Foot and Ankle Flashcards
4 functions of the foot
- absorb rotation
- loose adaptor
- base of support
- rigid lever
what is the most common cause of heel pain
plantar fascitis
T or F: >80% of patients experience resolution of plantar fascitis symptoms in 12 months regardless of treatment
T
What are some risk factors for plantar fasciitis
1 - ankle DF loss
2 - high BMI
3 - running
4 - work-related weight bearing
Your pt comes in with c/o heel pain. The pain is the worst in the morning or walking after long periods of sitting. It gets better initially with activity but worse with prolonged WB. They have both active and passive DF loss and are TTP over the calcaneal tubercle. What do they most likely have?
plantar fasciitis
what are some interventions for plantar fasciitis
- manual therapy
- stretching
- arch support taping
- foot orthoses
- night splint
what is a good way to determine if someone with plantar fasciitis needs a foot orthotic
arch taping… if it helps an orthotic may be helpful
T or F: there is a superior modality for plantar fasciitis
F
T or F: conservative treatment for planar fasciitis is effective for most
T: surgery can lead to a lot of issues
What are 2 reasons someone may need a custom orthotic instead of an OTC one
- significant eversion at calcaneus
- significantly pronated
*for everyone else, OTC is usually sufficient and costs less
T or F: manual therapy has shown to be very effective for planar fasciitis
T
heel pain syndrome
increasing tension on the achilles tendon is coupled with an increasing strain on the planar fascia
*this is where overstretching can become a problem
What 2 things did ultrasound show on symptomatic heel pads
1 - thickened planar fascia
2 - less energy absorption
T or F: heel pain syndrome can be due to overuse or direct trauma
T
Pts with heel pain syndrome have pain during what 2 parts of gait
heel strike
toe off
tarsal tunnel syndrome
- compression of the tibial nerve in the tarsal tunnel along the medial ankle
- causes N/T down into foot and toes
T or F: pts with tarsal tunnel usually need surgery
T
What are some complications with planar fasciopathy surgery
- lateral column instability
- calcaneus fc with heel spur removal
- neurovascular injury
is surgery recommended in early stage of plantar fascitis
- NO, only after you try 6-12 months of conservative treatment
- it is a complicated surgery
hallux valgus
- bunion
- 1st metatarsal starts to project more medially and great toe moves laterally
what are some risk factors for hallux valgus
- women
- family history
- loss of DF
- narrow heel/wide forefoot
- foot wear
- pes planus
- RA
do studies show foot orthotics help hallux valgus in children? adults?
not for children but may for adults
T or F: there are a lot of possible complications for hallux valgus surgery
T
First MTP joint sprain is also known as
turf toe
MOI for 1st MTP joint sprain
- loss of ankle DF
- forced great toe DF
- common in football
is a medial or lateral MTP sprain more common
medial
grade 1 MTP joint sprain
stretching of the plantar structures
how to treat grade 1 MTP sprain
- PROM 3-5 days post injury
- tape 1st MTP in slight PF
grade 2 MTP joint sprain
partial rupture of the plantar structures
treatment for grade 2 MTP sprain
- protection for up to 2 weeks (boot/tape)
- early gentle PROM
- slow progression back to activity
- return to play
grade 3 MTP joint sprain
complete rupture of the plantar capsule distal to the sesamoids
treatment for grade 3 MTP joint sprain
- protection for up to 8 weeks (boot/cast)
- PROM
- up to 6 months before return to play
- may need surgery
progression for treatment after grade 3 MTP joint sprain surgery
- NWB for 4 weeks
- PROM at 5-7 days (min DF)
- 4 weeks = begin protected WB
- 8 weeks = walking with stiff-soled shoe
- 16 weeks-12 months = return to activity
cuboid subluxations normally occur with an _____mechanism
inversion
ex: repetitive lateral ankle sprains
T or F: cuboid sublux always shows up on radiographs
F: not always
Your pt comes in after a lateral ankle sprain. The pt has had multiple ankle sprains before. They are tender over the plantar surface of the medial cuboid. What may they have? How can you treat it?
- a cuboid sublux
- treated with cuboid whip joint manipulation - dorsal glide of the medial cuboid
is the dorsal surface of the medial cuboid/lateral navicular joint convex or concave
concave
supinated feet are more susceptible to _____ injuries while pronated are more susceptible to ______ injuries
boney
soft tissue
what are 5 bones in the foot at high risk of stress fractures
1 - medial malleolus
2 - talus
3 - navicular
4 - base of 5th metatarsal
5 - sesamoid
ottawa ankle rules
age >55
unable to wb (4steps)
TTP over base of 5th met, navicular, lateral and medial malleolus
what are 4 bones in the foot at low risk of stress fractures
1 - calcaneus
2 - cuboid
3 - cuneiforms
4 - lateral malleolus
jones fracture
- fracture of the base of the 5th methead
- poor healers, often need surgery
T or F: navicular fractures aren’t painful with walking
T: because you aren’t WBing on it, but it is painful to palpation
lis franc injury
tarsometatarsal fracture/dislocation
MOI for lisfranc injury
- crushing injury to dorsum of foot
- foot forcefully abducted
- jumping on PF foot *significant MOI
Your pt is a soccer player with diffuse tenderness on the dorsum of the foot. He was going to kick the ball when a player behind him fell on his trailing leg while it was in the push-off position. He could not play after the injury but hoped that it would be better the next morning. He comes into PT still limping. What does he likely have and what should you do?
- lis franc injury
- refer to PCP b/c he most likely needs surgery
T or F: after surgery for a lisfranc injury, early mobilization of the foot is recommended
T
treatment after lisfranc
- slow progressive PF strengthening
- progressive return to impact
- plyometrics
- 6m timed hop/triple hop terst
T or F: most athletes return to full level of play after lisfranc injury
F: most return to play but have a decline in performance
metatarsalgia
irritation of the bone and soft tissue surrounding the metatarsal heads (usually 2-4)
what are some things that can cause metatarsalgia
- foot pronation
- tight gastroc/soleus
- activities where the weight is on the forefoot (sports, high heels)
treatment for metatarsalgia
- gastroc/soleus stretching
- full-length foot orthotic device
- metatarsal pads/bars
adult-acquired flatfoot deformity - four stages
1 - pain and swelling
2 - degeneration and elongation
3 - fixed flatfoot deformity
4 - ankle becomes involved
T or F: advanced stages of AAFD (stages 3&4) require bracing or surgery
T
