L13 Plantar Pain

Question 1

Ottawa Imaging Rules for foot

Answer 1

Pain in midfoot zone and

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

OR

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

Question 2

Ankle Ottawa imaging rules

Answer 2

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

2. Inability to bear weight both immediately and in ER

Question 3

Foot pain prevalence

Answer 3

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

Question 4

Foot pain is an independent risk factor for

Answer 4

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

Question 5

What was significantly associated with disabling foot pain prevalence?

Answer 5

age

Question 6

Plantar fasciitis prevalence

Answer 6

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

Question 7

What contributes most to disability with foot pain?

Answer 7

Fear of movement (TSK-11 scores)

pain, ROM, and demographics were also contributors

Question 8

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

Answer 8

shoe rotation

Question 9

Risk factors for plantar fasciitis

Answer 9

limited DF ROM
high BMI in nonathletic individuals

Question 10

Non RF for plantar fasciitis

Answer 10

footwear
pes planus or cavus
calcenal osteophytes

Question 11

Pt reports w/plantar fasciitis

Answer 11

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

Question 12

CP of Plantar Fasciitis

Answer 12

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

Question 13

Tests and measures for plantar fasciitis

Answer 13

windlass test
BMI
AROM/PROM of df

Question 14

S/S of Calcaneal Bursitis

Answer 14

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

Question 15

Treatment of Calcaneal Bursitis

Answer 15

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

Question 16

S/S of Sever’s Disease

Answer 16

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

Question 17

Sever’s Disease

Answer 17

overuse injury of calcaneal apophysis in young person

Question 18

CP of Sever’s Disease

Answer 18

positive squeeze test
limited DF
painful calcaneal apophysis

Question 19

Interventions for Sever’s

Answer 19

it is a self-limiting condition

increase DF, cushion heel, limit impact

Question 20

Intrinsic causes of Tarsal Tunnel Syndrome

Answer 20

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

Question 21

Extrinsic causes of tarsal tunnel syndrome

Answer 21

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

Question 22

S/S of Tarsal Tunnel Syndrome

Answer 22

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

Question 23

CP of Tarsal Tunnel Syndrome

Answer 23

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

Question 24

Tarsal Tunnel Syndrome Interventions

Answer 24

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

Question 25

S/S of Baxter's Nerve Entrapemnt

Answer 25

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

Question 26

Baxter's nerve entrapment

Answer 26

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

Question 27

Etiology of Baxter's nerve

Answer 27

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

Question 28

Interventions for Baxter's Nerve

Answer 28

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

Question 29

Biomechanics and plantar fasciitis

Answer 29

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

Question 30

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

Answer 30

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

Question 31

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

Answer 31

thickness alters the fat pad

Question 32

Calcaneal Bone Spur

Answer 32

those with larger or hooked spurs had the greatest improvement in function and pain before treatment, neither shape nor size correlated with symptoms

Question 33

Grade A interventions for Plantar Fasciitis

Answer 33

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

Question 34

Grade B Interventions for Plantar Fasciitis

Answer 34

Therapeutic Exercise Neuromuscular Re-education

Question 35

Grade C interventions for Plantar Fasciitis

Answer 35

Foot orthoses

Question 36

Night splints

Answer 36

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

Question 37

Foot orthoses and PF

Answer 37

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

Question 38

Manual Therapy and PF

Answer 38

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

Question 39

Therapeutic Exercises and Neuromuscular Re-Education

Answer 39

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