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Kin 2236 Athletic Injuries > (2) Lecture 11: Foot and Ankle Prolems 1.0 > Flashcards

(2) Lecture 11: Foot and Ankle Prolems 1.0 Flashcards

1
Q

Plantar fascia

A

Composed of 3 segments: CENTRAL, medial + lateral

  • central starts from medial tubercle on plantar surface of calcaneus
  • travels towards toes as solid band dividing just before MT heads into 5 slips

helps support foot against downward forces

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2
Q

Most important segment of plantar fascia

A

Central

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3
Q

Windlass Mechanism

A
  • when toes are extended, plantar fascia functionally shortens and wraps around MT heads
  • planta fascia dynamically affects ARCH HEIGHT
  • responsible for transferring weight from medial to lateral side of foot during gait
  • also important for arch support/shock absorption
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4
Q

Plantar Fasciitis

A
  • most common condition in foot

Caused by overuse or excessive loading
- especially in those w/ atypical arches (Pes Planus + Pes Cavus)
- with active ppl, may be due to changes in training/FITT
- linked to BMI in less active ppl

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5
Q

Plantar Fasciitis - Tissue Level

A

NOT inflammation

a FASCIOSIS

  • OVERUSE condition
  • changes in structure (ex. collagen disarray)
  • non-inflammatory degenerative condition
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6
Q

Symptoms of Plantar Fasciitis

A
  • gradual onset of pain
  • SHARP STABBING PAIN on FIRST steps in morning or after long periods of non-weightbearing
  • pain improves after initial few steps but worsens w/ prolonged activity
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7
Q

Signs of Plantar Fasciitis

A
  • Pes Planus or Pes Cavus
  • decreased dorsiflexion (tight gastroc/soleus, poor jt mobility)
  • weakness of Tib. Post. (plantar flexor)
  • pain on palpation over origin of PF (medial side of calcaneus)
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8
Q

Over pronators

A

Turn IN too far
- have hard time maintaining arch
- trouble w/ resupination = no rigidity
- may cause twist during propulsion

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9
Q

Over supinators

A

Decreased shock absorption
- decreased ability to adapt to terrain
- due to lack of pronation
- force thru fascia to absorb shock

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10
Q

Role of Pronation in Gait Cycle

A

Foot function: MOBILE ADAPTER

Foot structure: lowered arches, looser joints

Gait Phase: just after heel strike to foot flat

NOT WANTED AT PROPULSION

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11
Q

Role of Supination in Gait Cycle

A

Foot Function: RIGID LEVER

Foot structure: heightened arches, tighter joints

Gait Phase: short period at heel strike; foot flat to toe-off

NOT WANTED WHEN LOADING

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12
Q

Tight Posterior Structures

A
  • anatomical connection btwn Achilles tendon and plantar fascia
  • if Achilles tendon is tight, plantar fascia may be pulled too tight

Tight plantar flexors affects dorsiflexion ROM and will affect motion

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13
Q

Heel Spurs

A
  • in 80% of plantar fasciitis patients
  • due to REPETITIVE MICROTRAUMA
  • spur length is correlated w/ age, BMI, symptom duration + perceived pain
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14
Q

Treatment of Plantar Fasciitis

Initial Pain Control

A

Taping
- over pronators - acute < 10 days

Orthotics - over the counter vs custom < 1year

Night splints
- for symptoms > 6 months

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15
Q

Treatment of Plantar Fasciitis

Fibroblastic/Repair

A
  • correct training errors

Manual therapy/soft tissue work and exercise
- cavus foot
- tight posterior muscles

Stretching
- tight posterior muscles
- plantar fascia

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16
Q

Treatment of Plantar Fasciitis

Late Repair/Remodeling

A
  • idealize strength
  • add in power + agility (push off, jumping, cutting)
  • decide on return to play: taping, shoes or insole
17
Q

Morten’s Neuroma

A
  • not a true neuroma
  • compressive neuropathy of COMMON PLANTAR DIGITAL NERVE of 3rd webspace
  • nerve is thickest from medial plantar nerve and lateral plantar nerve
18
Q

Transverse arch anatomy

A

good transverse arch = more space for nerves

decreased transverse arch = less space for nerves as bones drop
- causes inflammation from mechanical irritation

19
Q

Symtpoms of Morten’s Neuroma

A

Pain/burning into
- plantar aspect of forefoot
- toes

Made worse by forefoot weight-bearing
- dancing, high heeled shoes

Might describe as working over a stone/pebble

20
Q

Signs of Morten’s Neuroma

A

Squeeze test
- examiner compresses forefoot w/ hand, while squeezing web space

  • webspace tenderness
  • plantar percussion (Tinel’s test) - tap test
  • toe-tip numbness
21
Q

Treatment of Morten’s Neuroma

A

Acute and inflamed
- Police/Peace & Love
- refer for corticosteroid injection

Chronic or after acute phase
- avoid high-heeled, pointed or narrow shoes
- select shoes w/ wide toe box
- avoid aggravating activities

22
Q

Correction of transverse flatfoot

A
  • mobilization of foot (splaying to increase transverse arch position)
  • metatarsal pad = raises arch
23
Q

Last Resort for Morten’s Neuroma

A

Surgical
- inter-metacarpal ligament cut
- nerve transsected

24
Q

Sesamoiditis

A
  • two sesamoids beneath 1st MTP jt to protect flexor hallicus longus from being crushed
  • transmit forces from ground to 1st MT head
  • often caused by repetitive stress and/or hyperextension of great toe

Most common in dancing + basketball

25
Q

Symptoms of Sesamoiditis

A
  • pain under great toe/forefoot when weight bearing
  • improved when not weight bearing
  • worse w/ dorsiflexion of great toe
26
Q

Signs of Sesamoiditis

A
  • swelling, redness
  • pain w/ passive dorsiflexion of great toe
  • pain and weakness w/ resisted plantar flexion
  • pain w/ direct palpation of medial or lateral sesamoid
27
Q

Treatment of Sesamoiditis

A

Treatment of “ITIS”
Inflammatory/Destructive Phase
- POLICE/Peace&Love
- restrict activity to allow inflammation to subside
- metatarsal bar, dancers pad or orthotics

Prior to return to play
- correct training errors

28
Q

Turf Toe

A
  • can be one time or repetitive trauma
  • MOI: posterior roll-up
  • forced hyperextension of great toe (dorsiflexion > 100 degrees) = tear of plantar capsule + plantar ligaments of great toe

Predisposing factors
- playing on artificial turf
- soft flexible footwear

29
Q

Symptoms of Turf Toe

A
  • hyper dorsiflexion of great toe
  • pain swelling and at first MTP jt
  • worse w/ movement + weight-bearing
  • weak “push-off”
30
Q

Signs of Turf Toe

A
  • visible swelling, redness, ecchymosis
  • pain w/ passive plantar and dorsiflexion of great toe
  • pain + weakness w/ resisted plantar flexion of great toe
  • pain + laxity w/ dorsoplantar drawer test
31
Q

Treatment of Toe Turf

Inflammatory/Destructive Phase

A
  • POLICE/PEACE&LOVE
  • crutches and/or tape to protect

Before end of this stage
- optimize healing environment
- palliate pain
- decrease swelling

32
Q

Treatment of Toe Turf

Repair/Fibroblastic

A

Protect tissue and idealize healing environment

  • increase blood flow = heat

Before end of this stage
- idealize ROM
- progress weight-bearing
- begin gentle strengthening

33
Q

Treatment of Toe Turf

Remodeling Stage

A

Functional training for return to play
- idealize strength thru range
- add in power + agility (push-off, jumping, cutting, etc)
- decide on return to play taping, shoes and/or ridged insole

Kin 2236 Athletic Injuries (20 decks)

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