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Foot & Ankle

Foot & Ankle. Differential Diagnosis & Treatment. Capsular. More loss of PF OA – common post # RA – heat, synovial thickening Traumatic Arthritis. Non - capsular. Loose body in joint Intermittent twinges of pain Springy end feel Ref to surgeon. Ligament - Acute. P R I C E

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Foot & Ankle

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  1. Foot & Ankle Differential Diagnosis & Treatment

  2. Capsular • More loss of PF • OA – common post # • RA – heat, synovial thickening • Traumatic Arthritis

  3. Non - capsular • Loose body in joint • Intermittent twinges of pain • Springy end feel • Ref to surgeon

  4. Ligament - Acute • P • R • I • C • E • Massage • Grade A ex’s + prop • Strapping • WB as soon as poss

  5. Ligament - Chronic • Friction • Grade C manip • Proprioception + ROM + strengthening work

  6. Contractile

  7. Achilles TendonEpidemiology • Runners, tennis, badminton, football • More common in older athletes • More common in men

  8. Aetiology • Training errors -sudden increase training intensity -changes in terrain • Biomechanical factors • Pronation • footwear • Gout • Sero –ve arthropathy

  9. Achilles Tendon Disorders • Tendinosis • Paratenonitis • Insertional tendinopathy/ enthesopathy • Bursitis -retrocalcaneal -achilles

  10. Histology • Usually no inflammation • Peritendinous changes -thickened macroscopically -fibroblast proliferation, adhesions • Intratendinous degeneration -hypoxic, myxoid, fibrinoid degeneration -calcification • Neovascularisation

  11. History & Examination • Establish Aetiology • Pain • Palpate • Assess biomechanical alignment -foot -tibia -LL

  12. TA Grading • Grade 1 Brief symptoms post training, absent the following morning • Grade 2 Symptoms post training with 24-48hr morning stiffness • Grade 3 Symptoms during activity and morning stiffness • Grade 4 Not able to train

  13. Treatment • Activity -Rest -Modification of activity -Cross training • Medication -NSAID’s -Injection -?peritendinous into paratendon -?into retrocalcaneal bursa -Intratendon contraindicated

  14. Orthotics • Correct/ compensate malalignments • -overpronation • -high arches

  15. Other treatments • Electro thermal modalities • Soft tissue mobility • Flexibility • Strength • Micro current • SWT • Acupuncture

  16. Tendons in a sheath • Peroneii • Tibialis Posterior

  17. Gastrocnemius Tear • Sudden, acute onset • Pain in calf • Pain on resisted PF • Pain on passive DF • PRICE • Grade A ex’s • WB with heel lift • STM

  18. Plantar Fasciitis • Correct biomechanics • Address predisposing factors • Pain relief • DTF’s

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