Ortho 2 Exam 2 (LLAF and shoulder) --> LLAF Conditions (Tarsal tunnel and posterior tibial tendinopathy)

what is tarsal tunnel syndrome?

- compression or entrapment of the tibial nerve as it passes deep to the flexor retinaculum

what causes tarsal tunnel syndrome?

- any condition that compromises space in the tarsal tunnel

- severe foot pronation

clinical presentation of tarsal tunnel syndrome

- burning pain on plantar foot and behind medial malleolus

- pain on plantar foot (especially at night)

- increased signs and symptoms with WB

- no tenderness to palpation

how do you confirm tarsal tunnel syndrome?

electrodiagnostic tests

interventions for tarsal tunnel syndrome (6)

- activity limitation / immobilization

- NSAIDs (if inflammation)

- strengthening exercises

- neuro mobs

- orthotics to prevent over pronation

- surgery

what is tarsal coalition?

- fibrous, osseous, or cartilaginous bar spanning talocalcaneal or calcaneonavicular joint

- pain initially seen in teens

- decreased rear foot motions and rigid pes planus

ho to treat tarsal coalition?

- rest and immobilization

- orthotics

- surgery in some cases

what does the posterior tibial tendon do?

- PF and invertor

- adductor of forefoot

- dynamic stabilizer of the medial longitudinal arch

> elongation by as little as 1cm reduces PTT efficiency as a stabilizer

signs and symptoms of posterior tibial tendinopathy

- insidious onset is most common (but can be present for months)

- rarely occurs bilaterally

- swelling medially

- pain in medial plantar arch

- standing on toes is painful and difficult

- gradually worsening until eventual collapse of medial longitudinal arch

what are some risk factors / causes of posterior tibial tendinopathy?

- age related degeneration of the tendon

- sedentary lifestyle

- obesity

- HTN

- diabetes

- steroids

what are systemic inflammatory diseases that can cause PTT?

- RA and posterior tibial synovitis

how do chronic microtraumas and increased mechanical stress cause PTT?

- combination of repetitive mechanical stress and poor blood supply leads to tendinopathy

what does it mean for the posterior tibial tendon to be considered a "gliding" tenon?

- it changes direction

- most common rupture site is at the direction change of the fibers

how do adjacent anatomical structures increase the stress on posterior tibial tendon? (2)

- tight flexor retinaculum

> tendon constriction posterior to medial malleolus

- shallow medial malleolar groove

> anterior subluxation of the PTT

what is a major cause of acquired flatfoot deformity in adults?

PTT

what are the 4 signs of PTT?

1. increased heel valgus

2. PF of the talus

3. flattening of MLA

4. abduction of forefoot

what does "too many toes" sign look at?

- shows a dropped MLA on the affected side

- heel moves into eversion and forefoot moves in adduction

- will see toes on the lateral side of the heel from a posterior view

what is a B limb heel rise (BLHR)?

assess for symmetrical inversion of calcaneus

what is single limb heel rise (SLHR)?

- rise on ball of foot while the other foot is held off the ground

- with PTT elongation, heel inversion is weak

> pt will either rise up incompletely without locking the heel or does not get up onto ball of foot

T/F: low level laser therapy can help with PTT?

true

interventions for PTT?

- selective activation of posterior tibialis

- closed chain resisted foot add with silverTB

- SLHR with knee in extension

- open chain resisted supination with silverTB

what imaging modality is used to monitor changes/improvements in muscle activation during exercise interventions?

MRI

are orthoses helpful for PTT?

yes when paired with a structured exercise program

when were arch-supporting shoes and orthoses found to be the most beneficial?

- pts with asymptomatic pes planus

- got the most selective activation when wearing them

> pattern of muscle activation with shoes on was similar to a person with a normal arch

in what 2 ways are orthotics beneficial? (how do they work)

- elevate the MLA and resist pronation

- decrease tension on PTT

how do medial heel wedges / medial column post arch supports work for PTT?

- decrease LE symptoms by possibly improving biomechanical impairments

- corrects valgus of hindfoot and abduction of forefoot