Plantar fasciitis / cortisone injections
Athletes - soccer players, NFL
Mosca et al Foot Ankle Spec 2022
- systematic review of 155 feet
- 8% spontaneous
- 89% associated with plantar fasciitis
- 84% associated with cortisone injection
Sudden onset acute during athletics
Focal tenderness
Non-operative
Walking cast / NSAIDS
- 6/52
UCBL
- 3/12
- worn inside the shoe
- ends under malleoli
- controls the heel (which must be flexible)
- supports the arch
Operative / Synovectomy and debridement
(+/- FDL transfer and calcaneal osteotomy +/- T Achilles lengthening)
Usually occurs in patients over 60
- due to decreased vascularity & collagen weakness
Younger patient on steroids / growth hormone
Occasionally occurs in young athlete with excessive contracture
Often preceded by quadriceps tendinosis
Adolescent apophyseal avulsion
- treat non operatively
- unless displaced > 2 cm
Adult
- soft tissue avulsion
Usually associated with sporting activities
- skiing
- water skiing
Violent contraction
- knee extended
- hip flexing
LHB primary function is humeral head depressor
Also accelerate / decelerate arm in overhead sports
Biceps problems usually occur with other pathology
- rotator cuff / instability
3 main problems
1. Degeneration
1. Flexor Tendon Rupture
2. Adhesions
3. PIPJ contractures
4. Triggering
5. Pulley failure
6. Quadrigia
5%
FDS only
Extremely common
- 90% by 10 years have wrist problems
Landsmeer 1961
- treat wrist at same time as treat fingers or will recur
Frequently combine procedures
- synovectomy
- tendon transfer
- ulna procedure
Usually occurs in young people
- often previous history of tendonitis ± steroid injections
Usually at level of inferior pole of patella
- less common at tibial tubercle
- mid-substance ruptures rare
Severe pain
Palpable defect
Extensor deficit / unable to SLR
Patella alta / high riding patella