foot

Question 1

Medial tibial stress syndrome

Answer 1

MOI
Progressive pn at shin! Recent change in running surfaces, shoes, intensity or volume
Pn reduced post warm up, returns worse post exercise or next day
SIGNS
Pn palp medial tibia at least 5cm
TX
NSAID! Reassurance (can take 9-12 months), avoid provok (cross training low impact), load management, graded RTS only in a sense of pain
Stretch and strength foot w foot alphabet, heel toe walking, calf raise and toe scrunch

Question 2

stress fracture in foot

Answer 2

SSX
Running, jumping, insidious, overuse, increased pain with activity and reduced with rest, pain worsens with activity unlike tendinopathy, night pain

SIGNS
Forefoot pn worsens w activity, no swelling, n spot pn palp and extensors tendons

TX
Stop sport, modify activity level for pn control, bio mechanical factors
Return to gradual training once pain free walking
N spot for navicular used as a guide for tenderness

Question 3

planar heel pain / plantar fasciitis

Answer 3

SSX
Pn in Morning or after prolonged sitting, pn decrease when walking but increases once exercise and that returns again - so increased pn post exercise

Heel spurs: heel pn for several months, pn tenderness on the AM aspect of calcaneus, heel pn on palp

TX
NSAID, Heel padding, replace shoes, activity modification,
Calf raise with towel under toe for PF sl or dl

Question 4

Achilles Tendinopahy

Answer 4

SSX
Pn 2-6cm above AT
Pn w exercise, subside, then returns w consistent use ?
Morning stiffness, Increase training load

SIGNS
Tenderness, weakness w reprinting SL heel raise
Reduced ankle dorsiflexion
Positive Thompson for full tear

TX
5 x 30-45 sec 2 min rest
Calf raise or toe splay

Question 5

Morton’s neuroma

Answer 5

SSX
Athletes such as kickboxers, ballet dancers and runners, unilateral interdigital pn
Positive Morton’s neuroma test, tenderness to palp, no weakness

TX
Decrease pressure on toes w padding,
Wider shoes
Avoid repetitive dorsiflexion of toe
Strengthen intrinsic foot muscles with a foot curl
Stretch PF and roll on golf ball

Question 6

gastroc strain

Answer 6

Immediate calf pn, swelling, busing , not being warmed up,

Signs
Swelling of ankle, tenderness, AROM and PROM dorsiflexion terminal, plantar flexion weak pn RROM

TX
Early: isometric/weight bearing
Foundation: strength
Directional: propulsion
RTS: running / plyo