This document discusses overuse syndrome and nonoperative management of ankle joint injuries. It begins by defining overuse syndrome as degeneration without inflammation due to repetitive microtrauma or biomechanical stresses. Potential causes of overuse syndrome include obesity, muscle imbalances, improper footwear, and changes in exercise routines. Common related pathologies are then described, such as plantar fasciitis, Achilles tendinopathy, and shin splints. The management section outlines a protection phase using immobilization, orthotics, and avoiding aggravating activities. Later phases focus on controlled motion, strengthening, stretching exercises, and a home exercise plan. Several clinical tests are also detailed to help diagnose specific conditions like plantar fasciitis and Ach

1. OVERUSE
SYNDROME AND
NONOPERATIVE
MANAGEMENT
FOR ANKLE JOINT
QURATULAIN MUGHAL
BATCH IV
DOCTOR OF PHYSICAL THERAPY
ISRA UNIVERSITY

2. CONTENTS
• OVERUSE SYNDROME
• BIOMECHANICAL STRESSES
• PREDISPOSING FACTORS
• REALATED PATHOLOGIES
• CAUSES
• MANAGEMENT
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3. OVERUSE SYNDROME
• Also described as degenerative without inflammation.
• Occurs due to repetitive microtrauma, biomechanical stress
or overload.
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4. BIOMECHANICAL STRESSES
• Obesity.
• Work habits.
• Faulty alignment of lower extremity.
• Muscles imbalance or fatigue.
• Changes in the exercise or functional routines.
• Training errors.
• Improper foot wear for the ground.
• Functional demand placed on feet.
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5. PREDISPOSING FACTORS
• Painful syndromes is due to excessive pronation of subtalar joint
during weight-bearing activities.
CAUSES OF PRONATION:
 Excessive joint mobility.
 Leg length discrepancy.
 Femoral anteversion.
 External tibial torsion.
 Genu valgum.
 m/s flexibility.
 Strength imbalance in lower extremity.
 Hypomobile gastrocnemius-soleus complex.
Pronation is the
combination of
dorsiflexion, eversion
and abduction
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6. RELATED PATHOLOGIES
1. HEEL PAIN
2. TENDINOSIS, TENDONITIS &
TENOSYNOVITIS
3. SHIN SPLINTS
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7. HEEL PAIN
• ACFAS published a revised CPG that categorizes mechanical
heel pain as:
1. PLANTAR HEEL PAIN: plantar fasciitis, plantar fasciosis
and heel spur.
2. POSTERIOR HEEL PAIN: insertional achilles tendinopathy
and bursitis.
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8. PLANTAR FASICIITIS
• Pain is felt on plantar aspect of the heel. Where the plantar
fascia inserts on the medial tubercle of the calcaneous.
• The site is very tender to palpation.
• Pain occurs on initial weight-bearing after periods of rest,
then decreases, but returns as weight-bearing activity
increases.
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9. ASSOCIATED IMPAIRMENTS
• Hypomobile gastrocnemius-soleus m/s.
• Plantar fascia pain.
• Restriction when extending the toes creating the windlass
effect.
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10. PREDISPOSING FACTOR
• High body-mass index.
• Inappropriate footwear.
• Flexible flat foot(pes planus).
• High arch(cavus foot).
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Heel spur may
develop at the
site of irritation
on the
calcaneus.
Causing pain
during heel
strike

11. ACHILLES
TENDINOPATHY
ACHILLES
BURSITIS
ACHILLES
TENDINITIS
•PAIN: midportion of tendon 2-
6cm proximal to the insertion on
the calcaneus or at calcaneal
insertion.
•ASSOCIATED IMPAIRMENTS:
decreased ankle dorsiflexion,
decreasesd strength in ankle
plantar flexion, increased foot
pronation.
•RISK FACTORS: obesity, HTN,
DM.
•SYMPTOMS: pain, stiffness in
tendon, decreased ROM initially
but increased with additional
activities.11

12. • TENDINOSIS: degeneration of a tendon from repetitive
microtrauma; collagen degeneration without inflammation.
• TENDONITIS: scarring or calcium deposits in a tendon.
• TENOSYNOVITIS: inflammation of the synovial sheath covering a
tendon.
SIGN AND SYMPTOMS:
• Pain after repetitive activity.
• Pain when resistance is applied on the site of lesion.
• Posterior tibial tendon is common source of pain leads impaired
walking and acquired foot flat deformity.
• Also tibialis tendon, peroneus tendon associated with running,
tennis and basketball.
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13. SHIN SPLINTS
• This term is used to described activity-induced leg pain along the
posteriomedical or anteriolateral aspect of proximal 2/3 of tibia.
• Include different pathological condictions:
 Musculotendinitis.
 Stress fractures of tibia.
 Periosteitis.
 Increased pressure in muscular compartment.
 Irritation of interosseous membrane.
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14. TYPES
A. ANTERIOR SHIN SPLINT
• Overuse of anterior tibialis m/s.
• Most common type of shin splint.
• Hypomobile gastrocnemius-soleus
complex.
• Weak ant.tibialis m/s along with
Foot pronation.
• Pain with active dorsiflexion and
when m/s is stretch in plantar
flexion.
B. POSTERIOR SHIN SPLINT
• Tight astrocnemius-soleus
complex .
• Weak or inflamed post.tibialis m/s
along with foot pronation .
• Associated with posteriomedial
shin splints.
• Pain in passively dorsiflexion with
eversion and active supiation.
• m/s fatigue with vigorous
exercise.
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16. MANAGEMENT(PROTECTION PHASE)
• Immobilization with the cast or splints with the foot slightly
plantarflexion or use of heel lift.
• Custom orthotic inside the shoe may relieve stress.
• Cross-friction massage .
• Electrical stimulation.
• AROM within painfree range.
• Avoid activities that provoke pain.
• Use supportive tapping.
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17. CONTROLLED MOTION AND RETURN TO
FUNCTION PHASES
• When Symptoms will become subacute:
• Examine for deformity.
• Strength all m/s of L/L.
• Stretching exe.
• Improve m/s performance by resistive isometric-dynamic
resistive-close & open chain exe.
• Orthotic devices.
• Educate pt.
• Home plan for pt.
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18. DIAGNOSTIC TEST FOR PLANTAR
FASCIA
• WINDLASS TEST:
 A “windlass” is the tightening of a rope or cable.
 The plantar fascia simulates a cable attached to the calcaneus and the
metatarsophalangeal joints.
 This winding of the plantar fascia shortens the distance between the calcaneus and
metatarsals to elevate the medial longitudinal arch.
 A positive windlass test: heel pain reproduced with passive dorsiflexion of the toes.
CAN PERFORM IN:
• Weight bearing position
• Non weight bearing position
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21. DIAGNOSTIC TEST FOR ACHILLES
TENDON
• Thompson test or Simmonds-Thompson test:
 is used in lower limb examination to test for the rupture of
the Achilles tendon.
PROCEDURE:
 The patient lies face down with feet hanging off the edge of
the bed.
 If the test is positive, there is no movement of the foot
(normally plantarflexion) on squeezing the corresponding
calf, signifying likely rupture of the Achilles tendon.
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23. DIAGNOSTIC TEST FOR SHIN SPLINTS
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24. REFERENCE
• THERAPEUTIC EXECRISE:KISNER AND COLBY
6th edition
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26. ANY QUESTION?????
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