Management of Chronic Conditions in the Foot and Lower Leg 1st Edition by Keith Rome, Peter McNair ISBN 0702047694 9780702047695

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ISBN 10: 0702047694 
ISBN 13: 9780702047695
Author: Keith Rome, Peter McNair

Management of Chronic Conditions in the Foot and Lower Leg 1st Table of contents:

Chapter 1 Osteoarthritis of the Ankle Joint
Introduction
Predisposing Factors
General Risk Factors
Anatomy and Biomechanical Loading at the Ankle Joint
FIGURE 1-1 Typical in-vivo cartilage contact areas in the ankle during the stance phase of gait.
Previous Trauma
FIGURE 1-2 Example of articular cartilage at the knee compared with the ankle joint. Histological sections of full-thickness articular cartilage and subchondral bone from the femur (A) and talus (B) of a 52-year-old man that were stained with Safranin O and fast green. The relative positions of the superficial, middle and deep layers of the cartilage are shown (original magnification = 4×).
FIGURE 1-3 Radiograph of an ankle with a stage-3 pronation–abduction ankle fracture, showing lateral comminution with bending failure of the fibula after an abduction stress.
FIGURE 1-4 Chondral lesion of the talus after a stage-IV supination–external rotation fracture, as seen at arthroscopy prior to surgical reduction. The lesion exceeds 50% of the cartilage depth, and the subchondral bone is visible (a grade-IV lesion).
Limb Alignment
FIGURE 1-5 Example of a radiographic assessment to determine the coronal plane alignment of the ankle joint.
Diagnosis
History
Physical Examination
Pain
Swelling
Imaging
Impairments
Range of Motion (ROM)
Strength
Gait
Balance
Function
Quality of Life
TABLE 1-1 Typical Scores Observed for a Range of Common Scales in Individuals with Ankle Osteoarthritis
Management Strategies
Pharmacological Strategies
Acetaminophen
Non-steroidal Anti-inflammatory Drugs
Opioids
Local Intra-articular Injections
Corticosteroids.
Hyaluronic Acid.
Glucosamine
Chondroitin Sulphate
Other Analgesic Agents
Physical Strategies
Surgical Strategies
FIGURE 1-6 Microfracture at the ankle joint. Thirteen months following microfracture to the lateral margin of the talar dome, a coronal quantitative T2 map demonstrates diffuse short T2 values without colour stratification at the site of cartilage repair indicative of less normal/mature tissue.
FIGURE 1-7 Autologous osteochondral transplantation at the ankle joint. Coronal quantitative T2 map of an autologous osteochondral plug transplanted into the medial margin of the talar dome showing normal colour stratification of T2 values, at the site of cartilage repair, indicative of relative normal cartilage.
FIGURE 1-8 Total ankle joint replacement as seen on a radiograph.
Lifestyle and Education Strategies
Future Directions
Invited Commentary
References
Chapter 2 Rheumatic Diseases
Introduction
Foot Involvement In Rheumatoid Arthritis
FIGURE 2-1 Ulcerated feet.
Predisposing Factors
Diagnosis
Classification
Diagnostic Markers
Disease Activity
Blood Investigations
Imaging
History
Clinical Examination
FIGURE 2-2 Early RA with daylight sign.
Impairments and Function
Patient-reported Foot Pain, Function and Disability
The Foot Function Index
The Manchester Foot Pain and Disability Questionnaire
The Foot Health Status Questionnaire
The Foot Impact Scale
The Salford Arthritis Foot Evaluation Tool
Gait
Gait Analysis.
FIGURE 2-3 Severe valgus deformity of the rearfoot.
Kinematics
Plantar Pressure
Electromyography
Quality of Life
Management Strategies
Early Treatment Strategies in Ra
Goal-Directed Treatment Strategies
Pharmacological Strategies
Symptom-relieving Agents
Disease-modifying Agents
Conventional.
Biologic Disease-Modifying Anti-Rheumatic Drugs.
Foot Health Management
Foot Health Assessment
FIGURE 2-4 Foot-screening pathway.
Management of Plantar Callus
Footwear and Foot Orthoses
Foot Orthoses.
Footwear.
Surgical Strategies
Physical Strategies
Lifestyle and Education Strategies
Future Directions
Invited Commentary
References
Chapter 3 Gout
Introduction
Prevalence
Pathogenesis
Mechanisms of Crystal Formation and Inflammation
Natural History
Asymptomatic Hyperuricaemia.
Acute Gout.
FIGURE 3-1 The four phases of gout.
Intercritical Gout.
Chronic Gout.
Predisposing Factors
Co-morbidities
Lifestyle Factors
Gout and Osteoarthritis
Genetics
Diagnosis and Classification
Box 3-1 ACR Criteria for Gout
Diagnostic Criteria
Imaging
Box 3-2 EULAR Recommendations for the Diagnosis of Gout
FIGURE 3-2 (A, B) Monosodium urate crystals.
Radiography
Ultrasound
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)
Dual-energy CT (DECT)
Impairments
Function
Quality of Life
Management Strategies
Pharmacological Strategies
Physical Strategies
Footwear and Foot Orthoses
Surgical Strategies
Lifestyle and Education Strategies
General Patient Education
Future Directions
Invited Commentary
References
Chapter 4 Forefoot Entities
Hallux Limitus and Hallux Rigidus
Introduction
Predisposing Factors
Foot Posture and First-Metatarsal Function
First-Metatarsal Length and Position
Hallux and First-Metatarsal Morphology
Functional Hallux Limitus
Diagnosis
TABLE 4-1 Clinical-Radiographic System for Grading Hallux Rigidus
Impairments
Function
Quality of Life
Management Strategies
Pharmacological Strategies
Physical Strategies
Footwear.
Foot Orthoses.
Surgical Strategies
Cheilectomy.
Phalangeal Osteotomy.
Proximal and Distal Metatarsal Osteotomies.
Implant Arthroplasty.
Arthrodesis.
Hallux Valgus
Introduction
Predisposing Factors
Diagnosis
Impairments
Function
FIGURE 4-1 Hallux valgus grading photographs. (A) Grade 1 (no deformity); (B) grade 2 (mild deformity); (C) grade 3 (moderate deformity); (D) grade 4 (severe deformity).
Quality of Life
Management Strategies
Physical Strategies
Footwear and Foot Orthoses.
Surgical Strategies
TABLE 4-2 Operative Techniques for Hallux Valgus Surgery
Plantar Intermetatarsal Nerve Compression (Morton’s Neuroma)
Introduction
Prevalence
Predisposing Factors
Impairment and Function
Quality of Life
Diagnosis
Physical Examination
Diagnostic Imaging
Ultrasound.
Magnetic Resonance Imaging.
Plain Film Radiographs.
Histomorphological Examination
Neurodiagnostics
Management Strategies
Non-invasive Therapies
Extracorporeal Shockwave Therapy
Emerging Therapies
Injection Therapies
Corticosteroid Injection.
Alcohol Injection.
Surgical Strategies
Adverse Effects of Surgery.
Lesser Digit Deformities
Introduction
Prevalence
Predisposing Factors
Diagnosis
Physical Examination
Diagnostic Imaging and Other Modalities
Impairment and Function
Management Strategies
Non-surgical Strategies
Surgical Strategies
Future Directions
Invited Commentary
References
Chapter 5 Rearfoot Entities
Plantar Fasciitis / Plantar Heel Pain
Introduction
Predisposing Factors
Physical Predisposing Factors
Psychosocial Predisposing Factors
Diagnosis
Impairments
Pain
The Jack Test or Windlass Mechanism.
Plantar Fascia Tightness
Rearfoot Posture
Ankle Dorsiflexion and Triceps Surae Involvement
Muscle Performance
Function
Quality of Life
Management Strategies
Overview of Approach to Management
Pharmacological Strategies
Corticosteroid Injections.
Other Injection Types.
Physical Strategies
Foot Orthoses.
Taping.
Stretching and Manual Therapy.
Extracorporeal Shock Wave Therapy (ESWT).
Surgical Strategies
Lifestyle and Education Strategies
Future Directions
Tibialis Posterion Tendon Dysfunction (Adult-Acquired Flatfoot)
Introduction
Predisposing Factors
Diagnosis
Impairments
Heel-rise Test
Posterior Tibialis Muscle Performance
Medial Longitudinal (Midfoot) Arch Height
Function
Gait Performance
Quality of Life
Management Strategies
Pharmacological Strategies
Physical Strategies
Orthoses.
Surgical Strategies
Lifestyle and Education Strategies
Exercise Programmes.
Dietary Strategies.
Future Directions
Tarsal Tunnel Syndrome
Introduction
Predisposing Factors
Diagnosis
Impairments
Management Strategies
Pharmacological Strategies
Physical Strategies
Surgical Strategies
Lifestyle and Education Strategies
Future Directions
High-energy Injury Calcaneal Fracture
Introduction
Diagnosis
Impairments and Function
Quality of Life
Management Strategies
Future Directions
Calcaneal Stress Fracture
Introduction
Predisposing Factors
Diagnosis
Impairments and Function
Management Strategies
Future Directions
Invited Commentary
References
Chapter 6 Achilles Tendon
Introduction
Prevalence
Terminology
Anatomical Considerations
Pathology of Achilles Tendinopathy
Diagnosis
Symptoms
Signs
Diagnostic Imaging
Diagnostic Musculoskeletal Ultrasound
FIGURE 6-1 Musculoskeletal ultrasound of Achilles tendinopathy. Greyscale longitudinal scan of the mid-portion of the Achilles tendon. (Left) Achilles tendinopathy of the right leg showing an increase in tendon thickness, and disruption of the fibrillar pattern of the tendon (hypoechogenicity) (denoted by *). (Right) Normal Achilles tendon of contralateral leg. The letter ‘P’ on the left side of each image highlights the proximal aspect of the image. Thickness of the Achilles tendons was measured using electronic calipers: 59 mm for Achilles tendinopathy (calipers denoted by +) and 48 mm for the normal contralateral side (calipers denoted by x).
Magnetic Resonance Imaging
Impairments
Ankle Joint Dorsiflexion Range of Motion and Muscle Strength
Ankle Joint Dorsiflexion Range of Motion
Strength and Endurance of the Ankle Joint Plantarflexor Muscles
Physical Performance Measurements
Patient-Reported Outcome Measurements
FIGURE 6-2 The Victorian Institute of Sport Assessment – Achilles (VISA-A) questionnaire.
Predisposing Factors
Extrinsic Risk Factors
Inappropriate Footwear and Type of Weightbearing Surface
Type of Activity
Medications
Intrinsic Risk Factors
Age and Sex
Co-morbidity
Previous Injury
Pre-existing Tendon Abnormalities
Abnormal Lower Limb Biomechanics
Ankle Joint Dorsiflexion Range of Motion
Muscle Weakness
Genetics
Management Strategies
Lifestyle and Education Strategies
Physical Therapy Strategies
Eccentric Calf Muscle Exercise
FIGURE 6-3 Alfredson protocol for eccentric calf muscle exercise. Figures A to D show the starting position (A), the lowered position (B), and the use of the contralateral leg to lift the patient back to the starting position for the straight-knee exercise (C and D). Figures E to H show the same technique, but for the bent-knee exercise. Note the use of a block to aid the contralateral leg in lifting the patient.
TABLE 6-1 Summary of Major Findings from Clinical Trials Investigating Physical Therapies for Achilles Tendinopathy
Calf Muscle Stretching
Manual Calf Muscle Stretching.
Ankle Joint Dorsiflexion Night Splints.
Soft-Tissue Therapy
Pharmacological Strategies
Non-steroidal Anti-inflammatory Drugs and Simple Analgesics
Local Injection or Application of Corticosteroids
TABLE 6-2 Summary of Major Findings from Clinical Trials Investigating Pharmacological Interventions for Achilles Tendinopathy
Autologous Growth Factor Injections (Autologous Whole Blood and Platelet-rich Plasma)
Sclerosing Injections
Glyceryl Trinitrate Patches
Electrotherapeutic Strategies
Extracorporeal Shock Wave Therapy
TABLE 6-3 Summary of Major Findings from Clinical Trials Investigating Electrotherapeutic Strategies for Achilles Tendinopathy
Low-level Laser Therapy
Mechanical Strategies
Taping
Foot Orthoses
Heel Lifts
TABLE 6-4 Summary of Major Findings from Clinical Trials Investigating Mechanical Therapies for Achilles Tendinopathy
Footwear
Surgical Strategies
Future Directions
Invited Commentary
References
Chapter 7 Stress Fracture / Stress Reaction of the Lower Leg and Foot
Introduction
Aetiology
FIGURE 7-1 Compressive bone strains acting on the tibia during different physical activities. 1000 µε is equal to a strain of 0.1%.
FIGURE 7-2 Theoretical model of the pathophysiology of stress fracture injury.
Epidemiology
Predisposing Factors
Intrinsic Factors
Injury History
Bone Strength
Genetic and Nutritional Factors
Muscle
Biomechanics
Structure.
Function.
FIGURE 7-3 Typical vertical ground reaction forces for rearfoot- and forefoot-striking runners.
Physical Fitness
Gender
Extrinsic Factors
Training Load
Footwear
Running Surface
Diagnosis
Differential Diagnosis
History
Physical Examination
Imaging
TABLE 7-1 Image Characteristics, Advantages and Disadvantages of Tools Available to Detect Stress Reactions and Stress Fractures of the Lower Extremities
TABLE 7-2 Utility of Methods Used to Detect Stress Reactions and Stress Fractures of the Lower Extremity
Radiography
Isotopic Bone Scan (Scintigraphy)
FIGURE 7-4 Typical bone-scan appearance of a stress fracture of the tibia.
Computed Tomography
Magnetic Resonance Imaging
FIGURE 7-5 CT appearance of navicular stress fracture.
Ultrasonography
FIGURE 7-6 MRI appearance of a stress fracture of the tibia showing fracture line (arrows).
Impairments
Function and Quality of Life
Management Strategies
Pharmacological Strategies
Pain Management
Bisphosphonates
Physical Strategies
Electrotherapy Modalities
Low-intensity Pulsed Ultrasound.
Low-power Laser.
Magnetic Field Application.
Extracorporeal Shock Wave Therapy.
Bracing
Fitness Maintenance
Muscle Strengthening
Manual Therapy
Modification of Risk Factors
Gait Retraining
Surgical Strategies
Lifestyle and Education Strategies
Resumption of Impact-loading Activities
FIGURE 7-7 Schematic for the progression of activities during rehabilitation from tibial stress fracture.
Dietary Factors
Future Directions
Invited Commentary
References
Chapter 8 Cerebral Palsy
Introduction
Definition and Incidence
Predisposing Factors
TABLE 8-1 Perinatal Factors Associated with Cerebral Palsy
Diagnosis and Classification
Impairments
Changes in Muscle Tone and Movement Patterns
TABLE 8-2 Gross Motor Function Classification System (GMFCS) Levels for Children
Box 8-1 Description of Ashworth, Modified Ashworth, and Tardieu Scales
Ashworth Scale (Ashworth 1964)
Modified Ashworth Scale (Bohannon and Smith 1987)
Modified Tardieu Scale (Fosang et al. 2003)
Quality of Muscle Reaction (X)
Angle of Muscle Reaction (Y)
Definition of Velocities Used
Joint Range of Motion
Muscle Strength
Pain
Gross Motor Function and Gait
Quality of Life
Management Strategies
Pharmacological Strategies
Physical Strategies
Physiotherapy
FIGURE 8-1 Management algorithm for botulinum toxin A injections in the lower limb.
Serial Casting
FIGURE 8-2 (A–F) Example of application of a below-knee cast as part of a serial casting programme.
Orthoses
Neuromuscular Electrical Stimulation
Surgical Strategies
Equinus Deformity
Calcaneus Deformity
Equino-varus Deformity
Equino-valgus Deformity
Hallux Valgus
FIGURE 8-3 Radiographs of a 12 year old boy with equino valgus foot. (A, B) Preoperative AP and lateral weight bearing radiographs and (C) postoperative AP radiograph after lateral column lengthening and medial cuneiform plantar closing osteotomy.
Lifestyle and Education Strategies

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Tags: Keith Rome, Peter McNair, Chronic Conditions, Foot, Lower Leg