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Musculoskeletal 1 > Foot and ankle overuse/running injuries > Flashcards

Foot and ankle overuse/running injuries Flashcards

1
Q

internal factors that can cause overuse injuries in the foot and ankle

A
  • abnormal bony structure alignment: pes cavis foot, tibial torsion, leg length etc
  • abnormal biomechanics or foot and ankle: pronation, supination, exercise, mobility, orthotics etc
  • Muscle imbalances: weakness/tightness
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2
Q

External factors that can cause overuse injuries in the foot and ankle

A
  • faulty training
  • overzealous training
  • improper footwear
  • ground surface/terrain
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3
Q

How does overuse injuries relate to physiological tissue stress

A
  • results of repetitive sub-traumatic forces (often w/o recovery)
  • microtrauma to tissue exceeds rate of repair
  • inadequate recovery time
  • pathophysiology: inflammatory response in tissues
  • can alter tissue: fatigue, weakness, atrophy, fat infiltration, tissue breakdown
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4
Q

Physical stress theory - excessive stress on tissues
- tendon
- ligament
- muscule
- bone

A
  • tendon: tendonitis → tendinosis → tendon tear → rupture
  • ligament: sprain → tear ligament fibers → full tear
  • muscle: strain → muscle fiber tear → complete tear
  • bone: stress fractures → fx
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5
Q

running injuries occur as a result of

A
  • higher stress during short period of time (sprinting)
  • milder abnormal stresses for longer periods
  • an abrupt increase in activity level
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6
Q

Excessive pronation or late pronation can causes what?

A
  • lack supination = decreased stability of foot in terminal stance
  • pronation stresses to foot/ankle
  • plantar fasciitis, tarsal tunnel syndrome
  • overuse of anterior tibialis, posterior tibialis, FD and FHL tendons - eccentrically trying to control pronation
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7
Q

What can also contribute to excessive or late pronation

A
  • excessive Hip IR, adduction (adductor collapse)
  • valgus stress at knee
  • MCL tensile stress, compression at lateral knee
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8
Q

Supinated foot/pes cavis cancause what

A
  • less shock absorption → increase forces on bones → stress fx
  • tensile stress on lateral ankle → muscles and ligaments
  • prone to lateral ankle sprains
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9
Q

structural leg length discrepancy compensation causes

A
  • supination on short leg (makes it functionally longer) and problems with supinated foot
  • pronated on long leg to functionally shorten it + problems associated with pronation stresses
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10
Q

What are abnormal structural factors that can result in excessive stress on tissues

A
  • supinated foot/pes cavis
  • structural leg length
  • tibial torsion
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11
Q

Lateral tibial torsion

A
  • too many toes sign
  • stress gets put on medial side leading to pronation and stress
  • normal = 15 degress of ER
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12
Q

Musucle imbalances factors reatedto stress on tissues examples

A
  • weak hip ER, and abductors
  • tight gastroc-soleus and weak a pre-tibial
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13
Q

Weak hip ERs and abductors

A
  • allows femoral adduction/IR collapse
  • knee stresses: genu valgum, MCL, PFJ (maltracking of patella)
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14
Q

Tight gastroc-soleus and weak pre-tibial muscules

A
  • anterior tibialis, EHL, ED have to work harder
  • associated with anterior shin splints especially with hill running
  • uphill– pretibial muscles work excessively to clear ground - also stress Achilles
  • downhill: pre-tibial muscles work excessively eccentrically after heel strike to lower foot
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15
Q

Shin splints

A
  • catch all term
  • pain and inflammation at: bone insertional sites, tendon, musculotendinous junction of lower leg muscles, muscle belly
  • anterior, posterior, or lateral compartments
  • overuse, recovery, terrain, abnormal biomechanics
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15
Q

tenosynovitis + S&S

A
  • inflammation synovial tendon sheath
  • Swelling, pain, crepitis
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16
Q

common tendons involved with tenosynovitis (over pronators vs supinated foot)

A
  • over pronation: medially posterior tib, FDL, FHL, anterior tib (increased tensile stress eccentrically to control pronation)
  • Supinated foot: peroneus longus and brevis (subjected to tensile stress)
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16
Q

Posteromedial shin splints

A
  • muscules: tibialis posterior, FDL, FHL
  • excessive pronation stress
  • posterior medial musculature
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17
Q

Anterolateral shin splints

A
  • Tibialis anterior ED, EHL
  • eccentric control of foot at heel strike

OR

  • concentric: swing phase to clear ground
  • overworked with tight Achilles
  • worse with up and down hill running
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18
Q

Lateral shin splints:

A
  • tensile stress on peroneus longus and brevis
  • usually with supinated foot
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19
Q

How to tell in shin splints are muscule vs bone

A
  • RI: if it was musuclotendonious it would be painful
  • bone: could use a tunning fork
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20
Q

Shin splints and tenosynovitis additional factors

A
  • ground reaction force: walking 1.2x BW, running 2x BW, jumpping 5x BW
  • running surface considerations: soft surfaces (dirt/soft track), trail running (better but symmetrical)
  • hard surfaces: asphalt, concrete increase GRF
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21
Q

Crowned roads

A
  • uphill sloped foot: pronates and angles into valgus
  • downhil sloped foot = supinates and varus
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22
Q

Additional common running injuries: ankle joint pain/ligamentous pain

A
  • pronation and supination stress to ankle ligaments and joint s
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23
Q

additional common running injuries: heel pain

A
  • plantar fasciitis and or heel spur
  • heel pad breakdown as we age
24
Q

plantar fasciitis

A
  • microtearing, inflammation of plantar fascia
25
Q

factors for plantar fasciitis

A
  • over pronation/late pronation → tensile stress to plantar fascia
  • weak/fatigued extrinsic and intrinsic muscles, poor arches
  • G toe MTP extension ROM = inadequate windlass mechanism
  • a high arched foot with inherent tight plantar fascia
  • tight gastroc/soleus - pulls calcaneus posterior and puts tension on plantar fascia
26
Q

Windlass test

A
  • extend G toe
  • = test for plantar fascia = heel pain
27
Q

Windlass test mechanism effect

A
  • mid stance to terminal stance BW is transferred to metatarsal heads
  • normal extension of 1 MTP and other MTPs → tenses arch and plantar fascia resulting in calcaneal inversion → STJ, MTJ supination
  • w/o windlass mechanism arch and plantar fascia dont tense
  • and if there is weak extrinsics and intrinscis → lose stability and foot pronates
28
Q

Plantar fascia interventions

A
  • orthotics in short term offter pain relief
  • ionto: short term 2-4 weeks
  • stretching calf, plantar fascia - short term 2-4 months pain relief
  • night splints: initial 1-3 months/symptoms persist >6 months to keep foot from going into pF and tighening up Plantar fascia
  • low dye taping = short term 7-10 days
  • manual therapy: jt mobs, STM and nerve mobilization provide short term pain relief and increase function
29
Q

Tarsal tunnel syndrome typically occurs in who

A
  • over pronators with fatigue of extrinsic and intrinsic muscles and poor arch support
30
Q

What happens with tarsal tunnel and what are S&S

A
  • inflammation of posterior tibial nerve, flexor retinaculum tightness and tenosynovitis PT, FDL, FHL

S&S

  • parethesia plantar aspect of foot
  • may lead to weakness of intrinsics
  • claw toe
  • responds to orthotics and taping
31
Q

Metatarsalgia

A
  • forefoot pain
  • between metatarsal
  • often hypermobility of foot = stresses on bone
  • musculature, ligaments, joint capsules
32
Q

Neuroma (Mortons)

A
  • pain and paresthesia between 3rd and 4th toe
  • pinched nerves between metatarsals 3,4
  • can be caused by tight shoes, hypomobility, compressed between ground and inter-metatarsal ligaments
33
Q

test for Mortons neuroma

A
  • metatarsal squeeze test
  • compress the metatarsals together
34
Q

Treatment for motions neuroma

A

mobilization, shoes with proper toe box

35
Q

Factors related to stress fractures, in tibia and metatarsals

A
  • supinated foot = increased GRF
  • hard surfaces; hard soles and heels
  • over training: microtraum and fatigue of fx bone, abnormal recovery, osteoblasts can’t keep up with osteoclasts
36
Q

first stage of a stress fx

A
  • gradual onset over 2-3 weeks
  • pain with activity such as running
  • pain relived with rest
37
Q

Progression stage of stress fractures

A
  • pain for hours after running
  • night pain
  • fx of tibial cortex may become evidence - bone scan
38
Q

Clinical tests for stress fractures

A
  • (+) pain upon palpation over fx site
  • (+) percussion test/pain with percussion at fx site
  • (+) tuning fork test - pain with vibration at fracture site
  • (+) pain w/ application of US at fx site
39
Q

Treatment for stress fx

A
  • rest from running - allow bone healing
  • orthotic cushioned: dampen forces of supinated foot
40
Q

Exertional compartment syndrome

A
  • increased intramuscular pressure in lower leg fascial compartment (no a lot of give)
  • influx of blood in working muscles
  • anterior, deep poster, superficial, lateral compartments
41
Q

Signs and symptoms of exertion compartment syndrome

A
  • gradual onset of pain and tingling with exercise
  • ischemia to nerves and muscles within compartment
  • palpation: tenderness, tightness, diminished pulses (vascular can be compromised)
  • relieved with rest
42
Q

Treatment for exertion compartment syndrome

A
  • soft tissue mobilization of compartment and stretching
  • activity modification - stop exercise at pain onset and rest
  • resume exercise to pain, stop, rest repeat
  • sometimes surgery is needed to cut fascia and release the pressure
43
Q

Acute compartment syndrome

A
  • emergent
  • trauma: severe contusion, crush injury, fx
  • excessive bleeding and acute rapid increase in volume and pressure
  • anterior, lateral, posterior compartments
  • anterior is the most common and has thick fascia
  • causes compression of vascular, neural and muscle tissue
44
Q

Signs and symptoms of acute compartment syndrome

A
  • acute intense pain, tingling, numbness not relieved by rest
  • diminished pulses, paresthesia, weakness, “drop foot”
  • medical emergency: irreversible tissue damage within hours
  • surgery: fasiotomy
45
Q

what to do with subtalar joint neutral test

A
  • STJN talus is neutral in mortis
  • assess alignment of rearfoot on leg and forefoot on rearfoot
  • assess in NWB and WB
46
Q

Navicular drop test

A
  • mark Navicular in STNJ allow relaxed stance and measure drop
47
Q

Rearfoot varus

A
  • normal is 0-4
  • greater than 4 is assoicated with a supinated foot
48
Q

Rear foot valgus

A
  • assoicated with a pronated foot
49
Q

Rear foot varus in relation to lower leg

A
  • inversion of calcaneus in STJ neutral
  • 0-4 varus is normal
  • assoicated with supinated foot
50
Q

Rear foot vaglus in relation to lower leg

A
  • eversion of calcaneus in STJ neutral
  • associated with pronation
51
Q

forefoot valgus

A
  • forefoot is everted in respect to rear foot when in STJ neutral
  • pronation stresses and instability of 1st ray to push off
  • 5th ray is up
52
Q

forefoot varus

A
  • forefoot inverted (1st ray up) in respect to rear foot in sTJ neutral
  • in WB compensation brings 1st ray, forefoot to floor
  • result is late pronation, pronation stresses
  • instability 1st ray at push off
  • 1st ray is up
53
Q

Feiss line test

A
  • in WB testsfor pronation
  • similar to navicular drop test
  • medial malleolus, navicular tubercle and metatarsal head are in a line
54
Q

Lacking Talocrual DF/gtoe extension compensation

A
  • compensation Hip ER, push off medial foot
  • that can increase pronation but stress STJ and MTJ
55
Q

Rigid supinated foot

Compensations

A
  • walk on lateral foot becomes painful
  • compensation increased pronation but that stresses hypo STJ, MTJ, intertarsals, TMT, causes pain
56
Q

Forefoot varus/inverted 1st ray

A
  • WB compensation brings 1st ray , forefoot to floor
  • pronation stress to STJ, MTJ, intertarsal joints TMT
57
Q

Orthoics correct

A
  • dont change the foot rather change the floor
  • alignment of rear foot to lower leg
  • alignment of forefot to rear foot
  • prevent abnormal stress
58
Q

Types of orthotics:

A
  • t provide motion control and support rigid, semi-rigid orthoic = pronation correction
  • shock absorption orthoic spreads foreces and increases ground contact for a supinated foot
59
Q

Match footwaer to foot

A
  • supinator = cushioned shoe for shock aborption
  • neutral foot: neutral stability shoe
  • over pronator: motion control shoe to control pronation adequate toe box
60
Q

Chi runner vs RS

A
  • chi runners: forefoot/midfoot strikers; contact ground in PF (need eccentric control)
  • RS: rearfoot heel strikers (have greater vertical forces and need knee extensors to work to counter act the GFR causing knee flexion)

Musculoskeletal 1 (42 decks)

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