Chronic ankle and foot Flashcards
Windlass mechanism
extend toe, lifts arch of the foot- becomes more rigid- more effective leaver for push off
MTSS 2 Hypothesis
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
Other bone factors MTSS
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 .
Why is Achilles vulnerable
3-4 cords blended together- twisted structure of tendon, like wringing out washcloth every time plantarflex. hypo vascular region therefore heals very slowly
Acute Achilles tendinopathy
proteoglycans and bound water get hyperecruited and cause stiffness- not truly inflammatory
Chronic Achilles tendinopathy
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
One leg hop test
skill specific not tissue specific test- alt pattern based on person
Does bracing help?
for first 6wks post injury: good evidence that helps decrease relative risk or reccurance.
For first time sprain (prevention)- not as good evidence.
Carbon fibre plate
blocks hallux movment- prevents extension (during push off phase of gait)
Rocker bottom shoe
pushes foot throguh gait without toe extension- used for 2and and 3rd degree ankle sprain, high ankle sprain, fracture and turf toe
Strassburg sock
for plantar fascia- stretches fascia while sleep to prevent morning stiffness
Orthotics
can be sued for plantar fascia, MTSS, achilles tendonopathy. Helpful especially for thoe with excessive pronation (flat feet).
Alfredson Eccentric heel drop protocol
for achilles tendonapathy, ecc load to what it can handle- 180 per day (3x15 x2day)
Injury prevention for runners
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.
Relative risk of recurrance, semiridigid brace for 6wks after injury
RR=0.3, 95%CI 0.21-0.43
