Podcast
Questions and Answers
What is the primary pathology associated with shin splints?
What is the primary pathology associated with shin splints?
Which type of shin splints involves the anterior compartment muscles?
Which type of shin splints involves the anterior compartment muscles?
What is a common mechanism that leads to postero-medial shin splints?
What is a common mechanism that leads to postero-medial shin splints?
What type of pain is usually associated with antero-lateral shin splints?
What type of pain is usually associated with antero-lateral shin splints?
Signup and view all the answers
What is a recommended treatment guideline for shin splints?
What is a recommended treatment guideline for shin splints?
Signup and view all the answers
Which condition may cause excessive tension on the plantar fascia during gait?
Which condition may cause excessive tension on the plantar fascia during gait?
Signup and view all the answers
What is a possible consequence of pes cavus foot related to plantar fasciitis?
What is a possible consequence of pes cavus foot related to plantar fasciitis?
Signup and view all the answers
In ROM testing for antero-lateral shin splints, what movement would typically reproduce pain?
In ROM testing for antero-lateral shin splints, what movement would typically reproduce pain?
Signup and view all the answers
What is the primary indication for performing a Brostrom Repair?
What is the primary indication for performing a Brostrom Repair?
Signup and view all the answers
What is the recommended initial immobilization period after a Brostrom Repair?
What is the recommended initial immobilization period after a Brostrom Repair?
Signup and view all the answers
Which of the following is NOT a sign or symptom of an eversion sprain?
Which of the following is NOT a sign or symptom of an eversion sprain?
Signup and view all the answers
What is a common symptom of plantar fasciitis?
What is a common symptom of plantar fasciitis?
Signup and view all the answers
In the context of a Brostrom Repair with Modified Evans Tenodesis, what is the purpose of the tenodesis?
In the context of a Brostrom Repair with Modified Evans Tenodesis, what is the purpose of the tenodesis?
Signup and view all the answers
Which of the following is NOT commonly used for treating plantar fasciitis?
Which of the following is NOT commonly used for treating plantar fasciitis?
Signup and view all the answers
What is a common mechanism of injury for syndesmotic ('high ankle') sprains?
What is a common mechanism of injury for syndesmotic ('high ankle') sprains?
Signup and view all the answers
Which ligament is primarily involved in an eversion sprain?
Which ligament is primarily involved in an eversion sprain?
Signup and view all the answers
Which condition is most commonly associated with an inversion sprain?
Which condition is most commonly associated with an inversion sprain?
Signup and view all the answers
What is the typical time frame to initiate range of motion and strengthening exercises after a Brostrom Repair?
What is the typical time frame to initiate range of motion and strengthening exercises after a Brostrom Repair?
Signup and view all the answers
Which exercise is emphasized during the rehabilitation of an inversion sprain?
Which exercise is emphasized during the rehabilitation of an inversion sprain?
Signup and view all the answers
What might be a temporary relief method for plantar fasciitis despite not addressing biomechanical issues?
What might be a temporary relief method for plantar fasciitis despite not addressing biomechanical issues?
Signup and view all the answers
Which of the following is a common outcome after a high ankle sprain?
Which of the following is a common outcome after a high ankle sprain?
Signup and view all the answers
Which test is commonly positive in the assessment of an inversion ankle sprain?
Which test is commonly positive in the assessment of an inversion ankle sprain?
Signup and view all the answers
What is a symptom that may occur following increased activity in patients with plantar fasciitis?
What is a symptom that may occur following increased activity in patients with plantar fasciitis?
Signup and view all the answers
Which treatment is a part of the initial management of an inversion sprain?
Which treatment is a part of the initial management of an inversion sprain?
Signup and view all the answers
Study Notes
Foot & Ankle Pathologies
- This presentation discusses various foot and ankle pathologies.
Shin Splints
- The pathology is believed to be periostitis.
- Tendon fibers pull away from bony insertion, causing inflammation and pain.
- Microscopic vasculitis and thickening of periosteum and cortical bone may occur.
- Shin splints can be categorized into antero-lateral and postero-medial types.
Shin Splints: Antero-lateral
- Involves anterior compartment muscles.
- Mechanisms: excessive eccentric forces to control plantar flexion (PF) at heel strike, especially on hard surfaces.
- Limited dorsiflexion (DF) causes effort by dorsiflexors for toe clearance during gait.
- Pain in the anterior lateral leg, worsening with activity and improving with rest.
- Gradual onset, related to overuse syndromes.
- Range of motion (ROM) testing: pain reproduced with DF combined with inversion (Inv) or eversion (EV), or PF combined with Inv or EV.
Shin Splints: Postero-medial
- Usually involves deep posterior compartment muscles, potentially including the soleus.
- Mechanisms: excessive eccentric activity to control excessive pronation.
- Pain in the posterior and medial leg, worsening with activity and improving with rest.
- Over-pronation, varus rearfoot and/or forefoot deformity (confirmed by navicular drop test).
- ROM testing: PF combined with Inv and DF combined with EV.
Shin Splints: General Treatment Guidelines
- Relative rest and anti-inflammatory measures.
- Stretching (if restricted).
- Eccentric strengthening of appropriate compartment muscles.
- Foot orthotics (if needed) to control pronation.
- Consider shock-absorbing shoes and playing surfaces.
Plantar Fasciitis (Heel Spur)
- Mechanisms:
- Excessive foot pronation: overstretches the plantar fascia, causing irritation.
- Pes cavus foot: reduced shock absorption during gait, leading to excessive force on the plantar fascia, causing irritation and inflammation.
- Limited ankle dorsiflexion (DF): increased tension on the plantar fascia from MTP joints.
- Limited DF of MTP joints: places excessive tension through the plantar fascia during gait.
Plantar Fasciitis (Heel Spur): Signs and Symptoms
- Pain on palpation of the calcaneal insertion of the plantar fascia.
- Severe pain on weight bearing after periods of rest or sleep, resolving temporarily with walking.
- Pain reappears after increased activity.
- Symptoms may be reproduced with passive extension of MTPs or resisted flexion of the toes.
- Patients may experience limited passive range of ankle DF and MTP DF.
- Pes cavus deformity or rearfoot/forefoot varus deformity may be present in individuals with excessive pronation.
Plantar Fasciitis (Heel Spur): Treatment
- Inflammation treatment: NSAIDs, ice, and rest from activities that reproduce symptoms.
- Stretching of ankle plantar fascia, toe flexors, and plantar fascia.
- Strengthening exercises for toe flexors and intrinsics.
- Deep friction massage of the plantar fascia.
- Orthotics to correct biomechanical dysfunctions.
- Heel cups or donut pads may provide temporary relief by reducing pressure.
- Resting dorsiflexion night splint.
Inversion Sprains
- Most common type of sprain.
- Mechanism: Involves plantar flexion (PF) and inversion (Inv).
- Typically involves anterior talo-fibular and calcaneo-fibular ligaments.
- Severe injury may also involve the posterior talo-fibular ligament.
Associated Pathologies
- Peroneal tendon injury.
- Fracture of the distal fibula or lateral malleolus.
- Fracture of the medial malleolus.
- Sinus Tarsi syndrome.
Signs and Symptoms for Inversion Sprain
- Tenderness to palpation of the lateral collateral ligaments.
- Swelling and possible discoloration (echymosis) in the lateral ankle and foot.
- Painful limitation of plantar flexion (PF) and inversion (Inv).
- Possible painful and weak resisted eversion.
- Positive anterior drawer and medial talar tilt tests.
- Antalgic gait, limping due to reduced weight bearing and limited ROM.
Non-operative Treatment of Inversion Sprains
- Initial period of immobilization (bracing).
- Treat initial inflammation and injury using RICE (Rest, Ice, Compression, Elevation).
- Early passive and active ROM within pain-free range of motion.
- Progress to ankle strengthening exercises (isometrics, theraband, PRE, weight bearing exercises), emphasizing ankle everters.
- Proprioceptive and coordination exercises (Perturbation, Agility training).
- Functional retraining activities.
- Protective bracing or taping upon return to activities.
Operative Treatment: Brostrom Repairs, With and Without Modification
- Indicated for chronic lateral ankle sprains and instability.
Brostrom Repair Post-op Rehab
- Splint for 10 to 14 days.
- Cam Walker for 4 weeks.
- Air Stirrup for 4 weeks.
- Initiate ROM and strengthening at 6 weeks.
- Return to full activity at 3 to 4 months.
Brostrom Repair with Modified Evans Tenodesis
- Same indications as Brostrom, plus need to stabilize the talus.
- Tenodesis of peroneus brevis tendon reduces excessive inversion of the subtalar joint.
- Rehabilitation similar to regular Brostrom.
- May take longer to restore peroneal strength and inversion ROM.
Eversion Sprain
- Mechanism: Forced excessive pronation or abduction of the planted foot.
- Typically involves the deltoid ligament, potentially the distal tib-fib interosseous membrane.
- Severe injury might involve an avulsion fracture of the calcaneal insertion of the deltoid ligament.
- Less common than inversion sprains due to the fibula's distal extension, which provides extra medial stability to the ankle.
Signs and Symptoms for Eversion Sprain
- Tenderness to palpation over the deltoid ligament, possibly the tibio-fibular ligament and interosseous membrane.
- Swelling and possible discoloration (echymosis) in the medial ankle and foot.
- Painful limitation of dorsiflexion (DF) and eversion (EV).
- Possible painful and weak resisted inversion.
- Positive anterior drawer and Kleiger tests.
- Antalgic gait, limping due to reduced weight bearing and limited ROM.
Non-operative Treatment of Eversion Sprain
- Similar principles to inversion sprains.
- May require an extended immobilization period if an avulsion fracture is present.
- Strengthening exercises should focus on ankle inverters.
Syndesmotic ("High Ankle") Sprains
- Involves the anterior distal tibiofibular ligament and the distal interosseous membrane.
High Ankle Sprain Mechanisms
- Mechanism: Forced external rotation of the foot combined with internal rotation of the leg (e.g., a lateral blow to the knee when the foot is fixed on the ground).
Signs and Symptoms
- Tenderness to palpation of the distal tib-fib region; possible minimal swelling.
- Patients avoid full dorsiflexion (DF) during gait to minimize stress on the distal tib-fib joint.
- May walk with a steppage gait.
- Passive full DF may reproduce symptoms.
- External rotation test is positive.
- Distal tib-fib compression test will reproduce pain.
High Ankle Sprain: Non-operative Treatment
- Key difference from other ankle rehab: prolonged protected weight bearing (WBAT) and return to sports.
- Patients may have no pain but aren't ready to return.
- WBAT period is approximately 4 weeks, then gradually advance to functional retraining activities until 8 weeks.
- External ankle support or brace is used for functional retraining and return to sports.
High Ankle Sprain: Operative Treatment
- Internal fixation of the distal tib-fib joint.
- Splint for 10–14 days.
- Protected weight-bearing (PWB) with Cam walker for 4–6 weeks.
- Screw removal after 3 months.
Morton's Neuroma
- Entrapment of the third common digital branch of the medial plantar nerve between the third and fourth metatarsal heads.
- Mechanisms: nerve compression and shear due to hypermobile metatarsals.
- Tight shoes can worsen the condition.
Morton's Neuroma: Signs and Symptoms
- Metatarsalgia of the third and fourth metatarsals is the most common complaint.
- Pain during weight-bearing activities.
- Paresthesias or impaired sensation in the affected area.
Morton's Neuroma: Treatment
- Wider shoes.
- Metatarsal pads to elevate the transverse arch and separate the metatarsals.
- Steroid injection.
- Surgical excision.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz explores various pathologies related to the foot and ankle, with a specific focus on shin splints. It covers the mechanisms, symptoms, and classifications of anterior-lateral and posterior-medial shin splints. Test your knowledge on the intricate details of these common musculoskeletal conditions.
