Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

athletic injuries 2036 > lecture 11: Foot and ankle problems > Flashcards

lecture 11: Foot and ankle problems Flashcards

1
Q

Plantar Fascia Anatomy

A
  • composed of 3 segments: central, medial and lateral
  • the central ordinates from the medial tubercle on the plantar surface of the calcaneus
  • travels toward the toes as a solid band of tissue dividing just prior to the MT heads into 5 slips
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

the central band in the foot

A
  • very important
  • starts at calcaneus, moves down towards the meta-tarsal heads
  • gives us support and helps for “heel off” when we are starting to propel ourselves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

windlass mechanism review

A
  • when the toes are extended, the plantar fascia/arch is functionally shortened as it wraps around each MT head
  • in this way, the plantar fascia functions “dynamically”, and affects arch height
  • it is responsible for transferring the weight from the medial to the lateral side of the foot during the gait cycle, as well as arch support/dynamic shock absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does the windlass mechanism review help us do

A
  • move our foot from medial to lateral side of the end of our gait sections
  • helps pronate and supinate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

plantar fasciitis - the facts

A
  • most common condition in the foot
    (1 in 10 will report medial heel pain)
    (usually on affects 1 foot (70%) with 30% having bilateral involvement)
  • brought about by overuse of excessive loading
  • especially in those with atypical arches
    (pes planus and pes Cavus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when might plantar fasciitis occur in in people other than pronation?

A

1: with active people it may be due to changes in training (FITT), than over pronation

2: linked to BMI in less active or recently active people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

plantar fasciitis - tissue level

A

1: overuse condition
2: changes in structure I.e. collagen disarray
3: non-inflammatory degenerative condition
4: this is a fasciOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

symptoms of plantar fascia

A
  • gradual onset of pain
  • sharp “stabbing pain” on first couple of steps in the morning or after long periods non-weightbearing
  • pain generally improves after initial few steps but as condition progresses pain will worsen with prolonged activity (running, jumping, standing, etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

signs of plantar fascia

A
  • pes Planus or Pes Cavus (flat or high aches of feet)
  • often decreased dorsiflexion ROM
    • Tight Gastrocnemius or soleus
    • poor joint mobility
  • weakness of Tibialis posterior
  • pain on palpation over again of PF and along its length
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

signs vs symptoms

A

symptoms: what someone says they feel, them telling you

signs: something that you can actually see or touch, you actually see or touch for yourself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

shape of the foot (arch): over pronators and supinators

A

1: over pronators
- turn in too far
- have hard time mantaining arch
- trouble/slow with resupination
- may cause twist during propulsion

2: supinators
- usually people with super high arches, because their foot is not unlocking so when ti comes down it gets a pull through it which eventually breaks down
- decreased shock absorption and ability to adapt to the terrain
- due to lack of pronation
- force through the fascia to absorb shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

the role of pronation through the gait cycle

A

foot function: mobile adapter

foot structure: lowered arches, looser joints

Gait phase : just after heel strike to foot flat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

the role of supination through the gait cycle

A

foot function: rigis lever

foot structure: heightened arches, tighter joints

gait phase: short period at heal strike and foot flat to toe off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

tight posterior structures of the ankle

A
  • anatomical connection between achilles tendon and plantar fascia
  • if achilles tendon (or those structures attaching to it) is/are tight, then the plantar fascia may be pulled excessively tight
  • tight plantar flexors will also affect dorsiflexion ROM and will affect motion throughout foot contact
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

heel spurs

A
  • present in 80% of PF patients
  • due to repeptivie microtrauma
  • spur length is signficantly correlated with age, BMI, symptom duration, perceived pain
  • may not be casually related to pain and may worsen on x ray after symptoms have resolved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

why do heel spurs take a while to fully heal?

A

because it heels over night, but when the patient wakes up in the morning and steps everything tears again
- this then may lead to the body begins to lay down bone because the body can not heal the muscle (bone spur)

17
Q

treatment for plantar fasciitis - initial pain control

A
  • taping
    -over pronators (calcaneal/low dye) acute < 10 days
  • orthotics - Over the counter vs Custom < 1 year
  • night splints - for symptoms > 6 months
  • you can use ice, however it is not for inflammation. it is just used to block the C fibers and help to control the pain
18
Q

treatment for plantar fasciitis - fibroblastic/repair

A
  • correct training errors!
  • manual therapy/soft tissue work and exercise
    -cavus foot
    • tight posterior muscles
  • stretching (2-4 months)
    • tight posterior muscles
    • plantar fascia
19
Q

treatment for plantar fasciitis - late repair/remodeling

A
  • idealize strength through range
  • add in power and agility component
    • push-off, jumping, cutting etc
  • decide on return to play taping, shoes and/or insole
20
Q

Morten’s Neuroma - the facts

A
  • the condition was initially described in 1876 by Thomas morton
    • not a true neuroma
  • this is a compressive neuropathy of the common plantar digital nerve of the 3rd webspace
  • this nerve is thickest as it receives branches from medial plantar nerve and lateral plantar nerve
    • nerve splits at the metatarsal (MT) head under ligament
21
Q

transverse arch anatomy

A
  • nerve bifurcates to give sensory to plantar aspect of foot.
  • good transverse arch = more space for nerves
  • decrease transverse arch means less space for nerves as bones drop causing inflammation from mechanical irritation
22
Q

Morten’s neuroma - assessment findings (symptoms)

A
  • pain/burning that radiates into the plantar aspect (the bottom of the foot) of the forefoot, usually 3rd webspace.
    • toes
    • occasionally the dorsal webspace
  • made worse by forefoot weight-bearing
    • dancing
    • high heeled shoes
    • may describe it as walking on a stone or pebble
    • worse with narrow fitting footwear
23
Q

Morten’s neuroma - assessment findings (signs)

A
  • squeeze test, the examiner compresses the forefoot with his/her hand, while squeezing the webspace
  • web space tenderness
  • plantar percussion (Timel’s) test
  • toe-tip numbness
24
Q

Morten’s Neuroma- treatment

A

if acute and inflamed:
- police/peace &love
- refer for corticosteroid injuction

chronic or after acute phase: avoid high heeled, pointed or narrow shoes. (select shoes with a wide toe box). also avoid aggravating activities

25
Q

morten’s neuroma - Treatment for correction of transverse flatfoot

A
  • mobilization of foot-splaying to increase transverse arch position
  • metatarsal pad
    (graduated return to activity)
26
Q

Morten’s Neuroma - last resort

A

Surgery
- but if you take the nerve out then you are loosing sensory to the bottom of your foot which can cause further issues

27
Q

sesamoiditis - the facts

A
  • two sesamoids beneath 1st MTP joint, to protect flexor halitus longus from being crushed
  • transmit forced from ground to 1st MT head
  • may be fractured, arthritic, but usually irritated or stress reaction
  • estimated that 30% of seasamoid injuries are sesamoiditis
28
Q

what is sesamoiditis mostly caused by

A
  • often caused by repetitive stress and/or hyperextension of the great toe
  • most common in dancing and basketball
29
Q

sesamoiditis - symptoms

A
  • patients reports pain under their great toe/forefoot when weight bearing (because you are putting pressure through the two bones)
  • improved when not weight bearing
  • worse with dorsiflexion of great toe
30
Q

sesamoiditis - signs

A
  • all the signs of the initial inflammation stage
  • swelling, redness, pain with passive dorsiflexion of great toe
  • pain and weakness with resisted plantar flexion of great toe
  • pain with direct palpation of medial or lateral sesamoid
31
Q

sesamoidities - treatment

A
  • treatment of an
    “ITIS” (red, hot, swollen, painful)

inflammatory/destructive phase
- POLICE/ Peace & love
- restrict activity to allow inflammation to subside
- metatarsal bar, dancers pad or orthotiics

32
Q

prior to return to play for sesamoiditis treatment

A
  • correct training errors/modify equipment (mostly like shoes)
  • graded return to training
33
Q

Turf toe - the facts

A
  • can be one time or repeptive trauma (posterior roll-up MOI)
  • forced hyperextension of the great toe (dorsiflexion > 100 degrees)
    • causing tear of the plantar capsule and plantar ligaments of the great toe
    • graded like other sprains (grading 1,2,3, looking for laxity and endpoint)
  • predisposing factors are:
    • playing on artificial turf
    • soft flexible footwear
34
Q

Turf toe - symptoms

A
  • described a mechanism that includes hyper-dorsiflexion of the great toe
  • reports pain swelling and at the first MTP joint (distal to sesamoids)
  • worse with movement and weight-bearing
  • may describe a weak “push-off”
35
Q

turf - toe - signs

A
  • visible, swelling, redness and or ecchymosis (bruising)
  • pain with passive plantar and dorsiflexion of great toe, with limited ROM
  • pain and weakness with resisted plantar flexion of great toe
  • pain and laxity with dorsiplantar drawer test (slinging the toe up )
36
Q

turf-toe - treatment phase 1: inflammatory/destructive phase, hot, painful, swollen

A

plan:
- POLICE/ peace & love (crutches and or tape to protect)

before the end of this stage:
- optimize healing environment
- palliate pain
- decrease swelling

37
Q

turf toe - phase 2

A

repair/fibroblastic (pain, swelling subsides tissue healing)

  • protect the tissue and idealize healing environment
  • increase flow flow (heat)
    before the end of this stage:
  • idealize ROM
  • progress weight-beairng
  • being gentle strengthening
38
Q

turf-toe remodelling stage treatment

A
  • functional training for return to play
  • idealize strength through range
  • add in power and agility component
  • push-off, jumping, cutting etc
  • decide on return to play taping, shoes and/or rigid insole

athletic injuries 2036 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions