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Pod practice > Regional Foot Pain > Flashcards

Regional Foot Pain Flashcards

1
Q

Describe the symptoms of Plantar Fasciitis.

A
  • insidious onset of first step pain
  • inflammation
  • pain close to plantar medial heel
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2
Q

What is the pathophysiology of plantar fasciitis?

A
  • considered to be associated with repetitive tensile overloading of the soft tissue attachments e.g. bent foot and heavy load applied through foot
  • pathological changes are comparable to those of tendinitis and tendinosis
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3
Q

Plantar Fasciitis is most commonly seen in…

A
  • overweight individuals
  • reported more frequently in females
  • those with gastroc/soleus complex tightness
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4
Q

What is Plantar Fasciitis incorrectly termed?

A
  • heel spur, due to radiological changes seen

- BUT heel spurs will not cause pain unless #

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5
Q

What is the treatment for Plantar Fasciitis?

A
  • manage symptoms (RICER and rest)
  • Stretching of aponeurosis and posterior muscle group
  • correct biomechanical factors e.g. taping (first line), orthoses and footwear
  • decrease irritation (rest)
  • extracorporeal shockwave therapy
  • Acupuncture ?
  • Surgery ?
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6
Q

What type of footwear should be avoided in plantar fasciitis?

A
  • negative heel shoe such as a soccer shoe
  • puts foot into a DF position, which puts more pressure on the PF insertion
  • want the patient to stretch but not that much and not whilst they are running
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7
Q

What is the benefit of orthoses in Plantar Fasciitis treatment?

A
  • orthotics can speed the resolution of PF
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8
Q

Describe the symptoms of Achilles Tendinopathy?

A
  • gradual onset
  • swelling
  • tenderness
  • nodules
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9
Q

What is the pathophysiology of Achilles Tendinopathy?

A
  • gradual onset due to overuse
  • can be extrinsic/intrinsic
  • insertional or non-insertional
  • may start as local oedema and progress to degeneration and granulation
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10
Q

What are the precipitating factors for Achilles Tendinopathy?

A
  • biomechanical deficits
  • old age
  • males
  • increased body weight and height
  • fluoroquinalone exposure
  • tight gastroc/soleus complex
  • common in runners
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11
Q

Achilles Tendinopathy is a combination of what degenerative changes?

A

tendinitis/osis
OR
paratendonitis/osis

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12
Q

What is the treatment for Achilles Tendinopathy?

A
  • eccentric muscle loading (no dynamic stretching)
  • rest with gradual return to activity
  • heel lifts
  • correct biomechanical factors
  • steroid injections (last resort)
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13
Q

What is the pathophysiology of Retrocalcaneal Bursitis?

A
  • inflammation of the bursa between Achilles tendon and calcaneus
  • due to extrinsic factors
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14
Q

What is the treatment for Retrocalcaneal Bursitis?

A
  • off-loading

- NSAIDs

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15
Q

Retrocalcaneal bursitis can progress into a…

A

Haglund’s deformity

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16
Q

What is the pathophysiology of Sever’s disease?

A
  • calcaneal apophysitis
  • inflammation of the growth plate caused by microtrauma
  • self limiting
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17
Q

What factors can contribute to Sever’s?

A
  • rapid growth
  • tight calf muscles
  • hard surfaces
  • poor footwear
  • occurs commonly in boys
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18
Q

How is Sever’s treated?

A
  • heel raises
  • footwear modifications
  • stretching
  • NSAIDs
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19
Q

What is a plantar fat pad contusion?

A
  • injury to the protective fat pad on the plantar surface of the calcaneus
  • acute or chronic
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20
Q

What is the treatment for a plantar fat pad contusion?

A
  • rest
  • use of heel cup
  • good footwear
  • compression
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21
Q

What is Sinus Tarsi Syndrome?

A
  • injury of the interosseous talocalcaneal ligament within the sinus tarsi
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22
Q

What is the treatment for Sinus Tarsi Syndrome?

A
  • rest
  • corticosteroids
  • Mx of biomech factors
  • surgery (occasionally)
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23
Q

How long does a ligament, tendon and bone take to heal?

A
  • ligament: 12 months
  • tendon: 6 months
  • bone: 6-8 weeks
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24
Q

What is the pathophysiology of Tarsal Tunnel Syndrome?

A
  • constriction of the Posterior Tib nerve through the tarsal tunnel
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25
Q

What are the symptoms of Tarsal Tunnel Syndrome?

A
  • neural symptoms

- pain extending into the plantar foot

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26
Q

How is Tarsal Tunnel Syndrome diagnosed?

A
  • subjective information
  • Tinel’s sign
  • evidence of forced/ prolonged pronation
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27
Q

What is Tinel’s sign?

A

A way to diagnose irritated nerves by tapping on the nerve.

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28
Q

How is Tarsal Tunnel Syndrome treated?

A

Correct pronation so less tension on nerve.

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29
Q

What is the pathophysiology of Tarsal Coalition?

A
  • tarsal bones develop a bridge between them (fibrous, osseous, cartilaginous)
  • bones don’t separate during childhood, and they progressively ossify with age
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30
Q

What are the symptoms of Tarsal Coalition?

A
  • majority are asymptomatic into adulthood
  • symptomatic coalitions present in teenage years
  • ossification of the bar will correspond with onset of symptoms
  • cause painful flatfoot
  • ankle sprains common
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31
Q

What coalition bars are common in Tarsal Coalition?

A
  • calcaneonavicular most common followed by middle facet of talocalcaneal joint
  • single coalition most common but more can be found
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32
Q

What coalition bar will ossify first?

A
  • calcaneonavicular at 8-12 years

- talocalcaneal at 12-15 years

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33
Q

Treatment of tarsal coalition generally involves…

A

Surgery. Those who do not get surgery before 18 years old don’t fare well.

34
Q

Is tarsal coalition genetic?

A

Yes it can be passed down and it is more common in boys than girls.

35
Q

What comprises the mid-foot?

A

Cuboid, navicular, cuneiforms and surrounding soft tissues.

36
Q

What is the pathophysiology of Adult Acquired Flatfoot Deformity (AAFFD)?

A
  • progressive flattening of the medial longitudinal arch (MLA)
  • can progress to deformity if not arrested
37
Q

What is the most common aetiology of AAFFD?

A
  • tib post dysfunction or insufficiency
38
Q

What symptoms are related to AAFFD?

A
  • pain along the tendon

- inability to complete a single leg raise

39
Q

What is the treatment for AAFFD?

A
  • physio
  • taping
  • orthosis (put into supinated position)
  • shoe wear modifications
40
Q

What form of tendinitis/opathy is most common in the mid-foot?

A
  • extensors

- tib ant

41
Q

How is tendinitis in the mid foot diagnosed?

A

Objective testing - palpation, passive motion and resisted motion

42
Q

How is mid foot tendinitis treated?

A
  • manage inflammation (NSAIDs)
  • electrotherapeutic modalities
  • soft tissue therapy (massage)
  • concentric and eccentric exercises (to build strength)
  • correct biomechanical factors
43
Q

What is the pathophysiology of a Lisfranc fracture?

A

Injury, dislocation, or fracture of one or more of the tarsal in relation to the mid foot junction (generally traumatic).

44
Q

What are the three classifications of a Lisfranc fracture?

A
  1. homolateral - all 5 mets are displaced in the same direction
  2. isolated - one or two mets are displaced from others
  3. divergent - mets are displaced in the sagittal or frontal plane
45
Q

What is the treatment for Lisfranc fracture?

A

Casting or surgery.

46
Q

What is the pathophysiology of a sprain?

A

Damage to one or more ligaments in a joint, may be preceded by a sudden sharp pain.

47
Q

How are sprains classified?

A
  • First degree: fibres stretched but in tact.
  • Second degree: tear of part of a ligament, up to a third.
  • Third degree: complete rupture of the ligament, frequently involves an avulsion #.
48
Q

In which group/s of people are mid foot sprains most common?

A
  • gymnasts
  • jumpers
  • footballers
49
Q

What mid foot ligament is commonly sprained?

A

Spring ligament

50
Q

What are the symptoms of a ligament sprain?

A
  • localized tenderness

- limitation in joint movement

51
Q

How is a mid foot sprain treated?

A
  • acute Rx involves RICER
  • taping
  • orthoses
  • NSAIDs
  • corticosteroids
52
Q

What is the pathophysiology of Cuboid Syndrome?

A
  • subluxation of the cuboid

- often associated with peroneal tendinopathy, excessively pronated feet, or lateral instability

53
Q

What are the symptoms of Cuboid Syndrome?

A
  • pain with lateral WBing
  • can see displacement sometimes
  • history may include inversion sprain
54
Q

How is Cuboid Syndrome treated?

A
  • reduce subluxation

- manage associated inflammation

55
Q

What is the pathophysiology of Kohler’s Disease?

A
  • temporary avascular necrosis of the navicular bone
  • navicular is subject to repetitive compressive forces
  • navicular is more vulnerable to compressive damage as it is the last bone to ossify
56
Q

What are the symptoms of Kohler’s Disease?

A
  • gradual pain in medial aspect of foot
  • painful limp
  • shift of weight laterally to relieve pressure on MLA
  • pain, tenderness and swelling in the area of the navicular
  • tib post contraction may be painful
57
Q

What is the prognosis for Kohler’s Disease?

A
  • self limiting with good prognosis if well managed
  • bone will regain normal shape before foot completes growth
  • normal ossification reach at 2 y.o.
58
Q

How is Kohler’s Disease treated?

A
  • cast (WBing or NWBing)
  • rest
  • orthoses
59
Q

What age is Kohler’s Disease most common?

A

3-7 years old

mainly boys

60
Q

What is the pathophysiology of HAV?

A
  • abduction and external rotation of the first toe
  • adduction and internal rotation of the 1st met
  • displacement of hallux at 1st MPJ
  • displacement of met at met/cuneiform joint
61
Q

When is abduction of the hallux considered a deformity?

A

When it is greater than 10-12 degrees.

62
Q

What is the pathophysiology of Hallux Limitus?

A
  • painful passive and active motion around the MPJ

- cause can be functional or structural

63
Q

What are the symptoms of Hallux Limitus?

A
  • dorsal exostosis may be evident

- limited ROM at 1st MPJ

64
Q

What is the Hallux Rigidus?

A
  • end point of hallux limitus
65
Q

What is the treatment for hallux rigidus and limitus?

A
  • biomechanical evaluation and management
  • shoewear modifications
  • surgical intervention may be required
66
Q

What is the pathophysiology of sesamoiditis?

A
  • gradual onset of pain over medial or lateral sesamoid with a limited, painful active ROM
67
Q

What are the differential diagnoses for sesamoiditis?

A
  • bipartite sesamoid
  • osteochondritis dissecans
  • sesamoid #
68
Q

How can you distinguish between a bipartite sesamoid and a sesamoid #?

A

Bipartite sesamoids will have smoother edges whereas # sesamoids will demonstrate irregular edges on a radiograph.

69
Q

What is the pathophysiology of Morton’s Neuroma?

A
  • painful compression of nerve, usually between 3rd/4th
  • tumour on nerve, tends to be benign
  • interdigital nerve can be compressed during toe off
70
Q

What are the symptoms of Morton’s Neuroma?

A
  • burning and tingling down the interspace of involved toes
  • radiating pain to the toes
  • vague pain radiating up the leg
  • worse in high heels or shoes with a narrow toe box
71
Q

What is the treatment for Morton’s Neuroma?

A

reduce or remove pressure with padding or surgical excision.

  • acute: a met dome
  • chronic: surgery
72
Q

What is the pathophysiology of Turf Toe?

A

Acute or traumatic tear of joint capsule from met head and subluxation or dislocation of 1st MPJ

73
Q

How is Turf Toe caused?

A

hyperextension, hyperflexion or valgus injury

74
Q

What is the treatment for Turf Toe?

A
  • reduce activity

- wear an orthosis that block dorsiflexion (force hallux rigidus)

75
Q

What is the pathophysiology of Freiburg’s Infraction?

A
  • avascular necrosis of met head/s
  • caused by repetitive stress with micro # at the junction of the metaphysics and growth plate
  • # deprive epiphysis of adequate circulation
76
Q

In which group of people does Freiburg’s infraction most commonly occur?

A
  • prepubescent girls

- people whose 1st toe is shorter than their 2nd - more pressure through the second

77
Q

What are the symptoms of Freiburg’s Infraction?

A
  • pain in forefoot

- localized to head of 2nd met

78
Q

What is the pathophysiology of Tailor’s Bunion?

A
  • created by a wide 4th/5th IM angle
  • 5th toe lies contracted in a dorsal medial direction over the 4th toe
  • offending agent is usually the condyle of the proximal phalanx of 5th toe
79
Q

What are the symptoms of Tailor’s Bunion?

A
  • plantar callus due to concomitant PF of the 5th
  • soft corn under 5th
  • bunionette
80
Q

What is the pathophysiology of Claw toes?

A
  • hyperextension at the MPJ, flexion at the proximal and distal IPJs
  • caused by an imbalance between extensor tendons and flexor tendons
  • simultaneous contraction of extensors and flexors
  • flexed IPJs are constantly irritated by shoe and painful met callosities develop
81
Q

What is the differential diagnosis for claw toes?

A
  • hammer toes
82
Q

What are the predisposing conditions for claw toes?

A
  • Rheumatoid arthritis
  • Age
  • Diabetes
  • Compartment syndrome involving deep posterior compartment
  • Polio
  • Charcot Marie Tooth
  • Stroke
  • Pes Cavus foot

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