DOCSLIB.ORG

Inferior Heel Pain Is Not Necessarily Plantar Fasciitis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Inferior Heel Pain Is Not Necessarily Plantar Fasciitis Agenda . -Plantar fasciitis / heel pain -Achilles tendinopathy Plantar fasciitis -Flatfoot -2nd MP synovitis -Morton’s neuroma [email protected] Plantar fasciitis Old Definition: acquired inflammatory condition characterized by inflammation Inferior heel pain at the origin of the plantar fascia is not necessarily plantar fasciitis New Definition: “fasciosis” with degeneration, inelasticity, and Differential . microscopic tears Plantar fasciitis Plantar fasciitis Clinical presentation: Differential: - inferior heel pain with insidious onset - entrapment neuropathy - fat atrophy - first-step / morning pain - worsens as day progresses - tarsal tunnel - neoplasm - alleviated with rest - calcaneal stress fracture - plantar fibroma - plantar fascia rupture - Achilles Physical exam . Physical exam . Take home . Take home . Plantar Nerve Lateral wall tenderness . calcaneal stress fx Fascia entrapment Imaging . Plantar fasciitis - X-rays if sx’s > 6 weeks Non-operative Rx: - MRI if stress fx - Shoewear modification - Achilles / plantar fascia stretching - Night splint - NSAIDs Plantar fascia specific stretching . Custom orthotics Take home . - No better Take home . Plantar fasciitis Other options: Take home . - Walking cast/boot - Steroid injection (x 1) Refer for surgical evaluation if symptoms persists after - Shockwave 6 months of non-operative treatment Surgical release for recalcitrant disease What about the heel spur? Leave it alone Achilles Tendinopathy Definition: Tendinosis and/or peritendonitis Achilles Tendinopathy Etiology: - Inelasticity - Hypovascularity - Overuse / Age - Fluoroquinolones - Constrictive shoes - Inflammatory arthropathy Achilles Tendonitis/osis Achilles Tendonitis/osis Peritendinitis: inflammation involving peritendinous structures. In acute setting, symptoms typically last less than 2 weeks; in Insertional disease Non-insertional subacute setting, symptoms last 2 to 6 weeks; with chronic disease peritendinitis, symptoms are present 6 weeks or longer. Chronic peritendinitis may be associated with tendinosis. Peritendinitis with tendinosis: inflammatory process involving peritendinous structures along with degeneration of tendon. Tendinosis: typically an asymptomatic degeneration of tendon without concomitant inflammation caused by accumulated microtrauma, aging, or both. With tendinosis an interstitial rupture, partial rupture, or acute rupture may develop Physical exam . Physical exam . Thompson test: Take home . No rupture Ruptured Imaging . Achilles Tendinopathy Clinical presentation: - posterior heel pain and swelling - ankle stiffness - posterior prominence Differential: Acute rupture Posterior tibial tendon pathology Tarsal tunnel syndrome Posterior ankle impingement (os trigonum, etc.) Achilles Tendinopathy: Non-operative Treatment Biomechanical measures - Eccentric stretching exercises The term “pump bump” is used - Immobilization - Night splint loosely but generally applies to a Haglund’s process or Local measures swelling associated with - Shoewear modification/stretching insertional Achilles - Gel sleeve tendonitis Biochemical measures -NSAIDs Non-operative Treatment -Eccentric stretching -Night splint -Heel lift (1/4”) Surgical Treatment . Take home . When considering steroid injections for Achilles tendonitis, … don’t Insertional Achilles tendinosis . Simple . Complex . More substantial debridement and FHL transfer: Non-Insertional Tendinosis . Adult acquired flatfoot Definitions 1. Pes planus 1. Pes planus 2. Pes planovalgus 2. Pes planovalgus 3. Adult acquired flatfoot 3. Adult acquired deformity flatfoot deformity 4. Posterior tibial tendon 4. Posterior tibial dysfunction (PTTD) 5. Foot pronation tendon dysfunction (PTTD) - Hindfoot valgus - Forefoot abduction Flatfoot: Potential Etiologies PTTD: Potential Etiologies 1. Posterior tibial tendon dysfunction (PTTD) 1. Hypovascularity 2. Arthritis 2. Obesity • Degenerative 3. Gastrocnemius contracture • Inflammatory 4. Trauma 3. Congenital deformity 5. Systemic inflammatory disease 4. Trauma 6. Systemic non-inflammatory disease 5. Gastrocnemius contracture Posterior tibial tendon dysfunction: association with seronegative Etiology inflammatory disease 76 patients with PTTD Take home . 52 percent of patients with the adult acquired flatfoot secondary to PTTD Two Groups: had either diabetes mellitus, A – Young men (age ~ 39) with other sites of inflammation hypertension or obesity. B – Older patients (age ~ 64) with isolated PTTD _________________________________________ _________________________________________ Myerson MS, et al. Foot Ankle Int., 1989 Holmes GB and Mann RA, Foot Ankle Int., 1992 PTT dysfunction Staging Stage I No deformity Diagnosis Stage II Flexible asymmetric deformity Stage III Rigid deformity Stage IV Ankle valgus 1. Medial hindfoot symptoms Diagnosis 2. Medial lateral symptoms History • “Subfibular impingement” 1. History 3. Deformity 2. Physical • “fallen arches,”“pronation” examination 4. Arthritic symptoms 3. Radiographs • Start-up pain, polyarthralgia, 4. Advanced imaging morning stiffness 5. Systemic non-inflammatory disease Physical Exam Gait analysis 1. Gait analysis 1. Overall alignment 2. Examination Standing 2. Midstance: • Alignment (foot is flat) • arch collapse • Medial foot swelling • valgus thrust of ankle/hindfoot 3. Examination Sitting • Range-of-motion 3. Antalgic gait • Strength testing • shortened stance phase • Neurovascular exam 4. Observe from front, • Palpation back, and side 4. Provocative maneuvers Examination Standing • Heel valgus • Abducted foot (“too many toes” sign) • Low arch •Medial foot/ankle tenderness and swelling Heel valgus •Low arch Examination Sitting Take home . • Medial Swelling • Palpation / Tenderness • Weak inversion • Neurovascular exam Provocative Maneuvers Take home . Silfverskiold test: 1. Detect gastrocnemius contracture 2. Assess for Achilles vs gastrocnemius contracture With attempted toe raise heel stays in valgus Diagnosis Silfverskiold Radiographs Test - must be weight-bearing - ankle and foot Diagnosis Diagnosis Radiographs Ankle valgus … “Stage IV” PTTD Diagnosis Diagnosis Magnetic resonance Radiographs - Highly sensitive Arthritis - Other structures - Costly - Necessary? Diagnosis Diagnosis Computed Tomography Ultrasound - Arthritis - Coalition - Inexpensive - Potentially lucrative . Not commonly - Center/technician needed dependent . Probably note necessary My preferred treatment . Take home . 6 – 12 mo’s Non-operative Treatment 6 weeks _________________________________________ Alvarez RG, et al. Foot and Ankle Int’l, 2006 My preferred treatment protocol . Stage I and II posterior tibial tendon dysfunction treated by a structured Other options: nonoperative management protocol: an 1. Cast orthosis and exercise program 2. AFO -47 consecutive patients 3. Arizona Brace -AFO/orthosis + physical therapy 4. Stirrup/Sports Brace -Mean f/u 4 months 5. Orthotics -83% patients with successful outcomes 6. Time -89% patients satisfied -11% required surgery _________________________________________ Alvarez RG, et al. Foot and Ankle Int’l, 2006 Braces . Be aggressive . Advantages Custom-fitted Low profile Maximal support Disadvantages Procurement time Cost Orthotics - Know your orthotist /podiatrist - “Wholesale” price ~ $100 Sports braces offer coronal support Orthotics Orthotics Materials: - Plastazote - Polypropylene - Graphite - Carbon fiber -Others Physical Therapy - Modalities and more . - Plantarflexion / inversion conditioning - Gastrocsoleus stretching - Peroneal stretching Operative Treatment - Mobilization -Hindfoot valgus -Forefoot varus -Medial ray elevation - Combine with supportive brace Many surgical options . But almost everyone gets . FDL tendon transfer - Synovectomy / Debridement - Tendon transfer with calc osteotomy Rationale: Replaces/augments posterior tibial tendon - Lateral column lengthening Comment: Performed in most cases - Isolated hindfoot fusion - Triple arthrodesis - Cotton osteotomy - Arthroereisis - Strayer Medializing calcaneal osteotomy Rationale: Corrects heel valgus Converts Achilles vector from evertor to invertor Calcaneal Slide Toes . Long 2nd met leads to joint weakness 2nd MTP Synovitis and Instability Physical exam . “Drawer test” Take home . Lesser MTP Instability “Budin” Splint: Initial Treatment Options (6-12 weeks) - Taping - Splint - NSAIDs - Boot - Orthotics Surgery: shortening metatarsal osteotomy Interdigital (Morton’s) Neuroma Definition: an entrapment neuropathy of an interdigital nerve at the transverse metatarsal ligament Morton’s neuroma Possible Etiologies - Increased mobility of nerve - Bursa formation - Thick ligament/nerve - Trauma Morton’s Neuroma Take home . Clinical presentation: Morton’s Neuroma - sharp/radiating plantar forefoot pain - worse with walking - bunched up sock Diagnosis - webspace numbness/paresthesias - webspace tenderness - Mulder’s click - insidious onset - Diagnostic lidocaine injection - usually progressive but can be intermittent - MRI or ultrasound Morton’s Differential Diagnosis Take home . Metatarsal and MP joint disorders If the pathology isn’t in the - MTP synovitis/instability second or third webspace, - MP arthrosis it probably -Freiberg’s Infraction (osteonecrosis) isn’t a neuroma - Stress fracture - “Metatarsalgia” (metatarsal overload) Remember the“double crush phenomenon” in patients Proximal Neurogenic Pathology Degenerative disks, tarsal tunnel, neuropathy, etc with a Morton’s neuroma Morton’s neuroma Morton’s neuroma Non-operative Rx: Non-operative Rx: First Line Second
Load more

Recommended publications
  • Juvenile Spondyloarthropathies: Inflammation in Disguise
    PP.qxd:06/15-2 Ped Perspectives 7/25/08 10:49 AM Page 2 APEDIATRIC Volume 17, Number 2 2008 Juvenile Spondyloarthropathieserspective Inflammation in DisguiseP by Evren Akin, M.D. The spondyloarthropathies are a group of inflammatory conditions that involve the spine (sacroiliitis and spondylitis), joints (asymmetric peripheral Case Study arthropathy) and tendons (enthesopathy). The clinical subsets of spondyloarthropathies constitute a wide spectrum, including: • Ankylosing spondylitis What does spondyloarthropathy • Psoriatic arthritis look like in a child? • Reactive arthritis • Inflammatory bowel disease associated with arthritis A 12-year-old boy is actively involved in sports. • Undifferentiated sacroiliitis When his right toe starts to hurt, overuse injury is Depending on the subtype, extra-articular manifestations might involve the eyes, thought to be the cause. The right toe eventually skin, lungs, gastrointestinal tract and heart. The most commonly accepted swells up, and he is referred to a rheumatologist to classification criteria for spondyloarthropathies are from the European evaluate for possible gout. Over the next few Spondyloarthropathy Study Group (ESSG). See Table 1. weeks, his right knee begins hurting as well. At the rheumatologist’s office, arthritis of the right second The juvenile spondyloarthropathies — which are the focus of this article — toe and the right knee is noted. Family history is might be defined as any spondyloarthropathy subtype that is diagnosed before remarkable for back stiffness in the father, which is age 17. It should be noted, however, that adult and juvenile spondyloar- reported as “due to sports participation.” thropathies exist on a continuum. In other words, many children diagnosed with a type of juvenile spondyloarthropathy will eventually fulfill criteria for Antinuclear antibody (ANA) and rheumatoid factor adult spondyloarthropathy.
    [Show full text]
  • Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
    Name of Blue Advantage Policy: Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions Policy #: 076 Latest Review Date: November 2020 Category: Medical Policy Grade: A BACKGROUND: Blue Advantage medical policy does not conflict with Local Coverage Determinations (LCDs), Local Medical Review Policies (LMRPs) or National Coverage Determinations (NCDs) or with coverage provisions in Medicare manuals, instructions or operational policy letters. In order to be covered by Blue Advantage the service shall be reasonable and necessary under Title XVIII of the Social Security Act, Section 1862(a)(1)(A). The service is considered reasonable and necessary if it is determined that the service is: 1. Safe and effective; 2. Not experimental or investigational*; 3. Appropriate, including duration and frequency that is considered appropriate for the service, in terms of whether it is: • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member; • Furnished in a setting appropriate to the patient’s medical needs and condition; • Ordered and furnished by qualified personnel; • One that meets, but does not exceed, the patient’s medical need; and • At least as beneficial as an existing and available medically appropriate alternative. *Routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000 which meet the requirements of the Clinical Trials NCD are considered reasonable and necessary by Medicare. Providers should bill Original Medicare for covered services that are related to clinical trials that meet Medicare requirements (Refer to Medicare National Coverage Determinations Manual, Chapter 1, Section 310 and Medicare Claims Processing Manual Chapter 32, Sections 69.0-69.11).
    [Show full text]
  • The Painful Heel Comparative Study in Rheumatoid Arthritis, Ankylosing Spondylitis, Reiter's Syndrome, and Generalized Osteoarthrosis
    Ann Rheum Dis: first published as 10.1136/ard.36.4.343 on 1 August 1977. Downloaded from Annals of the Rheumatic Diseases, 1977, 36, 343-348 The painful heel Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthrosis J. C. GERSTER, T. L. VISCHER, A. BENNANI, AND G. H. FALLET From the Department of Medicine, Division of Rheumatology, University Hospital, Geneva, Switzerland SUMMARY This study presents the frequency of severe and mild talalgias in unselected, consecutive patients with rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthosis. Achilles tendinitis and plantar fasciitis caused a severe talalgia and they were observed mainly in males with Reiter's syndrome or ankylosing spondylitis. On the other hand, sub-Achilles bursitis more frequently affected women with rheumatoid arthritis and rarely gave rise to severe talalgias. The simple calcaneal spur was associated with generalized osteoarthrosis and its frequency increased with age. This condition was not related to talalgias. Finally, clinical and radiological involvement of the subtalar and midtarsal joints were observed mainly in rheumatoid arthritis and occasionally caused apes valgoplanus. copyright. A 'painful heel' syndrome occurs at times in patients psoriasis, urethritis, conjunctivitis, or enterocolitis. with inflammatory rheumatic disease or osteo- The antigen HLA B27 was present in 29 patients arthrosis, causing significant clinical problems. Very (80%O). few studies have investigated the frequency and characteristics of this syndrome. Therefore we have RS 16 PATIENTS studied unselected groups of patients with rheuma- All of our patients had the complete triad (non- toid arthritis (RA), ankylosing spondylitis (AS), gonococcal urethritis, arthritis, and conjunctivitis).
    [Show full text]
  • Management of Rotator Cuff Tendinopathy
    Management of rotator cuff tendinopathy Jeremy Lewis PhD FCSP MMACP Consultant Physiotherapist, Central London Community Healthcare NHS Trust, London, UK; Professor of Musculoskeletal Research, Faculty of Education and Health Sciences, University of Limerick, Ireland; Reader in Physiotherapy, School of Health and Social Work, University of Hertfordshire, Hatfield, UK; Sonographer Rotator cuff (RC) tendinopathy is characterised by shoulder pain and weakness most commonly experienced during shoulder external rotation and elevation. Assessment is complicated by the lack of diagnostic accuracy of the special orthopaedic tests and the poor correlation between structural changes identified on imaging and symptoms. Clinicians and people suffering with the symptoms of RC tendinopathy should derive considerable confidence that the outcomes achieved with an appropriately graduated exercise programme are equal to those achieved with surgery for RC tendinopathy, as well as atraumatic partial and full thickness RC tears. Education is an essential component of rehabilitation. Outcomes may also be enhanced by clinically sub-grouping RC tendinopathy presentations and directing treatment strategies according to the clinical presentation as against a generic “one size fits all” approach. There are substantial deficits in our knowledge regarding RC tendinopathy that need to be addressed to further improve clinical outcomes. Learning outcomes has at least equivalent outcome to surgical intervention, with the added generalised benefits of exercise http://www.youtube. 1 Review a presented model for the assessment and com/watch?v=aUaInS6HIGo , a faster return to work and at a management of rotator cuff tendinopathy. lower cost than surgery. This evidence relates to those diagnosed 2 Consider consistent evidence supporting an with subacromial pain syndrome (Lewis 2011), rotator cuff exercise based approach for management that is tendinopathy (Holmgren et al 2012) and atraumatic partial and equivalent to surgical outcomes.
    [Show full text]
  • The Pathomechanics of Plantar Fasciitis
    Sports Med 2006; 36 (7): 585-611 REVIEW ARTICLE 0112-1642/06/0007-0585/$39.95/0 2006 Adis Data Information BV. All rights reserved. The Pathomechanics of Plantar Fasciitis Scott C. Wearing,1 James E. Smeathers,1 Stephen R. Urry,1 Ewald M. Hennig2 and Andrew P. Hills1 1 Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia 2 Biomechanik Labor, University Duisburg-Essen, Essen, Germany Contents Abstract ....................................................................................585 1. Anatomy of the Plantar Fascia ............................................................586 1.1 Gross Anatomy of the Plantar Fascia...................................................586 1.2 Histological Anatomy of the Plantar Fascia .............................................589 1.2.1 Neuroanatomy ................................................................590 1.2.2 Microcirculation ...............................................................590 1.2.3 The Enthesis ...................................................................590 2. Mechanical Properties of the Plantar Fascia ................................................592 2.1 Structural Properties ..................................................................593 2.2 Material Properties ...................................................................593 3. Mechanical Function of the Plantar Fascia .................................................594 3.1 Quasistatic Models of Plantar Fascial Function ..........................................594
    [Show full text]
  • Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment
    Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment The glenohumeral joint is the most mobile joint in the human body, but this same characteristic also makes it the least stable joint.1-3 The rotator cuff is a group of muscles that are important in supporting the glenohumeral joint, essential in almost every type of shoulder movement.4 These muscles maintain dynamic joint stability which not only avoids mechanical obstruction but also increases the functional range of motion at the joint.1,2 However, dysfunction of these stabilizers often leads to a complex pattern of degeneration, rotator cuff tear arthropathy that often involves subacromial impingement.2,22 Rotator cuff tear arthropathy is strikingly prevalent and is the most common cause of shoulder pain and dysfunction.3,4 It appears to be age-dependent, affecting 9.7% of patients aged 20 years and younger and increasing to 62% of patients of 80 years and older ( P < .001); odds ratio, 15; 95% CI, 9.6-24; P < .001.4 Etiology for rotator cuff pathology varies but rotator cuff tears and tendinopathy are most common in athletes and the elderly.12 It can be the result of a traumatic event or activity-based deterioration such as from excessive use of arms overhead, but some argue that deterioration of these stabilizers is part of the natural aging process given the trend of increased deterioration even in individuals who do not regularly perform overhead activities.2,4 The factors affecting the rotator cuff and subsequent treatment are wide-ranging. The major objectives of this exposition are to describe rotator cuff anatomy, biomechanics, and subacromial impingement; expound upon diagnosis and assessment; and discuss surgical and conservative interventions.
    [Show full text]
  • Gluteal Tendinopathy
    Gluteal Tendinopathy What is a Gluteal Tendinopathy? In lying Up until recently hip bursitis was diagnosed as the main Either on your bad hip or with bad cause of lateral hip pain but recent studies suggest that an hip hanging across body like so irritation of the gluteus muscle tendon is the likeliest cause. The tendon attaches onto a bony prominence (greater trochanter) and it is here that the tendon is subject to All these positions lead to increase friction of the tendon, compressive forces leading to irritation. can cause pain and slow the healing process. This can result in pain over the lateral hip which can refer down the outside For sleeping you might like to try these positions: of the thigh and into the knee. How common is it? Gluteal tendinopathy is relatively common affecting 10-25% of the population. It is 3 times more prevalent in women than men and is most common in women between the ages of 40 and 60. One of the reasons for this is women It is also important to modify your activity. Avoid or reduce tend to have a greater angle at their hip joint increasing things that flare up your pain, this could be climbing stairs compressive forces on the tendon. or hills or those longer walks/runs. Signs and Symptoms Exercise Therapy • Pain on the outside of your hip, can refer down outside of the thigh to the knee This is best administered by a Physiotherapist to suit the • Worse when going up and/or down stairs individual but below is a rough guide to exercises which • Worse lying on affected side (and sometimes on the can help a gluteal tendinopathy.
    [Show full text]
  • Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions
    Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis Page 1 of 62 and Other Musculoskeletal Conditions Medical Policy An Independent licensee of the Blue Cross Blue Shield Association Title: Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions Professional Institutional Original Effective Date: July 11, 2001 Original Effective Date: July 1, 2005 Revision Date(s): November 5, 2001; Revision Date(s): December 15, 2005; June 14, 2002; June 13, 2003; October 26, 2012; May 7, 2013; January 28, 2004; June 10, 2004; April 15, 2014; April 14, 2015; April 21, 2005; December 15, 2005; August 4, 2016; January 1, 2017; October 26, 2012; May 7, 2013; August 10, 2017; August 1, 2018; April 15, 2014; April 14, 2015; July 17, 2019, March 11, 2021 August 4, 2016; January 1, 2017; August 10, 2017; August 1, 2018; July 17, 2019, March 11, 2021 Current Effective Date: August 10, 2017 Current Effective Date: August 10, 2017 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care.
    [Show full text]
  • Current Trends in Tendinopathy Management
    Best Practice & Research Clinical Rheumatology 33 (2019) 122e140 Contents lists available at ScienceDirect Best Practice & Research Clinical Rheumatology journal homepage: www.elsevierhealth.com/berh 8 Current trends in tendinopathy management * Tanusha B. Cardoso a, , Tania Pizzari b, Rita Kinsella b, Danielle Hope c, Jill L. Cook b a The Alphington Sports Medicine Clinic, 339 Heidelberg Road, Northcote, Victoria, 3070, Australia b La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Victoria, 3083, Australia c MP Sports Physicians, Frankston Clinic, Suite 1, 20 Clarendon Street, Frankston, Victoria, 3199, Australia abstract Keywords: Tendinopathy Tendinopathy (pain and dysfunction in a tendon) is a prevalent Management clinical musculoskeletal presentation across the age spectrum, Rehabilitation mostly in active and sporting people. Excess load above the ten- Achilles tendinopathy don's usual capacity is the primary cause of clinical presentation. Rotator cuff tendinopathy The propensity towards chronicity and the extended times for recovery and optimal function and the challenge of managing tendinopathy in a sporting competition season make this a difficult condition to treat. Tendinopathy is a heterogeneous condition in terms of its pathology and clinical presentation. Despite ongoing research, there is no consensus on tendon pathoetiology and the complex relationship between tendon pathology, pain and func- tion is incompletely understood. The diagnosis of tendinopathy is primarily clinical, with imaging only useful in special circum- stances. There has been a surge of tendinopathy treatments, most of which are poorly supported and warrant further exploration. The evidence supports a slowly progressive loading program, rather than complete rest, with other treatment modalities used as adjuncts mainly targeted at achieving pain relief.
    [Show full text]
  • Conditions Related to Inflammatory Arthritis
    Conditions Related to Inflammatory Arthritis There are many conditions related to inflammatory arthritis. Some exhibit symptoms similar to those of inflammatory arthritis, some are autoimmune disorders that result from inflammatory arthritis, and some occur in conjunction with inflammatory arthritis. Related conditions are listed for information purposes only. • Adhesive capsulitis – also known as “frozen shoulder,” the connective tissue surrounding the joint becomes stiff and inflamed causing extreme pain and greatly restricting movement. • Adult onset Still’s disease – a form of arthritis characterized by high spiking fevers and a salmon- colored rash. Still’s disease is more common in children. • Caplan’s syndrome – an inflammation and scarring of the lungs in people with rheumatoid arthritis who have exposure to coal dust, as in a mine. • Celiac disease – an autoimmune disorder of the small intestine that causes malabsorption of nutrients and can eventually cause osteopenia or osteoporosis. • Dermatomyositis – a connective tissue disease characterized by inflammation of the muscles and the skin. The condition is believed to be caused either by viral infection or an autoimmune reaction. • Diabetic finger sclerosis – a complication of diabetes, causing a hardening of the skin and connective tissue in the fingers, thus causing stiffness. • Duchenne muscular dystrophy – one of the most prevalent types of muscular dystrophy, characterized by rapid muscle degeneration. • Dupuytren’s contracture – an abnormal thickening of tissues in the palm and fingers that can cause the fingers to curl. • Eosinophilic fasciitis (Shulman’s syndrome) – a condition in which the muscle tissue underneath the skin becomes swollen and thick. People with eosinophilic fasciitis have a buildup of eosinophils—a type of white blood cell—in the affected tissue.
    [Show full text]
  • Advice and Exercises for Patients with Plantar Fasciitis
    Advice and exercises for patients with plantar fasciitis This leaflet provides management advice and exercises for people diagnosed with plantar fasciitis, a condition causing pain in the heel, sole and /or arch of the foot. Structures of the foot The plantar fascia is a sheet or broad band of fibrous tissue that runs along the bottom of the foot. This tissue connects the heel to the base of the toes. Under normal circumstances, the plantar fascia supports the arch of the foot and acts as a shock absorbing “bow string” within the arch of the foot. With weight bearing, the foot flattens and the plantar fascia stretches, then springing you forward ready for the next step. While walking, the stresses placed on the foot can be one and a quarter times your body weight (this increases to two and three quarter times your body weight when running). Unsurprisingly then, that heel pain is common. If tension on this “bowstring” becomes too great, irritation or inflammation can occur causing pain. What is plantar fasciitis? Plantar fasciitis is a relatively common foot problem affecting up to 10-15% of the population. It can occur at any age. It is sometimes known as “policeman’s heel”. When placed under too much stress due to abnormal loading, the plantar fascia stretches causing micro tearing and degeneration of the tissue. It can lead to pain in the heel, across the sole of the foot and sometimes into the arch area of the foot too. These micro tears repair with scar tissue, which is less flexible than the fascia and can cause the problem to persist for many months.
    [Show full text]
  • Plantar Fasciitis
    Recent Advances in Orthotic Therapy for Plantar Fasciitis An Evidence Based Approach Lawrence Z. Huppin, D.P.M. Assistant Clinical Professor, Western University of Health Sciences, College of Podiatric Medicine Disclosures I disclose the following financial relationships with commercial entities that produce health care related products and services relevant to the content of this lecture: ◦ Employee (Medical Director) of ProLab Orthotics, manufacturer of foot orthoses Our Goals . Review Three Studies that Help Optimize Clinical Outcome of Custom Foot Orthoses Used to Treat Plantar Fasciitis • Cause of Plantar Fascial Tension • Forefoot Wedging Effect on Plantar Fascial Tension • Arch Contour Effect on Plantar Fascial Tension . Develop a “pathology specific” orthosis prescription to most effectively treat plantar fasciitis . Offloading Excessive Fascia Tension is Goal of Orthotic Therapy . What Causes Tension? Tissue Stress Theory McPoil, Hunt. Evaluation and Management of Foot and Ankle Disorders: Present Problems and Future Directions. Journal of Orthopaedic & Sports Physical Therapy, 1995 Effect of STJ Pronation on PF Strain . Cannot by itself cause strain of plantar fascia . Can only increase plantar fascia strain via the MTJ • (inversion of the forefoot on the rearfoot) Scherer. “Heel Pain Syndrome: Pathomechanics and Non-surgical Treatment. JAPMA 1991 Effect of Forefoot Inversion on Plantar Fascial Strain 73 patients with 118 painful heels 91% had foot deformity compensated by supination of long axis of MTJ Out of 118 painful heels 63 had forefoot valgus 33 had everted rearfoot 20 had plantarflexed first ray Scherer 1991 What foot types supinate the MTJ? . 47% forefoot valgus . 24% everted heel . 20% plantarflexed first ray Scherer 1991 What foot types supinate the MTJ? .
    [Show full text]