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MSK II > Foot and Ankle 2 (test 4) > Flashcards

Foot and Ankle 2 (test 4) Flashcards

1
Q

prevalence of achilles tendinopathy

A

most frequent overuse injury

10-20% of runners

most common in recreational activities, training > competition

30-50 yr olds

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2
Q

risk factors/etiology of achilles tendinopathy

A

reduced DF ROM (limit PE of achilles)

limited calf flexibility

calf weakness

possible L4-S1 regional interdependence

male gender/family hx

abnormal tendon structure

older age

obesity

systemic conditions with inflammation/limited blood supply

training errors/environment/improper shoes

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3
Q

how might L4-S1 regional interdependence cause achilles tendinopathy

A

excessive EV/pronaiton with tendinopathy origins b/c achilles attaches more medially

hip neuromuscular deficits

balance deficits

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4
Q

pathomechanics of achilles tendinopathy

A

repetitive lengthening with compression from limited DF and/or excessive EV

lack of PE with limited DF so overworked

collagen fibril thinning/disorganization and fibroblast death from altered fluid movement that leads to heating and increased nitric acid with persistent inflammation

ineffective force transfer

impaired motor control

thickened but weaker tendon from increase of non-collagen matrix and fat deposition

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5
Q

functional questionaires for achilles tendinopathy

A

victorian institue of sport assessment

foot and ankle ability measure

LEFS

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6
Q

symptoms of achilles tendinopathy

A

gradual onset that limts WBing activity

localized pain and stiffness
-especially after inactivity
-lessed with mild activity
-increase with mod to severe activity

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7
Q

observation of achilles tendinopathy

A

achilles thickening

possible imaired LE control

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8
Q

ROM findings for achilles tendinopathy

A

pain and limits with DF

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9
Q

resisted/MMT findings for achilles tendinopathy

A

pain with PF possible; maybe weak

possible hip and knee weakness

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10
Q

AM findings for achilles tendinopathy

A

possible talar hypomobility for DF

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11
Q

special tests for achilles tendinopathy

A

arc sign

royal london test

single leg heel raise
-flat surface vs incline (plataris and insertional injury if more pain on incline
-for PF endurance = less reps vs uninvolved

single leg hop = less reps than uninvolved

M. length shortened gastroc

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12
Q

palpation findings for achilles tendinopathy

A

TTP 2-6 cm proximal to insertion

more medial achilles pain indicates plataris

achilles crepitus

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13
Q

differential dx at posterior ankle

A

achilles/fascial tears
calcaneal bursitis
plataris tendinopathy
posterior ankle impingement
sural neuritis
acessory soleus muscle
achilles ossification or talar bone spur
inflammatory dz

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14
Q

pt edu for achilles tendinopathy

A

rest is NOT indicated

optimal stess is best within appropriate pain levels = mild pain

wt management

shoe wear

timeline = 8-12 wks; at least 6

prognosis = 80% improvement if both pt and PT are doing the right things

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15
Q

modalities and their effectiveness for achilles tendinopathy

A

LASER = contradictory evidence

iontophoresis = dexamethasone helpful for pain and function

shockwave
-support for pain relief with ADLs when added to 4 wks exercise
-no indication on structure change or return to sport

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16
Q

bracing support for achilles tendinopathy

A

neoprene sleevs on involved muscles only anecdotal

night spint NOT beneficial and NO support

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17
Q

taping support for achilles tendinopathy

A

anecdotal and conflicting evidence

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18
Q

arch taping/foot orthotics support for achilles tendinopathy

A

taping may help predict orthotic benefit

shock absorbing orthotic decreased injury rate

heel lift = mixed support; needs to happen on both sides

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19
Q

dry needling support for achilles tendinopathy

A

helful for pain when added to exercise

questionable otherwise

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20
Q

STM support for achilles tendinopathy

A

mostly anecdotal

ASTYM helpful for motion when added to exercise

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21
Q

gentle stretching support for achilles tendinopathy

A

weak but some support for pain

may be contraindicated due to higher tension/compression on tendon

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22
Q

JMs serve what purpose for achilles tendinopathy

A

mobility and function

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23
Q

what MET has best evidence for achilles tendinopathy

A

varied muscle actions

eccentrics only = alfredson protocol
heavy and slow eccentrics
isometrics
lower compliance rates with eccentric training

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24
Q

ultimate MET parameters

A

3 sets 10-15 reps

3 sec phases of muscle actions

heavy load - NOT during inflammatory phase

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25
Q

how should you progress MET for achilles tendinopathy

A

progress resistance and activity with less than or equal to mild symptoms

can add weight via backpack, use heel raise machine, or do sitting/standing heel raises

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26
Q

how long should achilles tendinopathy be treated

A

at least 2x/week for 6 weeks

recommended to do every other day

may need more recovery time between loading in older/non-athletic pt (about 72 hours)

repeat exercises once normal pain levels return

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27
Q

recurrence rate for achilles tendinopathy

A

27%

28
Q

success rates for achilles tendinopathy

A

mostly normalized tendon structure and thickness

improved mechanical properties as well as cortical structures

about 12 weeks to recovery

80% fully recovered within 3-6 months of progressive loading at 5 year follow up

29
Q

success rates for eccentric exercuses

A

82-100% mid portion tendinopathy in athletes
60% sedentary individuals
less than 32% insertional tendinopathies

30
Q

what % of people have mild pain remaining with achilles tendinopathy

A

20-45%

31
Q

effect of injections for achilles tendinopathy in mid portion vs insertional

A

midportion
-insufficient evidence for cortisone
-emergign evidence for high volume injection/scleroptherapy

insertional = guided cortisone is effective for pain and function
-alternate option when MET isnt working
-recommended for non-athletic population

32
Q

MD Rx for achilles tendinopathy

A

injections

achilles debridement

remove plantaris

33
Q

prevalence and etiology of calcaneal apophysitis

A

aka Sever’s disease

9-12 years old most common

males > females

etiology = growth with high activity

34
Q

structure/pathomechanics for calcaneal apophysitis

A

leg bone growth exceeds PF lengthening

increased tendon tension

growth plate is the weak spot as opposed to tendon in the adult

mostly inflammation

complcations = avulsion/premature closure

35
Q

risk factors for calcaneal apophysitis

A

long or year round sports

poor fitting shoes that lack cushion

training errors

shortened PFs

foot dysfunction (i.e. pes planus/cavus)

36
Q

symptoms of calcaneal apophysitis

A

gradual onset of heel pain with overuse

Bilateral more than unilateral

pop = avulsion

37
Q

observation for calcaneal apophysitis

A

poor shoe/support cushion

foot dysfunction (i.e. foot pronation or supination)

impaired LE control

38
Q

ROM findings for sever’s

A

limited DF leading to greater tensile forces on growth plate

39
Q

resisted/MMT findings for severes

A

possible weak and painful PFs

weak DFs

40
Q

special tests for calcaneal apophysitis

A

squeeze test on heel

severe’s sign = pain with heel raise

M. length = short gastroc

41
Q

palpation findings for severe’s

A

TTP over “cap” of calcaneus

42
Q

PT Rx for calcaneal apophysitis

A

pt edu:
-soreness rule
-load management
-movement cues for LE control

POLICED

“U” shaped foam upside down on achilles with ankle sleeve

restore DF ROM/accessory motion
-JM and STM
-careful with prolonged calf stretch

hamstring stretch due to fasical connection with gastroc

43
Q

orthotics effectiveness for calcaneal apophysitis

A

arch support for excessive pronation

heel lifts

heel lifts > arch support
-more effective at 2 months
-equally effective at 12 months

gel heel cups with a lift work best

44
Q

MET for calcaneal apophysistis

A

for any impaired LQ control

caution with muscle/tendon attached to growth plate to avoid greater overuse

45
Q

prognosis for calcaneal apophysitis

A

75% resolved at 1 month and 95% at 3 months

can be a recurrent and or persistent problem

growth plate closes around 14 years

46
Q

what is plantar fasciopathy

A

heel pain

most common foot condtion

47
Q

clear risk factors for plantar fasciopathy

A

increased PF ROM (ankle instability)

High BMI

running/ work related WBing with poor shock absorption

impaired 1st MTP ext that reduces PE of fascia

older age

48
Q

unclear risk factors for plantars fasciopathy

A

decreased DF that limits PE of fascia

tendinopathy origins (excessive dynamic pornation and standing calcaneal EV)

49
Q

describe the structure of the plantar fascia

A

3 bands (medial, central and lateral)

central originates on medial tubercle

inserts in all proximal phalanges

assists with gait via windlass effect that is PE developed by normal foot and ankle motion

50
Q

structures involved with plantar fasciopathy

A

intrinsic foot muscles

heel fat pad innervated by tibial n

achilles tendon fibers connect with plantar fascia

medial and lateral plantar nn

bone spurs (plantar fascia thickening and fat pad thinning were better indicators)

51
Q

etiology and pathomechanics of plantars fasciopathy

A

primarily = structural changes (54%)

only inflammation = ~20%

neoplastic (connective tissue tumor) = 25%

52
Q

functional questionaires for plantars fasciopathy

A

foot and ankle ability measure (FAAM)

foot health status questionnaire (FHSQ)

foot function index (FFI)

lower extremity functional scale (LEFS)

53
Q

symptoms of plantars fasciopathy

A

gradual onset of heel pain after recent increase in WBIng activity

medial > central heel pain
-after long periods of inactivity
-worse at end of day/prolonged WBing
-can improve with mild/mod activity

54
Q

observation for those with plantar fasciopathy

A

thickened plantar fascia

possible static calcaneal EV

possible asymmetrical and antalgic gait

possible excessive dynamic pronation

possible impaired LQ control

55
Q

ROM findings for plantar fasciopathy

A

limited 1st MTP ext

56
Q

resisted/MMT findings for plantar fasciopathy

A

possible weak and painful toe flexors

57
Q

special tests for plantar fasciopathy

A

lack of plantar flexion tautness

58
Q

palpation findings for plantars fasciopathy

A

TTP over medial calcaneal insertion > central heel pain

59
Q

other differential dx for plantar fasciopathy/heel pain

A

spondyloarthropathies or autoimmune conditions

calcaneal stress fx

bone bruise

fat pad atrophy

tarsal tunnel syndrome

fibrous tumor

calcaneal apophysitis

radiculopathy

60
Q

PT Rx for plantar fasciopathy aside from MET and MT

A

pt edu
-sireness rule
-load management
-movement cues
-wt. loss
-cushioned surfaces with long standing

POLICED

modalities
-short term relief with ionophoresis + dexamethasone or acetic acid

-short term relief with LASER + ponophoresis

-shockwave = NOT more effective than stretching or US; possible adverse affects

US/electrotherapy not recommended

taping = short term relief only

orthotics
-better for those who benefited from taping
-benefits for persistent type

dry needling NOT RECOMMENDED

61
Q

manual therapy for plantar fasciopathy

A

goal = normalize mobility and m lengths for pian, ROM, and function

JM = mixed benefits
-improves pain and function along with orthoses and MET
-helpful but not additive to stretching
-imporve DF and 1st MTP ext

stretching calf & plantar fascia
-calf stretch alone = no difference with DF and pain
-both improved pain but more reduction with fascia stretch

JM + STM
-deep massage to gastroc and fascia
-rear foot JMs

62
Q

what shoe characteristics may help those with plantar fasciopathy

A

-shoe rotation = dont wear the same ones all the time
-rocker bottom shoe =

63
Q

how is the static standing method of choosing footwear concerning

A

overly simplistic
potential injury
problematic for those with excess pronation
doesnt represent dynamic foot

64
Q

effectiveness of night splint

A

wear for 1-3 months

improved impaired DF due to shortened PFs

hard to get pts to comply

65
Q

MET for plantar fascipathy

A

primarily for fascia proliferation

tendinosis Rx (like achilles but + hyperextension of toe)

pronation control exercises (especially tibialis post and other LE muscles that can contribute to impaired LE control)

66
Q

prognosis for plantar fasciopathy

A

80% resolution of symptoms

MSK II (18 decks)

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