Chronic Ankle and Foot

Question 1

Describe the windlass mechanism

Answer 1

see notes
extend toe, lifts arch of the foot- becomes more rigid- more effective leaver for push off

Question 2

2 hypothesises for MTSS

Answer 2

periostitis: soleus and FDL attatch on posterior medial tibia. deep curual fascia also wraps deep plantarflexors in area. FDL and soleus both plantarflexors and EEC load when landing- pulls on attachment.
Soft tissue tensile load: tibia bends when walk- compression on posterior side as part of bowing- causes overload of tibial cortex.

Question 3

Other bone factors contributing to MTSS

Answer 3

regional bone density- 23% lower- improves as condition improves .
Bone stress injury- osteoblasts can’t keep up with osteoclast activity- can lead to structural fatigue, swelling, stress fractures .

Question 4

Why is the Achilles vulnerable

Answer 4

3-4 cords blended together- twisted structure of tendon, like wringing out washcloth every time plantarflex. hypo vascular region therefore heals very slowly.

Question 5

Acute (reactive) Achilles tendinopathy

Answer 5

proteoglycans and bound water get hyperecruited and cause stiffness- not truly inflammatory

Question 6

Chronic Achilles tendinopathy

Answer 6

tendon disrepair and degeneration- breakdown of fibres over time. body tries to repair damage but stuck in repair phase- don’t get remodelling of good collagen- weaker and more likely to damage again

Question 7

One leg hop test

Answer 7

skill specific not tissue specific test- alt pattern based on person

Question 8

Does bracing help? semirigid hinge brace

Answer 8

for first 6wks post injury: good evidence that helps decrease relative risk or reccurance.
For first time sprain (prevention)- not as good evidence.

Question 9

Carbon fibre plate

Answer 9

blocks hallux movment- prevents extension (during push off phase of gait)

Question 10

Rocker bottom shoe/boot

Answer 10

pushes foot throguh gait without toe extension- used for 2and and 3rd degree ankle sprain, high ankle sprain, fracture and turf toe

Question 11

Strassburg sock

Answer 11

for plantar fascia- stretches fascia while sleep to prevent morning stiffness

Question 12

custom orhtotics

Answer 12

can be sued for plantar fascia, MTSS, achilles tendonopathy. Helpful especially for thoe with excessive pronation (flat feet).

Question 13

Alfredson eccentric heel drop protocol

Answer 13

for achilles tendonapathy, ecc load to what it can handle- 180 per day (3x15 x2day)

Question 14

Preventing injury in runners

Answer 14

change the training surface, reduce training speed, duration, frequency, increase volume of recovery. Graded runningprogram. Body can’t adapt to >10% increase in training load.

Question 15

Relative risk of recurrance, semiridigid brace for 6wks after injury

Answer 15

RR=0.3, 95%CI 0.21-0.43

Question 16

Relative risk, semiridigid brace for injury prevention

Answer 16

RR=0.69, 95%CI 0.49-0.96