18 Tendinitis (post. tib., achilles, peroneal) Usually insidious in onsetPain with WB – stretch or contractionImproves with light activityLatent inflammatory responseTTP, warmLabs and Radiography not helpful
19 Treatment Relative rest Ice – 15 Anti inflamatories – dosage and durationPT - Find the biomechanical causemodalities, stretching, strengthening (hip partner), transverse friction massage, biomechanical control (shoes, inserts, lifts or orthotics)
20 Ankle Sprains Account for 25% of all sports injuries Lateral (ATF+CF)(85%)Medial (Deltoid)>“High” (Syndesmosis)>Mid tarsalPossible causes:Cavus, poor proprioception, poor rehab, over weight and poorly conditionedNo significant male – female ratio
27 CausesUnlocked midtarsal joint at push off phase of gait causing stretch to fasciaVariety of foot typesTight heelcords for level of functionTight great toe flexors or fasciaWeakness in control of pronationTraining errors, shoes
28 Treatment No correlation to heel spurs Differentiate from tarsal tunnelTreat the cause:Stretch tight heel cords and FHLSupport unstable biomechanics – orthotics, taping or arch strappingNight splints, morning/first step routineAnalgesic modalities, injections? Surgery?
40 Stress Fractures Probable Causes Increasing the amount or intensity of an activity too quickly (most common)Hard or uneven running surfaceImproper or old shoesUntreated biomechanical imbalancesBiomechanical limitations of motion (subtalar and midtarsal joints)
41 Other Risk Factors for Stress Fractures Female, short, thin and caucasianCertain sports, especially involving plyometric loading:Distance runningGymnasticsDanceBasketball and TennisAmenorrhea>decrease hormone supportPoor diet- low in calcium and high in acidityOsteopenia (Reduced bone thickness or density)Poor muscle strength or flexibilityOverweight or underweight
42 Compartment SyndromeCompartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.Compartment syndrome can be either acute or chronic.Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion.Compartments are groupings of muscles, nerves, and blood vessels in your arms and legs. Covering these tissues is a tough membrane called a fascia. The role of the fascia is to keep the tissues in place, and, therefore, the fascia does not stretch or expand easily.
44 Symptoms and Diagnosis Chronic (Exert ional) Compartment SyndromeChronic compartment syndrome causes pain or cramping during exercise. This pain subsides when activity stops. It most often occurs in the leg.Symptoms may also include:NumbnessDifficulty moving the footVisible muscle bulging
45 Differential Chronic (Exertional) Compartment Syndrome To diagnose chronic compartment syndrome, other conditions that could also cause pain in the lower leg should be ruled out. Tendonitis can be ruled out but history and physical exam (palpation, passive and resistive tests) . To rules out stress fractures, an x-ray, bone scan or CT scan can be used depending on the duration and location of the injury.To confirm chronic compartment syndrome, pressure tests of the compartment before and after exercise must be performed .Treatment may involve a combination of rest, activity modification, change of shoes and orthotics and PT or in more involve cases surgery (fasciotomy).
47 Reflex Sympathetic Dystrophy Chronic Regional Pain Syndrome Hyper reactivity of the sympathetic nervous system causing sustained “fight and flight” response.The symptoms of RSD/CRPS often progress in three stages—acute, dystrophic, and atrophic.The acute stage occurs during the first 1–3 months (usually after injury to bone or nerve, surgery and/or immobilization of an extremity) and may include burning pain (not proportionate to the degree of injury), swelling, increased sensitivity to touch, increased hair and nail growth in the affected region, joint pain, and color and temperature changes.
48 Advanced SymptomsThe dystrophic stage may involve constant pain and swelling. The affected limb may feel cool to the touch and appear bluish in color. Muscle stiffness, wasting of the muscles (atrophy), and early bone loss (osteoporosis) also may occur. This stage usually develops 3–6 months after onset of the disorder.During the atrophic stage, the skin becomes cool and shiny, increased muscle stiffness and weakness occur, and symptoms may spread to another limb.Characteristic signs and symptoms of sympathetic nervous system involvement include the following:Burning painExtreme sensitivity to touchSkin color changes (red or bluish)Skin temperature changes (hot or cold)
50 TreatmentTreatmentThe goals of RSD/CRPS treatment are to control pain and promote as much mobilization of the affected limb as possible without increasing symptoms. Treatment must be individualized and will often combine medications, physical therapy, nerve blocks (ganglion blocks with alpha adrenergic antagonist), and psychosocial support. Sympathectomy can be helpful in recalcitrant cases.Early detection and intervention is paramount.
51 MetatarsalgiaInflammation of the heads of one or more metatarsal heads (periostitis)Caused by uneven loading of forefoot during propulsionCaused by forefoot imbalance or deformity
53 Treatment Rest, ice and NSAIAs Shoe, cushioned insoles Callous reduction (egg)Biomechanical exam to determine extent of forefoot imbalance and prescription of custom orthotic with FF balancing and relief cut outs
55 Inter Metatarsal (Morton’s) Neuroma Enlarged, fibrotic and benign interdigital nervesMost commonly between the third and forth metatarsalsBrought on by shearing between metatarsalsAggravated by narrow shoes and forefoot imbalanceTreatments include special shoes or inserts, NSAIAs and/or cortisone injections, but surgical removal of the growth is sometimes necessary.
58 Osteo arthritiscondition characterized by the breakdown and eventual loss of cartilage in one or more joints (ankle>MTJ>1st MTP>ST)degenerative arthritis, reflecting its nature to develop as part of the aging processPain and stiffness in the joint, swelling in or near the joint, difficulty walking or bending the joint
60 Treatment Proper footwear Medications to relieve pain and swelling (NSAIA, analgesic, glucosamine)Education on activity modificationWeight lossPT -heat/cold therapy, E Stim., US, exercises to improve range of motion and strength, insoles or custom orthoticsInjections and in some cases surgery.Read more: