Lecture 8B Flashcards
These are associated with what foot type:
Plantar fasciitis
Pronator and Supinator, but moreso Pronator
These are associated with what foot type:
Interdigital neuroma
Shin splint
Pronator
These are associated with what foot type:
Tarsal tunnel syndrome
Patellofemoral dysfunction
Posterior tibialis tendon dysfunction
Pronator
These are associated with what foot type:
Stress fracture
Peroneal tendinitis
Supinator
These are associated with what foot type:
IT band friction
Lateral ankle sprain
Low back pain
Supinator
Do studies support the use of manual therapy alone to treat ankle sprains?
Yes
Do studies support RICE and immobilization for ankle sprains
No
Do studies show that exercise can help prevent chronic ankle sprains?
Yes, but does not reduce postural sway
Studies show a large relationship between _____ and the occurrence of ankle sprains
BMI
What does the McGuine et al balance program include for treating ankle sprains
Static and dynamic balance activities
What is the CPG for using manual therapy to help with inversion ankle sprains
Symptoms worse when standing
Symptoms worse in evening
Navicular drop over 5mm
Distal tibiofibular joint hypomobility
Is manual therapy with therex proven better than just therex alone for lateral ankle sprains?
Yes
Is manual therapy + therex + soft tissue release proven better than just
Manual therapy + therex
for the management of acute inversion ankle sprain?
No
When implementing the 4 week comprehensive rehab program for chronic ankle instability do we need to do all of the exercises listed?
Don’t do all exercises immediately, focus on fewer exercises with quality movement
What clinical measures are important for ankle
Measure ankle swelling
Measure ankle ROM (particularly dorsiflexion in open and closed chain when possible)
Talar inversion/eversion
SL balance (star excursion test)
Note: need to measure everything 2 or more times during care
What outcome measures have Strong evidence for foot and ankle
FAAM (foot ankle ability measure)
LEFS
how much evidence do single leg hop tests have for foot and ankle outcomes
moderate
Should you use ultrasound for acute ankle sprains?
NO
strong evidence NOT to use
Evidence levels for ankle
Cryotherapy:
Manual therapy:
Therex:
External support/Assistive devices:
Cryotherapy: weak
Manual therapy: strong
Therex: strong
External support/Assistive devices: strong
What do you need to rule out for every case that could be an ankle sprain:
Fractures!
Use the ottawa ankle and foot rules
What is needed if a patient is positive under the ottawa foot and ankle rules
Immobilization, clearance by MD w/ repeated imagining required
NO MANIPS or MOBs
While a patient has an immobilized ankle/foot what do we treat
edema, gait w/ AD, and CV conditioning
Ottawa ankle rule
Boney tenderness at lat mal
Bone tenderness at med mal
Inability to bear weight in ER and after injury
Ottawa foot rules:
bone tenderness at base of 5th met
bone tenderness at navicular
inability to bear weight in ER and after injury
Is compartment syndrome urgent or emergent?
acutely, it can be emergent (especially if there is pulselessness)
How do we prevent compartment syndrome from developing:
No massage, no modalities, if casted use bivalve cast, extended rest
Place limb ________________
AT the level of heart
not above or below
What is the progression for achilles tendinopathy rehab
Start with isometrics -> eccentric -> energy storage
What intervention has grade A evidence for achilles tendinopathy
Eccentric loading
heavy load and slow speed eccentric/concentric
What level of evidence does PF stretching have for achilles tendinopathy
C level, weak evidence
Loss of arch height, forefoot abduction, rear foot valgus
painful plantarflexion
Posterior Tibialis Tendon Dysfunction
Weak/painful single leg heel raise, assymetrical bilateral heel raise, weakness with inversion and plantarflexion. Decreased push off during gait
Posterior tibialis tendon dysfunction
Which way does the cuboid most commonly sublux
Plantar
Overuse injury with flat pronated foot, pain along the medial ankle and along the PTT, swelling at medial posterior ankle, weakness with push off, difficulty and/or pain with heel raise
posterior tibialis tendon dyfunction
When is a plantar cuboid dyslocation most common in dancers
during transition from foot-flat to demipointe
How good is the evidence for corticosteroid injection for SHORT TERM relief of pain in the plantar heel
limited evidence
How good is the evidence for night splints for reducing pain in CHRONIC conditions of the plantar heel
limited evidence
What is the evidence like for manual therapy for plantar heel pain?
Young et al JOSPT found that manual therapy works and cured all patients to 0/10 pain at discharge and short term follow up
How helpful are Orthoses for plantar fascitis
only for short term relief
Grade B evidence NOT to use isolated foot orthoses
how helpful is plantar fascia stretching for plantar fascitis
good
is manual therapy + Therex better than therex alone for plantar fascitis?
yes
Is ultrasound helpful for plantar fascitis?
no, dont use it!
are night splints helpful for plantar fascitis?
Yes, grade A evidence
especially for people who have consistent pain with first step in the morning
perscribe for 1-3 months
what has strong evidence for plantar fascitis?
Manual + Stretching (plantar fascia and gastroc/soleus) + Taping + Night splints
What has moderate evidence for plantar fascitis
Therex
Low level laser therapy
Dry needling
How much great toe ext is needed for gait
65-70
how do we treat hallux rigidus
Mobilization
Rigid insert
Rocker bottom shoe
