ankle 3

Question 1

MEDIAL TIBIAL STRESS SYNDROME (SHIN SPLINTS)
def
pt presentation
objective

Answer 1

Definition:
* Periosteal irritation localized to the
fascial insertion of the medial soleus
* Patient Presentation
* Dull aching pain along tibia typically
anterior and medially
* Pain at beginning and end of workout
* Pain increases in intensity and duration
with chronicity of pathology
* Can evolve to be painful at rest
* Poor footwear or surface for activity
* Objective Testing
* Weakness in tibialis anterior and
extensor muscles
* Limited DF
* Pes planus
* Weakness up the chain, hips/core
* Poor single leg balance and stability

Question 2

MEDIAL TIBIAL STRESS SYNDROME (SHIN SPLINTS)
treatment

Answer 2

• Treatment
• Reduction and modification of pain
  provoking factors
• Manual therapy and modalities to
  posterior/anterior soft tissue
• Gradual reintroduction of activity
• Surgical option of fasciotomy left for
  extreme cases or emergency

Question 3

POST TRAUMATIC OSTEOARTHRITIS

Answer 3

background
* More common posttraumatic than
osteoarthritis
* Associated with repeated inversion
sprains
* Damage to cartilage via injury or postoperative
* Typically involving talocrural joint and
subtalar joint

Subjective/Objective Presentation
* Previous injury/surgical intervention
* Stiffness/swelling
* May complain of mechanical symptoms
(clicking/popping)
* Limited joint mobility and A/PROM

• Treatment
• Manual therapy for joint/soft tissue restrictions
• Offloaded training, aquatic/bike
• Work above the ankle for mobility and stability (hip/knee)

Question 4

NAVICULAR STRESS FRACTURE

Answer 4

• Background:
• Most common of midfoot fractures
• Midportion of navicular with less
  blood supply
• MOI: repetitive or acute
  plantarflexion
• Patient Presentation
• Tender to palpation on dorsal surface
  of foot
• Objective Testing
• Radiograph - repeated if index of
  suspicion high, often missed
• Difficulty bearing weight through limb
• Inability to reach full PF
• Treatment
• Offload for 6-8 weeks in boot/cast
• Gradual progression back to full
  activity

Question 5

metatarsalgia

Answer 5

• Background:
• Incidence 5-36%
• Commonly found when lack of proper
  biomechanical norms at the foot
• Patient Presentation
• Pain in the plantar aspect of the foot
  near the 2nd, 3rd, 4th, rays
• Objective Testing
• Pain during toe off phase of gait
• 1st ray insufficiency – load
  transferred to 2, 3, 4
• Poor foot intrinsic strength
• Poor hip strength
• Treatment:
• Orthotic/tape use to support arch and redistribute force
• Improve impairments of mobility and focus on strength to decrease
  load through metatarsal joints

Question 6

MORTON’S NEUROMA

Answer 6

• Background:
• Pathology affecting the digital nerve
  thought to be due to fibrosis
• Pressure to nerve and irritation causing
  thickening
• Females > males, common in runners
• Most common 3rd digit, then 2nd and 4th
• Subjective/Objective
• Forefoot pain, burning most
  common description
• “pebble in the shoe” reported
• Tightly worn shoes
• Landing on forefoot during
  running
• Pain can be at rest and at night
• Painful when squeezing
  metatarsals
• Treatment:
• Metatarsal pad/bar to disperse force
• Various injections report some help, corticosteroids most common
• Improve flexibility of posterior chain, strength of foot intrinsics

Question 7

Hallux rigidus

Answer 7

defined by restricted sagittal plane motion of great toe
occurs in 30-60% of adults over 65 years old
contributing factors include: pes planus, hypermobile first ray, hallux valgus
female more than male

treatment
orthotic to support first MTP joint
rocker sole shoe
manual therapy/modalities to reduce pain and improve motion

Question 8

hallux valgus/toe deformities/