- Very common (1/10), F(2:1), peak (30-50)
- MOI: Overuse, direct trauma
- Point tenderness ANT/MED calc
- Pain first step in morning (or period NWB)
- Limited and painful DORSIFLEXION
- +/- walk on tiptoes
Plantar Fasciitis
Test:
Calc Squeeze test, Windlass Test
Management: PRICE, STRETCH
- 10-30 (any age)
- Sport injury
- Mild pain with extreme end ROM, no bruising
- Reoccurrence rate is 50%
- TENDERNESS + SWELLING OVER OUTER ANKLE
- No bruising, (-) stress test, no instability
Inversion Ankle Sprain (grade 1)
Test
Anterior Drawer, Talor Tilt (INVERSION)
Management
Ottawa rules >
week 1: PFROM
week 2: ROM rocker board (flex/ext)
week 3: ROM wobble board (ever/inv)
week 4: sports specific (as tollerated)
- 10 - 30, Rare
- Associated w/ fracture (MM or other ankle bones)
- Reoccurrence rate is 50%
- TENDERNESS + SWELLING OVER INNER ANKLE
- Retinaculum involvement (decreased proprioception)
Eversion Ankle Sprain
* associated with fracture + dec proprioception
Test:
Anterior Drawer, Talor Tilt (EVERSION)
Management
same as previous
- Dull, achy medial foot pain
- MOI: Eversion, Abduction, dorsiflexion
- Runners
- Worn out medial part of shoes
- Hellbing’s sign (achilles tendon)
- Management?
Overpronation syndrome
Management:
medial arch supports > motion control shoes >
- Normal and asymptomatic < 10 y.o.
- May be associated with pain inner heel
- Associated with Ehlers Danslow, Marfans, Charcot joint
- Typically due to failure of one of:
Tib posterior, Spring ligament, Deltoid ligament, Plantar aponeurosis, FHL + FHB
Pes Planus
- Middle aged, M (5:1)
- Posterior heel pain (2-6 cm above calcaneus) and
along the LATERAL MARGINS (not posterior - think bursitis) - Pain with (P) dorsiflexion, (R) plantar flexion
- +/- swelling or bruising
Test:
Tender palpation, Achilles Squeeze, Thompson Test
Management:
PFROM (asap) > Calf stretch + strengthen
DDX posterior ankle TENDERNESS:
(1) Achilles insertion (anterior)?
(2) Medial malleolus (post + inf)
(3) Point tenderness DIRECTLY over Tibia
(4) Other considerations/likely ddx:
(1) Retro-calcaneal bursitis
(2) Tibialis Posterior tendonitis
(3) Stress fracture
(4):
Tennis ankle (med gastrocnemius tear)
Sever’s disease
Syndesmotic ankle sprain
Reiters inflammatory arthropathy
- F, 18-50
- Pain anterior or posterior/medial leg (bottom 2/3rds)
- Pain at start of run > subsides > returns post run
- (-) direct palpation, (+) rest
- PAIN TENDS TO SUBSIDE WITHIN 2-3 DAYS
- +/- Swelling (RARE)
- Aggravation dorsiflexion/ plantarflexion
Shin Splints
DDX:
- Chronic exertional compartment syndrome
(extreme feeling of firmness in anterior compartment)
- Tibial stress fracture (PAIN LASTS 2-3 WEEKS)
Compartment Syndrome
(1) 6 P’s?
(2) big clue to differentiate acute vs chronic/exertional
(3) DDX - pain post/med tibia + selling
(4)
(1) Pain, Paresis, Paralysis, Pallor, Paresthesia, Pulseless
(2) acute - not relieved with rest while chronic is
(3) Tibial stress fracture
- MOI: Trauma (acute) or Exercise induced (chronic)
- “A runner who is experiencing gradual onset of burning leg pain and numbness on dorsum of foot ~ 15 min into run which resolves after 30 min of rest”
- FEELING OF FULLNESS IN LEG
Compartment Syndrome
- Pain in the big toe + swelling + tender
- TIGHT ACHILLES
- Progressive Pes Planus
- Decreased big toe Abd (AROM) + tight FHB
- Management/imaging?
Hallux Valgus
Test: Radiograph: HV angle >15
Management:
Educate/prevent > footwear/orthosis > stretch achilles > strengthen Halux Abd, Add, Flex
- Gradual onset of diffuse forefoot pain
- (-) activity (+) rest
- Flat foot, callus formation ball of foot
- Toe (A) extension is decreased + (R) flexion is weak
- POINT TENDERNESS OVER DISTAL MT/FAT PAD
- Management?
Metatarsalgia
Test: Morton’s Squeeze Test (rule out)
DDX:
- Pain interdigital - Mortans neuroma
- Pain midshaft with direct palpation - Stress fracture
Management
Education > PRICE > MT pad > orthotic (planus/cavus) > Surgery > Rehab (swim)
- Gradual onset of pain on plantar surface of forefoot
(2nd or 3rd MT interspace) - “WALKING ON MARBLES”
- Gradual progression of sharp pain > numbness
- (-) walking, (+) rest
- TOE EXTENSION MAY AGGRAVATE SYMPTOMS
Morton’s Neuroma
Test: Morton’s Squeeze Test
- Foot pain (-) walking, running, squatting
- Loss of ROM at 1st MTP (sagital plane)
- Red/swell, plantar callus, enlarged joint
- +/- burning/paresthesia
- Assoc. w/: ANTALGIC GAIT (hip hike + circumduction)
- Management/Imaging?
Hallux Rigidus
Hallux valgus –> hallux limitus > Hallux Rigidus
Test: ROM + Xray
Management:
PRICE > proper shoe/ortho > Mop > stretch + strengthen
Compartment Syndrome Presentation
- Anterior
- Lateral
- Deep Posterior
(A): Deep peroneal:
sensation first 2 toes + weak DORSI FLEXION
(L): Superficial peroneal:
ant/lat shin, dorsum + weak EVERSION
(DP): Tibial
sensation foot arch + weak PLANTAR FLEXION, TOE MOVEMENT
* pulse dorsal pedal and tibial should NOT be effected, if so MEDICAL EMERGENCY
- W
- paresthesia into medial, lateral or both forefoot
- +/- weakness in foot abductors + flexors, atrophy
- TENDERNESS BEHIND MEDIAL MALLEOLUS
- aggravated w/ (P) eversion, dorsiflexion
Tarsal Tunnel Syndrome
Test: Tinnel, EMG
Management:
PRICE > Taping > stretch (calf) > floss > Manual > Surgery
- Deep, bruise-like pain in the middle heel
- (-) walking, standing, direct firm palpation of MID HEEL
- Unilateral
- DDX?
- Management/imaging?
Heel Fat Pad Syndrome
DDX: PF - ANT/MED HEEL, HFPS - CENTRAL HEEL
X-ray: normal HPT = 1-2 cm (< 1cm = atrophied)
Management: Act mod. > Mobs > Ortho > stretch/streng
- F, RF: OP, Amenorrhea, underweight, over pronation
- Gradual onset of dull, diffuse pain with exercise and
eventually progresses to more constant pain - antalgic limp, +/- swelling,
- Morton’s squeeze,
- Management/Imaging:
MT Stress Fx
Test: Mortons Squeeze Test:
- Pain local to MT shaft (Fx) pain between MT heads (MN)
US (x-ray may not show up immediately)
Lab panes: thyroid (OP) +ESR (RA)
Management:
PRICE > rest (3-6 wks) > low impact (water run) (4-8 wks)
