treatable issues Flashcards
Plantar Fasciitis Symptoms
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.
Plantar Fasciitis Causes
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
Plantar Fasciitis Common treatments
NSAIDS, Ice, Injection, PT for modalities & exercise; taping; Pedorthic care to address footwear/orthotic needs; night splinting & immobilization PRN.
Plantar Fasciitis Diagnostics
X-ray vs. Dx ultrasound
Plantar Fasciitis is most common in _____________ to ___________ feet
normal; cavus
_________% of the population may present with heel pain over the course of their lives
10
Tibialis Tendonitis or Dysfunction (PTTD) is most common in ____________ feet
planus (flat)
Tibialis Tendonitis or Dysfunction (PTTD): what is usually typical presentation?
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
What is the key test for Tibialis Tendonitis or Dysfunction (PTTD)?
single-limb calf raise
Tibialis Tendonitis or Dysfunction (PTTD): gait
usually poor quality with limited or no forefoot propulsion due to pain
Those with Tibialis Tendonitis or Dysfunction (PTTD) occasionally present with ________ feet due to functional instability
cavus
Tibialis Tendonitis or Dysfunction (PTTD): treatment
Commonly treated medically with NSAIDS & rest; occasionally immobilized with casting/cam walker when acute; PT for modalities, exercise and taping.
Tibialis Tendonitis or Dysfunction (PTTD): key factor!
This is almost ALWAYS a mechanical/positional issue; treatment that does not include positional correction/support is likely to fail over the long-term.
Tibialis Tendonitis or Dysfunction (PTTD): mild to moderate strains treatment
orthotic and shoes
Tibialis Tendonitis or Dysfunction (PTTD): for tendon failure or gross deformity treatment
bracing, shoes or surgery are likely in order
Metatarsalgia
Forefoot pain with loading/weight-bearing
Mechanical reasons for Metatarsalgia
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).
Environmental reasons for metatarsalgia
Ill-fit shoes; poor shoe choice for activity (or prolonged activity w/o shoes)
Structural reasons for Metatarsalgia
Toe deformities, IPK/callousing, stress reactions, capsulitis of the toes
common interventions for Metatarsalgia
Orthoses to address positional issues; proper fit footwear; PT for modalities, manual therapy and exercise/gait training; education in callous/skin care
Prevalence of Metatarsalgia: _____% in 18-65 year olds and ______% in those over 65
23, 35
Metatarsal/Transverse Arch Collapse
1st ray insufficiency syndrome that causes a splayed forefoot
Claw Toe Deformity
Ext of MTP, Flexion of PIP and DIP
Hammer Toe Deformity
Ext of MTP, Flexion of PIP and Ext of DIP
Mallet Toe Deformity
Primarily flexion of the DIP
Neuromal irritation
Forefoot symptoms that include referred symptoms such as numbness, pain, and burning, generally into the toes
Causes of Neuromal irritation
similar to metatarsalgia; may occur with or without deformity present
Neuromal irriation intervention
similar to metatarsalgia; often injected by DPM/ortho;PT/Pedorthic care
Neuromal irritation symptom presentation
symptoms increase with palpation of intermetatarsal space &/or forefoot squeeze test; sx often remain irritable in NWB (longer than with pure metatarsalgia)
Need to determine if neuromal irritation is ______________ or ______________
radicular or neuropathic
Forefoot squeeze test
squeeze forefoot/intermetatarsal space to see if symptoms are provoked, used for neuromal irritation
Functional Hallux limitis
restriction in WB related to mechanical alignment/issues
Structural Hallux limitis
Restriction in NWB related to capsular and/or boy abnormality
Hallux rigidis
Functionally fused 1st MTPJ due to bony/capsular restriction.
Hallux abductovalgus deformity
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
Morton’s toe
Structurally short 1st ray relative to the other metatarsals. Consider implications on medial column engagement during late stance
Bunions
the result of exostosis of the 1st met head causing drift of the phalanx.
Exostosis
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.
Bunionettes (Tailor’s Bunion)
Bunions occurring at the 5th toe; primary issue is generally with shoe fit; creates callous/corn issues due to neighboring toe friction/deformity
Hallux abductovalgus positional managment
silicone or foam toe separator
Sesamoiditis
focal pain/tenderness at the plantar base of the 1st met head with pressure/WB.
causes of sesamoiditis
Sesamoid fracture; unstable bipartite sesamoid; hallux limitis; cavovarus foot with PF’d 1st ray; footwear issues; IMPACT
treatment of sesamoiditis
NSAIDS, rest, PT for manual therapy, therapeutic ex, gait training and modal, pedorthic care to address footwear/orthoses.
Bi-partite sesamoid
Rare in the fibular sesamoid; Tibial occurs in 10% of population; bilateral in about 25% of these
Most often, a pure achilles tendonitis is ________________ with a __________ onset. Consider ___________ origin as the cause
idiopathic; gradual; mechanical
Sometimes its difficult to differentiate Achilles insertional tendonitis vs __________________
posterior calcaneal bursitis
What can contribute to Achilles tendon dysfunction?
Look for PTT/peroneal tendon contributions, adaptive tendon shortening, varus/valgus calcaneal stance, and footwear
____________ Achilles tears may be the reason behind lack of conservative care success and _________________________ may be necessary acutely
intrinsic; Putting slack into the tendon &/or immobilization
PT interventions for Achilles Tendon Dysfunction
local modalities PRN, MT, TE, gait training & taping procedures
Charcot Arthropathy
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
Signs and symptoms of Charcot arthropathy
Abrupt onset of erythema, edema, & planus foot position. Often non-painful due to neuropathy.
Charcot arthropathy intervention
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
Charcot arthropathy chronic stages
Will require footwear (often custom) and custom accommodative orthoses once stabilized
Charcot Joint
Neuropathic Arthropathy; Progressive destructive arthropathy 2° to neurological condition
Excessive foot pronation results in excessive ____ moment throughout the kinetic chain in WB
IR
Excessive IR throughout the LE results in altered _______________ in standing and gait
lumbopelvic position & mobility
Excessive foot supination results in increased LE _____ in WB/gait positions.
ER
Lack of functional pronation ___________ impact forces up the kinetic chain.
increases
Altered supination/pronation mechanics alters _______________ relationships of musculature throughout the LE and lumbopelvic regions during gait.
length/tension
Leg length issues alter_______________ relationships as well as ___________________
length/tension; bony structural alignments
_______ are often an important missing piece of a long-term comprehensive solution in conservative care
orthoses
