Chapter 18 Special tests and Tarsal injuries

Etiology
· Laterally from severe inversion/doriflexion
· Medially from inversion/plantar flexion w/ external, tibial rotation

Signs and Symptoms
· history of ankle trauma
· pain w/ weight bearing
· ** intermittent swelling
· ** catching/snapping
· tender while palpate

Management
· xray for diagnosis
· progressive weight bearing
· ROM and strengthening
· if surgery - return 6-8 mo

Etiology
· jumping/ falling from a height
· usually cause avulsion fracture (anteriorlly and posteriorlly)

Signs/Symptoms
· immediate swelling/pain
· cant weight bear

Management
· RICE immediately
· x ray for diagnosis
· non-displaced fracture- immobilization & early ROM

Etiology
· Repetitive trauma during heal strikes- in distance runners
· In plantar-calcaneal area

Signs/Symptoms
· Pain w/ weight bearing
during heal strike
· Pain continuous after exercise

Management
· 2-3 w rest/AROM
· Non weight bearing cardio
· Gradual return to activity

· Tap over posterior tibial nerve
· Numbing in distal area indicates tarsal tunnel syndrome

· Transverse pressure applied to head of metatarsals
· burning/ sharp pain indicate neuroma or metatarsalgia

· Tendon reflexes should elicit a response when gently tapped
· Sensation can be tested by running hands over surfaces of foot and ankle

Etiology
· Traction injury of apophysis of calcaneus, where Achilles attaches
· Over use injury in kids

Signs/Symptoms
· Pain posteriorally at Achilles insertion

Management
· Rest, ice, stretching, NSAIDs
· Heel lift

Etiology
· inflammation of bursa between Achilles and calcaneus
· caused by rubbing of shoe's heel counter
· may lead to exostosis (Haglund's deformity)

Signs/Symptoms
· pain when palpate bursa just above and anterior insertion if Achilles
· Swelling on both sides of heel cord

Management
· RICE and NSAIDs
· ultrasound reduce inflammation
· Stretching of Achilles
· Heal lifts/ donut pads
· shoes with wider heel contour

Etiology
· caused by sudden starts, stops, change in direction, irritation of fat pad
· pain on lateral aspect  bc of heel strike pattern

Signs/Symptoms
· Severe pain in heel- Can't weight bear
· Warm and red

Management
· reduce weight bearing 24 hrs
· RICE, NSAIDs
· Use heel cup or doughnut pad

Etiology
·  any condition that compromises the tibialis posterio, felxor hallucis longus, flexor digitorum, tibial nerve, artery or vein
· may result form previous fracture, tenosynovitis, acute trauma or excessive pronation

Signs/Symptoms
· pain and paresthesis along medial and plantar aspect of foot
· motor weakness- atrophy may occur
· increased pain at night

Management
· NSAIDs, anti-inflam modalities
· orthodics
· possible surgery

Etiology
· Pronation and trauma injury
· Bc of stress on long peroneal muscle w/ foot in pronation
· ususally confused with plantar fascitis

Signs/Symptoms
· Displacement of cuboid- pain over 4th, 5th metatarsal and cuboid bone
· may refer pain to heal when long weight bearing

Management
· move cuboid back to position
· othodic to maintain position

area behind medial malleous forming tunnel with osseous floor and composed of flexor retinaculum

Etiology
· occurs when the foot is already plantar flexed and rearfoot locked then forceful hyper plantar flexion resulting in dorsal displacement of metatarsal bases

Signs/Symptoms
· pain and cant weight bear
· swelling/ tenderness on dorsum
· possible metatarsal fractures/sprains of 4th and 5th tarsometatarsal joints --> cause disruption of ligaments

Management
· recognition, realignment, maintaining stability
· usually requires open reduction with fixation- leads to metarsaligia, decreased metarsophangeal joint ROM, long-term disability