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MSK II > Foot and Ankle 2 (test 4) > Flashcards

Foot and Ankle 2 (test 4) Flashcards

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1
Q

prevalence of achilles tendinopathy

A

most frequent overuse injury

10-20% of runners

most common in recreational activities, training > competition

30-50 yr olds

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2
Q

risk factors/etiology of achilles tendinopathy

A

reduced DF ROM (limit PE of achilles)

limited calf flexibility

calf weakness

possible L4-S1 regional interdependence

male gender/family hx

abnormal tendon structure

older age

obesity

systemic conditions with inflammation/limited blood supply

training errors/environment/improper shoes

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3
Q

how might L4-S1 regional interdependence cause achilles tendinopathy

A

excessive EV/pronaiton with tendinopathy origins b/c achilles attaches more medially

hip neuromuscular deficits

balance deficits

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4
Q

pathomechanics of achilles tendinopathy

A

repetitive lengthening with compression from limited DF and/or excessive EV

lack of PE with limited DF so overworked

collagen fibril thinning/disorganization and fibroblast death from altered fluid movement that leads to heating and increased nitric acid with persistent inflammation

ineffective force transfer

impaired motor control

thickened but weaker tendon from increase of non-collagen matrix and fat deposition

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5
Q

functional questionaires for achilles tendinopathy

A

victorian institue of sport assessment

foot and ankle ability measure

LEFS

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6
Q

symptoms of achilles tendinopathy

A

gradual onset that limts WBing activity

localized pain and stiffness
-especially after inactivity
-lessed with mild activity
-increase with mod to severe activity

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7
Q

observation of achilles tendinopathy

A

achilles thickening

possible imaired LE control

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8
Q

ROM findings for achilles tendinopathy

A

pain and limits with DF

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9
Q

resisted/MMT findings for achilles tendinopathy

A

pain with PF possible; maybe weak

possible hip and knee weakness

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10
Q

AM findings for achilles tendinopathy

A

possible talar hypomobility for DF

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11
Q

special tests for achilles tendinopathy

A

arc sign

royal london test

single leg heel raise
-flat surface vs incline (plataris and insertional injury if more pain on incline
-for PF endurance = less reps vs uninvolved

single leg hop = less reps than uninvolved

M. length shortened gastroc

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12
Q

palpation findings for achilles tendinopathy

A

TTP 2-6 cm proximal to insertion

more medial achilles pain indicates plataris

achilles crepitus

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13
Q

differential dx at posterior ankle

A

achilles/fascial tears
calcaneal bursitis
plataris tendinopathy
posterior ankle impingement
sural neuritis
acessory soleus muscle
achilles ossification or talar bone spur
inflammatory dz

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14
Q

pt edu for achilles tendinopathy

A

rest is NOT indicated

optimal stess is best within appropriate pain levels = mild pain

wt management

shoe wear

timeline = 8-12 wks; at least 6

prognosis = 80% improvement if both pt and PT are doing the right things

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15
Q

modalities and their effectiveness for achilles tendinopathy

A

LASER = contradictory evidence

iontophoresis = dexamethasone helpful for pain and function

shockwave
-support for pain relief with ADLs when added to 4 wks exercise
-no indication on structure change or return to sport

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16
Q

bracing support for achilles tendinopathy

A

neoprene sleevs on involved muscles only anecdotal

night spint NOT beneficial and NO support

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17
Q

taping support for achilles tendinopathy

A

anecdotal and conflicting evidence

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18
Q

arch taping/foot orthotics support for achilles tendinopathy

A

taping may help predict orthotic benefit

shock absorbing orthotic decreased injury rate

heel lift = mixed support; needs to happen on both sides

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19
Q

dry needling support for achilles tendinopathy

A

helful for pain when added to exercise

questionable otherwise

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20
Q

STM support for achilles tendinopathy

A

mostly anecdotal

ASTYM helpful for motion when added to exercise

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21
Q

gentle stretching support for achilles tendinopathy

A

weak but some support for pain

may be contraindicated due to higher tension/compression on tendon

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22
Q

JMs serve what purpose for achilles tendinopathy

A

mobility and function

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23
Q

what MET has best evidence for achilles tendinopathy

A

varied muscle actions

eccentrics only = alfredson protocol
heavy and slow eccentrics
isometrics
lower compliance rates with eccentric training

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24
Q

ultimate MET parameters

A

3 sets 10-15 reps

3 sec phases of muscle actions

heavy load - NOT during inflammatory phase

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25
how should you progress MET for achilles tendinopathy
progress resistance and activity with less than or equal to mild symptoms can add weight via backpack, use heel raise machine, or do sitting/standing heel raises
26
how long should achilles tendinopathy be treated
at least 2x/week for 6 weeks recommended to do every other day may need more recovery time between loading in older/non-athletic pt (about 72 hours) repeat exercises once normal pain levels return
27
recurrence rate for achilles tendinopathy
27%
28
success rates for achilles tendinopathy
mostly normalized tendon structure and thickness improved mechanical properties as well as cortical structures about 12 weeks to recovery 80% fully recovered within 3-6 months of progressive loading at 5 year follow up
29
success rates for eccentric exercuses
82-100% mid portion tendinopathy in athletes 60% sedentary individuals less than 32% insertional tendinopathies
30
what % of people have mild pain remaining with achilles tendinopathy
20-45%
31
effect of injections for achilles tendinopathy in mid portion vs insertional
midportion -insufficient evidence for cortisone -emergign evidence for high volume injection/scleroptherapy insertional = guided cortisone is effective for pain and function -alternate option when MET isnt working -recommended for non-athletic population
32
MD Rx for achilles tendinopathy
injections achilles debridement remove plantaris
33
prevalence and etiology of calcaneal apophysitis
aka Sever's disease 9-12 years old most common males > females etiology = growth with high activity
34
structure/pathomechanics for calcaneal apophysitis
leg bone growth exceeds PF lengthening increased tendon tension growth plate is the weak spot as opposed to tendon in the adult mostly inflammation complcations = avulsion/premature closure
35
risk factors for calcaneal apophysitis
long or year round sports poor fitting shoes that lack cushion training errors shortened PFs foot dysfunction (i.e. pes planus/cavus)
36
symptoms of calcaneal apophysitis
gradual onset of heel pain with overuse Bilateral more than unilateral pop = avulsion
37
observation for calcaneal apophysitis
poor shoe/support cushion foot dysfunction (i.e. foot pronation or supination) impaired LE control
38
ROM findings for sever's
limited DF leading to greater tensile forces on growth plate
39
resisted/MMT findings for severes
possible weak and painful PFs weak DFs
40
special tests for calcaneal apophysitis
squeeze test on heel severe's sign = pain with heel raise M. length = short gastroc
41
palpation findings for severe's
TTP over "cap" of calcaneus
42
PT Rx for calcaneal apophysitis
pt edu: -soreness rule -load management -movement cues for LE control POLICED "U" shaped foam upside down on achilles with ankle sleeve restore DF ROM/accessory motion -JM and STM -careful with prolonged calf stretch hamstring stretch due to fasical connection with gastroc
43
orthotics effectiveness for calcaneal apophysitis
arch support for excessive pronation heel lifts heel lifts > arch support -more effective at 2 months -equally effective at 12 months gel heel cups with a lift work best
44
MET for calcaneal apophysistis
for any impaired LQ control caution with muscle/tendon attached to growth plate to avoid greater overuse
45
prognosis for calcaneal apophysitis
75% resolved at 1 month and 95% at 3 months can be a recurrent and or persistent problem growth plate closes around 14 years
46
what is plantar fasciopathy
heel pain most common foot condtion
47
clear risk factors for plantar fasciopathy
increased PF ROM (ankle instability) High BMI running/ work related WBing with poor shock absorption impaired 1st MTP ext that reduces PE of fascia older age
48
unclear risk factors for plantars fasciopathy
decreased DF that limits PE of fascia tendinopathy origins (excessive dynamic pornation and standing calcaneal EV)
49
describe the structure of the plantar fascia
3 bands (medial, central and lateral) central originates on medial tubercle inserts in all proximal phalanges assists with gait via windlass effect that is PE developed by normal foot and ankle motion
50
structures involved with plantar fasciopathy
intrinsic foot muscles heel fat pad innervated by tibial n achilles tendon fibers connect with plantar fascia medial and lateral plantar nn bone spurs (plantar fascia thickening and fat pad thinning were better indicators)
51
etiology and pathomechanics of plantars fasciopathy
primarily = structural changes (54%) only inflammation = ~20% neoplastic (connective tissue tumor) = 25%
52
functional questionaires for plantars fasciopathy
foot and ankle ability measure (FAAM) foot health status questionnaire (FHSQ) foot function index (FFI) lower extremity functional scale (LEFS)
53
symptoms of plantars fasciopathy
gradual onset of heel pain after recent increase in WBIng activity medial > central heel pain -after long periods of inactivity -worse at end of day/prolonged WBing -can improve with mild/mod activity
54
observation for those with plantar fasciopathy
thickened plantar fascia possible static calcaneal EV possible asymmetrical and antalgic gait possible excessive dynamic pronation possible impaired LQ control
55
ROM findings for plantar fasciopathy
limited 1st MTP ext
56
resisted/MMT findings for plantar fasciopathy
possible weak and painful toe flexors
57
special tests for plantar fasciopathy
lack of plantar flexion tautness
58
palpation findings for plantars fasciopathy
TTP over medial calcaneal insertion > central heel pain
59
other differential dx for plantar fasciopathy/heel pain
spondyloarthropathies or autoimmune conditions calcaneal stress fx bone bruise fat pad atrophy tarsal tunnel syndrome fibrous tumor calcaneal apophysitis radiculopathy
60
PT Rx for plantar fasciopathy aside from MET and MT
pt edu -sireness rule -load management -movement cues -wt. loss -cushioned surfaces with long standing POLICED modalities -short term relief with ionophoresis + dexamethasone or acetic acid -short term relief with LASER + ponophoresis -shockwave = NOT more effective than stretching or US; possible adverse affects US/electrotherapy not recommended taping = short term relief only orthotics -better for those who benefited from taping -benefits for persistent type dry needling NOT RECOMMENDED
61
manual therapy for plantar fasciopathy
goal = normalize mobility and m lengths for pian, ROM, and function JM = mixed benefits -improves pain and function along with orthoses and MET -helpful but not additive to stretching -imporve DF and 1st MTP ext stretching calf & plantar fascia -calf stretch alone = no difference with DF and pain -both improved pain but more reduction with fascia stretch JM + STM -deep massage to gastroc and fascia -rear foot JMs
62
what shoe characteristics may help those with plantar fasciopathy
-shoe rotation = dont wear the same ones all the time -rocker bottom shoe =
63
how is the static standing method of choosing footwear concerning
overly simplistic potential injury problematic for those with excess pronation doesnt represent dynamic foot
64
effectiveness of night splint
wear for 1-3 months improved impaired DF due to shortened PFs hard to get pts to comply
65
MET for plantar fascipathy
primarily for fascia proliferation tendinosis Rx (like achilles but + hyperextension of toe) pronation control exercises (especially tibialis post and other LE muscles that can contribute to impaired LE control)
66
prognosis for plantar fasciopathy
80% resolution of symptoms

MSK II (18 decks)

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