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30 minutes Initial C onsultation

30 minutes Initial C onsultation. Identify the What, Why & How Soft tissue management of lower limb injuries Lisa Mayo lisamayo@lanecovepodiatry.com.au. PAIN. What is pain? Where does it come from? How can we influence pain perception? Why does pain change?. Hunt for the WHAT.

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30 minutes Initial C onsultation

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  1. 30 minutes Initial Consultation Identify the What, Why & How Soft tissue management of lower limb injuries Lisa Mayo lisamayo@lanecovepodiatry.com.au lisamayo@lanecovepodiatry.com.au

  2. lisamayo@lanecovepodiatry.com.au

  3. PAIN • What is pain? • Where does it come from? • How can we influence pain perception? • Why does pain change? lisamayo@lanecovepodiatry.com.au

  4. lisamayo@lanecovepodiatry.com.au

  5. Hunt for the WHAT • What are you dealing with? • Know you anatomy this will reduce your options when identifying the structure involved. • Identify any underlying pathology that may complicate the diagnosis – reactive arthritis, infection, allergies. Think inflammation • Lower limb pathomechanics will influence injury and recovery. lisamayo@lanecovepodiatry.com.au

  6. WHY Get a good history of the injury • How did the injury occur • What were you doing • Where is the pain • What were you wearing • Note any lifestyle changes – footwear, activity, work demands or changed training routine lisamayo@lanecovepodiatry.com.au

  7. HOW ? • Once a diagnosis has been made a treatment plan for acute management, rehabilitation and long term management is required. lisamayo@lanecovepodiatry.com.au

  8. Case Study 1 • Posterior leg pain lisamayo@lanecovepodiatry.com.au

  9. lisamayo@lanecovepodiatry.com.au

  10. History • 50 year old Female. No medicaltions, no allergies . Good health reported • “Stood up from a chair and felt something go snap in my leg.” - Was unable to weight bear / get heel to the ground. Marked bruising in leg – posterior and mediolateral ankle. Pain on palpation musculotendinous junction of achilles. lisamayo@lanecovepodiatry.com.au

  11. Assessment • Ability to weight bear yes /no • Pain report. Type of pain – stabbing throbbing burning shooting ? • What are we testing? • Functional testing- quality of joint range of motion/ pain / inhibition • Muscle strength testing active/ resisted • Anything else? lisamayo@lanecovepodiatry.com.au

  12. Differential Diagnosis • Achilles rupture/tear • Plantaris rupture/tear • Achilles tendonosis • Tibial nerve entrapment • DIAGNOSIS???? lisamayo@lanecovepodiatry.com.au

  13. Treatment • Referred for Ultrasound • Trigger points gastrocnemius and soleus and flexor digitorumlongus. Stretch and spray • Roc Tape • Issued BK walking boot with 15 mm heel lift • RICE lisamayo@lanecovepodiatry.com.au

  14. Treatment lisamayo@lanecovepodiatry.com.au

  15. lisamayo@lanecovepodiatry.com.au

  16. lisamayo@lanecovepodiatry.com.au

  17. Case Study 2 • 53 year male with 2 year history of heel pain • No history of trauma • No allergies good health reported • Previous imaging had inidcatedplantrfasciiits • No pain on palpation of plantarfascia • Lateral plantar heel pain lisamayo@lanecovepodiatry.com.au

  18. Differnetial Diagnosis • Plantarfasciits • Plantar fat pad atrophy • Baxters Nerve entrapment – inferior calcanel nerve entrapment • Achilles insertionaltendonosis lisamayo@lanecovepodiatry.com.au

  19. Diagnosis • Combination heel pain • Plantar fat pad atrophy with associated Inferior calcaneal nerve entrapment lisamayo@lanecovepodiatry.com.au

  20. Trigger points associated with plantar heel pain Quadratus Plantae Abductor Hallucis . Pain pattern referred from TrPs at commonly observed locations in abductor hallucis & Quadratus Planate (Travell & Simons, 1992). lisamayo@lanecovepodiatry.com.au

  21. Trigger points associated with plantar heel pain cont. Soleus Gastrochnemius . Pain pattern referred from TrPs at commonly observed locations in the soleus and gastrocnemius muscle (Travell & Simons, 1992). lisamayo@lanecovepodiatry.com.au

  22. Abductor Hallucis and Quadratus Plantae needling lisamayo@lanecovepodiatry.com.au

  23. Abductor Hallucis Needling lisamayo@lanecovepodiatry.com.au

  24. Medial gastroch trigger and quatratusplantae Trp1 GastrochnemiusQuadratus Plantae lisamayo@lanecovepodiatry.com.au

  25. Quadratus Plantae Trigger Points lisamayo@lanecovepodiatry.com.au

  26. Additional treatment • Pedal joints and neural structures mobilized • Single leg balance strength and proprioception exercises • Intrinsic strength exercises and fascial rolling • Roc tape to support • Full biomechanical assessment and casting for orthoses lisamayo@lanecovepodiatry.com.au

  27. Cast Study 3 • 56 year old female with right medial ankle and lower leg pain. • Previous history of bilateral bunions and pain, skiing injury to right knee and associated reconstruction. • Onset of pain associated with 5km urban walk – in sandal. lisamayo@lanecovepodiatry.com.au

  28. Assessment • Loss of quality and range of ankle joint and subtalar joint motion. Limited inversion available • Inability to stand on one leg and elevate heel • Asymmetry of foot posture with loss of ILA height right > left, abduction of forefoot on the rearfoot right > left • Pain on palpation distal 1/3 medial aspect of the tibia, discrete tenderness at navicular medial plantar aspect. lisamayo@lanecovepodiatry.com.au

  29. Treatment Neural and pedal joint mobilization Trigger points Tibialis Posterior, Flexor Digitorumlongus and peroneals needled stretch and spray Rock Tape Home strength and balance program ASO Brace Assessment and casting for orthoses lisamayo@lanecovepodiatry.com.au

  30. Case Study 4 – What are we treating ? lisamayo@lanecovepodiatry.com.au

  31. Interossei and Flex Dig Brev lisamayo@lanecovepodiatry.com.au

  32. Case Study 5 • Pain sub 2nd MPJ • Increased walking activity • Testing/assessment • Differential diagnosis? • Treatment options? • Home management? • Footwear advice? lisamayo@lanecovepodiatry.com.au

  33. Flexor/Extensor DigitorumLongus lisamayo@lanecovepodiatry.com.au

  34. Case Study 6 lisamayo@lanecovepodiatry.com.au

  35. Peroneal Trigger Points lisamayo@lanecovepodiatry.com.au

  36. Case Study 7 • Anterior ankle pain • Pedal joint hypermobility • Bilateral HAV • Retracted lesser digits • Hospitality industry • Lace up Brooks Addiction shoes • WHAT? WHY? HOW? lisamayo@lanecovepodiatry.com.au

  37. Tibialis Anterior trigger points lisamayo@lanecovepodiatry.com.au

  38. Case Study 8 • Bilateral HAV, right painful • Left lateral ankle pain and swelling • Inversion ankle injury 20 years ago lisamayo@lanecovepodiatry.com.au

  39. Treatment • Pedal joints mobilized • Trigger points EHL,EDL FHB and peroneals • Taped – left abductor hallucis and right lateral ankle Roc tape used • ASO ankle brace issued • Referred for X ray and ultrasound • Bunion splints made • Assessment and casting for orthoses • home intrinsic exercise strength and balance program lisamayo@lanecovepodiatry.com.au

  40. Treatment of 1stmpj and lateral ankle pain lisamayo@lanecovepodiatry.com.au

  41. Treatment lisamayo@lanecovepodiatry.com.au

  42. THANK YOU lisamayo@lanecovepodiatry.com.au

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