Foot and Toes Flashcards
Plantar fascia rupture
Forced DF and toe extension
Increased risk w/ cortisone inj
S/S: Immediate problems w/ weight bearing Intense pain Pain during gait Swollen and discolored Palpable defect on calcaneal tubercle
Treatment:
Heals in 2 wks
Heel spur
Hook shaped Bony outgrowth-exotosis
Site of origin of short toe flexor muscles
Symptoms similar to PF
Bursitis
Haglaund’s deformity
Bony enlargement in posterior calcaneus caused by excessive friction
Common in women who wear heels
Treated conservatively
Tarsal tunnel syndrome
Entrapment of the posterior tibial nerve
Tarsal fx or dislocation, hyper PF or eversion, or chronic overuse
Rearfoot Varus and excessive pronation, increased tibial IR, and pes planus
Tensosynovitis of tib post, flexor hallicus longus, or flexor digitorum
S/S:
Pain, numbness, burning along plantar and medial aspect of foot that increases w/ activity and decreases w/ rest
Pain from medial malleolus and Lower leg and plantar aspects of foot
Increased pain at night
ST:
Tinel’s sign
DF- eversion test
Treatment:
Orthotics
Surgery
NSAIDS
Metatarsalgia
General discomfort around MT head
May have callus formation
Excessive body weight, valgus heel, hammer toes, arch conditions
Narrow toe box, repetitive jumping, excessive training, or running style
Fallen arch
S/S: Restricted extensibility of the gastroc-soleus Arch flattened Pain with 2-4 MT Cavus deformity
Tx: Pad to elevate heads Stretching Exercises concentrating on strengthening flexor and intrinsic muscles Thomas heel
Lisfranc injury
Tarsometatarsal- lisfranc
High energy-fx or dislocation
Low energy-sprain
Rotate with distal segment fixed
Axial load while toes are extended
Forceful hyperPF with dorsal displacement of the proximal end of the MT
Dorsum rolls forward with body weight forcing the base of MT dorsally
S/S: Swelling and tenderness in dorsum Possible palpable deformity Pain and inability to WB Fx of Mt possible Sprain of 4th and 5th MT causes ongoing pain
Treatment:
No weightbearing (8 wks fx)
May need surgical fixation if fx or dislocation
Intermetatarsal neuroma
Entrapment of nerve (3rd-4th Mortons)
Excessive motion, thickened and shortened transverse intermetatarsal ligament from collapsed arch, and excessive pronation
Activities that increase WB or compressive pressure
Women more likely than men cause high-heels
S/S:
Pain in anterior transverse arch
Pain radiating to toes or plantar aspect of foot or up the ankle or lower leg
Pain during weight bearing and w/shoes-relief when footwear removed
Increase in symptoms w/ direct pressure
Palpable nodule
Pain with DF and toe extension
Burning and numbness pain in forefoot and radiates to digits
Pain relieved with NWB
Test:
Milder sign
Eraser test
Treatment: Injection of lidocaine Modification of footwear Orthotics Anti inflammatory Cortisone inj Surgery Tear drop shaped pad to splay MT apart
Hallux rigidus
Progressive degeneration of 1st MTP joint articulation surface caused by arthritis, gout, hallux valgus, effusion, hyper mobility of 1st tarsometatarsal jt, long 1st MT leading to degeneration
Associated with Mortons toe
Strong genetic component
MT head erodes and fx occurs
Proliferation of bony Spurs on the dorsal aspect of first MTP joint, resulting in impingement and a loss of both active and passive DF
S/S: Loss of DF and pain Pain in 1st MTP Lateral foot pain Atrophy and tight triceps surae Palpable and painful bone growth on dorsal aspect extension of 1st MTP limited Swelling
Treatment: Joint mobs PROM for extension Orthotics to decrease hyperextended not forces on the first MTP joint Footwear modification-stiffer Boot to decrease joint motion Cortisone injection Surgery Anti-inflammatory
Turf toe
Hallux limitus
1st MTP joint sprain
Hyper extension of great toe
S/S:
Pain during push off phase of gait and quick stoping and jumping
Limited ROM
Pain and swelling of MTP joint
Treatment: Crutches, firm shoe insole, or other immobilization device Anti inflammatory Taping or orthoplast Ice and Ultrasound Rest until pain free
Sesamoiditis
Irritation of the bones and soft tissue
Repetitive hyper extension of the great toe
S/S: Pain when on their toes Passive extension painful Walking on lateral aspect of foot Pain under great toe, especially during a push off
Treatment:
Orthotics
Metatarsal pads, arch supports, and metatarsal bar
Decrease activity
Sesamoid fx
Eccentric loading during extension
Popping sensation followed by immediate inability push-off
S/S:
Swelling of 1st MTP joint
Point tender
Gait altered
Treatment:
Protected weight bearing
Metatarsal pad
Surgery
Phalangeal FX
Longitudinal force-kicking immovable object
Crushing force-being stepped on
S/S: Deformity Pain immediate and intense and increased with movement Crepitus Pain w/toe off Swelling
Treatment: Test Hard soled shoe Buddy taping Crutches Surgery may be necessary Casting for 3 wks
Jones fx
Inversion and PF and then everything and brining it back to proper orientation can cause the Peroneal Brevis tendon can be avulsed from the attachment of the styloid process of 5th MT
Direct force or repetitive stress
S/S: Pain Crepitus Swelling over insertion and 5th MT False joint Obvious deformity ROM of joints above and below limited to pain
Test:
Long bone compression
Treatment:
Immobilization and non-weightbearing
Avulsion-cast 4 weeks
MT shaft or neck- immobilization and weightbearing for 4-6 weeks
Early fixation of jones fx 8 weeks of immobilization followed by weight bearing in a cast as tolerated
Metatarsal stress fx
Dysfunction of 1st MTP joint, neuropathy, metabolic disorders, and rearfoot malalignment
March fx-shaft of 2nd MT
Post menopausal women at greatest risk
Can progress to full fx
Abnormally short 1st MT so 2nd looks longer making the WB on the 2nd predisposing to stress fx (Mortons toe)
Suddenly changing patterns of training
S/S:
Dull Local pain w/activity that decreases w/ rest but still there and progress to all the time
Pt tender area but first diffuse
Treatment: Withheld from activity Walking boot or stiff soled shoes 2-4 days of partial weight bearing followed by 2 weeks of rest Return to activity gradually Orthotic to correct stress
Plantar fasciitis
Inflammation of the plantar fascia
S/S:
Pain at origin of planar fascia-calcaneal tubercle may appear swollen
Pain w/first stepping out of bed and before and after activity (subsides during), walking bearfoot, or climbing stairs but can become constant
Decreased DF ROM
Decreased PF strength
Tightness of the triceps surae
Treatment: DF night splints Anti-inflammatory Meds Orthotics Heel cups Stretching of PF and LE musculature Cortisone inj Low dye taping, iontophoresis, stem 8 to 12 wks Short leg walking cast for 4-6 wks if severe Rolling PF Exercises to increase DF and great toe extension
Tarsal fx
Laterally from severe inversion and DF or medically from an inversion and PF force with ER of tibia on talus
S/S: Repeated ankle trauma Pain w/ WB Catching and snapping Swelling Talar dome tender
Treatment:
Protective immobilization w/NWB progressing to full WB
Rehab to strengthen and regain full ROM
Surgery may be necessary -6 to 8 month recovery
Calcaneus fx
Landing after a jump or fall from a height
Avulsion fx
S/S:
Immediate swelling and pain and can’t WB
Treatment:
RICE
Immobilization and ROM
Calcaneal stress fx
Repetitive impact during heel strike
S/S:
Sudden onset of constant pain in heel
WB increases pain-heel strike
Pain continues after exercise
Treatment:
Rest and AROM exercises
NWB cardio
2 weeks
Apophysitis of calcaneus (Severs disease)
Young, physically active
Traction injury where Achilles attaches
S/S:
Pain in posterior heel below attachment of Achilles insertion
Pain w/ vigorous activity and does not continue at rest
Treatment:
Rest, ice, stretching, NSAIDS
Heel lift
Retrocalcaneal bursitis
Inflammation of the bursa that lies between the Achilles and calcareous
Pressure and rubbing of the heel contour of shoe
Chronic
S/S:
Pain by palpating above insertion of achilles
Swelling on both sides of heel cord
Management: RICE and NSAIDS and analgesics Ultrasound Stretching Heel lift doughnut heel pad Larger shows with wider heel
Heel contusion
Stop-and-go response or sudden change from horizontal to vertical
S/S:
Severe pain in the heel and is unable to withstand the stress of WB
Warmth and redness over tender area
Management: NWB for 24 hr RICE and NSAIDS Pain free start activity with heel cup or doughnut Shock absorbent footwear
Cuboid subluxation
Pronation and trauma
S/S:
Pain on the dorsum of the foot and/or over the anterior/lateral ankle after inversion
Pain in 4th and 5th MT and over cuboid
Referred pain to heel
Pain increased after prolonged NWB position
Tx:
Manipulation to restore cuboid to neutral
Orthotic for support
Can return with no pain
Longitudinal arch strain
Increased stress produced by repetitive contact with hard surfaces
Chronic and acute
S/S:
Flattening or depression of the longitudinal arch
Pain only when running or jumping
Pain below post tib tendon with swelling and tenderness along medial foot
Tx: RICE Rehab NWB Arch taping
Bunions-hallux valgus deformity
Bunionettes-tailors bunions
Head of 1st MT
Forefoot Varus and Shoes that are pointed, too narrow, or too short
Bursa over 1st MTP joint becomes inflamed and eventually thickens
Tendinitis for flexor tendons of the great toe
Joint becomes enlarged and malaligned, moving laterally towards the 2nd toe
Depressed or flattened transverse arch and pronated foot
5th MTP joint-ambulated toward the 4th toes causing an enlarged MT head
S/S:
Tenderness, swelling, and enlargement of the joint
Angulation of the toe progresses, eventually leading to painful ambulation
Tx:
Wear correctly fitting shoes with a wide toe box
Wear appropriate orthotic to correct a structural forefoot Varus deformity
Place a felt or sponge rubber doughnut pad over the 1st or 5th MTP joint
Wear a tape split along with resilient wedge placed between the great toe and the 2nd toe
Engage in daily foot exercises to strengthen the extensor and flexor muscles
Surgery
Metatarsal arch strain
Fallen arch and pes cavus more susceptible
Heads of 1st and 5th MT bear more weight than others
Excessive pronation or if intermetatarsal ligaments are weak causing splaying or fallen arch
S/S:
Pain and cramping in metatarsal region
Pt tender and weakness
ST:
Mortons test
Tx:
Pad to elevate depressed MT heads
Sprained toes
Kicking a nonmoving object
Extend joint beyond its normal ROM (jamming it) or twisting motion
S/S:
Pain is immediate and intense but short lived
Immediate swelling and discoloration
Stiffness and pain may last several weeks
Tx:
RICE
Buddy taping
WB as tolerated
Hammertoe
Mallet toe
Claw toe
Hammetoe- flexible deformity caused by flexion contracture at the PIP joint
Mallet toe- flexion contracture at the DIP joint involving the flexor digitorum longus tendon. Eventually becomes fixed deformity with callus development dorsally
Claw toe- flexion contracture develops at the DIP joint but there is also hyper extension at the MTP joint. Callus develops over the PIP and under MT head
Caused by wearing shoes that are too short
S/S:
MTP, PIP, and/or DIP become fixed
Blistering, swelling, pain, callus formation and infection
Tx: Footwear modification Padding and protective taping can help prevent irritation Shave callus Surgery if fixed Kwire to maintain position
Subungual hematoma
Blood under the toenail from toe being stepped on, dropping an object on the toe, or kicking something
Repetitive forces
Can cause loss of toenail
S/S:
Pain
Bluish-purple color
Tx:
Ice pack
Elevation
12-24 hrs need to be drilled into nail bed
