Ruptured achillies tendon, plantar fascities, tarsal tunnel syndrome

Question 1

What is the mechanism of injury for a ruptured achilles tendon that has to be fixed surgically?

Answer 1

• forceful eccentric contraction of gastroc/soleus
• most frequently in older adults with compromised blood supply
• or high intensity WBing activity with rapid deceleration in younger individuals (ie basketball or tennis)

Question 2

Describe the maximum protection phases s/p achilles rupture

Answer 2

1. immobilization: 3-4 weeks in slight PF, then 2-4 weeks in more DF (TOTAL= 6-8 weeks)
2. NWB 6-8 weeks
3. Exercise hip and knee
4. Complete pain free muscle setting

Question 3

Describe the moderate- minimum protection phases s/p achilles rupture

Answer 3

• gentle stretching progress to vigorous stretch
• OC exer prgresses to PRE
• progress ROM
• bike or pool for endurance
• progress with CC exer as able
• May need heel lift in early stages of amb/wb without cast
• can used on SAME side as injury to assist with propulsion of gait

Question 4

How long does it take to return to function following a surgcial repair of achilles rupture?

Answer 4

6-9 months

Question 5

How does one get plantar fascitis?

Answer 5

-inflammatory response to stress from repetitive microtrauma due to: faulty LE alignment (ie excessive pronation)
-Other causes:
muscle tightness (ie tight gastrcs)
training errors
improper footwear
combination of above factors
-common S/S:
WBing pain after inactivity/sleep
pain with push off

Question 6

Describe the acute management of plantar fascitis

Answer 6

• modalites
• night splints
• taping
• footwear changes

Question 7

Describe the subacutes through crhonic stages of plantar fascitis

Answer 7

• Stretching: rolling pin, add stretch with towe/band to pull toes
• gastroc/soleus
• strengthen foot intrinsics
• correct muscle imbalances
• eval for orthotics

Question 8

What is tarsal tunnel syndrome caused by?

Answer 8

entrapment of posterior tibial nerve in the tunnel formed by the groove behind the medial malleolus which is covered by a ligament
-tendons of tib poster, FHL, FDL also occupy this groove

Question 9

What is the sensory distribution of the posterior tibial nerve?

Answer 9

Plantar surface of foot, toes, and dorsum of distal phalanges

Question 10

What muscles are innervated by the psterior tibial nerve?

Answer 10

intrinsic foot muscles:

• abductor hallucis
• flexor hallucis brevis
• lumbricals
• interossei
• quadratus plantae

Question 11

How do you manage tarsal tunnel syndrome?

Answer 11

• subtalar pronation- impairments of ROM
• stretch gastrocs
• strengthen post tib
• posture training
• eval foot biomechanics, orthotics PRN