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L. Parrinello , E. Bologna

IL DOLORE DEL SOTTODISTRETTO DEL PIEDE Strategie Riabilitative. L. Parrinello , E. Bologna. XX CONGRESSO NAZIONALE SICD - ROME REHABILITATION 2011 Sindromi algiche del distretto lombo-sacrale e dell’arto inferiore. Dolore. Borsiti / Tenosinoviti / Entesopatie Tendiniti Fratture

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L. Parrinello , E. Bologna

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  1. IL DOLORE DEL SOTTODISTRETTO DEL PIEDE StrategieRiabilitative L. Parrinello, E. Bologna XX CONGRESSO NAZIONALE SICD - ROME REHABILITATION 2011 Sindromi algiche del distretto lombo-sacrale e dell’arto inferiore

  2. Dolore • Borsiti/Tenosinoviti/Entesopatie • Tendiniti • Fratture • Deformità(Piedepiatto/cavo; Allucerigido; Allucevalgo; Dita a martello/artiglio) • Metatarsalgie • Disordinimetabolici(gotta; diabete) • Patologie degenerative (OA) • Patologiereumatichesistemiche (AR-SpA) • Neuropatie/Vasculopatie • Tumori (rari)

  3. Qual è il denominatore comune per la riabilitazione? ICF

  4. Dolore-Postura

  5. Dolore-Postura A-C-D : fornisce la misura della variabilità del COP intorno alla posizione media B: costituisce un buon indice della quantità di attività richiesta per mantenere la stabilità

  6. Forpain-freeambulation, humanfeet go through a seriesofrotatorymotionsinvolvingpronation and supination Dolore-Deambulazione

  7. Dolore-Deambulazione ABDUZIONE EVERSIONE FLESSIONE DORSALE ADDUZIONE INVERSIONE FLESSIONE PLANTARE Pathologicbiomechanics are generallydividedinto excessivepronation or excessivesupination Foot pain: biomechanical basics as a guide for assessment and treatmentPhys Sportsmed. 2009 Schuster J.

  8. Dolore-Deambulazione OBESITA’ DEBOLEZZA ABD ANCA GINOCCHIO VALGO FASCITE PLANTARE Eccessiva pronazione METATARSALGIA ALLUCE VALGO TENDINE ACHILLE CORTO TACCHI ALTI SCARPESTRETTE FLEX DITA DEBOLI DISFUNZIONE TENDINE TIBIALE POST Diagramma delle relazioni tra le cause e gli effetti di una eccessiva pronazione Phys Sportsmed. 2009 Schuster J

  9. Dolore-Deambulazione DITA A MARTELLO PATOLOGIA NEUROMUSCOLARE [Charcot Marie Tooth] FRATTURE DA STRESS Eccessiva Supinazione METATARSALGIA IDIOPATICA FASCITE PLANTARE Diagramma delle relazioni tra le cause e gli effetti di una eccessiva supinazione Phys Sportsmed. 2009 Schuster J

  10. Strategie riabilitative • Perdita peso • Calzature adeguate • Modificazione attività fisica • Ortesi prefabbricate • Ortesi su calco • Tutori • Terapia fisica: Stretching/Rinforzo muscolare • Farmaci • Infiltrazioni • Mezzi fisici • Ultrasuoni • Correnti interferenziali • Laser terapia • Tecar terapia • Onde d’urto

  11. Extracorporeal shock wave therapy Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis Arch Orthop Trauma Surg. 2010 ESWT is a reasonable earlier line of treatment of chronic plantar fasciitis before EPF is tried That is to say that we can use it as a first line of treatment before surgery when conservative treatment fails to control the symptoms of plantar fascitis after 6 months. Shock wave therapy for chronic plantar fasciopathyReview 2007 D. Rompe METHODS: Randomized trials were identified form a current search of the Cochrane Bone, Joint and Muscle Trauma Group specialized register of trials, the Cochrane Central Register of Controlled Trials, MEDLINE and reference lists of articles and dissertations. We identified and retrieved a total of 17 articles. It appears that one should only consider SWT for plantar fasciopathy after more common, accepted and proven non-invasive treatments have failed.

  12. Strategie riabilitative Analisi computerizzata della deambulazione Valutazione strumentale Foot drop and plantar flexion failure determine different gait strategies in Charcot-Marie-Tooth patients.Clin Biomech 2007

  13. Trattamento riabilitativo personalizzato Introduzione di una ortesi che elimini il deficit di flessione dorsale in oscillazione preservando l’attivita’ propulsiva vista l’integrita’ dei flessori plantari di caviglia Gruppo 1 Rieducazione motoria finalizzata al mantenimento delle potenzialita’ dei gruppi muscolari attivi nel piano sagittale Migliorare e preservare il contributo dei muscoli stabilizzatori del cingolo pelvico all’equilibrio Gruppo 2 Introdurre ortesi che non si limitino a correggere il footdrop ma stabilizzino in toto il complesso articolare della caviglia

  14. Tutte le patologie del piede causano dolore/limitazione funzionale? Foot Musculoskeletal Disorders, Pain, and Foot-Related Functional Limitation in Older Person 2005 J.Am.Geriatr.Soc Most commonly assessed musculoskeletal disorders, including halluxvalgus and toe deformities, were not associated with pain or function limitation

  15. Rischio cadute Reduced toe flexor strength and the presence of toe deformities increase the risk of falling in older people. To reduce thisrisk, interventionsdesignedtoincreasestrenghtof the toeflexormusclescombinedwith treatment ofthoseolderindividualswithtoedeformitiesmaybebeneficial ISB Clinical Biomechanics Award 2009 The results indicated that, although there were no effects of toe deformities on spatiotemporal gait characteristics or postural sway, older people with hallux valgus and lesser toe deformities were found to display altered forefoot plantar pressure patterns. These findings suggest that toe deformities alter weight distribution under the foot when walking, but that the relationship between toe deformities and falls may be mediated by factors other than changes in spatiotemporal gait parameters or impaired postural sway K.J. Mickle et al. Gait & Posture 2011

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