25_26- Foot/tibia disordera

Question 1

what is metatarsalgia

Answer 1

• sharp/aching/burning pain in forfoot
• worse when standing/walking/running
• a sharp/shooting pain that pt describes having a pebble in shoe

Question 1

what is metatarsalgia

Answer 1

• sharp/aching/burning pain in forfoot
• worse when standing/walking/running
• a sharp/shooting pain that pt describes having a pebble in shoe

Question 2

risk factors for metatarsalgia

Answer 2

• intense training (run)
• high arched feet/low arched
• tight pot compartment mm
• mortons/hammer toes

Question 3

3 types of metatarsalgia

Answer 3

A. Impact pain
B. Stress fx
C. Mortons neuroma

Question 4

mechanopathlogy of mortons neuroma

Answer 4

occurs as a result of compression of interdigital nerve against the distal end of the superficial transverse metatarsal lig during dorsiflex

Question 5

mc loc of mortons neuroma

Answer 5

Mc occurs between 3rd and 4th metatarsals

2/3, 5/5 after

Question 6

causes of mortons neuroma biomechanically

Answer 6

• overpronation results in loss of transverse arch which produces mechanical irritation to digital branches
• mc in women believed to be caused by high heal shoes

Question 7

histopathological causes to mortons neuroma

Answer 7

• deg changes (mucoid degenerative) are notes
• mucoid deposition in confined space results in increased pressure
• leading to ischemic compression/demylenation.axonal damage

Question 8

conservative tx to general metatarsalgia

Answer 8

• rest from aggravating activity
• stretch post compartment mm
• control over pro
• Stay away from positive heal
• orthotics (metatarsal pad)

Question 9

risk factors of plantar facciitis

Answer 9

• obesity/reduced ankle dorsiflexion
• associated w tight achilles
• associated with pes plants and pet caves

Question 10

characteristics of plantar fasciitis syndrome

Answer 10

• Am pain and stiffness
• medial heel pain w weight bearing
• w walking pain decreases but can reoccur later in day

Question 11

Why shoudnt it be called plantar facciitis

Answer 11

its aponeurosis and histologically no inflammation

Question 12

what does low arched foot cause in windlass effect

Answer 12

tension in plantar fascia has to be higher to get equal rot

Question 13

plantar fasciitis pathology

Answer 13

• deteriorated collageen fibres, increased secretion of ground substance pros, fibroblast proliferation and neovascularization
• believed if you can prevent the neovascularization you will stop the infiltration of nerves that accompany the blood vessels and hence stop pain

Question 14

foot orthosis an corticosteroid for plantar faccits

Answer 14

both can lead to decreased pain associated w plantar fasciitis

Question 15

what actually is achilles tendinosis

Answer 15

no inflammation

-biopsy revealed disorganized and degenerate collagen fibres

Question 16

mechanism of achilles tendinitis injury theories (4)

Answer 16

1. soleus portion which wraps around gastro portion strangles the tendon and injuries it
2. Poor blood supply prevents healing (then neovascularization occurs)
3. Whipping action causes by overpronation/oversupination
4. rapid eccentric action followed by rapid contraction action (toe off)

Question 17

clinical causes of achileies tendinosis

Answer 17

• racing in heel less spikes/ low heeled shoes
• worn out runners
• excessive pronation
• take off supination

Question 18

conservative approach to achileases tendinosis

Answer 18

• stop running (for at least 7-21 days)
• do other execises
• stretch
• strengthen

Question 19

how should strengthen + stretch in achilles tendonopathy be done

Answer 19

• stretch should be done for 10-20mins per day
• very painful to begin with
• eccentric heel lowering to strengthen (concentrate on the eccentric portion, not on the heel raise)

Question 20

grade 1 achilles tendonpathy

Answer 20

• rest one week before resuming normal schedule
• stretch calf 20 min/day
• add 7-15mm heel raise
• cross friction to tendon

Question 21

grade 2 achilles rehab (running pain not affecting performance)

Answer 21

• approach as per grade 1
• reduce speed work, hill running, long runs and weekly distance
• orthotics
• cross-frriction

Question 22

grade 3 achilles tendonopathy rehab (running pain affecting performance)

Answer 22

• approach as grade 1/2
• rest for 3 w
• after 3 w (resume jogging, cycle, or swim)
• resume serious running after injury reverts to grade 1

Question 23

running shoe tx for achilles tendonopathy (4)

Answer 23

7-15mm heel raise on outside or inside

• ridgid heel counter
• vertical achilles pad
• rigid midsole material

Question 24

primary postulated effect of foot orthoses on achilles tendinopathy

Answer 24

effect of foot orthoses on achilles tendinopathy relates to kinematic change and not distribution of plantar pressures, so we doubt this would have an sig effect

Question 25

definition of medial tibial stress syndrome

Answer 25

pain along posteromedial border of tibia that occurs during exercise, excluding pain from ischemic origin or signs of stress fracture

Question 26

role of tibia post (2)

Answer 26

1. decelerate subtler jt pronation during stance phase (eccentric action) 2. To return the subtler jt to neural after pronation (concentric action)

Question 27

traction theory of medial tibial stress syndrome

Answer 27

tib post actively tractions the periosteum which leads to inflammation and eventual bone

Question 28

tibial bowing theory of MTSS

Answer 28

ability of calf mm to cause repeated bending or bowing of the tibia, thereby causing a stress rxn and periosteal rxn (military recruits w MTSS has a lower cross sectional cortical area compared w similar subjects)

Question 29

risk factors of MTSS

Answer 29

- pronation - navicular drop >6.8mm - more rear/forfoot varus - running < 8.5 y