A Review of the Treatment and Prevention Options for Medial Tibial Stress Syndrome

Medial Tibial Stress Syndrome (MTSS) is a chronic lower-limb injury that effects a large population of athletes and exercisers. There is no definitive knowledge on what causes this injury, making prevention and treatment difficult. The purpose of this thesis is to identify the prevention and treatment methods for MTSS that seem the most promising. The risk factors of MTSS and possible preventative methods are first presented. Following this is an overview of both traditional and cutting-edge treatment options. One of the major conclusions reached in this thesis is that prevention of MTSS is often easier than treating it after onset. This thesis therefore highlights the need for a shift in emphasis from treatment to prevention of MTSS and presents practical ways to do so. This thesis also points to the need for continuing research, especially into less conventional treatment methods

Short Term Effect of Kinesiotaping in Children with Flexible Flat Foot

BACKGROUND: Flatfootmay exist as an isolated pathology or as part of a larger clinical entity. These entities include generalized ligamentous laxity, neurologic and muscular abnormalities, genetic conditions, collagen disorders and structural disorder. Flat foot is found to be associated with pronated foot. OBJECTIVE: The aim of the study was to determine the short term effect of kinesiotaping and custom made medial arch support in correcting flexible flatfoot. METHOD: A quasi experimental pre-posttest design was adopted for the study in which 20 children with flexible flatfoot were recruited out of which 10 children in the experimental group underwent kinesiotaping and 10 children in the control group were provided with medial custom made medial arch support. The study duration was 4 weeks wherein the tests were conducted across four timelines-pretest, mid test, posttest and a final follow up test. The scales administered were ChippauxSmirak Index and Navicular Drop test. There were 6 sessions of intervention wherein the tape was applied for three days a week after which a one day gap was given. RESULTS: Experimental group showed significant in reduction of CSI and NDT. No significant difference was found between groups (p>0.05).However, the reduction of CSI and navicular drop test was slightly more in experimental group when compared with control group. CONCLUSION: The study concluded that kinesiotaping and custom made medial arch were found to be effective in children with flexible flatfoot preschool aged children aged 3-6 years

A Study on the Effectiveness of Myofascial Release and Kinesio Taping in the Management of Pain and Range of Motion among Medial Tibial Stress Syndrome Subjects

INTRODUCTION: Shin Splints, also known as medial tibial stress syndrome (MTSS) is defined by the American Academy of Orthopaedic surgeons as “Pain along the inner edge of the shin bone. Researchers limited shin splints strictly to musculotendinous lesions of the leg. He included lesions of the tibialis anterior, extensor hallucis longus and extensor digitorum as anterior shin splints, lesions involving the posteromedial leg musclestibialis posterior, flexor hallucis longus, flexor digitorum longus and soleus are part of the posterior shin splint syndrome because there lesions often involve the periosteum as well, they will be clarified as part of what is known as medial tibial stress syndrome OBJECTIVES: 1. To find out the effectiveness of myofascial release in the management of shin pain among medial tibial stress syndrome subjects. 2. To find out the effectiveness of taping in the management of shin pain among medial tibial stress syndrome subjects. 3. To compare the effectiveness of myofascial release and tapingin the management of shin pain among medial tibial stress syndrome subjects. 4. To find out the effectiveness of myofascial release in the management of ankle range of motion among medial tibial stress syndrome subjects. 5. To find out the effectiveness of taping in the management of ankle range of motion among medial tibial stress syndrome subjects. 6. To compare the effectiveness of myofascial release and taping in the management of ankle range of motion among medial tibial stress syndrome subjects. METHODOLOGY: Study Setting: The study was conducted in Physiotherapy outpatient department of RVS College of Physiotherapy. Selection of Subjects: Twenty medial tibial stress syndrome subjects who fulfilled the inclusion and exclusion criteria were selected for the study and consecutively assigned in to two equal groups, Group A – Myofascial Release, Group B – Kinesiology Taping. Study Design: Pre-test and post-test experimental study design. Inclusion Criteria: • Clinically diagnosed MTSS subjects. • Both sexes are includes. • Subjects with Age group 20 – 30. • Actively involved in sports. 3.7 Exclusion Criteria: • Stress fractures. • Burns. • Deep vein thrombosis. • Taking blood thinning medications. • Nerve damage. RESULTS: Twenty clinically diagnosed medial tibial stress syndrome subjects were taken and divided in to two equal groups A and B. Group a were treated with myofascial release and group B were treated with kinesio taping for a period of two weeks. Pain and dorsiflexion range of motion were measured before intervention and after two weeks by VAS and goniometry respectively. CONCLUSION: Twenty medial tibial stress syndrome subjects were selected for the study and consecutively divided in to two equal groups group A and B. Group A subjects were treated with myofascial release and group B by kinesio taping for a period of two weeks. Shin pain and ankle dorsiflexion range of motion of all the subjects were measured at the beginning of the study and at end of two weeks intervention. Shin pain and ankle dorsiflexion range of motion were measured by visual analog scale and goniometry respectively. The statistical results of the study revealed that both the techniques are effective in reducing pain and improving statistical among medial tibial stress syndrome subjects. But when comparing both there is no significant difference between two interventions

Ankle-Foot Arthropathies

This chapter will focus mainly on the commonly found arthropathies in the ankle and foot, the pathology of the disease, its diagnosis, management and goals of management. The aim of this chapter is to understand how the basic anatomy of the joint is affected in these disorders and its effect as a whole. The learning objectives are as follows: (1) Learning the basic relevant anatomy of ankle and foot, (2) Discuss the causes, diagnosis, investigations and general prognosis. (3) Understanding its impairments, and (4) Providing a framework for the treatment and rehabilitation. It will cover the commonly found congenital and acquired conditions occurring at the ankle and foot

Investigation of the differences in foot and ankle characteristics of patients with lower limb osteoarthritis : implications for clinical practice

To date, the foot posture of patients with lower limb osteoarthritis (OA) has not been explored from an orthopaedic perspective. In other medical fields such as neurology and sports medicine, a relationship between foot posture, gait and pathology has been acknowledged. In view of the current high incidence of lower limb OA, investigation of any differences in foot posture in patients with lower limb OA that may lead to improved assessment and conservative management is worthy of consideration. The first component of the thesis investigated a clinically observed difference in the foot posture of 60 patients with hip OA, 60 patients with medial compartment osteoarthritis of the knee (MCOA) and 60 healthy volunteers using an observational study. A significant difference in foot characteristics was demonstrated. Patients with hip OA demonstrated a lack of dorsiflexion and a greater degree of calcaneal inversion, presenting with a supinated foot. Patients with MCOA demonstrated ample dorsiflexion and a greater degree of calcaneal eversion, presenting with a pronated foot. In general, the healthy volunteers demonstrated average dorsiflexion and average calcaneal eversion and this gave the appearance of a normal foot. This did not, however, provide evidence of any causal relationship. A pre and post operative observational study of 55 patients with MCOA who underwent the Oxford unicompartmental knee arthroplasty was then undertaken. As a result of this surgery there is a major correction of varus to valgus knee orientation which is significant clinically and statistically. Although there is a major change in knee orientation, this study showed that the foot posture was not altered. This study also does not provide evidence that foot posture is causal in the development of MCOA. It does, however, give an indication of the robustness of the foot postures of these patients. The second component of the thesis was concerned with clinical outcome measures for the assessment of foot posture in patients with lower limb OA. Currently there is no standard practice for physiotherapists. Routine examination of the foot is rare. Two systems of measurement: (a) The Foot Posture Index and (b) the F-Scan in-shoe pressure measurement system were examined in detail with a cohort of patients with lower limb osteoarthritis. The two measurement systems were found to be useful in a clinical setting and sensitive enough to support the findings in Component 1 of the thesis. In addition, the use of the Foot Posture Index score allowed investigation of the relationship between foot posture and talocrural dorsiflexion. A high degree of talocrural dorsiflexion corresponds with a positive FPI score indicating a pronated foot. A low degree of dorsiflexion corresponds with a negative FPI score indicating a supinated foot. This is the first time that talocrural dorsiflexion has been shown to be associated with foot posture, although previously it has been accepted anecdotally in clinical podiatry. The third component was a systematic review which explored the current clinical practice of using lateral wedges in the conservative management of MCOA by orthopaedic surgeons. This contrasts with the use of medial wedges in the world of sports medicine, physiotherapy and podiatry to correct over-pronation problems. As the foot posture of patients with MCOA had been shown to be pronated, it was felt necessary to examine the evidence for the use of lateral wedges. The systematic review found no strong evidence to support the use of lateral wedges in the conservative management of MCOA. Finally, the main findings of the thesis are discussed, the findings summarised and suggestions made for clinical practice and further research

A case study of the Physiotherapy treatment after Hallux valgus operation.

FyzioterapieFaculty of Physical Education and SportFakulta tělesné výchovy a sport

Bibliographic Comparison of the Treatments in Children with Flatfoot

Treball Final de Grau de Podologia, Escola Universitària d'Infermeria, Universitat de Barcelona, curs: 2014-2015, Tutor: Laura Pérez PalmaBackground: The flat foot is a common syndrome seen in the practice of pediatric health and there is no universally accepted definition and precise to define flat feet therefore the main aim of this study is better understand and manage paediatric flatfoot to make the best diagnosis, to find evidence supporting use of custom made orthotics by using the latest research available and to clarify if there is any difference in development between children with flat feet who receive a treatment for pes planus in scholar and pre-schooler and the ones that do not. Methods: The studies included in this bibliographic review examine the association between pes planus in children and the ideal treatment for those cases. Studies included were from 2006 to 2015 to ensure up-to-date results. Patient case studies between 3-14 years and adolescents up to 17 years old were used. Results: 45 studies were found with the selected keywords, 25 were excluded because they didn't meet the selection criteria. Of the 20 remaining studies, 12 were of conservative treatments for Pes planus, 2 of surgical treatments and 6 were articles related to factors that would potentially be useful as a part of a treatment. We classified the treatments listed in the studies as surgical or conservative. Conclusion: Flatfoot has a good established clinical term and a common diagnosis but there is a lack of consensus on the methods of evaluation. Flexible asymptomatic flatfoot in children under the age of seven, does not need use orthotic insoles, but periodically observation. Symptomatic flexible flatfoot should be treated with activity modification, stretching exercises and orthoses. If the response is not satisfactory, surgical intervention should be considered. Conservative management for rigid flatfoot indicated if it’s asymptomatic, but when nonsurgical options failed, operative interventions are warranted for painful flatfeet. Age is the primary predictor for flatfoot and the weight it’s a factor of prevalence. Patient’s control that didn’t follow any treatment (younger and older than 6 and older) reported improvement as wel

The effect of foot orthoses on muscle activity and morphology, foot biomechanics and skin sensitivity

Foot orthoses with a medial wedge or medial arch support are commonly used to treat musculoskeletal pathologies by altering external forces applied to the foot, which could consequently alter internal forces generated by muscles. However, little is known about whether systematic changes in foot orthosis geometry result in systematic changes in activation of lower limb muscles. This PhD investigated the effects of foot orthoses on selected lower limb muscles. A systematic review was conducted to establish if evidence exists that footwear, foot orthoses and taping alter lower limb muscle activity during walking and running. The review identified some evidence that foot orthoses can decrease activity of tibialis posterior in early stance and possibly increase activity of peroneus longus in mid-late stance, while not altering activity of other lower limb muscles. Findings concerning the peroneus longus were limited by previous reports of the poor reliability of EMG recordings from this muscle. A reliability study was thereafter conducted to demonstrate a reliable protocol for recording EMG from the peroneus longus, using ultrasound guidance and small surface sensors to improve results. This technique was used in the subsequent study on the effect of foot orthoses on lower limb muscle activity. A study of the immediate effect of foot orthoses was undertaken, with the aim of establishing whether medial heel wedging and increased medial arch height affect EMG of shank muscles and foot and ankle moments/motion. Muscle activity was recorded from 23 healthy participants using surface EMG and fine-wire EMG (tibialis posterior) in combination with kinematic and kinetic data during walking in shoes with four different foot orthoses. Tibialis posterior activity decreased in early stance by 17% (p=0.001) with a Salfordinsole orthosis with an additional 8 mm increase in medial heel wedging and by 14% (p= 0.047) with a Salfordinsole orthosis with both a 6 mm increase in arch height and an 8 mm increase in heel medial wedging. The reduced tibialis posterior activity with medial wedging in combination with reduced external ankle eversion moment provides a possible link between foot orthosis design and biomechanical effect and could be used to inform treatment practice. Building on the literature review and the results of the immediate effects study, it was hypothesised that altered loading of the foot with long term use of foot orthoses would alter the mechanical work required of internal structures. The purpose of the final study in this PhD was to investigate any effect of using foot orthoses over three months on soft tissue morphology and skin sensitivity. Twenty three healthy participants wore an orthosis that changed peak pressure in the medial arch and the heel by 8%, while nineteen healthy participants continued to wear their convention footwear. There were no changes in skin sensitivity, or the thickness and cross sectional area of intrinsic foot muscles and connective tissue after three months of orthoses use. This finding provides evidence to challenge the view held by some that foot orthoses make muscles smaller (and weaker)