Week 8 Lecture 8B - Foot & Ankle Flashcards
Lateral Stabilization Procedures
Post op splint, boot, cast for 4-6 weeks
What do you need to protect?
ROM limited
(DF/PF)
(Neutral to full DF is ok)
(INV/EVER)
(Neutral to Full EVER ok)
Want them in that cast so everything can tighten up
Protect the reconstruction. Avoid stretching into inversion, plantar flexion to neutral
PF; INV
Symptoms:
Dull ache in (anterior/posterior) (upper/lower) leg
Edema/tendon thickening
“Crunching”
Provocation of symptoms:
Up on toes
Push off
Landing
They’ll tell you they have a dull ache in the lower leg
Can be thick and swollen on either side of the tendon
posterior; lower;
Achilles Tendonitis
Overuse injury Repetitive (dorsi/plantar) flexion Repetitive work in DF / PF position Running hills Excessive training “Too much and not enough" - Too much volume and load and not enough strength to support that
Standing on a slanted surface for long periods of time can irritate the tendon, going up and down on their toes excessively
plantar;
Risk factors: Intrinsic: Limited (DF/PF) ROM Excessive foot (supination/pronation) - (causes rotational shear of AT) Decreased (DF/PF) strength
Extrinsic
Training errors
Poor proximal control
Foot pronation will cause rotational shear through the achilles tendon. That repetitive stress of the rotational shear will cause that tendonitis
Training errors – too much too quickly
Proximal control – dropping into valgus and pronation
AT – Achilles tendon
DF; pronation; PF
Achilles Rupture
Mechanism:
Forceful (concentric/eccentric) contraction
Location - 2-6 cm prox to calcaneous
Male (more/less) than Female - 30-45 years of age
Pushing off when running, landing from a jump are examples of forceful eccentric contraction
Common in males in their mid 30s.
eccentric; more
Achilles Tendon Rupture
Contributing Factors:
Decreased (flexibility/strength)
Hx of tendinitis/osis
Signs/Symptoms: “I got shot” Extreme (dorsi/plantar) flexion weakness Pain, swelling Palpable defect Positive Thompson Test
flexibility; plantar
Achilles Rupture Treatment
Surgical
NWB / PWB in boot (cast) ~ _ weeks
Don’t see them in the first 6 week period.. If anything, crutch/gait training. Usually see them around week 5 or 6 where they get off of the cast or boot.
6;
Achilles Rupture Treatment
Surgical ROM: AROM (INV / EVER / DF/PF) DF: Active DF to (10 degrees/neutral) (knee flexed 90) Foot mobilizations /mobility exercises
Put knee in flexion if you want to take some tension off of the system.
Forefoot mobilization, toe crunches to mobilize the metatarsals
INV/EVER; neutral;
Achilles Rupture Tx
Surgical
Flexibility:
(Stretch/Avoid stretching) the Achilles tendon in early phases!
Do NOT over lengthen the Achilles tendon!
Ambulation will help facilitate ROM
If you over lengthen that tissue – mess up the length tension relationship – will be too long.
Avoid stretching
Achilles Rupture Treatment
Surgical:
Restoration of PF strength is challenging
Strength progression:
Isometrics - Inv/Ever / DF (0 degrees) - (4/6) weeks
Progress to isotonics - (6/8) weeks
Direction? Prerequisites?
PF isometric (6 weeks) then progress to isotonics
T band resisted - ~6-8 wks:
Knee flexed > knee extended
Hard to build up the muscle mass of the PF post op.
Prereq – ROM
4; 6;
Plantar Fasciitis
Some will have that heelspur – people think that the heelspur is the cause of the pain but it is actually a symptom of tension on that bone – wolfs wall – pulls on the bone – more bone gets laid down. The tight plantar fascia is actually causing the pain.
Plantar Fasciitis
Can see this in new runners
They will always tell you that they have pain on the first step of the day –first step pain – will tell you it is plantar fasciitis.
Clinical Presentation of Plantar Fasciitis
Tests and Measures:
Pain with palpation of insertion of pf
Pain (lateral/medial) tubercle of calcaneus
(Dorsi/Plantar) flexor tightness- common (78% of patients)
Reproduce symptoms with (pf + flexion/df + extension) of great toe
Palpate medial tubercle of the calcaneus – if press on that spot and they have pain it is probably plantar fasciitis. Plantar fascia attaches at this spot.
Tighten the plantar fascia – putting it on stretch will reproduce symptoms
medial; plantar; df + extension
Bone bruise
Fxs – trauma – did you fall recently
Achilles tendinosis
Lumbar radiculopathy – can come from the spine into the heel
Lateral side – definitely not plantar fasciitis
Tarsal tunnel – medial side
Numbness and tingling is not plantar fasciits.
If the muscles fatigue quickly plantar fascia has to do more work to support
Unilateral Plantar fasciitis
Demonstrated weakness in toe (flexors/extensors)
Uninvolved toes 9% greater peak force
Weak toe (flexors/extensors) may increase tensile stress loading of PF Allen, JOSPT, 2003
flexors; flexors
ROM & Strength Deficits
Runners with Plantar fasciitis
Significant limitation in extension and flexion of (1st/3rd) MTP
(Creighton, JOSPT, 1987)
Runners with Plantar fasciitis
Significant limitations in (PF/DF) ROM w/ extended knee (less than 5° DF)
Deficits in peak torque @60 °/s, 180 °/s (Dorsiflexion/Plantarflexion) isokinetic strength
If the first mtp doesn’t extend plantar fascia can get tight and when you stretch it, it hurts
TC (talocrual) joint might be limited causing extra pronation
1st; DF; Plantarflexion
Plantar Fasciitis Checklist
ROM limitations:
(PF/DF)
MTP (flexion/extension)
Strength deficits
(Dorsi/Plantar) flexors
Toe (flexors/extensors)
DF; extension; Plantar; flexors
Footwear – often times the foot flop syndrome. Winter to summer.
Risk Factors
Epidemiological design
Increased risk of Plantar fasciitis:
Limited ankle (Dorsiflexion/Plantarflexion)
Increased Body-Mass Index (obesity)
Prolonged wt bearing with occupation
Things you want to look for in your history
Dorsiflexion
Risk Factor: Biomechanics
Predictors of TSF
Greater Peak hip (abduction/adduction)
Greater Peak rearfoot (inversion/eversion)
adduction; eversion
