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6 Orthopedics > L13 Plantar Pain > Flashcards

L13 Plantar Pain Flashcards

1
Q

Ottawa Imaging Rules for foot

A

Pain in midfoot zone and

  1. Bone Tenderness at base of 5th MC and navicular

OR

  1. Inability to bear weight both immediately and in emergency department
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2
Q

Ankle Ottawa imaging rules

A

Pain in malleolar zone and

  1. bone tenderness at posterior edge or tip of medial malleolus and posterior edge or tip of lateral malleolus

OR

  1. Inability to bear weight both immediately and in ER
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3
Q

Foot pain prevalence

A

13% to 36%
higher prevalence in females, obese, increasing age

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4
Q

Foot pain is an independent risk factor for

A

reduced physical function
impaired balance
increased risk of falls
loss of independence
reduced QOL

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5
Q

What was significantly associated with disabling foot pain prevalence?

A

age

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6
Q

Plantar fasciitis prevalence

A

most common foot condition treated by all health care providers

2 million cases per year

incidence of 10% over course of lifetime

common in runners

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7
Q

What contributes most to disability with foot pain?

A

Fear of movement (TSK-11 scores)

pain, ROM, and demographics were also contributors

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8
Q

_____ during a work week was found to reduce risk of plantar fasciitis

A

shoe rotation

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9
Q

Risk factors for plantar fasciitis

A

limited DF ROM
high BMI in nonathletic individuals

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10
Q

Non RF for plantar fasciitis

A

footwear
pes planus or cavus
calcenal osteophytes

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11
Q

Pt reports w/plantar fasciitis

A

pain in heel after inactivity
worse at end of day after WB
pain in morning, evening, period of resolved during day

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12
Q

CP of Plantar Fasciitis

A

pain w/palpation at medial tubercle
altered gait pattern, decreased toe off to avoid heel movement

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13
Q

Tests and measures for plantar fasciitis

A

windlass test
BMI
AROM/PROM of df

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14
Q

S/S of Calcaneal Bursitis

A

palpable mass
timing of pain
pain on achilles
worse in later day
worsens with standing
post heel pain

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15
Q

Treatment of Calcaneal Bursitis

A
  1. need more cushion on heel, less heel counter
  2. Heel cups (not taping)
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16
Q

S/S of Sever’s Disease

A

pain in area of growth plate
pain increased w/activity or impact
stretch of gastroc causes pain
superficial pain
inflammation signs

17
Q

Sever’s Disease

A

overuse injury of calcaneal apophysis in young person

18
Q

CP of Sever’s Disease

A

positive squeeze test
limited DF
painful calcaneal apophysis

19
Q

Interventions for Sever’s

A

it is a self-limiting condition

increase DF, cushion heel, limit impact

20
Q

Intrinsic causes of Tarsal Tunnel Syndrome

A

tendinopathy
tenosynovitis
lipoma
peri-neural fibrosis
ganglion cyst or post-op neuroma
malunion of calcaneal fracture
osteophystes

21
Q

Extrinsic causes of tarsal tunnel syndrome

A

shoes
trauma
anatomic deformity
post-surgical scarring
systemic inflammatory disease
edema of LE
flat foot

22
Q

S/S of Tarsal Tunnel Syndrome

A

numbness and tingling
increased pain w/eversion + DF
vague pain w/prolonged standing or walking
intermittent paresthesias
worse w/wb, better w/rest

23
Q

CP of Tarsal Tunnel Syndrome

A

tenderness of tibial nerve
usually inconclusive sensory exam
muscle wasting of intrinsics
pain w/df and eversion
positive triple compression stress test

24
Q

Tarsal Tunnel Syndrome Interventions

A

stretching of calf
foot orthosis for medial column
neural glides
avoiding compression

25
Q

S/S of Baxter’s Nerve Entrapemnt

A

pain on m aspect of calcaneous
radiating or burning pain under calcaneous
often worse following activity
atrophy of adductor digit minimi

chronic = hypoesthesia on lateral calcaneous or 5th MC

26
Q

Baxter’s nerve entrapment

A

entrapment of lateral plantar nerve
uncommon and difficult to differentiate
no reliable methods to differentiate it outside of subjective findings

27
Q

Etiology of Baxter’s nerve

A

advancing age
calcaneal osteophytes
plantar fasciitis
underlying mass
vascular enlargement
muscular enlargement
obesity
pronation

28
Q

Interventions for Baxter’s Nerve

A

orthotics
stretching/strengthening of foot intrinsics
footwear mod to decrease compression
activity mod
oral meds
ultrasound injections

29
Q

Biomechanics and plantar fasciitis

A

vertical impact peaks and loading rates were higher in those with PF

30
Q

What contributes to changes in vertical impact peaks and loading rates?

A

step rate (increased rate to lower impact)
foot inclination angle
vertical displacement of COM
over-stride
higher speeds

31
Q

Increased plantar fascia _____ was found to be associated with plantar fasciitis

A

thickness
alters the fat pad

32
Q

Calcaneal Bone Spur

A

those with larger or hooked spurs had the greatest improvement in function and pain

before treatment, neither shape nor size correlated with symptoms

33
Q

Grade A interventions for Plantar Fasciitis

A

Taping (short term)
Night splints (short term)
Manual therapy (short term)

34
Q

Grade B Interventions for Plantar Fasciitis

A

Therapeutic Exercise
Neuromuscular Re-education

35
Q

Grade C interventions for Plantar Fasciitis

A

Foot orthoses

36
Q

Night splints

A

1 to 3 mo program of night splints for individuals with heel pain who consistently have pain with first step in the morning

37
Q

Foot orthoses and PF

A

short term intervention (2 weeks) to reduce pain and improve function

focus on supporting medial arch and cushioning heel

good for those who respond well with taping

not to be used as a isolated treatment

38
Q

Manual Therapy and PF

A

helps to decrease pain and improve function
joint mobs (subtalar, talocrural, and 1st MTP)
soft tissue mob of calf

do it for 1 to 3 months

39
Q

Therapeutic Exercises and Neuromuscular Re-Education

A

resistance training for foot and ankle
should also include stretching of calf

6 Orthopedics (17 decks)

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