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ortho foot and ankle dysfunction pt 3 - Coggle Diagram
ortho foot and ankle dysfunction pt 3
hallux rigidus/limitus
-conservative treatment to address strength and mobility initially
-later stages treatment focused on decreasing force to MTP
normal mobility of first ray
-same plane as lesser MT
-dorsal/plantar motion should be equal
consequences of hypomobile first ray
-pts typically present with callous on MTP and hallux
-1st ray can't DF with weight acceptance causing inc plantar pressure on 1st ray
-report pain at end of stance
windlass mechanism
from midstance to terminal stance weight is shifted to MT heads and MTPs extend tightening tissues on plantar foot and elevating arch. dorsal movement of navicular results in PF of 1st ray.
-loss of windlass occurs without PF of 1st ray resulting in laxity of MTs, metatarsalgia and/or hallux valgus
hammer toes
-MTP extension, PIP flexion
-callus on dorsum of PIP and under MT head
-hammering of 2nd toe afoten accompanied by hallux valgus
-stretching of extrinsics, strengthening intrinsics
-deeper shoe
-surgery
claw toes
-MTP extension, PIP and DIP flexion
-active extrinsics are stronger than intrinsics
-may indicate neuro disorder
-common in high arches
-stretching and surgery
-shoe modification
sesmoiditis
-active individuals
-medial digital plantar nerve runs in close proximity and may be irritated
-pain at 1st MTP, pain on extension of great toe, swelling at head of 1st MTP
metatarslagia
-acute or chronic pain involving MT heads
-prevents MTP extension
-provoked by gait
-causes: overuse, anatomic misalignment, foot deformity, degenerative changes
-cavus foot commonly seen
best conservative treatment for forefoot disorders
-change pressure distribution with MT pad
-change ill fitting shoes
-improve MTP flexion, IP extensors
-strengthen in arch supported position
neuroma
-most commonly found in 3rd webspace bw 3rd and 4th MT
-deep burning pain with paresthesias in to toes
-pain in plantar aspect of foot increased with walking
-secondary to irritation of interMT plantar digital nerve
-pain elicited with MTP extension
diagnosis
-palpation in interspace should evoke symptoms
-positive Mulders sign
-MT squeeze test
treatment
shoe modification, neurodynamics, MT pads, steroid injection, surgical neurectomy in chronic cases
protective sensation
semmes-weinstein-inability to feel 10g force is loss of protective sensation