Ankle Injuries
Anatomy of Ankle Joint
Explanation
What is ankle injuries
Ankle Sprain Classification
Treatment of Ankle Injuries
What should be Avoided ?
Rehabilitation Programme ..
Ankle Injuries
Anatomy of Ankle Joint
Explanation
What is ankle injuries
Ankle Sprain Classification
Treatment of Ankle Injuries
What should be Avoided ?
Rehabilitation Programme ..
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
This ppt presentation is explaining the major soft tissue injuries (overuse injuries) around the ankle joint. we explain in this ppt about ankle impingement syndrome, ankle sprain, and plantar fascia. this ppt basically dedicated to my BPTh students.
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
ELBOW JOINT PATHOLOGY AND REHABILITATION 1.pptxSrishti Mahadik
Elbow joint pathomechanics and rehabilitation in physiotherapy explained in detailed manner.Each and every point from reference books mentiuoned above is included.
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
This ppt presentation is explaining the major soft tissue injuries (overuse injuries) around the ankle joint. we explain in this ppt about ankle impingement syndrome, ankle sprain, and plantar fascia. this ppt basically dedicated to my BPTh students.
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
ELBOW JOINT PATHOLOGY AND REHABILITATION 1.pptxSrishti Mahadik
Elbow joint pathomechanics and rehabilitation in physiotherapy explained in detailed manner.Each and every point from reference books mentiuoned above is included.
SPORTS INJURIES OF ANKLE AND FOOT original.pptxMeghaPrakash9
sports injuries of ankle and foot is a seminar done by Ms. Megha ck on behalf of completing her master of physiotherapy program during the year 2020-2022
Therapeutic ultrasound and application, physiotherapy based application of ultrasound, for basic understanding of ultrasound and its uses for therapeutic purpose.
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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Ankle injuries by sunil
1. FOOT AND ANKLE INJURIES IN ATHLETES
BY- SUNIL
CPRS, JMI
drsuniljmi@gmail.com
2. Foot and ankle injuries are very common among
athletes.
Increased competition means professional athletes
and dedicated amateur athletes push themselves to
their limits, so there are more foot and ankle injuries
than ever.
3.
4. Mobile Joints of the foot and ankle:
Ankle joint
Sub-talar joint
Talo-navicular joint
Metatarso-phalangeal (MTP) joints.
5.
6.
7.
8.
9.
10.
11.
12. POTT'S FRACTURE
• A fracture affecting one or more of the malleoli
(lateral, medial, posterior) is known as a Pott's fracture.
• It can be difficult to distinguish a fracture from a moderate-to-
severe ligament sprain as both condilions may result from similar
mechanisms of injury and cause severe pain and inability to weight-
bear.
• Careful and gentle palpation can generally localize the greatest
site of tenderness to either the malleoli (fracture) or just distal to
the ligament attachment (sprain).
13. The management of Pott's fractures requires
restoration of the normal anatomy between the
superior surface of the talus and the ankle mortise
(inferior margin of the tibia and fibula).
If this relationship has been disrupted, internal
fixation is almost always required.
14. Osteochondral lesions of the talar dome
It is not uncommon for osteochondral fractures of the talar
dome to occur in association with ankle sprains, particularly
when there is a compressive component to the inversion injury,
such as when landing from a jump.
The talar dome is compressed by the tibial plafond, causing
damage to the osteochondral surface the lesions occur most
commonly in the superome dial corner of the talar dome, less
commonly on the superolateral part.
15. The patient often gives a history of progressing well
following a sprain but then developing symptoms of
increasing pain and swelling, stiffness and perhaps
catching locking as activity is increased.
Reduced range of motion is often a prominent
symptom.
Examination with the patient's foot plantarflexed at
45degree to rotate the talus out of the ankle
mortise reveal tenderness of the dome of the talus.
16.
17.
18. Chronic grade I and II lesions should be treated
conservatively.
The patient should avoid activities that cause pain and
be encouraged to pedal an exercise bicycle with low
resistance.
If there is pain, or symptoms of clicking, locking or
giving persist beyond two to three months of this
conservative management, ankle arthroscopy is
indicated.
A grade IIa, III or IV lesion also requires arthroscopic.
19. Evalsion fracture of the base of the 5th
metatarsal
Inversion injury may result in an
evalsion fracture of the base of
the 5th metatarsal.
This fracture result from evalsion
of the peroneus brevis tendon
from its attachment to the base of
the 5th metatarsal.
X-rays should be examined
closely. Avulsion frature is
characterized by its involvement
of the joint surface of the base of
the fifth metatarsal.
20. Fracture of the base of the
fifth metatarsal may be
treated conservatively with
immobilization for pain
relief followed after one to
two weeks by protected
mobilization and
rehabilitation.
21. Calcaneal stress fractures
Calcaneal stress
fractures22 are the second
most common tarsal stress
fracture.
They occur most commonly
at two main sites: the upper
posterior margin of the os
calcis or adjacent to the
medial tuberosity, at the
point where calcaneal
spurs occur.
occur in runners, ballet dancers and jumpers
22. Clinical features
Patients give a history of insidious onset of heel
pain that is aggravated by weight- bearing
activities,especially running.
Examination reveals localized tenderness over the
medial or lateral aspects of the posterior calcaneus
and pain that is produced by squeezing the
posterior aspect of the calcaneus from both sides
Simultaneously.
23. Investigations
Plain X-ray may show a typical sclerotic
appearance on the lateral X-ray, parallel to the
posterior margin of the calcaneus
24. Treatment
Treatment involves a reduction in activity and for
those with marked pain a short period ofnon-
weightbearing may be required. Once pain-free, a
program of gradually increased weight-bearing
can occur.
Stretching of the calf muscles and plantar fascia,
and joint mobilization are important for long-term
recovery.
Soft heel pads, in conjunction with orthoses if
required, are recommended.
25. Stress fracture of the navicular
Stress fractures of the
navicular are among the most
common stress fractures Seen
in the athlete, especially in
sports that involve sprinting,
jumping or hurdling.
The stress fracture commonly
occurs in the mi dle third of the
navicular bone, a relatively
avascular region of the bone.
26. Cause
A comhination of overuse and training errors plays
a significant role in the development of navicular
stress fractures.
Although the exact cause ofa navicular stress
fracture is not known, it is believed that
impingement of the navicular bone occurs between
the proximal and distal tarsal bones when the
muscles exert compressing and bending forces.
27. Clinical features
The onset of symptoms is usually insidious, consisting
of a poorly localized midfoot ache associated with
activity.
The pain typically radiates along the medial aspect
of the longitudinal arch or the dorsum of the foot.
The symptoms abate rapidly with rest.
28. Stress fractures of the metatarsals
Stress fractures of the metatarsals in most series
have been shown to be the second most common
stress fracture, second to the tibia.
The most common metatarsal stress fracture is at
the neck of the second metatarsal.
This occurs in the pronating foot, when the first ray is
dorsiflexed, resulting in the second metatarsal being
subjected to greater load.
29. Clinical features
The patient with a metatarsal stress fracture
complain of forefoot pain aggravated by activity
such as turning or dancing.
The pain is not severe initially but gradually
worsens with activity.
30. Investigation
X-rays reveal a radiolucent line or periosteal
thickening if the fracture has been present for a few
weeks .
If the X- ray is negative, an isotopic
bone scan or MRI may confirm the diagnosis.
31. Treatment
The management of most stress fractures is straightforward, involving
rest from weight-bearing aggravating activities for approximatly
four weeks.
If the patient is required to be on his or her feet excessively, the use
of an air cast may be required for one to two weeks until pain
settles.
The athlete Should be allowed to recommence activity when he or
she does not experience pain when walking and there is no local
tenderness at the fracture site.
A graduated exercise program should be instituted to return the
athlete to full training and competition.
32. TARSAL TUNNEL SYNDROME
Tarsal tunnel syndrome occurs as a result of
entraptment of the posterior tibial nerve in the
tarsal tunnel where the nerve winds around
the medial malleolus.
It may also involve only one of its terminal
branches distal to the tarsal tunnel.
33. Causes
In approximately 50% of cases the cause of tarsal tunnel
syndrome is idiopathic . It may also occur as a result of trauma
(e.g. inversion injury to the ankle or overuse associated with
excessive pronation. Other less common causes include:
• Ganglion
Talonavicular coalition
Varicose veins
Synovial cyst
Lipoma
Accesory muscle- flexor digitorum accessories longus
Tenosynovitis
Fracture of the distal tibia or calcaneus.
34. Clinical features
Poorly defined burning, tingling or numb sensation on the
plantar aspect of the foot, often radiating into the toes.
Pain is usually aggravated by activity and releived by rest.
In some patients the symptoms are worse in bed at night and
relieved by getting up and moving or massaging the foot.
Swellings, varicosities or thickenings may be found on
examination around the medial ankle or heel.
35. A ganglion or cyst may be palpable in the tendon
sheaths around the medial ankle.
Tenderness in the region of the tarsal tunnel is common.
Tapping over the posterior tibial nerve ( Tinel's sign) may
elicit the patient's pain and occasionally cause
fasciculations but
this 'classic' sign is not commonly seen.
There may be altered sensation along the arch of the
foot.
36. Treatment
• Conservative treatment should be attempted in those
with either an idiopathic or biomechanical cause.
•Treatment with NSAID and, if required an injection of a
corticosteroid agenr into tarsal tunnel may be helpful. If
excessive pronation is present, an orthosis should be
utilised.
•Surgical treatment is required if there is mechanical
pressure on the nerve. A decompression of the posterior
tibial nerve and its branches should be performed, but
only after both the diagnosis and the site of nerve
entraptment have been confirmed.
37. PERONEAL TENDINOPATHY
The most common overuse injury causing lateral ankle pain is peroneal
tendinopathy.
The peroneus longus and peroneus brevis tendons cross the ankle joint within
a fibro-osseous tunnel, posterior the lateral malleolus.
The peroneus brevis tendon insert into the tuberosity on the lateral aspect of
the of the fifth metatarsal. The peroneus longus tendon passes under the
plantar surface of the foot to insert into the lateral side of the base of the
first metal and medial cuneiform.
The peroneal tendons share a common tendon sheath proximal to the distal
tip of the fibula, after which they have their own sheaths.
The peroneal muscles serve as ankle flexors in addition to being the primary
evertors of the ankle.
38. Causes
Peroneal tendinopathy may occur as a result of
an acute ankle inversion injury or secondary to an overuse injury.
Common causes of an overuse injury are:
• Excessive eversion of the foot, such as occurs when running on
slopes or on cambered surfaces.
• Excessive pronation of the foot.
• Secondary to tight ankle plantarflexors (most commonly soleus)
resulting in excessive load on lateral muscles.
• Excessive action on the peroneals (e.g. dancing, football,
volleyball).
39. It has been suggested that peroneal tendinopathy may be due
to the excessive pulley action of, and abrupt change in
direction of, the peroneal tendons at the lateral malleolus.
There are three main sites of peroneal tendinopathy:
1. posterior to the lateral malleolus
2. at the peroneal trochlea
3. at the plantar surface of the cuboid.
Clinical features
The athlete commonly presents with:
lateral ankle or heel pain and swelling which is aggravated
by activity and relieved by rest
40. local tenderness over the peroneal tendons on
examination, sometimes associated with swelling
and crepitus (a true paratenonitis)
• painful passive inversion and resisted eversion,
although in some cases eccentric contraction may be
required to reproduce the pain
a possible associated calf muscle tightness
excessive subtalar pronation or stiffness of the
subtalar or midtarsal joints.
41. Treatment
Treatment initially involves settling the pain with rest from
aggravating activities, analgesic medication if needed and
soft tissue therapy.
Stretching in conjunction with mobilization of the subtalar
and midtarsal joints may be helpful. Footwear should be
assessed and the use of lateral heel wedges or orthoses
may be required to correct biomechanical abnormalities.
Strengthening exercises should include resisted eversion (e.g.
rubber tubing, rotagym), especially in plantarflexion as this
position maximally engages the peroneal muscles.
In severe cases, surgery may be required, which may involve
a synovectomy, tendon debridement or repair
42. SINUS TARSI SYNDROME
The sinus tarsi is a small osseous canal running from an opening anterior and
interior to the lateral malleolus in a posteromedial direction to a point
posterior to the medial malleolus.
The interosseus ligament occupies the sinus tarsi and divides it into an
anterior portion, which is part of the talocalcaneonavicular joint, and a
posterior part, which represents the subtalar joint.
It is lined by a synovial membrane and in addition to ligament it contains
small blood vessels, fat and connective tissue.
43.
44. Causes
Although injury to the sinus tarsi may result from chronic overuse
secondary to poor biomechanics (especially excessive pronation),
approximately 70%of all patients with sinus tarsi syndrome have
single or repeated inversion injury to the ankle may also occur
after repeated forced eversion of the ankle, such as high jump
take off.
The sinus tarsi contains abundant synovial tissue that is prone to
synovitis and inflammation when injured. An influx of
inflammatory cells may result in the development of a low-grade
inflammatory synovitis.
Other causes of sinus tarsi syndrome may include chronic
inflammation in conditions such as gout, inflammatory
arthropathies and osteoarthritis.
45. Clinical features
The symptoms of sinus tarsi syndrome include:
• pain which may be poorly localized but is most often centered just anterior to the
lateral malleolus
• pain that is often more severe in the morning and may diminish with exercise
• pain that may be exacerbated by running on curve in the direction of the affected
anklepatientmayalso complain of ankle and foot stiffness, a feeling of instability of
the hind f and occasionally of weakness
• difficulty walking on uneven ground
• full range of pain-free ankle movement on examination but the subtalar joint may
be stiff.
• pain on forced passive eversion of the subtal joint; forced passive inversion may also
be painful due to damage to the subtalar Iigam
• tenderness of the lateral aspect of the ankle a“ the opening of the sinus tarsi and
occasionall also over the anterior talofibular ligament; th may be minor localized
swelling.
46.
47. TREATMENT
Conservative management includes relative rest, ice.
NSAID and electrotherapeutic modalities. Mobilization of the
subtalar joint is essential. Rehabilitation involves proprioception
and strenght to the anterior talofibular ligament may promote
synovial thickening and exudation.
48. MORTON’S NEUROMA
The most common presentation of an interdigital (Morton's) neuroma is pain
located between the third and the fourth metatarsal heads (in the third
interspace) that radiates into the third and fourth toes.
Patients often describe this as a burning pain that intermittently "moves
around." Usually, the pain is exacerbated by tight-fitting and/or high-
heeled shoes or increased activity on the foot. The pain is often relieved by
removing the shoe and rubbing the forefoot. Occasionally, these symptoms
occur in the second interspace with radiation into the second and third toes.
Seldom do neuromas occur in both interspaces simultaneously.
49.
50. Anatomy and Pathophysiology
The "classic" Morton neuroma is a lesion of the common
digital nerve that supplies the third and fourth toes. This
is not a true neuroma, but rather an irritated perineural
fibrosis where the nerve passes plantar to the
transverse metatarsal ligament.
It has been speculated that because the common digital
nerve to the third interspace has branches from the
medial and lateral plantar nerves (and thus increased
thickness) that this accounts for the third interspace
being the one most commonly involved.
51. Diagnosis-
The diagnosis of a Morton neuroma is clinical. There are no useful
radiographic or electrodiagnostic tests.
Serial examinations may be necessary to establish the correct
diagnosis.
Examination-
Direct palpation and palpation with a stripping motion of the
interspace will usually reproduce the patient's pain. This maneuver,
called "Mulder's sign,“ often reproducing the third (or second)
interspace. The examiner places the index finger and thumb
proximal to the metatarsal heads in the interspace, and while
pushing firmly into the interspace, "strips" distally to the end of the
interspace, often feeling a click or pop that elicits pain (Mulder's
click) a clicking or popping sensation and pain.
52.
53.
54. HALLUX RIGIDUS
The term hallux rigidus describes a limited arthrosis
of the first MTP joint. The first MTP joint and the
great toe (hallux) provide significant weight
transfer from the foot to the ground as well as
active push-off. An intact first MTP joint implies a
complete and pain-free ROM,and full intrinsic
and extrinsic motor strength.
55. Hallux rigidus is an arthritic condition limited to the dorsal
aspect of the first MTP joint. Also known as a dorsal bunion
or hallux limitus, the condition is most commonly idiopathic
(but may be associated with posttraumatic OCD of the
metatarsal head) and is characterized by an extensive
dorsal osteophyte and dorsal third cartilage damage and
loss. An associated synovitis may further aggravate the
limited and painful ROM.
A foot with increased first ray ROM and increased
pronation may be predisposed to the condition.
Excessive flexibility of the shoe forefoot increases the
potential for hyperdorsiflexion of the hallux MTP joint
For this reason, this type of shoewear should be avoided.
64. METATARSALGIA
Metatarsalgia describes an assortment of
conditions that cause plantar pain in the
forefoot.
Metatarsalgia is best characterized by
pain under the metatarsal heads
exacerbated by weight-bearing. The fatty
cushion of the forefoot is a highly
specialized tissue.
When weight is applied, hydrostatic
pressure builds within the compartments,
dampening and dispersing forces on the
plantar skin. This mechanism acts as a
cushion, protecting the area from
potentially damaging focal concentrations
in pressure arising.
65. Inflammatory arthritis, trauma, or neuromuscular disorders can
cause imbalances of flexion and extension forces around the
small joints of the toes.
Toe deformity is a consequence of this imbalance.
Hyperextension at the MTP joint is a common component of
these deformities and draws the fatty cushion of the forefoot
distally and dorsally with the proximal phalanx . When this
occurs, the weight transferred through the metatarsal heads is
applied to the thinner proximal skin without the intervening
fatty cushion.
66.
67. It is common in following factors:
• Pesplantaris
• Pescavus
• Muscular weakness in the toe flexors due to
inactivity or immobilization
• Wearing high heels
• Tightness of plantar aponeurosis
68. Treatment
1. Painful stage: warm water bath, contrast bath
TENS, ultrasonic, diapulse or hot packs.
2. When associated with swelling : suitable
cryotherapy with leg in elevation.
3. Speedy ankle and toe movements to reduce
oedema and to improve circulation.
4. Faradism under pressure (elastic bandage) with leg
in elevation.
5. Faradic foot bath synchronised with voluntary
intrinsic exercise.
6. Gradual re-education of walking with appropriate
shoe wedge, pad or metatarsal bar.
69. FLEXOR HALLUCIS LONGUS
TENDINOPATHY
The flexor hallucis longus tendon flexes the big toe
and assists in plantarflexion of the ankle.
It passes posterior to the medial malleolus, and runs
between the two sesamoid bones to insert into the
base of the distal phalanx of the big toe.
70. Causes
Flexor hallucis longus tendinopathy may occur secondary to
overuse, a stenosing tenosynovitis, pseudocyst or tendon tear.
A common cause is overuse in a ballet dancer, as dancers
repetitively go from flat foot stance to the en pointe position,
when extreme plantarflexion is required.
Wearing shoes that are too big and require the athlete to 'toe-
grip' may also result in flexor hallucis longus tendinopathy.
71. Clinical features
Pain on toe-off or forefoot weight-bearing(e.g. rising in ballet), maximal
over the posteromedial aspect of the calcaneus around the sustentaculum
tali.
Pain may be aggravated by resisted flexion of the first toe or stretch into
full dorsiflexion of the hallux.
In more severe cases, there may be 'triggering‘ of the first toe, both with
rising onto the balls of the foot (e.g. in ballet) and in lowering from this
position. Triggering occurs when the foot is placed in plantarflexion and the
athlete, unable to flex the hallux, but then with forcible active contraction of
the flexor halluds longus, is able to extend the interphalangeal or
metatarsophalangeal joints of the toe.
A snap or pop occurs in the posteromedial aspect of the ankle when this
happens. Subsequent passive flexion or extension of the interphalangeal
joint produces a painless snap posterior to the medial malleolus.
75. Management may require orthotic therapy.
Surgical excision with severe symptoms or after
failure of conservative therapy. The
cartilaginous bar may recur after surgery.