Plantar fasciitis Flashcards
What are risk factors for plantar fasciitis?
Middle aged (40-60) Obesity/BMI Increased pronation/pes planus Ankle equinus Prolonged standing Running Poor footwear
What are intrinsic factors of PF?
Age, BMI, pes planus/cavus STJ pronation LLD Tibial and subtalar varum Femoral/tibial torsion Reduced ankle DF/tight achilles tendon Weak ankle PF Heel pad characteristics
What are extrinsic factors of PF?
Footwear Surface properties Activity type Activity level (frequency, intensity, duration) Trauma
What does the windlass mechanism consist of?
Consists of the plantar aponeurosis
Attaches to the plantar aspect of the heel, spans out across the plantar surface of the foot, to underneath the metatarsal heads to attach to the base of the toes
How is the windlass mechanism activated?
Lift any of the toes on a weight bearing foot, esp the big toe, you pull on the plantar fascia and the arch is lifted up
What are the ten things the windlass mechanism does?
- Serves to support the medial and lateral longitudinal arch in a higher arched position
- Assists in resupination of subtalar joint during propulsive phase of walking
- Assists the deep posterior compartment muscles by limiting STJ pronation
- Assists the plantar intrinsic muscles in preventing longitudinal arch flattening
- Reduces tensile force in plantar ligaments
- Prevents excessive dorsal interosseous compression forces in the midtarsal and midfoot joints
- Prevents excessive dorsiflexion bending movements on metatarsals
- Passively maintains digital purchase and stabilize
- Reduces ground reaction force on metatarsal heads during late midstance and propulsion
- Helps to absorb and release elastic strain energy during running and jumping activities
What is the typical clinical presentation of plantar fasciopathy?
Gradual onset
What is the typical clinical presentation of plantar fasciopathy?
Gradual onset Usually no history of trauma Pain on weight bearing esp prolonged standing Worst thing in morning/after rest Better once warmed up No classic signs of inflammation Thickening of PF on ultrasound
What is the typical presentation of heel fat pad syndrome?
Obesity
Lack of shock attentuation at heel strike
Worse barefoot
Relieved by cushioned footwear
May not have typical morning pain (plantar fasciitis)
Pain palpated under central heel
What is the typical presentation of nerve entrapment?
Sharp, shooting pain
+ve tinsels sign (pins n needles when touching)
Baxters nerve: palpating medial heel will compress the nerve between Ab hall and OP
MCN (medial cutaneous nerve): compression near tarsal tunnel produces medial heel pain
What tendons are most and least affected by tendinopathy?
May affect any of the tendons crossing the ankle into the foot
Most common: achilles or tibialis posterior
Less common: peroneal tendons, FHL, tibialis anterior
What is the defintion of tendonitis?
Inflammation of the tendon itself
What is the definition of paratenonitis?
Inflammation of the tendon sheath
What is tendinosis?
Tendon degeneration (no inflammation) May be associated with tendon rupture May occur with paratenonitis
What are the two types of insertions for tendons?
Myotendinous (muscle-tendon)
Osteotendinous (tendon-bone)
What is the clinical presentation of tendinopathy?
Athletes/overuse Pain associated with activity Relieved by rest Athletes will often say they can run through the pain Local tenderness Swelling, creptius, weakness Restricted movement
What is involved with clinical examination of tendinopathy?
Pain on palpation of course of tendon
What functional movement do you perform based on muscles?
Pain with active restricted contraction Achilles: heel raise Tib post: plantarflexion/inversion Peroneals: eversion FHL: hallux plantarflexion
What is treatment of tendinopathy based on acute, chronic, necrosis
Acute inflammation: RICE, aspirin, NSAIDs, cortisone, LA injection
Chronic/degenerative: heat, electrotherapies, eccentric strength exercises
Tears or necrosis: surgical repair
What is a bursa?
Fluid filled sac lined with synovial membrane
Prevents friction usually between tendon and bone
What is bursitis?
When a bursa becomes inflamed or infected
What are three types of bursitis?
Acute and aseptic
Acute and infected
Chronic
What is the aetiology of bursitis?
Direct blow/injury
Excessive prolonged shear stress
Arthritis
Infection
What areas are commonly affected by bursitis?
Retrocalcaneal - associated with Haglunds deformity
1st and 5th MPJ - associated with HAV/tailors bunion
Plantar calcaneal bursitis - may mimic plantar fasciitis
