Ankle-Foot FME2 Teoría 24-25 PDF

Ankle-Foot FME2 Teoría Ankle: clinical processes Osteoarthritis Chronic ankle instability Achilles tendinopathy Fasciopathies Morton´s Neuroma Tarsal tunnel syndrome C/O- Clinical records Ankle Osteoarthritis Ankle Osteoarthritis Joint degenerative conditio...

Ankle-Foot FME2 Teoría Ankle: clinical processes Osteoarthritis Chronic ankle instability Achilles tendinopathy Fasciopathies Morton´s Neuroma Tarsal tunnel syndrome C/O- Clinical records Ankle Osteoarthritis Ankle Osteoarthritis Joint degenerative condition => progressive loss of articular cartilage => marginal bone hypertrophy (osteophytes) => changes in the synovial membrane Genetic and proteomic pattern of inflammatory characteristics.​ IRREVERSIBLE​ Prevalence lower than knee or hip, but higher if post-traumatic (65-80%) Ankle OA: Factors involved Age​ Overweight Anatomical malformations Mortise fracture Recurrent sprains High performance physical activity Ankle OA: Body chart Pain, swelling and stiffness, localised onset at the rearfoot and evolution towards the forefoot  Stiffness Crepitation Inflammation Ankle OA: 24 Pain hour behavior Decrease of physical activity Daily activities limitations Relieves NSAIDs and rest  Post-traumatic: o Tibial fractures Ankle OA: o Malleolus fractures o Talus fractures Current and past history Anatomical:​ ▪ Joint alignment ▪ Joint damage ▪ Chronic instability Ankle OA : Special questions Osteonecrosis o Freiberg disease Müller-Weiss disease Orthopedic soles Cronic ankle instability  Cronic ankle instability Differentiate: Mechanical instability=> Laxity caused by ligament injury => Evidence by examination. Functional instability=> proprioception and neuromuscular deficits caused by ankle sprain => Sx Congruency: Astragalar dome and TPA mortise. Very stable joint (max D flex+eversion). Main cause: Sprain PAAL is the weakest=> 60% sprains with rupture Sprain Lateral sprains: Forced plantar flex + inversion + slight RI 85% affects ELL=> APAL 44% sequelae. 15-25% of all musculoskeletal system injuries: 1 sprain/day per 10000 inhabitants. 20-30% sports injuries. 80% resolve without sequelae.  Alignment Laxity Cronic ankle Intrinsic factors Muscle strength Neuromuscular control instability: Proprioception Factors Extrinsic factors Footwear Field involved Physical Activity …. Mechanical and functional insufficiency Cronic ankle in stability: Body chart Cronic ankle instability: 24 hours behavior Persistent and dull pain at lateral surface. Instability in inversion Insecurity Mechanical disturbances: blockages, clicking sounds Acute episodes Hypersensitivity with swelling Cronic ankle instability: Current and past history 20% acute sprains=> Instability Recurrent sprains=> shoe dependence Deformities: Varus-valgus, astragalar dome and TPA mortise. Tibiotalar, subtalar and midfoot mobility. Cronic ankle instability: Special questions Ankle osteoarthrosis Sports practice Injury mechanism Sx duration Biomechanical evaluation Pathologies that affect laxity Achilles tendinopathy Achilles tendinopathy Achilles tendon overload injury. Poor vascularization=> Increased predisposition. Tendinopathy= Inflammation and degeneration. Mechanical factors Metabolic factors Differentiate: o Non-insertional tendinopathy o Insertional tendinopathy=>"Enthesopathy or enthesitis". Achilles tendinopathy: Incidence 24% in athletes=> Marathon runners 7.4%. Running-related: between 11% and 85% => between 2.5 and 59 injuries per 1000 hours of running. Tendinopathy=> Tendinosis=> Rupture 2.1 per 100,000 individuals/year, with a ratio of 3.5 to 1 male / female. Achilles tendinopathy: Factors involved Age Men Flat foot, varus or valgus. Overpronation. Obesity Muscle stiffness or weakness Impact sports Footwear in poor condition, type of footwear Training terrain Diseases Medication: Fluoroquinolones "Weekend-sports people". Achilles tendinopathy: Body chart Localized pain in tendon insertion in calcaneus Pain in tendon pathway Achilles tendinopathy: 24 hours behavior Heel pain and walking pain. Footwear. Tiptoes. Localized deformity. Improved with ice, NSAIDs and rest. Achilles tendinopathy: Special questions Knee valgus Orthopedic insoles Sport activity Fasciopathologies Fasciopathologies "Plantar fasciosis/calcaneal entesopathy/Calcaneal spur syndrome": Retraction of plantar aponeurosis=> thickening >5mm Fasciopathologies: Thikening. Differenciate: o Fasciitis: Acute, inflammation o Fasciosis=> Chronic, degenerative  Fasciopathologies Most frequent heel pain: >13% reasons for podiatric consultation Calcaneal Spur=> 89% Most frequent in military personnel and sports ( Runners)= One in three cases is bilateral Fasciopathologie + calcaneal spur Calcaneal spur = osteophite o Older people o Women: 16.3, men 6.5% o Plantar fat ratio o Asymptomatic  Fasciopathology: Factors involved Women, 40-60 yo. Mechanical causes Overweight Overload Intoxication Employment Spur Achilles tendom (83% => shortening posterior chain) Fasciopathology: body chart Localised calcaneal pain Referred plantar arch and Achilles tendon pain Fasciopathology: 24 hours behaviour Pain, flushing, heat and tumour. Pain in mid-heel area, radiating to Achilles tendon=> passive dorsal flexion. Worse in the morning or after inactivity. Improves with NSAIDs, stretching and ice (80%). Worsens according to footwear and with long walks.  Acute onset: Improves with rest, ice and NSAIDs. Fascipathology: Clinical records: Current and past history o Lower limb Cx o Immobilisation/Orhtesis (Walker..) o Calcaneus (Stress) Fx o Posterior chain muscular problems  Fasciopathology: Special questions Subcalcaneal bursitis Arthritis False fasciitis Fascia tear Plantar fat atrophy Soleus or Anterior Tibial TP Radiculopathy L5-S1 Insertional Achilles tendinopathy Morton´s neuroma Morton´s neuroma Plantar interdigital nerve neuralgia at the third metatarsal space. Histological changes=> Thickening of endoneurium and epineurium. Hyalinisation of endoneural vessels Demyelination and degeneration of nerve fibres. o Inflammatory aetiology: Bursas=> Compression o Anatomical aetiology: Nerve confluences o Mechanical aetiology: Mobility of the radii Morton´s neuroma Morton´s neuroma Unilateral, less than 20% bilat Dx with ultrasound more accurate than with MRI (88% and 68%) Most common neuroma of the foot=> 75%. Sometimes occurs between 2nd and 3rd space (17%)=> 2nd space Syndrome Morton´s neuroma: Factors involved Women (60-75%)=> 4:1 men Age 25-50 Footwear Deformities Sports Trauma or adjacent pathologies Morton´s neuroma: Body chart Electrical and hot shock with irradiation to the interdigital space. Located at the third intermetatarsal space Morton´s neuroma: 24 hours behaviour Electrical pain during toe off phase (toes in dorsal flex) 91% ptes=> Plantar location at the third intermetatarsal space Pain worsens with deambulation and relieves with rest and off-loading Pain improves with soft, wide toe box and low heeled shoes Pain improves with NSAIDs and ice Morton´s neuroma: Current and past history Use of narrow and stiff toe shoes Use of low heels=> Decompression of MTT heads=> hyperext MTT=> pain Use of insoles with subcapital off-loading  Morton´s neuroma: Special questions Rule out: - Synovitis of the metatarsal heads=> Pain at MTT heads. - Metatarsalgia, whether or not associated with psoriatic arthritis. - Inflammation of other structures - Second space syndrome (20% neuromas). Foot surgery Tarsal tunnel syndrome Tarsal tunnel syndrome Peripheral neuropathy Tunnel=> Flexor retinaculum=> Posterior tibial nerve External compression=> 17-43%. Internal compression Tarsal tunnel syndrome: Factors involved Under-described incidence: Women, 40-45 yo. Obesity Foot characteristics Space occupation Previous injuries Impact sports Tarsal tunnel syndrome: Body chart Pain-burning, accompanied by paraesthesia, hypoesthesia, dysesthesia or cramps May extend to the tibia  Inability to flex the toes, plantar flexion or inversion Weakness of toe extension Tarsal tunnel Worsens with activity and tight shoes syndrome: 24 hours Improves with rest and ice behaviour Improves with NSAIDs Night pain may intensify Tarsal tunnel syndrome: Current and past history Acute onset=> Marathons => NSAIDS, rest => Improvement Iatrogenic injuries Systemic diseases Tarsal tunnel syndrome: Special questions Study of the footprint Not to be confused with: - "Anterior tarsal tunnel syndrome"=> Peroneus profundus in extensor retinaculum - Plantar fasciitis Any questions?