treatable issues

Question 1

Plantar Fasciitis Symptoms

Answer 1

Heel and/or arch pain that worsens on initial WB after periods of NWB; may decrease while walking and increase with sustained walking or static standing; focal tenderness at calcaneal tubercle.

Question 2

Plantar Fasciitis Causes

Answer 2

Rarely traumatic; usually mechanical with a gradual onset; abrupt activity change; poor shoe choice/fit for activity; no shoes on hard surfaces; muscle tightness/weakness leading to excess fascial stress

Question 3

Plantar Fasciitis Common treatments

Answer 3

NSAIDS, Ice, Injection, PT for modalities & exercise; taping; Pedorthic care to address footwear/orthotic needs; night splinting & immobilization PRN.

Question 4

Plantar Fasciitis Diagnostics

Answer 4

X-ray vs. Dx ultrasound

Question 5

Plantar Fasciitis is most common in _____________ to ___________ feet

Answer 5

normal; cavus

Question 6

_________% of the population may present with heel pain over the course of their lives

Answer 6

10

Question 7

Tibialis Tendonitis or Dysfunction (PTTD) is most common in ____________ feet

Answer 7

planus (flat)

Question 8

Tibialis Tendonitis or Dysfunction (PTTD): what is usually typical presentation?

Answer 8

Navicular drop, valgus calcaneal stance, forefoot abduction, localized tenderness along the PTT, and pain on palpation of the medial deltoid ligament and/or spring ligament

Question 9

What is the key test for Tibialis Tendonitis or Dysfunction (PTTD)?

Answer 9

single-limb calf raise

Question 10

Tibialis Tendonitis or Dysfunction (PTTD): gait

Answer 10

usually poor quality with limited or no forefoot propulsion due to pain

Question 11

Those with Tibialis Tendonitis or Dysfunction (PTTD) occasionally present with ________ feet due to functional instability

Answer 11

cavus

Question 12

Tibialis Tendonitis or Dysfunction (PTTD): treatment

Answer 12

Commonly treated medically with NSAIDS & rest; occasionally immobilized with casting/cam walker when acute; PT for modalities, exercise and taping.

Question 13

Tibialis Tendonitis or Dysfunction (PTTD): key factor!

Answer 13

This is almost ALWAYS a mechanical/positional issue; treatment that does not include positional correction/support is likely to fail over the long-term.

Question 14

Tibialis Tendonitis or Dysfunction (PTTD): mild to moderate strains treatment

Answer 14

orthotic and shoes

Question 15

Tibialis Tendonitis or Dysfunction (PTTD): for tendon failure or gross deformity treatment

Answer 15

bracing, shoes or surgery are likely in order

Question 16

Metatarsalgia

Answer 16

Forefoot pain with loading/weight-bearing

Question 17

Mechanical reasons for Metatarsalgia

Answer 17

Cavus feet with tight heel cords and steep forefoot axis; collapsed forefoot transverse arch; degraded forefoot fat pad; altered 1st MTPJ function (with or w/o planus feet).

Question 18

Environmental reasons for metatarsalgia

Answer 18

Ill-fit shoes; poor shoe choice for activity (or prolonged activity w/o shoes)

Question 19

Structural reasons for Metatarsalgia

Answer 19

Toe deformities, IPK/callousing, stress reactions, capsulitis of the toes

Question 20

common interventions for Metatarsalgia

Answer 20

Orthoses to address positional issues; proper fit footwear; PT for modalities, manual therapy and exercise/gait training; education in callous/skin care

Question 21

Prevalence of Metatarsalgia: _____% in 18-65 year olds and ______% in those over 65

Answer 21

23, 35

Question 22

Metatarsal/Transverse Arch Collapse

Answer 22

1st ray insufficiency syndrome that causes a splayed forefoot

Question 23

Claw Toe Deformity

Answer 23

Ext of MTP, Flexion of PIP and DIP

Question 24

Hammer Toe Deformity

Answer 24

Ext of MTP, Flexion of PIP and Ext of DIP

Question 25

Mallet Toe Deformity

Answer 25

Primarily flexion of the DIP

Question 26

Neuromal irritation

Answer 26

Forefoot symptoms that include referred symptoms such as numbness, pain, and burning, generally into the toes

Question 27

Causes of Neuromal irritation

Answer 27

similar to metatarsalgia; may occur with or without deformity present

Question 28

Neuromal irriation intervention

Answer 28

similar to metatarsalgia; often injected by DPM/ortho;PT/Pedorthic care

Question 29

Neuromal irritation symptom presentation

Answer 29

symptoms increase with palpation of intermetatarsal space &/or forefoot squeeze test; sx often remain irritable in NWB (longer than with pure metatarsalgia)

Question 30

Need to determine if neuromal irritation is ______________ or ______________

Answer 30

radicular or neuropathic

Question 31

Forefoot squeeze test

Answer 31

squeeze forefoot/intermetatarsal space to see if symptoms are provoked, used for neuromal irritation

Question 32

Functional Hallux limitis

Answer 32

restriction in WB related to mechanical alignment/issues

Question 33

Structural Hallux limitis

Answer 33

Restriction in NWB related to capsular and/or boy abnormality

Question 34

Hallux rigidis

Answer 34

Functionally fused 1st MTPJ due to bony/capsular restriction.

Question 35

Hallux abductovalgus deformity

Answer 35

Classic bunion deformity with valgus drift of the great toe; altered FHL tendon position/function. Consider how this affects function of the 1st ray and medial column; Consider how this affects altering function of the other metatarsals with ff loading

Question 36

Morton's toe

Answer 36

Structurally short 1st ray relative to the other metatarsals. Consider implications on medial column engagement during late stance

Question 37

Bunions

Answer 37

the result of exostosis of the 1st met head causing drift of the phalanx.

Question 38

Exostosis

Answer 38

Benign outgrowth of bone; most commonly medial and dorsal on the 1st & 5th met heads. Can occur without a bunion. Exostosis with mobility is often painful. Exostosis with rigidity may be painless if position is functional.

Question 39

Bunionettes (Tailor's Bunion)

Answer 39

Bunions occurring at the 5th toe; primary issue is generally with shoe fit; creates callous/corn issues due to neighboring toe friction/deformity

Question 40

Hallux abductovalgus positional managment

Answer 40

silicone or foam toe separator

Question 41

Sesamoiditis

Answer 41

focal pain/tenderness at the plantar base of the 1st met head with pressure/WB.

Question 42

causes of sesamoiditis

Answer 42

Sesamoid fracture; unstable bipartite sesamoid; hallux limitis; cavovarus foot with PF’d 1st ray; footwear issues; IMPACT

Question 43

treatment of sesamoiditis

Answer 43

NSAIDS, rest, PT for manual therapy, therapeutic ex, gait training and modal, pedorthic care to address footwear/orthoses.

Question 44

Bi-partite sesamoid

Answer 44

Rare in the fibular sesamoid; Tibial occurs in 10% of population; bilateral in about 25% of these

Question 45

Most often, a pure achilles tendonitis is ________________ with a __________ onset. Consider ___________ origin as the cause

Answer 45

idiopathic; gradual; mechanical

Question 46

Sometimes its difficult to differentiate Achilles insertional tendonitis vs __________________

Answer 46

posterior calcaneal bursitis

Question 47

What can contribute to Achilles tendon dysfunction?

Answer 47

Look for PTT/peroneal tendon contributions, adaptive tendon shortening, varus/valgus calcaneal stance, and footwear

Question 48

____________ Achilles tears may be the reason behind lack of conservative care success and _________________________ may be necessary acutely

Answer 48

intrinsic; Putting slack into the tendon &/or immobilization

Question 49

PT interventions for Achilles Tendon Dysfunction

Answer 49

local modalities PRN, MT, TE, gait training & taping procedures

Question 50

Charcot Arthropathy

Answer 50

Neurovascular alteration of the midfoot typically associated with DM; progressive disorder; deformity occurring during the active process is irreversible. Immobilization, NWB, and medical care during the acute stage is imperative to avoid gross deformity

Question 51

Signs and symptoms of Charcot arthropathy

Answer 51

Abrupt onset of erythema, edema, & planus foot position. Often non-painful due to neuropathy.

Question 52

Charcot arthropathy intervention

Answer 52

If there is any question that this is a possibility, advise the client to go NWB and immediately refer to DPM/MD for dx testing to r/o Charcot arthropathy

Question 53

Charcot arthropathy chronic stages

Answer 53

Will require footwear (often custom) and custom accommodative orthoses once stabilized

Question 54

Charcot Joint

Answer 54

Neuropathic Arthropathy; Progressive destructive arthropathy 2° to neurological condition

Question 55

Excessive foot pronation results in excessive ____ moment throughout the kinetic chain in WB

Answer 55

IR

Question 56

Excessive IR throughout the LE results in altered _______________ in standing and gait

Answer 56

lumbopelvic position & mobility

Question 57

Excessive foot supination results in increased LE _____ in WB/gait positions.

Answer 57

ER

Question 58

Lack of functional pronation ___________ impact forces up the kinetic chain.

Answer 58

increases

Question 59

Altered supination/pronation mechanics alters _______________ relationships of musculature throughout the LE and lumbopelvic regions during gait.

Answer 59

length/tension

Question 60

Leg length issues alter_______________ relationships as well as ___________________

Answer 60

length/tension; bony structural alignments

Question 61

_______ are often an important missing piece of a long-term comprehensive solution in conservative care

Answer 61

orthoses