Foot and ankle injuries
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Foot and Ankle Injuries. Ankle Sprains. Most common lower leg injury Classified as to degree of ligamentous severity. Lateral ankle sprain . Mechanism: Inversion and plantar flexion Anterior talofibular ligament (ATF) usually first structure to injury

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Foot and Ankle Injuries

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Foot and ankle injuries

Foot and Ankle Injuries


Ankle sprains

Ankle Sprains

  • Most common lower leg injury

  • Classified as to degree of ligamentous severity


Lateral ankle sprain

Lateral ankle sprain

  • Mechanism:

    • Inversion and plantar flexion

  • Anterior talofibular ligament (ATF) usually first structure to injury

  • Calcaneofibular ligament (CF) is usually secondary

  • Posterior talofibular ligament (PTF) rarely injured


Lateral ankle sprain1

Lateral ankle sprain

  • Signs/Symptoms:

    • Obvious mech. of injury

    • Report of “popping” or “tearing” of tissue

    • Rapid swelling and point tenderness over soft tissue

    • Be careful of possible fracture


Medial ankle sprain

Medial ankle sprain

  • Less common

  • Mechanism:

    • Eversion

  • Deltoid ligament injury


Medial ankle sprain1

Medial ankle sprain

  • Signs/Symptoms:

    • Pain and swelling not as evident

    • Point tenderness over deltoid


Syndesmosis ankle sprain

Syndesmosis ankle sprain

  • Separation/widening of distal tibiofibular joint

  • Injury to Anterior/Posterior tibiofibular ligaments

  • Usually very disabling

  • “High” ankle sprain

  • Mechanism:

    • Dorsiflextion with inversion or eversion


Syndesmosis ankle sprain1

Syndesmosis ankle sprain

  • Signs/Symptoms:

    • Similar to lateral/medial ankle sprains

    • Point tender at bony junction – top of ankle

    • Swelling over medial/lateral malleoli


Fractures

Fractures

  • May occur anywhere in foot

  • Common at the base of 5th Metatarsal (Jones Fracture)

    • Usually result of forceful landing from jumping

    • May be considered an avulsion fracture from an inversion ankle sprain

    • Treatment is extremely controversial


Turf toe

Turf Toe

  • First Metatarsaophalangeal (MTP) Sprain

  • Common with artificial surfaces

  • Mechanism:

    • Hyperextending the MTP join or

    • Contact with the shoe end


Turf toe1

Turf Toe

  • Signs/Symptoms:

    • Pain and Tenderness

    • Swelling on the Plantar joint aspect

    • Discomfort with toe extension

  • Treatment

    • Cryotherapy, NSAIDS, Rest

    • Protection from mechanism


Chronic conditions

Chronic Conditions


Bunions hallux valgus

Bunions (Halluxvalgus)

  • Inflammation and thickening of the medial aspect of the MTP joint of the hallux

  • MTP joint becomes inflamed and causes lateral displacement of the hallux

  • As the condition progresses the 1st toe may overlap the 2nd toe

  • Predisposing factors

    • High heels, pointed shoe box, poor shoe fit

  • Management

    • Strapping of the hallux

    • Wider toe box

    • Surgical correction


Plantar fasciitis bone spur

Plantar Fasciitis (Bone spur)

  • Most common hindfoot problem in runners

  • Main support for longitudinal arch

  • Structurally weak near the origin attachment

  • Predisposing factors

    • Significant increase in training

    • Excessive tightness in Achilles tendon

    • Abnormal change in body weight

    • Pescavus (high arch)


Plantar fasciitis bone spur1

Plantar Fasciitis (Bone spur)

  • Signs/Symptoms

    • Pain is usually most sever during the first step in the morning

    • Discomfort is reduced throughout the duration of the day

    • Extreme point tenderness over origin

  • Management

    • Therapeutic modalities (e-stim, ultrasound)

    • Achilles tendon stretching

    • NSAIDS

    • Heel lifts, taping, orthodics

    • Night splints

    • MD referral


Achilles tendonitis

Achilles Tendonitis

  • Result of repetitive jumping or running (Loooooong distance runners)

  • Signs/Symptoms

    • Thickening of surrounding tissues

    • Crepitation with tendinous movement

    • Reduced ROM

  • Management

    • Ice therapy, NSAIDS

    • Active stretching, Heel lifts

    • Complete resolution of symptoms prior to return

    • A chronic weakness will progress to rupture


Medial tibial stress syndrome shin splints

Medial Tibial Stress Syndrome(Shin splints)

  • Early, painful component of first part of a training activity

  • Associated with repetitive activity on hard surfaces

  • Contributing factors

    • Muscled inflexibility

    • PesPlanus (Low arch)

    • Poor footwear

    • Dramatic change in training or surface

  • Signs/Symptoms

    • Pain along medial tibial border

    • Usu. Lower 1/3 of shin

    • Common for bilateral symptoms


Medial tibial stress syndrome shin splints1

Medial Tibial Stress Syndrome(Shin splints)

  • Management

    • Rule out stress fractures

    • Cryotherapy, NSAIDS

    • Modification in training

    • Pain free stretching of ankle/foot

    • Change in footwear


Acute and chronic

Acute and Chronic


Compartment syndrome

Compartment Syndrome

  • Acute compartment syndrome results from a direct blow to the lower leg.

  • Chronic compartment syndrome results from increase in the intramuscular pressure during exercise

  • Most common in Anterior Leg Compartment


Compartment syndrome1

Compartment Syndrome

  • Signs/Symptoms

    • Decreased distal pulse

    • Swelling

    • Pain and tenderness

    • Numbness, significant muscle weakness

    • Tight skin

  • Chronic – symptoms will reduce post-exercise


Compartment syndrome2

Compartment Syndrome

  • Treatment/Management

  • ACUTE

    • Medical Emergency

    • Immediate Referral to MD

    • Ice

  • CHRONIC

    • Ice, NSAIDS, Stretching, Alter activities

    • If severe (or not improving) refer to MD

      • Surgical Fascia Release


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