off
- palpable tenderness under first metatarsal head
Specific Injuries: Sever’s Disease
Occurs in young, physically active patients
Comparable to Osgood-Schlatter disease at tibial tubercle of knee
Traction injury at apophysis of calcaneus where achilles attaches
Specific Injuries: Sever’s Disease - Management
rest, ice anti-inflames
heel lift, may take stress off apophysis
Specific Injuries: Sever’s Disease - Signs and Symptoms
- pain at posterior heel below attachment of achilles
- Pain during vigorous activity and stops at rest
Specific Injuries: Tarsal Tunnel Syndrome
- Area behind medial Mal
- Any condition compromising tip post, FHL, FD, synovial sheaths, tibial nerve, artery and vein can cause tarsal tunnel syndrome
- Similar to carpal tunnel syndrome
Specific Injuries: Tarsal Tunnel Syndrome - Management
- use of an appropriate orthotic to correct excessive pronation
- surgery may be necessary
Specific Injuries: Tarsal Tunnel Syndrome - Signs and Symptoms
- c/o pain and paresthesia along medial and plantar aspects
- c/o increased pain at night
- tingle sign +’ve
- motor weakness and atrophy may gradually appear
Specific Injuries: Tarsometatarsal Fracture/ Dislocation (Lisfranc Injury)
- ankle PF with rearfoot locked, sudden, forceful hyper-plantar flexion of forefoot resulting in dorsal displacement of proximal end of metatarsals
- dorsum of foot rolls forward, with body weight providing force to displace base of metatarsals dorsally
Specific Injuries: Tarsometatarsal Fracture/ Dislocation (Lisfranc Injury) - Signs and Symptoms
- may be subtle
- c/o pain and inability to bear weight
- swelling and tenderness localized over dorsal of foot
- may be # of metatarsals
- sprain of 4th and 5th metatarsal causes ongoing pain
** refer to physician **
What are the systems of the foot?
passive, active and neural subsystems
