Masterclass 3 - Foot and Ankle pt 2 Flashcards
What does ROAST stand for
Rehabilitation-Oriented Assessment
How to assess lateral ankle sprain
- Mechanism of injury
- Previous history of lateral ankle sprain
- WB status
- Assessment of bones (palpate, ottawa ankle rule)
- Assessment of ligaments (special test ie anterior draw test, talar tilt test)
What does PEACE & LOVE stand for
Protect
Elevate
Avoid ant-inflammatory
Compress
Educate
Load
Optimism
Vascularise
Exercise
What causes MTSS
Overuse
What does MTSS stand for
Medial Tibial Stress Syndrome
MTSS treatment
Taping to control pronation
Orthotics
Soft tissue therapy of calf
Physical therapy
MTSS Risk factors
Excessive pronation
Shoe design
Increased int/ext rot. of hip
Previous stress fractures
Surface
Female
Higher BMI
Orthotics
Excessive PF ROM
Plantar Heel Pain Risk factors
Varus knee alignment
Spiked athletic shoes
Standing for work
Overtraining
Decreased flexibility of ankle and hamstrings
Decreased toe flexor strength
Where is pain most commonly felt in plantar heel pain
medial tuberosity of calcaneus
When is pain most commonly present in plantar heel pain
First few steps in the morning
Periods of inactivity during the day are then followed by an increase in pain as activity is recommenced
Pain can be present when standing
Treatment of plantar heel pain
Low dye taping
Gel heel cups
Windlass mechanism heel raise (3/2/3 tempo)
Tibialis Posterior functions
Inv of subtalar joint
Support of medial longitudinal arch
Tibialis Posterior tendinopathy causes
Overuse from walking, running or jumping or from excessive subtalar pronation (increases ecc. Tendon loading during supination for toe off)
Direct/indirect trauma, acute avulsion fracture
Inflammatory conditions (rheumatoid arthritis)
Where is pain in Tibialis Posterior tendinopathy commonly felt
Medial ankle pain from behind malleolus towards the insertion of tendon (navicular)
Treatment of tibialis posterior tendinopathy
Treat it as reactive tendinopathy (rest, ice, NSAIDs)
Orthotics to control excessive pronation
Conc and ecc tendon loading exercise program once inflammation has settled
Low dye taping
What is the traffic light system
A way of educating pt how much pain is tolerable for tendinopathy pt
0-3/10 (green) - keep going
4-5/10 (yellow) - proceed with caution
5-10/10 (red) - stop
Are heel spurs a cause of plantar heel pain?
No, but those with plantar Fasciopathy are 8x more likely to have a heel spur than those without
How to determine if a plantar fasciopathy pt should use orthotics
Perform a painful activity (e.g jogging) and get an NRS.
Then apply anti-pronation tape and if pt responds well, prescribe arch supporting insoles (usually cheaper than orthotics and can buy off the shelf)
Does manual therapy help those with plantar fasciopathy?
No. You cannot release muscles and fascia, however dry needling can help reduce pain in first steps
Windlass calf raise regressions
Calf raise from floor rather than platform
Reduce end ROM
Reduce height of towel
What type of running technique increases likelihood of developing plantar fasciopathy
Forefoot
What is MTSS more commonly referred to as
Shin splints
Where is pain present in MTSS
Anteromedial border of the tibia
MTSS RTP
SL hop x 15 – no pain
30 min walk with no/minimal pain
6 x 60% BW squats
25 SL heel raises
