Management Strategies Flashcards
What are some accommodative management strategies for HAV?
Semi compressed felt oval cavity pad over medial aspect of 1st MTPJ - to deflect pressure off of medial exostosis
OTC silicone digital cover or oval fleecy web pad over 1st MTPJ - to cushion medial exostosis and prevent friction with footwear
Footwear with rocker bottom sole and/or wide toe box - to facilitate pain free propulsion and prevent lateral compression of lesser digits and secondary pathologies (HD, PDN e.t.c)
NSAIDs - to manage pain symptoms
What are some functional management strategies for HAV?
Orthoses w/ EVA medial rearfoot wedge - To re-supinate foot and increase mid and forefoot stability in late stance, exerting less medial GFR on the 1st MTPJ
Intrinsic strengthening (short foot + toe spread exercises) - To strengthen FHB, adductor hallucis and abductor hallucis, stabilising the MLA
Extensor strengthening (toe extension exercise) - To maintain/improve toe dorsiflexion/ extension
Tib Post, Triceps Surae and Peroneus longus strengthening (Heel raises, plantarflexion and inversion, plantarflexion and eversion) - To reduce midfoot instability and adress late stance pronation
Achilles Tendon stretching - If tendon is tight and contributing to late stance pronation, to aid midfoot stability
Night-Splinting - To delay onset of Davis’ Law and attempt to realign joint position
Interdigital Ottoform K Toe Prop - to prevent lateral drift of hallux and manage soft tissue changes, useful if patient has a 2nd digit amputation or short 2nd met
What are some accommodative management strategies for Achilles tendinopathy?
NSAIDs + POLICE Principle - To manage pain symptoms and reduce inflammatory response
Activity Modification - To reduce pain symptoms in short term, try swimming as an alternative to running to prevent excessive overloading of tendon
12-15mm Orthotic Heel Lift - To reduce tensile stress on tendon and manage pain
Poron Heel Cup - To cushion the heel and prevent further irritation of tendon
Footwear w/ Rigid Sole + Adequate Heel Height - To reduce tensile loading on tendon and reduce rear and midfoot instability to avoid overloading
What are some functional management strategies for Achilles tendinopathy?
Alfredson’s Eccentric Loading (Single or double limb: lowering and raising heel on the edge of a step) - 3 sets of 15 reps daily for 12 weeks, to increase the tendon’s load tolerance and reduce pain symptoms in long term
Isometric Loading (Standing or seated single or double heel raises) - 3 sets of 15 reps daily for 12 weeks, to increase tendons load tolerance gently and reduce long term pain symptoms
Achilles Stretching - To increase tendons flexibility, allowing for more effective strengthening rehab, and reduce post static dyskinesia symptoms
Orthoses w/ medial rear-foot wedge - To control STJ pronation, re-supinating the foot during stance phase and preventing further tendon overload
What are some accommodative management strategies for plantar fasciopathy?
NSAIDs + POLICE Principle - To reduce pain symptoms in short term
Low Dye Strapping of Plantar Fascia - To reduce tensile stress on fascia and limit rearfoot motion in short term
Poron Heel Cups - To cushion fascia insertion at medial calcaneum and prevent further irritation of fascia
EVA Morton’s Extension or Long Shaft Pad - If patient has an SHL or hallux rigidus, to immobilise the 1st MTPJ and prevent pain symptoms from activation of windlass
Footwear w/ shock absorbing well cushioned soles - To reduce pain symptoms while walking and prevent further irritation of the fascia
CS injections - To reduce pain symptoms in short term (4-12 weeks) and facilitate physical rehab
Extra-Corporeal Shock Wave Therapy (EWST) or Therputic Ultrasound - To reduce pain symptoms if 1st line measures have failed
What are some functional management strategies for plantar fasciopathy?
Plantar Fascia and Achilles Tendon Stretches - To loosen tissues and reduce overstretching of the fascia due to Achilles tightness (which also contributes to excessive pronation and facial overloading)
Intrinsic Strengthening (Short foot + Doming exercise) - To strengthen the muscles that support the MLA, reducing the excessive strain on the fascia and improving midfoot stability
High Load Strengthening of Triceps Surae + Tib Post (Single limb heel raises) - Increase fascia’s load tolerance, stimulate collagen synthesis and strengthen anti-pronatory musculature to address late stance pronation causing fascia overloading
Orthoses w/ medial heel wedge and reverse Morton’s extension - To control STJ pronation, decreasing over exertion of fascia and encourage 1st MTPJ dorsiflexion if patient also has an FHL that could be contributing to the fascial overload
Night Splints - To increase ankle dorsiflexion and prevent contracture of plantar fascia and Achilles tendon (reducing post static dyskinesia symptoms)
What are some accommodative management strategies for TPTD?
NSAIDS + POLICE Principle - To manage pain symptoms in short term
Short Term Boot Immobilisation - To reduce pain symptoms and prevent further dysfunction of tib post
Activity Modification - In short term to reduce pain symptoms and prevent further trauma to tendon by using swimming or cross training as an alternative to running
Tib Post Taping - To reduce tensile stress on tendon in short term
Footwear w/ Rocker bottom sole - To aid progression of gait with less pain
Poron Heel Padding - In stage 3 or 4 where longstanding non-corrective pes planovalgus deformity is present, to cushion posterior heel and reduce pain symptoms
EVA or Semi-Compressed Felt PMP w/ ‘U’ cut outs or ‘wing’ cut out - To deflect increased pressure over plantar met heads and manage soft tissue pressure pathologies such as HD and callus
EVA or Semi-Compressed Felt Plantar Heel Pad w/ cavity - To deflect increased pressure away from soft tissue pressure pathologies such as HD and callus
US Guided CS Injection - In early stages only (because tendon is not elongated and weakened), to reduce inflammation and secondary damage to tendon, while managing pain symptoms in short term
EWST, Laser Therapy, Theraputic US - To attempt to relieve pain symptoms if 1st line therapies have failed
What are some functional management strategies for TPTD?
Orthoses w/ Medial Heel Wedge and MLA Support - To correct Pes Planovalgus deformity and reduce instability in gait due to excessive pronation
Stretching of Achilles Tendon - To manage ankle equines as a mechanical aetiology
Eccentric and Isometric Loading of Tib Post (Seated heel raises, progressed to single limb standing) - To strengthen Tib Post, optimising it’s function and preventing further progression of Pes Planovalgus deformity
What are some accommodative management strategies for FHL?
Semi-Compressed Felt or EVA PMP w/ Wings or ‘U’ cut outs - To deflect increased forefoot pressure away from lesser met heads, managing discomfort from any soft tissue pressure pathologies such as HD and callus
Footwear w/ Adequate Heel Height - To manage/reduce increased forefoot pressure
NSAIDs - To manage pain symptoms
What are some functional management strategies for FHL?
Orthoses w/ EVA Reverse Morton’s Extension, 1st Ray Cut Out, Kinetic Wedge - To facilitate plantarflexion of the 1st ray and encourage 1st MTPJ dorsiflexion during propulsion
Orthoses w/ Medial Heel Wedge - To supinate foot and provide midfoot stability in gait, preventing functional jamming of 1st MTPJ and progression of restriction
Strengthening of Tib Post (Single or Double Limb Heel Raises, plantarflexion and inversion with resistance band) - To control late stance STJ pronation and improve midfoot stability
Strengthening of Peroneus Longus (plantarflexion and eversion with resistance band) - To facilitate 1st Ray plantarflexion
Stretching of Triceps Surae/ Achilles Tendon - To manage tight calf musculature causing an ankle equines and subsequent compensations that lead to an FHL
Footwear w/ Forefoot Rocker - To improve dorsiflexion of the 1st MTPJ in propulsion
What are some accommodative management strategies used for plantar plate tears?
NSAIDs + POLICE Principle - To reduce pain symptoms
Poron Dome Pad - Placed proximal to the metatarsal heads to shift GFR and reduce pressure exerted on the met heads, reducing pain symptoms
‘Breast Cancer’ Zinc Oxide Strapping Around Affected Metatarsal - To reduce extension at affected MTPJ, preventing further dorsal translation/ dislocation and reducing pain symptoms
Semi-Compressed Felt or EVA PMP w/ ‘U’ Cut Out Over Affected Joint - To displace pressure away from met head and manage any secondary soft tissue pathologies causing further discomfort
Avoidance of High Heeled Shoes - Footwear w/ adequate forefoot cushioning, a rocker bottom sole with adequate rigidity to prevent bending at the toes is best for maximising comfort while facilitating efficient propulsion
CS Injection - To reduce inflammation and pain symptoms at affected MTPJ and allow for rehabilitation
What are some functional management strategies used for plantar plate tears?
Strengthening of Abductor Hallucis (Short foot exercise) - To improve mid and forefoot stability, reducing strain on affected MTPJ and it’s function
Management of Co-Existing Pathologies that Increase Strain on Plantar Plate - Such as HAV, ankle equinus, pes planus or cavus deformities.
Surgical Repair of Plantar Plate and/or Osseous Correction and Tendon Transfer - In cases where conservative management has failed and/or tear is too severe to be managed conservatively
What are some accommodative management strategies for lesser toe deformities?
Semi Compressed Felt Oval Cavity Pad, Semi Compressed Felt Crescent/ U Pad, Semi Compressed Felt Interdigital cavity pad (for interdigital HM) - To deflect pressure away from dorsal or interdigital HD/HM lesions
Fleecy Web Apical Cap, OTC Silicone Toe Covers, Ottoform K Interdigital Toe Prop - To reduce friction at the apices and interdigital aspect of the digits
Semi Compressed Felt or EVA PMP w/ ‘U’ or ‘Wing’ Cut Outs - To deflect pressure away from plantar callus or HD lesions over the met heads in short (SCF) and long term (EVA)
Footwear w/ a Good Retaining Medium, Wider/Deeper Toe Box, Flexible Upper and Adequate Heel Height - To prevent toe gripping required in poorly retained shoes (e.g in flip flops), to prevent dorsal irritation/ friction and to manage increased pressure on met heads
What are some functional management strategies for lesser toe deformities?
Semi-Compressed Felt or EVA Metatarsal Bar, Semi-Compressed Felt Single & Combined Toe Props - To correct MTPJ dorsiflexion and straighten joint
Dorsal or Plantar Ottoform K Toe Props - To manipulate joint into a straightened position, delaying the onset of Davis’ Law and improving the toes function in gait
Intrinsic Strengthening
Toe spreading exercise - Interossei
Lesser toe extension exercise - Lumbericals
Short foot exercise - Abductor Hallucis, FDL, Quadratus Plantae
To correct mobile lesser toe deformities by managing imbalance between extrinsic and intrinsic musculature
EDL and FDL Strengthening
Short foot and heel raises - FDL
Lesser toe extension, heel walking - EDL
To correct mobile lesser toe deformities by addressing imbalance between long flexors and extensors
Surgical Correction - PIPJ or DIPJ arthrodesis, tendon transfer, tenotomy e.t.c
To correct rigid deformities (arthrodesis) and reduce pain symptoms from joint or soft tissue pressure lesions, also improves aesthetic appearance
To correct mobile deformities and improve lesser toe function by altering surrounding soft tissue/ tendons
How can you manage secondary lymphoedema?
Elevation of the legs where possible
Avoid long periods of standing still and sitting in dependency
Use of compression stockings
