The document provides information on common foot pain problems including their anatomy, causes, symptoms, physical exam findings, investigations, and treatment options. It discusses issues such as plantar fasciitis, heel fat pad syndrome, stress fractures of the calcaneus, navicular, and cuboid bones, tarsal tunnel syndrome, lateral plantar nerve entrapment, tibialis posterior tendinopathy, extensor tendinopathy, cuboid syndrome, and midfoot issues. Conservative treatments include rest, ice, stretching, orthotics, and strengthening exercises while surgical options are considered for more severe or chronic cases.
Disorders of the Great toe (hallux) are very important as they are very painful, causes many clinical symptoms,and very difficult to treat.The presentation compiled from various important orthopedic textbooks and international journals.
The foot is the foundation to the body. The alignment of the foot is crucial for proper foot function. This lecture discusses normal and abnormal alignment and the exact cause that leads to a faulty foot structure.
Learn more at www.GraMedica.com.
Plantar Fasciitis : Origin, Causes, Examination, Treatment of plantar fasciitisClinique du Pied CDP
http://www.cliniquedupied-md.com/en/foot-aliments/plantar-fasciitis/
Plantar fasciitis: Origins and treatment of Plantar Fasciitis - Plantar fasciitis.Plantar Fasciitis Inflammation is caused by overstretching or excessive use of the plantar fascia.
Deformities observed with Pes cavus includes :
*clawing of the toes
*posterior hind foot deformity (described as an increased calcaneal angle)
*contracture of the plantar fascia
*cock-up deformity of the great toe
Following References were used to prepare this powerpoint presentation which makes the slides accurate and relaible for studying purpose; Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
Slides includes following headings;
DEFINITION
TYPES
ORTHOPAEDIC ASSESSMENT
MEDICAL MANAGGEMENT
PHYSIOTHERAPY MANAGEMENT
SURGICAL MANAGEMENT
Decades of standing changes your feet. Much of the natural cushion of padding under your heel and the ball of your foot is lost. The arches get flatter and less flexible, your ankles and foot joints become stiffer, and your whole foot gets wider and longer.
Because of these changes, you may develop foot pain and other problems even if you never had difficulties with your feet before.
Checkout this slide to know the exact problem of your foot or visit: http://www.footsolutions.com
Disorders of the Great toe (hallux) are very important as they are very painful, causes many clinical symptoms,and very difficult to treat.The presentation compiled from various important orthopedic textbooks and international journals.
The foot is the foundation to the body. The alignment of the foot is crucial for proper foot function. This lecture discusses normal and abnormal alignment and the exact cause that leads to a faulty foot structure.
Learn more at www.GraMedica.com.
Plantar Fasciitis : Origin, Causes, Examination, Treatment of plantar fasciitisClinique du Pied CDP
http://www.cliniquedupied-md.com/en/foot-aliments/plantar-fasciitis/
Plantar fasciitis: Origins and treatment of Plantar Fasciitis - Plantar fasciitis.Plantar Fasciitis Inflammation is caused by overstretching or excessive use of the plantar fascia.
Deformities observed with Pes cavus includes :
*clawing of the toes
*posterior hind foot deformity (described as an increased calcaneal angle)
*contracture of the plantar fascia
*cock-up deformity of the great toe
Following References were used to prepare this powerpoint presentation which makes the slides accurate and relaible for studying purpose; Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
Slides includes following headings;
DEFINITION
TYPES
ORTHOPAEDIC ASSESSMENT
MEDICAL MANAGGEMENT
PHYSIOTHERAPY MANAGEMENT
SURGICAL MANAGEMENT
Decades of standing changes your feet. Much of the natural cushion of padding under your heel and the ball of your foot is lost. The arches get flatter and less flexible, your ankles and foot joints become stiffer, and your whole foot gets wider and longer.
Because of these changes, you may develop foot pain and other problems even if you never had difficulties with your feet before.
Checkout this slide to know the exact problem of your foot or visit: http://www.footsolutions.com
Learn about the latest technology of sports footwear and types of sports footwear. In addition, you will be able to understand the Concept of foot movements from the biomechanical point of view. Right type of footwear selection, Basic anatomy of foot and the sports shoes. After getting through the slides you will be in a position to get wide idea about the footwear and the importance of right footwear selection.
Healthy, happy, pain-free feet are the key to mobility as we age. Learn the steps you can take now in your daily foot care to stay on your feet and avoid foot pain for years to come.
Dr. David Medncik offers overall treatment for all foot related problems. He is specialized in Heel pain treatment, Ankle sprains and many other foot problems
PHYSIOTHERAPY for Pain relief- Faster, simple & easy methodsdraalpal
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Neck Pain and Arm Pain : Cervical Radiculopathy by Pablo Pazmino MDPablo Pazmino
This video explains Cervical Radiculopathy and Cervical Herniations. When herniations begins to affect the nerves and spinal cord this is called Cervical Radiculopathy. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Cervical Herniation/Radiculopathy feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
This power point goes over how an organization can implement and sustain a hospital wide pressure ulcer prevention program using current evidence-based practice.
Common foot and ankle injuries and diseasesCATHY WILLIAMS
At RNV Podiatry, Dr. Rachel N. Verville provides you with the best treatment for your foot and ankle problems in Plano, Frisco, and Dallas, Texas.
http://www.rnvpodiatry.com/arthritic-foot-ankle-plano-texas.html
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Your Foot
_ The feet are flexible structures of bones, joints,
muscles, and soft tissues that let us stand
upright and perform activities like walking,
running, and jumping.
_ The foot contains
26 bones
33 joints
19 muscles
107 ligaments.
3. The feet are divided into three sections
- Forefoot
- Midfoot
- Hindfoot
4.
5. Forefoot
Contains the five toes (phalanges) and the five longer bones
(metatarsals).
Midfoot
Pyramid-like collection of bones that form the arches of the
feet.
Include the three cuneiform bones, the cuboid bone, and the
navicular bone.
Rearfoot
Forms the heel and ankle.
The talus bone supports the leg bones (tibia and fibula),
forming the ankle.
The calcaneus (heel bone) is the largest bone in the foot.
6. Foot arches
Foot has three distinct arches.
Two "longitudinal" arches (one on each side)
run from front to back
One "transverse arch"
runs across the midfoot from inside to outside.
8. Functions of foot arches
- The structure of an arch is the spread the load out so it
can be supported with the least amount of effort and
material.
- Some shock absorbency,
- Prevents blood vessels and nerves from being crushed.
9. Functions of the foot
Proper functioning of the foot is required for normal
gait
10. Weight Distribution
Weight of the body is supported by the foot, and is
transmitted and distributed over 6 areas
Functions of the foot
12. • Rear foot pain
the most common cause of rear foot (inferior heel)pain is :
- Plantar fasciitis
- fat pad (Bursitis )
The less common cause of rear foot is :
- calcaneal stress fracture
-Tarsal tunnel syndrome
- lateral plantar nerve entrapment
13. • Anatomy of the Plantar Fascia
• Broad, dense band of longitudinally
arranged collagen fibers
• 3 bands: medial, central, lateral
• Origin: anterior aspect of calcaneal tuberosity
• Distally divides into 5 digital bands
at the metatarsophalangeal joints
• Each digital band pass on either side of flexor
tendons and inserts dorsally at the base of the toes.
14. • Anatomy of the Heel Fat Pad
• Within the heel pad region, particular attention is paid to the calcaneal fat pad, which is
the portion of the plantar region interposed between the calcaneus and skin that plays a
fundamental role in foot mechanics (Natali et al., 2010).
• The calcaneal fat pad is mainly organized according to a honeycomb configuration
(Jahsset al., 1992a-1992b; Snow and Bohne 2006).
• Fat tissue chambers are embedded and separated from each other by connective septa .
15. • Roles of Plantar Fascia and the heel fat pad
_ Plantar Fascia:
• is a ligament structure that supports on static the
longitudinal arch of the foot and dynamic shock absorbation
_ The heel fat pad:
• Acting as a shock absorber, protecting the
calcaneus at heel strike
16. • Pathophysiology
- Plantar Fasciitis :
• Pain on the inner-bottom of the heel.
• Decreased vascularity
• Perifascial inflammation
• Thickening of the proximal plantar fascia
- fat pad (Bursitis ) or (contusion)
• The patient often complains of marked heel pain during weight-bearing
activities
• Thick fat pad covering calcaneus bruises from sport activities
• The pain is often felt laterally in the heel due to the pattern heel strike
• Examination reveals tenderness often in the posterolateral heel region
• There may be an area of redness
17. • Physical Exam
_ plantar faciitis
• Tenderness to palpation on the
anteromedial aspect of the heel.
• Ankle dorsiflexion limited by
calf tightness.
• Pain increased by toe extension
or by standing on toes.
18. • Physical exam (con’t)
_ The heel fat pad:
• The patient often complains of
marked heel pain particularly during
weight bearing activities.
• The pain is often felt laterally in
the heel due the pattern of heel strike.
• Tenderness often in the
posterolateral heel region.
19. Causes
Plantar fasciitis :
• Occupation requiring prolonged standing.
• Pes planus (low arches flat feet) or pes cavus ( high arches).
• Activities require maximal plantar- flexion of the ankle and
simultaneous dorsi-flexion of metatarsophalangeal joints.
• in older patient Excessive walking inappropriate or non-supportive
footwear
• Obesity
• Reduced ankle dorsiflexion
20. the heel Fat pad:
• Fat pad contusion or fat pad syndrome may develop either
acutely after a fall onto the heels from a height or
chronically because of the excessive heel strike with poor
heel cushioning or repetitive stops, starts and change
direction
21. Treatment plantar fasciitis
• Avoidance of aggravating activity
• Cryotherapy after activities
• Stretching of the plantar fascia, gastrocnemius and soleus
• Night splints or strasbourg socks
• Self massage with a frozen bottle of golf ball
• Strengthening exercises for intrinsic muscles of the foot to improve
longitudinal arch support and decrease stress on the plantar fascia
• Taping
• Silicone gel heel pad
• Soft tissue therapy both to the plantar fascia and proximal myofascial
regions including calf, hamstring and gluteals
22.
23. Heel fat pad treatment
• Treatment consists primarly of avoidance of aggravating activities, in
particular,excessive weight bearing
• RICE
• Silicone gel heel pad
• Good footwear are important as a athlete
• Heel lock taping will often provide symptomatic relief.
24. Calcaneal stress fractures
• Calcaneal stress fractures are the second most common tarsal
stress fracture. They occur most commonly at two main sites:
• Upper posterior margin of the os calcis
• Adjacent to the medial tuberosity
25. Causes
• Calcaneal stress fracture were first described among the
military and are related to marching; they also occur in
runners, ballet dancers and jumpers.
Symptoms
• Patient give history of heel pain that aggravating with weight
bearing activities especially running .
• Examination reveals tenderness over the medial or lateral
aspects of the posterior calcaneus
• Pain produced by squeezing the post aspect of the calcaneus
from both sides.
26. Investigation
• X-ray may show a typical appearance on the
lateral X-ray, parallel of the posterior margin of
the calcaneus
27. Treatment
• Reduce activity
• For who with marked pain a short period of non-weight
bearing may be required
• Program of gradually increased weight bearing can occur
• Stretching of the calf muscle and plantar fascia
• Joint mobilization For long term recovery
• Soft heel pads if required are recommended
28. Lateral plantar nerve entrapment
• An entrapment of the first branch of the lateral plantar nerve occur
between the deep fascia of the abductor hallucis longus and the medial
caudal margin of the qudaratus planus muscle
• Pain radiates to the medial inferior aspect of the heel and proximally
into the medial ankle region
• Patient do not normally complain of the numbness in the heel or the
foot
• A diagnostic injection with local anesthetic will confirm the diagnosis
29. Treatment
• Treatment consist of rest
• NSAIDs and iontophoresis
• Arch support using taping or an orthosis is helpful in
athletes with excessive pronation
30. tarsal tunnel syndrome
• impingement and inflammation of the posterior tibial nerve
within the tarsal tunnel
31. 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.
• EV or PF/EV ankle injury or Forced PF
• Repetitive stress associated with pes planus foot
• Possible related factors :raining surface ,Distance ,Shoes
Symptoms
• pain, numbness, or
• parasthesia along
medial or plantar aspect
of foot
• Point tenderness
proximal, over, and
distal to the flexor
retinaculum
32. Examination
• Pain is usually aggravated by activity and relieved by rest
• Swelling , varicosities or thickening may be found on examination
around the medial ankle or heel
• A ganglion or cyst may be palpable in the tendon sheaths around the
medial ankle
• Tapping over the posterior tibial nerve (Tinel’s sign) may elicit the
patients pain and occasinally cause fasciculation
• AROM normal EV may reproduce symptoms
• PROM PF & EV may reproduce symptoms
• RROM may demonstrate weakness of toe flexors
Investigation
• Ultrasound or MRI may be required for the space-occupaying lesion as
a cause of the syndrom
33.
34. Treatment
• Conservative
_Treatment with NSAID and, if required an injection of a
corticosteroid agent into the tarsal tunnel may be helpful
_ if excessive pronation is present , an orthosis should be
utilized
• surgical
_ if there is mechanism cal pressure on the nerve a
decompression of the posterior tibial nerve and its branches
should be performed
35. Talar stress fracture
• During weight bearing activity compressive forces are placed
through the talus. When these forces are excessive, too
repetitive and beyond what the bone can withstand, bony
damage gradually occurs.
• This initially results in a bony stress reaction, however, with
continued damage may progress to a talus stress fracture.
36. Causes
• Stress fractures of the talus typically occur gradually over time with
excessive weight bearing activity such as running.
• occur following a recent increase in activity or change in training
• in athletes involved in running sports such as football and athletics.
Signs and symptoms
• deep ankle pain that increases with weight bearing activity.
• walking may be enough to aggravate symptoms.
• night ache, pain during certain movements of the foot and ankle
• pain on firmly touching the talus.
Diagnosis
• thorough subjective and objective examination from a physiotherapist
may be sufficient to diagnose a talus stress fracture.
• Investigations such as an MRI, CT scan or bone scan are usually required
to confirm diagnosis.
37. Treatment
• Reduce activity
• For who with marked pain a short period of non-weight bearing
may be required
• Program of gradually increased weight bearing can occur
• Stretching of the calf muscle and plantar fascia
• Joint mobilization For long term recovery
• Soft heel pads if required are recommended
38. Mid foot pain
• the most common cause of mid foot:
- Navicular stress fracture
- Midtarsal joint sprain
- Extensor tendinopathy
- tibialis posterior tendinopathy
• Less common causes
- Cuneiform stress fracture
- Cuboid stress fracture
- stress fracture of base second Metatarsal
- Peroneal tendinopathy
- Abductor hallucis strain
- Cuboid syndrome
39. Navicular stress fracture
• Patients who develop navicular stress fractures will present with a chronic
mid-foot ache.
• The injury may begin after a series of repetitive loading episodes.
• In sport involving sprinting,jumping,hurdling
Causes
• Overuse and training errors plays
• Impingement of the navicular bone occur
between the proximal and distal tarsal
bones when muscle exert compressing
and bending forces .
40. Symptoms
• vague arch pain with midfoot tenderness
at the ‘N-SPOT’, located at the proximal
dorsal portion of the navicular.
• the pain radiates a long the medial aspect
of the litudonginal arch or the dorsum of
the foot .
• the symptoms abate rapidly with rest.
investigation
• X-RAY in the navicular stress fracture
is poor.
• CT scan or MRI is required
41. Treatment
The treatment of navicular stress reaction is :
• Weight bearing rest, often in an air cast until symptoms and signs have
resolved
• Gradually return to activity
The treatment of navicular stress fracture is :
• not bear weight on their foot for at least 6 to 8 weeks with immobilzation
In a cast .
• At the end of this period the cast should be removed and palpate the ‘N-
SPOT’ normally will be no tender .
• Some clinician advocate surgical treatment with the insertion of a screw
where there is significant separation of the fracture.
• It is essential to mobilize the stiff ankle after the cast and soft tissue
therapay and strengthening
• Gradually return to activity
42. Extensor tendinopathy
The extensor dorsiflexion of the foot comprise the :
• Tibialis anterior
• Extonsor onghallucis Lus and brevis
• Extensor digitorum longus and brevis
• Tibialis anterior is the most common tendinopathy
Causes
• Tibialis anterior tendon resists plantarflexion of the foot and
heel strike and Is ,therefore , sucpetible to over use injury.
• Extensor muscle Weakness.
• Increase training load or compression tight shoelaces.
• Stifness of the first metatarsophalangeal and midfoot may
contribute.
43. Symptoms
• patient complains of an aching dorsal aspect of the midfoot
• Examination reveal tenderness with mild swelling
• At the insertion of the tibialis ant tendon at the base of the first metatarsal
and cuneiform.
• Resisted dorsiflexion and eccentric inversion may elicit pain .
Investigation
• ultrasound and MRI may reveal swelling of
the tendon at it is insertion and exclude the
presence of degnerative tear .
Treatment
• Rlative rest
• Soft tissue therapy
• Extensor muscle strengthening
44. Tibialis posterior tendinopathy
• starts at a muscle in the calf, runs down the inside of the lower
leg and then travels around the ankle before attaching to bones
navicular in the arch of the foot.
• helps point the foot down and in to stabilize and support the
arch of the foot.
45. Causes
• occur from overuse of the tendon where it is attached to the navicular
bones and helps to stabilize your arch. If your arch flattens out more than
normal when you walk or run you strain more your tendon.
• With excessive, repetitive loading .
• posterior tibial tendon dysfunction is more common in women and in
people older than 40 years of age. Additional risk factors include obesity,
diabetes
signs and symptoms
• Pain or tenderness on the inner
side of the shin ankle or foot.
• Pain with lifting up your foot.
• Pain walking or running .
• Resisted inversion will elicit pain and
Weakness .
46. Investigation
• MRI or ultrasound may confirm diagnosis
• And reveal the extent of tendinosis.
• In cases of suspected inflammatory tenosynovitis ,blood test for
serological martand inlammatory markers should be performed
• Treatment
• Conservative treatment consisits of:
- Control pain with ice
- Concentric and eccentric tendon loading exercises
- Soft tissue therapy to the belly muscle and tendon
- Rigid orthosis to control excessive pronation
47. - in severe cases a period of immobilization in air cast has been
prescribed to provide short-term symptom relief.
- If there is tendon rupture or failed conservative treatment
surgery is recommended.
48. Cuboid syndrome
• The cuboid is one of the small bones on the outer side of the
midfoot,due to the excessive peroneus longus the cuboid
becomes subluxated
• With an inversion sprain of the ankle this is when the foot and
heel bone are forced inwards while the cuboid is forced
outwards.
49. Sings and Symptoms
• Pain with weight bearing down the outside of the foot
• quickly changing direction, jumping or hopping and
symptoms tend to ease with rest.
• quickly changing direction, jumping or hopping and
symptoms tend to ease with rest.
• There is may a visible depression over the dorsal aspect of
the cuboid.
Treatment
• Treatment involves a single manipulation to reverse the
subluxation
• The cuboid should be pushed upward and laterally from the
medial plantar aspect of the cuboid
50.
51. Cuneiform stress fracture
• The stress fracture of the cuneiform bones are rare and
described in military recruits and athletes
• they are thought to occur secondary to repetitive loading of the
bone
Management
• Limited weight-bearing rest for the medial cuneiform
• Surgical reduction and fixation for adequate healing for the
intermediate cuneiform
52. Cuboid stress fracture
• Stress fracture of the cuboid are rare and occur secondary to
compression of the cuboid between the calcaneus and the fourth
and fifth metatarsal bones when exaggerated plantar-felxion is
undertaken
Treatment
• In absence of displacement is non weight-bearing for 4 to 6
weeks.
• Graduated return to activity
• If displacement are present surgical reduction and fixation are
required
53. Fore foot pain
Hallux valgus
• Hallux valgus means lateral deviation of great toe
• Commonest of foot deformities
• Not a single disorder; but a complex deformity of the first ray
• Frequently accompanied by deformity and symptoms in lesser toes
54. Spectrum of hallux valgus
• Varus deformity of first metatarsal
• Valgus of great toe
• Great toe bunion formation
• Arthritis of 1st MP joint
• Hammer toe
• Toes corn
• Calluses
• Metatarsalgia
• Stress fractures of lesser metatarsals
55. Causes of Hallux Valgus
• High-heeled or ill-fitting shoes
• Inherited foot type
• Foot injuries
• Deformities present at birth (congenital)
• May be associated with various forms of arthritis and an activities
that puts extra stress on the feet (eg. Bunions are common in
ballet dancers.)
57. Symptoms and Signs
• Foot pain in the involved area when walking or wearing shoes.
That is relieved by resting.
• Bulging bump on the outside of the base of big toe
• Swelling, redness or soreness around big toe joint
• Thickening of the skin at the base of big toe
• Restricted movement of big toe
• Positioning of the big toe toward the smaller toes.
58. Classification of hallux valgus
• Mann and conghlin(1993) classified HV into 3 types based on
Hallux valgus angle
– Mild: Angle < 20 degree, intermetatarsal angle usually less
than 11 degree
– Moderate: Angle 20 - 40 degree, intermetatarsal angle
between 11 and 18 degree
– Severe: Angle > 40 degree, intermetatarsal angle > 16-18
degree
59. Treatment of hallux valgus
• Management:
– Young and asymptomatic patients
• Proper fitting shoes with wide deep toe boxes
• Night splinting and other orthosis
– Once the deformity is established, it is difficult to check the progression
of disease by conservative measures.
– In more severe cases surgery may be required to reconstruct the first
metatarsophalangeal and remove the bony exostoses .
60. Hammertoes
• A hammer toe or contracted toe is a deformity of the proximal
interphalangeal joint of the second, third, or fourth toe causing it
to be permanently bent, resembling a hammer.
61. Hammertoes Causes
Wearing poorly fitting shoes that can force the toe into a bent
position (eg. High heels)
Muscle, nerve, or joint damage resulting from conditions such
as osteoarthritis, rheumatoid arthritis, stroke or diabetes
Often found in conjunction with bunions or other foot
problems
62. Hammertoes signs and sympotms
Pain with walking
Difficulty moving the toe
Corns and calluses resulting from the toe rubbing against
the inside of footwear
63. Hammertoes Conservative treatment
• New shoes with soft, spacious toe box
• Physical therapy
• Wear shoe inserts (orthotics) or pads
to reposition the toe and relieve pressure and pain.
Surgical treatment
• If the toe has become tight and inflexible
64. Morton's neuroma
• Morton's neuroma is a painful condition that affects the ball of
your foot, most commonly the area between your third and
fourth toes.
• Involves a thickening of the tissue around one of the nerves
leading to your toes.
• May occur in response to irritation, injury or pressure
65. Morton's Neuroma Symptoms
• A feeling as if you're standing on a pebble in your shoe
• A burning pain in the ball of your foot that may radiate
into your toes
• Tingling or numbness in your toes
• Pain relieved with non-weight bearing
• Toe hyperextension increases symptoms
66. Morton's Neuroma Treatment
• Ice to alleviate acute tenderness
• Arch supports and foot pads fit inside your shoe help to reduce
pressure on the nerve.
• An “Arch Cookie” pad can help to spread the metatarsals and
give the nerve more space
• Intrinsic Muscle strengthening exercises to maintain the
transverse arch .
• Injection of steroids into the painful area .
• If the patient obtains no relief, surgical excision of the damaged
nerve is indicated
67. Athlete’s foot
• Very common skin condition that affects the sole of the foot and
the skin between the toes.
• Usually a scaly, red, itchy eruption( occasionally may be weepy
and oozing.)
• Athlete's foot, also called tinea pedis, is the most common type of
fungal infection.
• Athlete's foot is contagious and can be spread by contact with an
infected person or with contact with contaminated surfaces, such
as towels, floors and shoes
68. Athlete’s foot Risk factors
• Frequently wear damp socks or tight fitting shoes
• Share mats, rugs, bed linens, clothes or shoes with someone who
has a fungal infection
• Walk barefoot in public areas where the infection can spread,
such as locker rooms, saunas, swimming pools, communal baths
and showers
• Have a weakened immune system
69.
70. Athlete’s foot.... Causes
Caused by a fungus (group of mold-like fungi called
dermatophytes ).
Can be contracted in many locations, including gyms, locker
rooms, swimming pools, nail salons, airport security lines, and
from contaminated socks and clothing
Athlete's foot is closely related to other fungal infections,
including ringworm and jock itch- change the towel when
drying off!
71. Athlete’s foot... Symptoms
Itching, stinging and burning
Cracked and peeling skin
between your toes
on the soles of the feet
Excessive dryness of the skin on the bottoms or sides of the
feet
Toenails that are thick, crumbly, ragged, discolored or pulling
away from the nail bed
72. Athlete’s foot… Treatment
• Make the infected area less suitable for the athlete's
foot fungus to grow
• Keeping the area clean and dry.
• Absorbent socks like cotton that wick water away
73. References
• Clinical Sports Medicine 4th edition Brukner & Khan Brukner & Khan McGraw-
Hill Sydney; 2009
• http://orthoinfo.aaos.org/topic.cfm?topic=a00166
• https://www.physioadvisor.com.au/8131291/stress-fracture-of-the-talus-ankle-pain-
ankle-s.htm
• www.leedscommunityhealthcare.nhs.uk/msk
• Miller CM, Winter WG, Bucknell AL, Jonassen EA. Injuries to mid-tarsal and lesser tarsal
bones. J Am Acad Orthop Surg 1998;6:249–58.
• Shindle MK, Endo Y, Warren RF, et al. Stress fractures about tibia, foot and ankle. J Am
Acad Orthop Surg 2012;20:167–76.
• Watson TS, Shurnas PS, Denker J. Treatment of Lisfranc joint injury: current concepts. J
Am Acad Orthop Surg 2010;18:718–28.