COMMON INJURIES FOOT AND ANKLE

SQUEAMISH? Roll/twisted ankle: Breaking ankle:

BONES S&S Pain Decreased ROM Swelling Bruising NWB Obvious deformity

BONES Any bone Acute fx Stress fx Avulsion fx Jones Fx Fx of the styloid process of the 5 th Metatarsal Union vs non-union Knock-Off Fx

LIGAMENTS/TENDONS Ligament: bone to bone Tendon: muscle to bone Grading system: 1+/-: stretched, but no tearing/fraying of fibers 2+/-: tearing, but incomplete 3: complete tear

CONT’D Signs & Symptoms: Pain Swelling Decreased ROM Increased temp of skin Bruising NWB + laxity test

CONT’D ATFL– Candy if you can name it! Most commonly sprained MOI – “rolling ankle”, stepping in hole Deltoid Ligament Keep ankle from evertion; stronger than ATF MOI – Stepping in hole High Ankle Sprain – Syndesmotic Sprain MOI - Dorsiflexion and evertion Achilles Tendon More commonly torn with age MOI – Forced Dorsiflexion with knee bent

MUSCLES Strain Grade 1, 2, 3 Common muscles affected: Peroneals Calf

“SHIN SPLINTS” Medial tibial stress syndrome (MTSS) Caused by: Irritated and swollen muscles, often from overuse Stress fractures, which are tiny breaks in the lower leg bones Overpronation or ''flat feet" -- when the impact of a step makes your foot's arch collapses Runners might get them after ramping up their workout intensity, or changing the surface they run on

Treatment: Rest your body. It needs time to heal. Ice your shin to ease pain and swelling. Do it for 2mins every 3 to 4 hours for 2 to 3 days, or until the pain is gone. Anti-inflammatory painkillers. NSAIDs Arch supports for your shoes. These orthotics -- which can be custom-made or bought off the shelf -- may help with flat feet. Range-of-motion exercises Neoprene sleeve for support. Physical therapy to strengthen the muscles in your shins.

YOU KNOW IT’S HEALED WHEN.. Your injured leg is as flexible as your other leg. Your injured leg feels as strong as your other leg. Your can jog, sprint, and jump without pain. Your X-rays are normal or show any stress fractures have healed. There's no way to say exactly when your shin splints will go away. It depends on what's causing them. People also heal at different rates; 3 to 6 months is not unusual.

DIAGNOSIS PROCESS HOPS: History Observation Palpation – Provides a reference for the comparison of bilateral symmetry of bones, alignment, tissue temperature, or other deformity as well as the presence of increased tendernesss Joint and Muscle Functional Assessment – impairment due to ROM, Strength, P with movement Joint Stability Tests – reference for laxity, gapping, hypo/hypermobility, end-feel Special Test

MANUAL MUSCLE TESTING Patient position: Muscle tested must be against gravity Examiner position: stabilize proximal to the joint being tested and provide resistance to the distal joint “Break test” Positive test: weakness and/or pain compared contralateral

GRADING 5/5 Normal: can resist max pressure with no pain 4/5 Good: can resist moderate pressure 3/5 Fair: Can move body part against gravity thru full ROM 2/5 poor: Can move body part in gravity-eliminated position thru full ROM 1/5 Trace: cannot produce movement, but muscle contraction is palpable 0/5 Zero: No contraction is felt

END-FEEL (NORMAL) Soft: soft tissue approximation ex: knee flexion Firm: Muscular stretch/Capsular Stretch/Ligamentous Stretch ex: Hip flexion, Ext of MCP joints in fingers, forearm supination Hard: bone to bone ex: Elbow ext

END-FEEL (PATHOLOGICAL) Soft : occurs sooner or later in ROM than normal in a joint that normally has a firm or hard end-feel ex: edema/synovitis Firm : occurs sooner or later in ROM than normal in a joint that normally has soft or hard end-feel ex: Capsular/muscular/ligamentous shortening Hard : occurs sooner or later in ROM than normal in a joint that normally has soft or firm end-feel ; feels like a bony block ex: Loose bodies in joint/myositis ossificans/fx Spams : Joint motion is stopped involuntarily or voluntary muscle spasm ex: inflammation/strain/joint instability Empty: no end-feel bc end of ROM is never reached due to pain; no resistance felt except for patient’s protective muscle splinting or muscle spams ex: fx/brusitis/abscess

HOMEWORK Pages 4 and 5 in coloring packet