Common Foot and Ankle Pathologieshongkongpa.com.hk/sg/MSG/Foot and ankle workshop Joyce.pdfFoot and...
Transcript of Common Foot and Ankle Pathologieshongkongpa.com.hk/sg/MSG/Foot and ankle workshop Joyce.pdfFoot and...
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Foot and Ankle (II): Common Pathologies
Dr. Joyce TseDoctor of Podiatric Medicine
Dec 19, 2009
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Equinus
Less than 10o ankle dorsiflexion is Equinus
Equinus can be asymptomatic, but can also cause many pathologic entities:
Plantar fasciitisPes planusHAVMetatarsalgiaAchilles tendinosisCharcot’s midfoot collapseDiabetic ulcerations
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Over Pronation
Flexible Flatfeet
Sinus Tarsi Syndrome
Tarsal Tunnel Syndrome
Posterior Tibial Tendon Dysfunction
Plantar Fasciitis
Metatarsalgia (Ball of foot pain)
Hallux Limitus
Hallux Abducto Valgus(HAV / Bunion)
Equinus
Achilles Tendonitis
Peroneal Muscle Spasm
LLD
Tibial Stress Syndrome (Shin Splints)
Tired Aching Leg
Patello-Femoral Syndrome
Ilio-tibial Band Syndrome (Outside knee pain)
Lumbo-sacral pain (Lower Back Pain)
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Over Pronation
STJ Pronation: Abduct, Evert, Dorsiflex
Overpronation at the STJ commonly exhibits:
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Flatfeet
Most are asymptomatic
Flexible Hubscher Maneuver Resupination
Foot appears externally rotated in relation to the leg
WB axis of the LE is medial to the mid-axis of the foot
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Flatfeet
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Hallux Abducto Valgus
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Interesting Facts
Effect of shoes (Sim-Fook 1958)
Hallux valgus: 17x more common in shoe wearers than unshod members
Hallux varus: 4x more common in unshod members than in the shod
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First MTPJ ROM
Extension / dorsiflexion 70o-90o (min. 65o)
Flexion / plantarflexion 45o
Angle measured from the long axis of the metatarsal not the ground.
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Functional Hallux Limitus
First Ray Hypermobility
Over Pronation
First Ray dorsiflexed due to GRF Decreased hallux DF Limited hallux ROM
Joint jamming Pain & Arthritis
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Functional Hallux Limitus
Orthotics:
Minimal Arch Fill
Orthotics:
Reverse Mortons Extension
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Plantar Fasciitis
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Achilles’ Tendonitis
When the foot accelarated into an excessively pronated positionCalcaneus evertsIncrease medial tendo
achilles tractionTransverse shearing
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Peroneal Tendonitis
Peroneals have the longest moment arm when exerting STJ pronations or resisting STJ supinations
Increased peroneal muscle contractile activity may lead to either tendonitis or muscle fatigue
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Sinus Tarsi Syndrome
Subacute or chronic pain on the lateral aspect of sinus tarsi
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Tarsal Tunnel Syndrome
Entrapment or compression neuropathy within the tarsal tunnel beneath the flexor retinaculum
Stretching of the Tibial Nerve
Analogous to Carpal Tunnel Syndrome in the wrist
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Tired Aching Legs
Abnormal traction on calf muscles occurs when the leg internally rotate
Muscles of lower limb attempt to stop this excessive pronation and become fatique
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Shin Splints (Tibial Stress Syndrome)
Excessive stretching (traction) of the soft tissue structures (deep flexors and extensors of the leg) along the shin bones (tibia and fibula)
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Patello-femoral Syndrome ( knee pain )Excessive pronation
Excess tibial internal rotation
Medial displacement of patello- femeral path
Lateral displacement of patella
Cartilage under patella soften and resulted in pain and inflammation
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Ilio-tibial band syndrome
Excess pronation
Excess internal tibial rotation
The ilio-tibial band to shear over the lateral femoral condyle
Friction, tightness, and secondary inflammation
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Limb Length Discrepancy (LLD)
Pathologic if > 5mm discrepancy
Longer leg pronatesShorter leg supinates
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Treatment
RICE
Pain reduction
Anti-inflammatory modalities
Biomechanic support
Cortisone injection
Surgical correction
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