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The Foot and Ankle Evaluation. History. Past Has this ever happened Before Mechanism What happened How did it happen When did it happen What specific mvmt caused the injury? Did you fall? How did you land? Which direction did the body part move? Changes in symptoms

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history
History
  • Past
    • Has this ever happened Before
  • Mechanism
    • What happened
    • How did it happen
    • When did it happen
    • What specific mvmt caused the injury?
    • Did you fall? How did you land?
    • Which direction did the body part move?
  • Changes in symptoms
    • Symptoms incr. or decr. since injury
    • Taking any meds?
    • Treating it on your own at all
history3
History

Sounds or Sensations

Did you feel any unusual sensations when it occurred?

Did you hear any unusual sounds when it occurred?

  • Pain
    • Where does it hurt?
      • Point with ONE finger
    • Rate the pain
      • Scale of 1-10
    • What makes it hurt?
      • Specific movements?
      • positioning
    • When does it hurt?
    • Can you describe the pain?
observation inspection
Observation/Inspection

Movement

How do they move?

How did he walk in?

What mannerisms did he use during the history?

Facial expressions

Asymmetries/ Deformity

Do both sides look the same?

Obvious deformity

Swelling - Lumps

Markings - Redness/ Discoloration

Sounds

pes planus or cavus
Pes Planus or Cavus

Structural Deformities

Pes Planus = flat footed/ no arch

Pes Cavus = high arch

observation
Observation

Structural Deformities

Valgus or varus

Gait (walking pattern)

Shoe Wear

Worn down on the heel = walks mostly on heels

Worn only on ball of foot = walks flat footed or only on toes

Etc.

the gait cycle
The Gait Cycle

Heel Strike – shock absorption

Toe-off – propel forward

the gait cycle9
The Gait Cycle

Have you ever watched people walk?

What do you notice?

Do you think that this can leave people at risk to injuries?

palpation
Palpation

Used to confirm or deny assessments.

Start away from the injury and move toward the site of pain (about 2-3 inches when appropriate)

Palpate Bilaterally (both sides)

Start w/ light pressure then move to deeper palpation

palpation11
Palpation

Notice

Point Tenderness

Specific site of pain

Trigger Points

Crepitus

Grinding, crunching, or crackling sensation with the rubbing of tissues

Tissue Density

Increased

Spasm

Scarring

Decreased

Swelling

Hemorrhage

Symmetry

Are both sides equal

Temperature

special tests
Special Tests

1st Special Tests

________ ___ ____________

____________

____________ or ____________

Fracture Tests

____________

____________

____________

Range of motion

Active

Passive Assistive

Bump

Lever

Compression

types of injuries
Types of Injuries
  • Sprain – tear of a ligament
  • Strain – tear/ pull of a muscle
  • “-itis” – irritation of
      • Tendonitis – irritation of a tendon (joins muscle to bone)
      • Bursitis – irritation of a bursae (fluid filled sac under tendons)
  • Fracture – break of a bone (complete or incomplete
  • Dislocation – Joint pops out and stays out
  • Subluxation – joint pops out and goes back in
ankle injuries
Ankle Injuries

Grade 1

Stretching or slight tear

Mild pain

Little to no disability

Grade 2

Moderate tear

Moderate pain and diability

Trouble weight bearing (PWB)

Swelling and Bruising may occur

Grade 3

Severe/Total tear of the ligament

Often causes ankle to subluxate

Disabling

Cannot weight-bear (NWB) – put weight/ pressure on it.

ankle injuries16
Ankle Injuries

Fibular fracture (fx)

Avulsion fx

Piece of bone broken off

Transverse fx

“crack” Straight across

Peroneal tendon subluxation/ dislocation

The tissue that holds the tendon in place behind the fibula is torn and therefore the tendon snaps over the fibula when walking.

achilles injuries
Achilles Injuries
  • Tendonitis – irritation of the tendon
    • Initially
      • slight pain
      • Only hurts after practice/ activity
    • As it progresses pain lasts longer and gets irritated with even regular walking
    • Hurts to dorsiflex (stretch/ lengthen the tendon)
    • Painful to the touch
  • Achilles Tendon Rupture (complete tear)

*Common w/ athletes 30+

    • Cannot “see” the tendon
    • Gastroc/ Soleus recoil (ball up) towards knee
    • Athlete cannot plantarflex the foot/ push off
special test achilles rupture
Special Test – Achilles Rupture

Thompson Test

Positioning

Athlete prone with leg off the table

Both hands on the calf

Test

Squeeze calf at proximal 1/3 of lower leg

Positive

Foot does not plantarflex

TRY IT!!

Have your partner lie on your desk

ankle injuries19
Ankle Injuries

Inversion Sprain

PF and inversion

Tears Anterior Talofibular

Pure Inversion

Tears Calcaneofibular

Eversion Sprain

Deltoid ligament

Syndesmotic Sprain (“high” ankle sprain)

Tear anterior and posterior tib-fib

External rotational or forced df

special tests atf
Special Tests - ATF

Anterior Drawer

ATaloFib

Positioning

Grasp calcaneus w/ one hand

Let foot lie on your forearm

Other hand on tibia

Test

Pull Calcaneus forward while push tibia backward

Positive Test

Foot slides forward

Makes a clunking sound/ sensation

Pain (if pain only then grade 1 sprain)

special tests ataf or ptaf
Special Tests – ATaF or PTaF

Talar Tilt

Positioning

Stabilize tibia

Grasp calcaneus

Test

Invert calcanus

Positive

Excessive motion

Pain

special tests deltoid lig
Special Tests – Deltoid Lig.

Kleiger’s Test

Positioning

Patient seated w/ ankle over the table

Stabilize the lower leg

Hold the medial aspect of the foot and evert the foot

Test

rotate the foot laterally

Positive

Pain over the deltoid ligament

Pain over the lateral malleolus (indicates a syndesmotic sprain)

foot injuries
Foot Injuries

Calcaneus

Heel Spurs

Bursitis

Contusion

Cuboid

Subluxation

Tarsal

Lisfranc

Disloc./fx

foot injuries25
Foot Injuries

Morton’s toe

Short Great Toe

Usually benign, may cause probs w/ running

Plantar Fasciitis

Common problem

Pain in the proximal arch and heel

Jones Fracture

Fracture of 5th met

foot injuries26
Foot Injuries

Bunion

Caused by poorly fitting shoes

Hammertoe

Flexion contracture of toes

Turf Toe

Hyperextension

other conditions injuries
Other Conditions/ Injuries

Tibial Contusion

Muscle Cramps

Muscle Strain

other conditions injuries28
Other Conditions/ Injuries

Shinsplints

Catch-all term for anterior pain

Stress fractures, muscle strains and chronic compartment syndrome

Medial Tibial Stress Syndrome

Due to repetitive microtrauma

Weak muscles

Poor shoes

Overtraining

Running surface

Malalignment

grades of mtss
Grades of MTSS

Grade 1

pain after activity

Grade 2

pain before and after activity

No performance affects

Grade 3

Before during and after

Affects performance

Grade 4

Activity impossible/ too painful

compartment syndrome
Compartment Syndrome

Compartment Syndrome

Acute – secondary to trauma

Exertional – activity related

Symptoms

Deep Aching Pain

Tightness and Swelling

Pain w/ stretching

Reduced circulation and sensation

management of ankle injuries
Management of Ankle Injuries

Inversion Ankle Sprains

RICE

Compression with Horseshoe

Reduce Weight-bearing

Begin ROM exercises

Syndesmotic Sprain

RICE

Take MUCH longer to heal

Immobilize for at least 6-10 days before beginning ROM exercises

management of ankle injuries32
Management of Ankle Injuries

Achilles Tendon Rupture

Surgical Repair or

Cast for 6-8 weeks

Contusion

RIC

Doughnut pad

Light ROM

Light stretching

management of ankle injuries33
Management of Ankle Injuries

Cramps/ Spasms

Massage

Overpressure (trigger point)

Stretching

Monitor hydration and electrolytes if this becomes chronic

management
Management

Medial Tibial Stress Syndrome (MTSS)

Rest

Modification of activity

Gait analysis

Ice massage

Stretching

Arch taping

Compression

achilles tendinitis
Achilles Tendinitis

Rest

Stretching of calf and foot muscles

Look at foot alignment

Recent change in running surface, distance, form, or intensity

Decrease what is aggravating Achilles

Heat

Massage

Heel Lifts

plantar fascitis
Plantar Fascitis

Rest, Ice

Stretch foot and lower leg

Add tennis ball stretch

Strengthen lower leg and foot

Check foot alignment

Tape arches

Night Splint

in grown toe nail
In-Grown Toe Nail

Soak in hot water for 10-15 minutes

Lift edge of nail and put small piece of cotton under to elevate the nail

Apply antiseptic and cover with a sterile dressing

Or cut a “v” into middle of nail (grows and pulls toward center)

If pus present, refer to MD for antibiotics