Foot and Ankle 3 (test 4) Flashcards
(47 cards)
structures involved in shin splints
anterior = anterior tibialis and lateral tibial shafted
posterior or medial tibial stress syndrome = tibialis posterior and medial tibial shaft
posterior more common (4-19% athletes)
periosteum
-connective tissue that surrounds bone except articular surfaces
-most densly innervated tissue
risk factors for medial tibial stress syndrome (MTSS)
female
high BMI
previous running injury
excessive pronation (increased navicular drop; primarily controlled by tibialis posterior)
increased PF ROM (unclear why)
greater hip ER (not understood)
no meaningful association with shoes
pathomechanics of MTSS
increased load on tibialis posterior leading to subsequent tension and inflammation of periosteal tissue
symptoms of MTSS
gradualonset medial shin pain
generally worsened with exercise and not ADLs
no cramping/burning/tingling
1/3 have coexisting leg injuries
observation of those with shin splints
overstriding leading to greater heel strike
impaired LE control
-excess pronation
-increased pelvic drop
-increased LE IR
resisted/MMT findings for MTSS
weak and possibly painful PFs
limited hip ext/abd strength and endurance
possibly weak and painful IV
special tests for MTSS
pain with hop on ball of foot due to plantar flexion of tibialis posterior
possible foot and or ankle instability
palpation findings for MTSS
TTP over posterior medial tibial border >5cm or 2 in in length
PT Rx for MTSS aside from MET and MT
POLICED
pt edu
taping/orthotics
specific edu for MTSS
movement pattern training
-not changed by strength alone
-reduced LE IR
-decreased heel strike + cue for shorter/faster steps
shoe wear
-light/supportive/cushioned
-rotate shoes
-change running shoes every 250-500 miles
purpose/effectiveness of taping/orthotics for MTSS
taping to assist tibialis posterior
foot orthotic for
-excess pronation
-heavy heel strikers
air cast for functional support that allows ankle motion
walking boot in severe cases
MET and MT for MTSS
MT for any joint dysfunction like limited DF
MET primary focus = unloading tibia and tibialis post
hip ER/EXT/ABD
improve PF and IV strength
-soleus supports 8x BW
-gastroc/soleus counters distal tibia bending
-tibialis posterior is primary invertor
address spinal stabilization as needed
differential dx for medial tibial stress syndrome
bone stress injuries of tibia
-stress reaction (periosteal and/or marrow inflammation)
-stress fx (cortical break)
compartment syndrome
bones stress prevalence/incidience
females > males
common in adolescent (specifically early HS age)
tibia most common bone
most common in people who dont let body rest (6-7 days/ wk sports participation)
common in runners
common bones for stress injuries
tibia = most common in runners
fibula = distal most common
metatarsals
-base of 5th most common; prone to avulsion
what are the 3 zones of injury for metatarsals
zone 1 = 90% of fxs and mostly with sprains
zone 2 = most susceptible to AVN
zone 3 = typically from repetitive stress
risk factors for bone stress injury
high forces
impaired LE control
longer stride
greater heel strike
repetitive jumping/walking
weakness
lack of recovery from training
high training load
pathogenesis of bone stress injuries
increased loads and frequency w/o recovery
osteoclastic activity exceeds osteoblastic activity
symptoms of bone stress injuries
generally worse pain eith ADLs and exercise and may become constant
signs of bone stress injuries
typical fx S&S
bone pain reproduced with hop test
imaging
-radiograph = may not show for 2-6 weeks
-MRI = gold standard; doesnt refelct healing
PR Rx for bone stress injuries (lifestyle changes)
adress diet and hormonal limits due to possibly decreased bone density
-meet energy expenditure
-Vit D
-Calcium
-regular menstrual cycle
well managed sleep/stress/BMI
meds = antacids prevent gut absorption of calcium
important facts related to bone stress injuries
adolescent bone doesnt equal adult bone
bone density decreases before growth spurt and takes up to 4 years after to increase
average growth spurt = 11.9 female and 13.6 males
average menarche = 12 years
SO WHAT = there is a period of skeletal weakness after a growth spurt especially with females who are also dealing with hormonal and skeletal changes and greater affects on BMD and muscle strength
load management rx for bone stress injury
graded unloading to ambulate without pain
gradual and progressive return to activity while addressing risk factors and etiologies
prognosis for tibial stress fx
BMD lowest at 3 mothts post fx in BOTH legs
BMD returned to baseline between 3-6 months
reinjury to either is likely prior to 3 months
all were at bseline BMD at 6 months, surpassed at 12 months
