SOFT TISSUE PATHOLOGY OF REARFOOT

Question 1

a strong correlation between thickness of PF and achilles paratenon would indicate a plantar fasciitis and so when we see this thickening would should we do?

Answer 1

evaluate achilles tendon and paratenon

Question 2

2nd most common location of stress fracture

Answer 2

calcaneus

Question 3

what happens when the windlass mechanism elevates the medial longitudinal arch?

Answer 3

prevents arch collapse via great tensile strength

Question 4

what nerve could be entrapped causing a plantar fasciitis?

Answer 4

conservative treatment for plantar fasciitis?

Question 5

conservative tx for plantar fasciitis?

Answer 5

achilles tendon stretching
steroid injecting
prolotherapy
dry needling
PRP

Question 6

what is the effect of dry needling?

Answer 6

stimulates healing response instead of suppressing inflammation

Question 7

major tx for calcaneal spur?

Answer 7

major cause is due to extensive resection then calc fx

isolated gastric release
endoscopic
in step incision
open release

Question 8

t/f, slight chance of recurrent heal pain for all techniques?

Answer 8

true

Question 9

physical exam for tarsal tunnel pain?

Answer 9

-palpate nerve to note any swelling
+tinel distal and +valleix proximal and distal

plantarflexion-inversion (trepman test) tibial nerve test

• burning, tingling, numbness
• pain difficult to localize; ganglion, lipoma, exostosis, coalition

Question 10

which of the following is true of tarsal tunnel syndrome?

diagnosis is based on EDS with correlations found in H/P

off lateral plantar nerve 25%

sensory conduction velocity and distal motor latency, most accurate study

pts with TT will demonstrate a decrease in amplitude and an increase in duration

all the above

Answer 10

all the above

Question 11

most accurate study for TTS?

Answer 11

sensory conduction velocity and distal motor latency

Question 12

T/F, no randomized controlled trials pertaining to the management of TTS exists?

Answer 12

T

Question 13

what is the significance of an MEP in relation to TTS?

Answer 13

muscle amplitude of motor evoked potentials

• looking for presence of fibrillation potentials
• more sensitive study
• pts with TT will demonstrate a decrease in amplitude and increase in duration

Question 14

what is the significance in surgical release of TT?

Answer 14

MCN, laciniate ligament, abductor hallucis spette or myofascial with success rate 44-91%

prefer no tourniquet

intermediate rehab helps to prevent occurrence of ST contractions

Question 15

for TT syndrome relief how is the flexor retinaculum? effect?

Answer 15

don’t close the flexor retinaculum over top of release, leave it released off the nerve

early ROM to prevent scar formation