L13 Plantar Pain Flashcards
Ottawa Imaging Rules for foot
Pain in midfoot zone and
- Bone Tenderness at base of 5th MC and navicular
OR
- Inability to bear weight both immediately and in emergency department
Ankle Ottawa imaging rules
Pain in malleolar zone and
- bone tenderness at posterior edge or tip of medial malleolus and posterior edge or tip of lateral malleolus
OR
- Inability to bear weight both immediately and in ER
Foot pain prevalence
13% to 36%
higher prevalence in females, obese, increasing age
Foot pain is an independent risk factor for
reduced physical function
impaired balance
increased risk of falls
loss of independence
reduced QOL
What was significantly associated with disabling foot pain prevalence?
age
Plantar fasciitis prevalence
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
What contributes most to disability with foot pain?
Fear of movement (TSK-11 scores)
pain, ROM, and demographics were also contributors
_____ during a work week was found to reduce risk of plantar fasciitis
shoe rotation
Risk factors for plantar fasciitis
limited DF ROM
high BMI in nonathletic individuals
Non RF for plantar fasciitis
footwear
pes planus or cavus
calcenal osteophytes
Pt reports w/plantar fasciitis
pain in heel after inactivity
worse at end of day after WB
pain in morning, evening, period of resolved during day
CP of Plantar Fasciitis
pain w/palpation at medial tubercle
altered gait pattern, decreased toe off to avoid heel movement
Tests and measures for plantar fasciitis
windlass test
BMI
AROM/PROM of df
S/S of Calcaneal Bursitis
palpable mass
timing of pain
pain on achilles
worse in later day
worsens with standing
post heel pain
Treatment of Calcaneal Bursitis
- need more cushion on heel, less heel counter
- Heel cups (not taping)
S/S of Sever’s Disease
pain in area of growth plate
pain increased w/activity or impact
stretch of gastroc causes pain
superficial pain
inflammation signs
Sever’s Disease
overuse injury of calcaneal apophysis in young person
CP of Sever’s Disease
positive squeeze test
limited DF
painful calcaneal apophysis
Interventions for Sever’s
it is a self-limiting condition
increase DF, cushion heel, limit impact
Intrinsic causes of Tarsal Tunnel Syndrome
tendinopathy
tenosynovitis
lipoma
peri-neural fibrosis
ganglion cyst or post-op neuroma
malunion of calcaneal fracture
osteophystes
Extrinsic causes of tarsal tunnel syndrome
shoes
trauma
anatomic deformity
post-surgical scarring
systemic inflammatory disease
edema of LE
flat foot
S/S of Tarsal Tunnel Syndrome
numbness and tingling
increased pain w/eversion + DF
vague pain w/prolonged standing or walking
intermittent paresthesias
worse w/wb, better w/rest
CP of Tarsal Tunnel Syndrome
tenderness of tibial nerve
usually inconclusive sensory exam
muscle wasting of intrinsics
pain w/df and eversion
positive triple compression stress test
Tarsal Tunnel Syndrome Interventions
stretching of calf
foot orthosis for medial column
neural glides
avoiding compression
S/S of Baxter’s Nerve Entrapemnt
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
Baxter’s nerve entrapment
entrapment of lateral plantar nerve
uncommon and difficult to differentiate
no reliable methods to differentiate it outside of subjective findings
Etiology of Baxter’s nerve
advancing age
calcaneal osteophytes
plantar fasciitis
underlying mass
vascular enlargement
muscular enlargement
obesity
pronation
Interventions for Baxter’s Nerve
orthotics
stretching/strengthening of foot intrinsics
footwear mod to decrease compression
activity mod
oral meds
ultrasound injections
Biomechanics and plantar fasciitis
vertical impact peaks and loading rates were higher in those with PF
What contributes to changes in vertical impact peaks and loading rates?
step rate (increased rate to lower impact)
foot inclination angle
vertical displacement of COM
over-stride
higher speeds
Increased plantar fascia _____ was found to be associated with plantar fasciitis
thickness
alters the fat pad
Calcaneal Bone Spur
those with larger or hooked spurs had the greatest improvement in function and pain
before treatment, neither shape nor size correlated with symptoms
Grade A interventions for Plantar Fasciitis
Taping (short term)
Night splints (short term)
Manual therapy (short term)
Grade B Interventions for Plantar Fasciitis
Therapeutic Exercise
Neuromuscular Re-education
Grade C interventions for Plantar Fasciitis
Foot orthoses
Night splints
1 to 3 mo program of night splints for individuals with heel pain who consistently have pain with first step in the morning
Foot orthoses and PF
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
Manual Therapy and PF
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
Therapeutic Exercises and Neuromuscular Re-Education
resistance training for foot and ankle
should also include stretching of calf
