Foot and Ankle Injuries

Objectives Recognize various injuries to the foot and ankle Identify causes and signs/symptoms of various foot and ankle injuries Be able to perform a basic ankle evaluation

Terminology Review Plantar Flexion Dorsiflexion Inversion Eversion Varus Valgus

Motions of the foot/ankle Plantar Flexion (pointing the toes) Dorsiflexion (bring toes back) Inversion (turn the foot inward) Eversion (turn the foot outward) Pronation – rolling the foot inward; combination movement (dorsiflexion, eversion) Supination – rolling the foot outward; combination movement (plantar flexion, inversion) Pronation/Supination only occur when the foot is in contact with the ground.

Pes Planus (flatfoot) Abnormal loss of the medial longitudinal arch “Flexible Flatfoot” disappears when NWB Don’t confuse w/ hyperpronation Can lead to MANY lower extremity injuries.

Pes Cavus (high arch) Abnormally high arch Does not disappear with weight bearing Keeps the midfoot in a “locked” position. Causes “clawing” of the toes Foot becomes a very poor shock absorber. Prone to stress injuries of both feet and legs

Plantar Fasciitis Inflammation of plantar fascia Caused by prolonged abnormal stress on the fascia. Characterized by heel pain in the AM. Treatments include rest, soft tissue mobilization, gastroc/soleus stretching, orthotics?

Turf Toe A sprain of the 1st MTP joint. Caused by hyperextension Downward force to the foot while weight bearing on the toes. NOT specific to turf playing surfaces

Turf Toe (cont’d) S/S: pain and swelling of 1st MTP joint. Pain with weight bearing Inability to “push off” Inability to actively flex or extend the big toe

Turf Toe (cont’d) Treatment: Consists of rest, cryotherapy, and a period of immobilization Shoes w/ rigid sole Turf toe taping …limit 1st MTP hyperextension

Hallux Valgus (Bunion) “HAV” Valgus deformity of the 1st MTP joint. Mostly genetic Can also occur from wearing pointed shoes. More common in females Pain/swelling over medial MTP joint Callus formation (due to shearing forces)

HAV (cont’d) Usually treated conservatively Rest, modality tx. Custom padding and/or orthotics Properly fitted shoes Surgical correction is necessary if there is no response to conservative treatment

Morton’s Neuroma Inflammation of nerve tissue between metatarsals Usually b/t 2nd and 3rd or 3rd and 4th. Exact cause is unknown Abnormal bone structure; flat feet; bunions; high arches; poor footwear Causes pain and numbness in forefoot and toes, usually with weight bearing

Jones Fracture Fx. to base of the 5th metatarsal (styloid) Usually caused by direct impact to lateral side of the foot. S/S: pain and swelling over styloid process Poor healing bone due to poor vascularization

Jones Fracture (cont’d)

Lisfranc fracture Fracture in which one or all of the metatarsals become displaced from the tarsals. Rare….usually occurs in sports where feet are fixated. Occurs occasionally in football (Matt Schaub, Darren McFadden) Similar mechanism to turf toe. S/S include severe pain through the midfoot; inability to bear weight; possible deformity; swelling and discoloration on both the top and bottom of the foot This is a severe injury….may take months to heal…..may require surgical intervention.

Lisfranc Fracture

Ankle joint Made up of the distal tibia (medial malleolus) Distal fibula (lateral malleolus) Talus bone

Ankle Ligaments Anterior Talofibular (ATF) Connects the talus to the lateral malleolus Prevents anterior movement of the foot on the ankle.

Ankle Ligaments Calcaneofibular ligament (CF) Connects the calcaneus to the lateral malleolus Prevents inversion of the foot

Ankle Ligaments Deltoid Ligament Connects the medial malleolus to the calcaneus and navicular bone on the medial side. Prevents eversion of the foot

Ankle Ligaments Anterior Tibiofibular Ligament (syndesmosis) Connects distal ends of tibia and fibula Prevents external rotation of the foot on the ankle

Ankle Sprains Inversion most common mechanism Grade 1-3 S/S: pain, swelling, loss of motion, loss of strength, instability Not always a time-loss injury (+) Anterior Drawer test

Ankle Sprains - Inversion

Inversion Ankle Sprain

Ankle Sprains Syndesmotic Sprain “high ankle sprain” Caused by an external rotation mechanism Causes severe pain and dysfunction Even minor sprains may take 2-4 weeks to heal.

Ankle Sprain - Syndesmotic

Peroneal Tendon Subluxation Tearing of the retinaculum that holds peroneal tendons in place. Tendons sublux anteriorly/posteriorly around the lateral malleolus https://www.youtube.com/watch?v=eaIQBfXZZt0