Week 3 [not including lab] Flashcards
What are the functions of the skin (4)?
- protection
- thermoregulation
- sensation
- excretion
What are the 3 layers of the skin from the surface to the deepest layer?
- epidermis
- dermis
- subdermal adipose tissue
What is the epidermis made of (3)?
- basal cells
- squames
- melanocytes
What are hairs and nails derived from?
skin
What are basal cells for?
where keratinocytes originate before they move to the outer layer of the skin
Define: melanocytes (and give location?)
cells in the bottom layer of the epidermis; produce melanin
Define: squames
a scale or flake of skin
Define: hyperhydrosis
- secondary effects
- Tx
- define: excessive sweating
- secondary effects: chafing, blisters, calluses, greater chance of skin infection or fungal infection. difficulty taping these athletes
- treatment: try and keep important areas dry with baby powder or frequently changing clothes
Blisters
- cause
- Tx
- how can we avoid them?
- cause: shearing force
- try not to puncture it to avoid infections
- to avoid: place vaseline on places where they’re likely to occur
Calluses, corns
- cause
- secondary effects
- Tx
- cause: shear or pressure
- thickening skin can cause problems like tighter fitting shoes
- treatment: soak and use pumice stone to file it; could be surgically removed
ingrown nail
- causes
- secondary effects
- treatment
- causes: trimming too close to your nail bed
- secondary effects: can lead to infection if nail punctures skin
- treatment: for infection use saline soap and anti fungal creams
Fungal infections
- causes (4)
- prevention
- treatment
causes
- warmth
- darkness
- moisture
- contamination (direct/indirect contact)
prevention: keep workout areas clean and dry (mats, gym floors, etc), general good hygenie
treatment: anti-fungal creams, wash hands, oral medication (must exercise after to get anti-fungal medication to skin surface by sweating)
Describe the different varieties of fungal infections
- Tinea corporis
- Tinea capitis
- Tinea cruris
- Tinea pedis
- Tinea unguium
- Tinea corporis: body (ringworm)
- Tinea capitis: scalp (rash & alopecia)
- Tinea cruris: groin
- Tinea pedis: feet
- Tinea unguium: nail and nail beds; not responsive to topical tx
How many phalanges are there per foot?
14! 2 in the great toe, 3 in toes 2 through 5
Which bone is attached to the flexor hallucis brevis?
sesamoid bones
Describe the 3 areas of the foot
- forefoot
- midfoot
- hindfoot/rearfoot
How much degrees of extension do you need in your metatarsal joint for normal walking-running gait?
45-70 degrees
What joint makes up the hindfoot?
- subtalar (talus and calcaneus)
What joints are part of the midfoot?
- Navicular joints (cunneiform & cuboid bones)
- Tarso-metatarsal (cuneiforms & cuboid with MTs)
What joints are part of the forefoot?
- metatarsophalangeal (MTP)
- interphalangeals (distal DIP, interphalangeal IP, proximal PIP,
What is the metatarsophalangeal (MTP) responsible for?
- flexion and extension and some abudction and adduction
What are the interphalangeals (MTP) responsible for?
- flexion and extension (hinge)
Foot flexor muscles (4)
- Flexor hallucis longus (FHL)
- Flexor hallucis brevis (FHB)
- Flexor digitorum longus (FDL)
- Flexor digitorum brevis (FDB)
- All flex at MTP & IP joints
- Also assist foot plantar flexion
Foot extensor muscles (4)
- EHL
- EHB
- EDL
- EDB
Describe the foot posture names for a high arch, normal arch, and a flat foot
- high arch: Pes cavus
- normal arch: neutral
- flat foot: Pes planus
How can we easily test foot posture?
analyze wet foot pattern on concrete
Describe foot pronation vs supination
- over pronation leads to calcaneal valgus position/ rear foot valgus (decrease in joint angle)
- supination leads to rear foot varus (increase in joint angle)
Differentiate between walking and running
- walking: one foot is always in contact with ground
- running: a point exists where neither foot is in contact with ground
Describe the Windlass mechanism
- tightening of the plantar fascia during dorsiflexion which shortens the longitudinal arch; allows for shock absorption and stiffness for propulsion
- Prior to heel strike, ankle is in dorsiflexion, Plantar Fascia (PF) is taught, medial arch is high
- During midstance PF is relaxed to allow medial arch to collapse pronation for shock absorption
- Prior to toe-off, first toe is in extension, PF become taught again, foot is stiff for take off, medial arch is high again
- Relies on ability of 1st toe to extend normally
List the four different arches in the foot
- medial longitudinal arch
- lateral longitudinal arch
- anterior metatarsal arch
- transverse arch
What supports the arches of your foot (4)?
- bony anatomy
- ligaments
- tendons/ plantar flascia
- muscle activity
Give examples of staple support for an arch
staple examples: plantar and calcaneovicular ligaments
Give examples of tie beam/cable support for an arch
- FHL and plantarfascia
Give examples of suspension support for an arch
- tibialis anterior (for medial longitudinal arch) and peroneus longus (for lateral longitudinal arch)
What are the Keystone Bones for the arches of the feet?
- medial longitudinal: talus
- lateral longitudinal: cuboid
- anterior metatarsal: 3rd metatarsal
- transverse: intermediate cuniform
List all the bones that comprise the arches in the foot
- medial longitudinal
- lateral longitudinal
- transverse
- medial longitudinal: talus, calcaneus, navicular, medial cuneiform, first metatarsal, aproximal phalange
- lateral longitudinal (calcaneus, cuboid, 5th metatarsal)
- transverse arch: metatarsal bases, the cuboid and the three cuneiform bones
Define: exostoses
- causes
- mechanism
- Ssx
- Tx
- exostoses: excess bony growth on one of the tarsals bones or bones in the foot
- causes: obesity and abnormal weight, faulty footwear, heredity
- mechanism: without proper supportive footwear, an increase in stress on the bones causes more bone growth (bones are alwasy remodelling)
- Ssx: bony bump, redness, pain, swelling
- Tx: greater arch support (insoles, new shoes, cushions which will correct predisposing factors); donut pad (incircles bony growth so shoes don’t put pressure on it); surgical removal (last resort)
Define: bunion (hallux valgus)
- cause
- SSx
- Tx
- define: valgus deformity at MTP1
- cause: tight shoes, heredity
- SSx: pain
- Tx: warm soaks, improved footwear +/- orthoses (braces), wedge pads or taping, surgery
Define: Plantar (Morton’s) Neuroma
- cause
- DDx
- SSx
- Tx
- define: nerve tissue growth usually between MTs III and IV that feels as if you are standing on a pebble in your shoe;
- cause: interdigital nerve becomes entrapped between metatarsal heads; running & pounding +/or tight shoes
- DDx: anterior arch sprain
- SSx: lateral forefoot pain: intermittent, spontaneous, reduced when barefoot, excruciating, click & pain with MT compression (this is caused by squeezing of metatarsal heads)
- these help rule out arch
sprains - Tx: metatarsal pad or cortisone injection into nerve to settle inflammation
arch sprains
- causes
- Ssx
- grades of arch sprains
- Tx
- causes: obesity, heredity, overuse, fatigue, poor footwear, hard surfaces
Ssx:
• Pain with use, more when barefoot
• 1st degree – slight soreness
• 2nd degree – inflammation, drop of arch
• 3rd degree – fallen arch - Tx: POLICE, rest, rehab
Define: periostitis
inflammation of the membrane enveloping a bone
Define: turf toe
- cause
- Ssx
- Tx
- define: sprain of 1st MTP joint ligament and capsule due to forced hyperextension of 1st MTP joint beyond 60 degrees
- SSx: Pain, decreased ROM, difficulty running or changing directions; 1st MTP is red, swollen, tender; pain worst at the end range of 1st toe extension
- Tx: immobilize them, crutches, maybe even surgery, rehab; return to sport: taping to stabilize joint and limit hyperextension
Plantar Fasciitis
- treatment/ management
- rest then gradual return to sport
- ultrasound physiotherapy
- orthotics (soft>hard); wear all the time
- heel cups built into orthotics
- taping
- night splint
- short leg walking cast
- achilles tendon stretching (3x a day)
- rolling plantar surface with a rigid ball
- rehab exercises that increase big toe dorsiflexion
- anti-inflammatory medication
- steroidal injection (if all other management options fail to resolve symptoms
- strausberg sock
Fill in the blank: Don’t do surgery for Plantar Fasciitis before 6 months of conservative treatment. ______ will resolve with 6 months of consistent nonoperative treatment.
- 97%
Define: crepitus
grinding/ crunching sensation in joints when moving
- can be found in fractures
Specific foot injuries with risk of foot fractures where?
- ankle sprains
- fall or jump
- crush injury
- overuse
- kicking injury
- ankle sprains: talus, fibula, tibia
- fall or jump: calcaneus (possible spine vertebrae?)
- crush injury: metatarsals, phalanges
- overuse (stress): metatarsals, tibia, fibula, calcaneus
- kicking injury: phalanges
Jones fracture
- define
- Ssx
- Tx
- notorious for?
- define: Fracture at fifth metatarsal proximal diaphysis/metaphysis junction
- Ssx: pain, swelling, difficulty walking
- Tx: brace, cast or splint for 4 to 8 weeks, risk of non-union (25%), surgical repair
- notorious for poor healing because not much blood flow to this area
Describe some foot rehab modalities (4)
- contrast bath (hot/cold)
- ultrasound: sound waves travel to tissues causing them to heat up and dilate and increase blood flow (helps with healing
- shockwave therapy: higher intensity than ultra sound but usually used to break down scar tissue or adhesions
- laser therapy: alters permeability of cells; allowing different healing substrates to enter
Describe some foot strengthening exercises
- towel scrunches
- marble pick ups
- short foot exercises (isometric exercise where you try and contract arch muscles and hold them)
What are some foot tape jobs we can do (2)?
- low dye arch tape job
- calcaneal fat pad tape job
Plantar fasciitis
- etiology
- pes cavus or pes planus
- running (weight on the ball of foot)
- bursitis
- heel spurs
- inappropriate footwear
- poor running technique (long strides),
- running on soft surfaces
- discrepancy in leg length
- excessive pronation of the subtalar joint, inflexibility of the longitudinal arch
- tightness of the gastrocnemius + soleus
Plantar fasciitis
- signs and symptoms
- pain the medial arch/ medial distal heel
- pain worst in morning and with sitting
- swelling and tenderness
- heel spur on x ray
