Heel pain

quickster2008's version from 2015-07-28 08:24

Section 1

Question Answer
the bottom of my right foot hurts, this pt hasheel pain
PE: rule in heel pain+ windlass mechanism, pain along the medial plantar fascial band, (+) POP plantar medial tubercle
PE: rule out heel pain(-) tine's sign/valleix's sign over PT nerve (tarsal tunnel)
plantar fasciitis is caused by repetitive utensil overload of the plantar fascia as it inserts in the medial calcaneal tubercle
tier 1, plantar fascitisSCIPS N stretching, corticosteroid injection, ice, padding/stripping, shoe gear, NSAIDS
tier 2 PFin 6w SON IBP 2 second corticosteroid injection, orthotics(prescription), night splints, immobilize/CAM, botox injections, PT
tier 3surgery(instep or endoscopy), ESWT(extracorporeal shock wave therapy)
you should try tier 1&2 for ? months before you try tier 36 months
procedure utilizes two small incisions with a slotted canal passed just inferiorly to the fascia. through one end of the canula a camera(scope) is passed and thr the other end a small knife is passedendoscopic plantar fasciotomy
complications of in-step plantar fasciotomyhematoma, complex regional pain syndrome, arch falls

Section 2

Question Answer
posterior superior prominence of calcaneus(burial projection)haglund's deformity
degenerative process involving achilles tendon insertionachilles insertional calcific tendinosis(AICT)
Clinical of AICT and haglundshaglunds-pain only with shoe gear AICT-pain with or without shoes
what are + and - indications of bone tumor+ sunburst
how to determine if ben or malign bone tumorgeographic
F-P angle
parallel pitch angle
kagler's triangle what are the borders? what does it mean if you can see the borders?
post op tx for haglunds and AICTHaglunds-immediate WB in CAM boot, AICT resection-2w in post splint, 6-8w in walking boot

Section 3

Question Answer
Fracture txexternal fixation


Pain in back of leg List 3 things: achilles tendon rupture(tear), achilles tendonitis(around tendon), achilles tendonosis(in tendon)
Question Answer
What would u see on a PE for achilles rupture+ palpable dell, + thompson test, + calf atrophy compared to contralateral leg
Manual m testingmaybe
Achilles rupture is considered chronic when >4 weeks
tx options for achillesarizona brace, ankle foot orthosis(AFO)
tx for tendon gap 2cm or lessend to end repair +/- allograft augmentation
tx for tendon gap 2-3cmend to end repair +/- allograft augmentation +/- gastroc recession
tx for tendon gap 3-5cmend to end gastroc recession or V-Y advancement
tx for tendon gap >5cmFHL tendon transfer or allograft/autograft +/- gastroc recession or V-Y advancement
Why use the FHL tendonstronger plantar flexion than braves, axis of contracture more in line w/achilles than FDL & preoneus braves
post op of chronic achilles tendon ruptureNWB 4-6 weeks (1st week PF splint, 2nd week 2-4 splint, week 4 PROM in PT, week 6 AROM & tabulation in PT


Question Answer
pain on the outside of leg after rolling ankleankle sprain
PE findings for ankle sprain+


Question Answer
clubfoot can be corrected by ? months of casting2
deformities of talipes equinovarus: FF adduction, RF varus, ankle equines, PF 1st ray


Question Answer
Pain sensation in an insensate limbcharcot
protein level that rises in response to inflammationC-reactive protein
non specific measurement of inflammationerythrocyte sedimentation rate