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Sports Injuries > Chronic Lower Leg > Flashcards

Chronic Lower Leg Flashcards

1
Q

Define the difference between plantar fasciopathy and fasciitis

A

ITIS = inflammation
OPATHY = disease/something wrong

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2
Q

What’s a classic symptom of plantar fasciopathy as it pertains to timing of day and pain?

A

pain is worse in the morning and after any period of time when you’re sedentary and load the plantar fascia

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3
Q

A person has heel pain localized on the plantar side, with pain sometimes spreading and landing on medial side of the heel. What could this condition be and why does it present in that location?

A

plantar fasciopathy
- plantar fascia acnchors to medial side of heel and spreads into medial longitudinal side (anchors onto calcaneal tuberosity)

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4
Q

Describe the plantar fascia, listing its function and structure

A
  • very tough web of tissue
  • helps to support medial longitudinal arch
    as approaches the toe it spits into 5 strips/bands past the MTP joints
    toe movement may influence the plantar fascia: toe extension lifts the arch of the foot
  • plantar fascia passively lifts the arch of th efoot to create a rigid lever for pushing off when in extension
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5
Q

What are some potential risk factors for plantar fasciopathy?

A
  • excessive foot pronation (flatter feet population)
  • BMI greater than 30 kg/m^2 (obese range, weight could cause you to push on the plantar fascia all the time and pronate
  • plantarflexor tightness (limit ability to get into dorsiflexion)
  • less or equal to 0 degrees of dorsi
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6
Q

What does insidious onset mean?

A

sneaks in over time and occupies more space, chronic

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7
Q

what’s another name for shin splints?

A

medial tibial stress syndrome

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8
Q

List some indications and qualities of MTSS

A
  • insidious onset
  • usually very exercise focused (ppl who have to absorb impact in some way during landing are typically affected)
  • when not training it usually doesn’t bother ppl
  • pain is on medial and posterior aspect of tibia, behind medial malleolus
  • length of pain will be at least 5 cm (if pain more in one small spot, more likely to be stress fracture)
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9
Q

What’s an indication of a stress fracture rather than MTSS?

A

Pain localized to one specific point

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10
Q

Sometimes symptoms can overlap with ones that signal more serious emergency issues. What should you look out for?

A
  • cramping, burning or pressure = ALERT
  • neurological symptoms (pins and needles, numbness, tingling) = ALERT
  • signs of vascular issue (discoloration, capillary refill/circulation = ALERT
    WHY? Compartment syndrome
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11
Q

What is compartment syndrome?

A
  • each leg compartment has it’s own blood supply
  • in some ppl this compartment can be constrained, can start to press down on nerve supply and cut it off
  • not very common
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12
Q

What are the overlapping hypotheses for MTSS?

A

PERIOSTOSIS (some kind of inflammation with periosteum)
- can be irritated because soft tissue are pulling on it when you’re running, jumping, landing
*stemming from local soft tissue tensile loading

  • MTSS could be BONE STRESS INJURY
  • bone stress is coming from impact load
  • MTSS could be a result of how bone is responding to it
    *response related to impact loading and bony integrity
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13
Q

What is periostitis?

A

some kind of inflammation with periosteum (what tendons blend into, connective tissue that wraps around bone)

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14
Q

If soft tissues are pulling on the tibia, which ones might be the issue?

A
  • flexor digitorum longus
  • soleus
  • both pull on deep crural fascia
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15
Q

Describe the function of the soleus and FDL, and how they might pull on their attachments

A

SOLEUS
- when you land on toes and drop heels to the ground we get dorsiflexion. Gravity wants dorsiflexion, we fight this by using plantarflexors. When plantarflexors lose and contract eccentrically this will pull on it’s attachments

FDL
- also plantarflexor
- toe control
- catches arch a little as comes into medial side, some pronation/supination effects

*both very important in absorbing energy especially when landing on toes. Every time we land and pull on them they pull on their attachments

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16
Q

What happens to the tibia when we load it?

A

bends a bit posteriorly when we load it, back of bone compresses every time you land

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17
Q

define the function of osteoclasts

A

break down bone

18
Q

name the function of osteoblasts

A

build bone

19
Q

what happens to regional bone density with MTSS?

A
  • worsens, in class example it was 23 % lower than matched athletes
  • the load is leading to increased osteoclasts breaking bone down = decreased bone density
  • as condition improves the bone density increases, bone is always remodelling to match activity
20
Q

What is the physiology of a bone stress injury?

A
  • remodelling by osteoblasts and osteoclasts
  • edema, structural fatigure and microfracture/stress fracture/complete fracture
21
Q

Describe the characteristics of achilles tendinopathy

A
  • repetitive impact: jumping and running sports
  • insidious achilles tendon pain (mostly 2-6cm above attachment onto calcaneus)
  • thickened, swollen paratenon
  • morning stiffness (long period of inactivity makes it stiff and slow to respond)
22
Q

The achilled tendon has a paratenon, what is this?

A

membrane that wraps around tendon, thicker than periosteum

23
Q

Why is the Achilles vulnerable?

A
  • twisting structure of the tendon (the 3/4 cords bound together get “wrung out”)
  • region of hypovascularity (low blood supply = slower to heal)
  • high tensile loading, up to 10x body weight (built to accommodate but structural reasons can feed into its fail, we also have a little TOO much faith in it XD)
24
Q

Describe ACUTE tendinopathy

A
  • swells in the area not because of inflammation but because of packing tendon full of fluid as a protective mechanism (proteoglycans and bound water)
  • short lived, acute
25
Q

Describe CHRONIC tendinopathy

A
  • tendon starts to break down
  • gradually fibers rip
  • makes you weaker which makes you more likely to damage the rest
  • tendon gets stuck in repair phase (lay down garbage tissue to hold it temporarily but we damage it again)
  • no time to rest so the tissue never fully heals
26
Q

What are some questions to ask when attempting ROM, resistance and special tests for PF, MTSS AND AT

A
  • imagine/draw chart: active, passive, dorsi, plantar
  • does this pull apart apart an injured structure
  • does this test cause the muscle that might be injured to work/contract?
  • PAIN? Yes = might have identified problem. No = move on.
27
Q

Which ROM tests are most likely to be painful for plantar fasciopathy?

A
  • toe extension (passive and active) pulls the plantar fascia apart (windlass mechanism)
  • will get through more ROM with passive extension

**why not resisted extension?
- plantar fascia is not a muscle, doesn’t contract
- if we had damage to the FHL as well, this would change

28
Q

Which ROM tests are most likely to be painful for MTSS?

A
  • active and resisted ankle plantarflexion, toe flexion, ankle inversion
  • passive tests are less sensitive: pull apart test won’t always do much for MTSS, usually active tests will bother them more
    *soleus and FDL pull on the deep crural fascia
29
Q

Which ROM tests are most likely to be painful for achilles tendinopathy?

A
  • active and resisted ankle PF
  • passive ankle DF
30
Q

What’s a special test for MTSS?

A
  • windlass test
  • take person and stand with their toe on the end of the surface
  • put all BW into foot and push the toe up into extension while person is putting BW into floor
  • this combination is special test for MTSS but also can pick up turf toe
31
Q

What’s a special test to check for achilles issues?

A
  • thompson test
  • used to look at ppl with achilles issues, do they have an achilles rupture?
  • person lies prone, you squeeze muscle belly and ankle should plantarflex

NOT A TEST FOR ACHILLES TENDINOPATHY
- just a check for rupture that might need surgery

32
Q

What are different variations of single leg hop tests and what might they be used for?

A

*one leg hop on injured side, compare to other uninjured side
- 1 hop forward
- 3 hops forward
- cross hopping forward around line for things like soccer that reflect the skills they need to do
- measure distance and time how long it takes to get through 6 metre space
- SL hop for height

  • will give you info about progress/abnormalities between limbs
33
Q

Does bracing help foot, ankle and leg conditions?

A

YES
- the ones that have the best evidence are semi rigid hinge brace (first 6 weeks)
- 2 firm plastic pieces secure foot
- after ankle sprain we want to protect it from further sprain

34
Q

How does relative risk of respraining in brace compare to non brace?

A

0.30 (your risk is 30% of unbraced ppl)

35
Q

How does relative risk of getting a first time sprain in brace compare to no brace?

A
  • 0.69 (69% of the risk of non-braced ppl)
36
Q

How can shoe inserts help turf toe?

A
  • blocks movement of toe into extension by carbon fiber piece
37
Q

A lot of injuries land people in a boot: why are these used and which injuries might benefit?

A
  • has rocker bottom which allows the foot to roll through the gait cycle instead of putting toe into extension
  • 2nd and 3rd degree ankle sprain ppl will land in a boot
  • high ankle sprains!
  • fracture, lateral injuries, turf toe can benefit from boot
38
Q

Shoes with a rocker bottom exist: how do these help injuries and what injury might it not help?

A
  • helps offload plantar fascia
  • won’t help ankle sprain
39
Q

Describe now a “Strassburg Sock” works

A
  • worn at night when you sleeo
  • pulls toe into extension (not good for turf toe or sprain)
  • if you weat this there will be increased comfort in the morning where usually pain and tightness is present
  • relieves plantar fascia
40
Q

How might orthotics help some conditions?

A
  • sometimes helpful for plantar fascia, MTSS, sometimes achilles but less likely, sometimes overpronating foot
  • helps support arch
  • you may just need new shoes with better soles though
41
Q

What is an exercise for achilles tendinopathy?

A
  • alfredson eccentric heel drop protocol
  • in achilles the issue is it’s supposed to absorb energy as it lengthens
  • eccentrically load the achilles to whatever it can tolerate
  • toe drops down into DF, eccentrically load
  • straight knee
  • 3 sets of 15, 4x a day
  • 180 heel drops a day *this has been argued in journals
42
Q

What are some things that can be changed to prevent running injuries?

A

Create a graded running program:
- change the training surface
- reduce training speed, duration, frequency
- increase volume of recovery

  • training error is a very big factor in most ppl
  • something changed in their training where they under/overload (more common)

Sports Injuries (21 decks)

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