Week 9 Lecture 9A Foot & Ankle - Shin Splints Flashcards
Shin Splints - Anterolateral
Causes
Inflexible (dorsi/plantar) flexors
Causes resistance moving into (DF/PF)
↑’s work of anterolateral muscles
Training errors
Strength ≠ demands
Hard surface (shoe)
Improper footwear - not enough shock absorption
throws foot into plantarflexion at heel strike
↑’s work of anterolateral muscles
Training errors – too much too soon, running – overdoing it and the tib anterior is overloaded
Inflexible PFs – not a lot of DF
plantar; DF;
Shin Splints
Causes:
Foot strike pattern: (forefoot/heel) strikers
↑’s work of anterolateral muscles
Heel strike increases the work of the anterior tib
heel;
Medial Tibial Stress Syndrome
Causes
Excessive (supination/pronation)
Foot structure
Proximal weakness
Running technique:
(ADD/IR / ABD/ER)
Banked surface
↑’s work of posteromedial muscles to control pronation
ADD/IR
Pain along the posterior tib on the medial side or tib anterior on the lateral side
Compartment Syndrome
Acute: Presentation
Disproportionate, intense pain - (Relieved/Not relieved) by rest
Most common location: (anterior/posterior) lower leg:
Tightness in anterior compartment
Pain with passive (df/pf)
Neurologic changes - Deep peroneal nerve, Weakness (PF/DF), Toe (flexion/extension) (EHL)
Diminished/absent pulses:
Anterior Tibial a. > Dorsalis Pedis a.
Not relieved; anterior; pf; DF; extension
Compartment Syndrome
4 compartments
(Anterior/Lateral)
Ehl, Edl, tibialis anterior
Deep Peroneal N.
(Anterior/Lateral)
Peroneus longus and brevis
Superficial Peroneal N.
(Deep/Superficial) posterior
Gastrocnemius and soleus
(Deep/Superficial) posterior
Contains tibialis posterior, fdl, fhl
Anterior; Lateral; Superficial; Deep
Chronic Exertional Compartment Syndrome
Clinical Presentation - History
Developing pain in a compartment of the leg at a fixed point or intensity of exercise
Described as burning, aching, or cramp-like pressure:
“Leg feels full”
Pain (decreases/increases) in intensity as exercise continues
Pain (increases/resolves) after cessation of exercise
Other symptoms can include: numbness, tingling, weakness of affected muscle
15 min into my run and I get numbness
Leg could be burning and aching
The pain and sxs increase as the exercise continues, as they stop the symptoms resolve
increases; resolves
Have the person do the exercise that causes their symptoms – can find pain with palpation, passive stretching, firm / swollen
Chronic Exertional Compartment Syndrome
Common Physical Findings for Involved Compartments
Anterior Compartment: Weakness in (plantarflexion/dorsiflexion) or toe (flexion/extension), persistent foot drop, paresthesias over dorsum of foot, numbness in first web space
Posterior Compartment: Weakness in (dorsiflexion/plantarflexion), pain and/or paresthesias to the upper/mid posterior calf
Lateral Compartment: Weakness in (inversion/eversion), pain and/or paresthesias over the anteriolateral aspect of leg
Deep Posterior Compartment: Paresthesias in plantar aspect of foot and weakness of toe (extension/flexion) and foot (eversion/inversion)
dorsiflexion; extension; plantarflexion; eversion; flexion; inversion;
Testing for CECS
Measurement of intracompartmental pressures
Needle placed into the compartment
Pressures taken pre and post-exercise
+ test = one or more of following pressure criteria:
Pre-exercise pressure ≥ (10/15) mm Hg (normal resting pressure is <(10/15))
1 minute post exercise pressure ≥ (20/30) mm Hg
5 minutes post exercise pressure ≥ (20/30) mm Hg
If it stays elevated it is a positive test
These are tests done by physicians
15; 10; 30; 20
Post tib tendon helps to stabilize the medial longitudinal arch
Adult acquired flat foot – start to get a flatter foot in late adulthood – possibly short gastroc soleus (can cause more pronation and more stress on the posterior tib tendon).
5th Metatarsal Fxs
Jones Fx;
(Sir Robert Jones)
“dancers fracture”
MOI: (eversion/inversion)
Poor blood supply
greater chance of non union
usually longer NWB period - (8-12/12-16) weeks
Slower rehab if not fixed with hardware
Jones fx – fx of the 5th metatarsal that is more distal than the base of the 5th metatarsal
Takes longer time to heal due to the poor blood supply.
inversion; 8-12;
This ligament is important for stability. If you lose it, not good due to how important it is for the stability
Lis Franc Injury
Mechanism
High Energy
Force through MT in (dorsiflexed/plantarflexed) position
Symptoms:
TTP: base of the (3rd and 4th/1st and 2nd) metatarsals
Provocative tests
Compression of midfoot - Squeeze test
Dorsiflex/plantarflex 1st mt while stabilizing 2nd
Misstep down the step and landing awkwardly
Squeeze test will cause pain on the lis franc joint
Stabilize the 1st or 2nd metatarsal and move the other one – will recreate symptoms
TTP – Tender to palpation
plantarflexed; 1st and 2nd;
Growth plate gets pulled off
Adolescent males – bone grows faster than soft tissue – growth spurts
Heel lift helps unload it
Gastroc / soleus stretching
Hallux Valgus - Bunion
Lateral deviation of hallux Medial deviation of metatarsal > _ degrees significant = Hallux valgus Genetics Pes planus Shoe wear
These can be severe
Risk factors – genetics
Flat foot causes valgus to go in the lateral direction
Sometimes tight shoes or heels make it worse
15;
Happens a lot in middle age males
Can happen in any joint, most common in big toe
PT – manage the swelling, modalities, work on ROM, gait (assisitive device), decrease WB
Repetitive activity – jumping, push offs
Turf Toe
Sprain of MTP
Grades 1,2, 3
MOI: (hyperflexion/hyperextension) of MTP - Injury to plantar plate, collateral ligaments
hyperextension;
Hallux Limitus / Rigidus
Gait deviations?
Normal ROM?
MTP extension - _°
Stiff toe
Gait deviations – on the lateral side of the foot
75
These are the originals
Explosive strength and power is what these athletes do this for
The purpose of the hang – shorter ROM, greater rate of force development !
Power moves are typically harder – use less weight than the other lifts (80-90% of what you would do with the standard).
