The Foot & Ankle

1/4/20162 Bony Anatomy of the Foot

1/4/20163

4

5

6 Muscles of the Lower Leg

1/4/20167 Muscles of the Lower Leg

Common Injuries to the Foot & Ankle

1/4/20169 Fractures MOI: combo of plantar flex & inversion S/S: Edema, deformity ecchymosis, point tender,  ROM, &  pn with wt. bearing Special Tests: Percussion Test or Compression Tests Management: Splint, Ice

1/4/ Dislocations & Subluxations MOI: Twisting Motion S/S: Loss of function, severe pn, swelling, & deformity Special Tests: None Management: Check Dorsal Pedal Pulse, Splint, Refer to MD

1/4/ Contusions MOI: Direct blows or improperly fitted shoes S/S: point tender over heel Special Test: Palpation of heel Management: Ice, Donut pad

1/4/ Sprains MOI: Stepping on something, in a hole, or land off balance (85% are inversion, involving the ATF ligament) S/S:  ROM, crepitation, point tender, instability, immediate edema Special Test: Talar Tilt, Anterior Drawer, Kleiger’s Management: Bracing or taping, RICE, strengthening

1/4/ Tendon Ruptures MOI: Abrupt starts & stops S/S: severe pn, swelling, deformity, loss of function Special Tests: Thompson Test Management: Ice, Splint, Refer to MD

1/4/ Turf Toe MOI: jamming great toe in end of the shoe S/S: point tender, pn with push off, swelling Special Tests: None Management: RICE, NSAID’s, Taping, or stiff-soled shoes

1/4/ Hammer & Claw Toe MOI: often congenital, but can be caused by improperly fitted shoes, or muscles contractures S/S: Hammer-flexion deformity at DIP Claw: hyperext. MTP & hyperflex of DIP & PIP joints Special Tests: none Management: padding controls symptoms, but surgery needed to treat condition

1/4/ Ingrown Toenail MOI: Improper cutting or shoe size S/S: pn, swelling over site, redness Special Test: None Management: Soak foot, then cotton or “V” shape cut

1/4/ Morton’s Neuroma MOI: tight fitting shoes S/S: pn in the 2 nd and 3 rd metatarsal spaces that can radiate into the toes Special Test: Interdigital Neuroma Test Management: Wider toe box, NSAIDs, low heels, metatarsal pads, possibly cortisone shots

1/4/ Plantar Fasciitis MOI: Excessive or prolonged pronation, tightness of the Achilles, obesity S/S: pn on bottom of foot usually noticeable 1 st thing in morning, subsides & builds again during the day Special Test: None Management: Ice massage, NSAIDs, stretching exercises, heel lift, or taping

1/4/ Bunions (aka Hallux Valgus) MOI: foot pronation, arthritis, ligament laxity S/S: medial aspect of MTP with hallux shifting laterally Special Test: None Management: little can be done, straping, surgery for severe cases

Syndesmotic Sprain AKA – high ankle sprain MOI – Ankle external rotation S/S: pn on the superior/anterior portion of ankle Special: Squeeze Tx: Roman Sandal 1/4/201620

Shin Splints (aka MTSS) MOI: chronic condition, running on different surfaces, poor arches S/S: Pain over anterior medial tibia that increases with activity Tests: none Tx: RICE, Tape, ice massage, strengthen anterior tibialis muscle

Deep Vein Thrombophlebitis (DVT) Aka Blood Clots MOI:post-Surgery or Direct Blows S/S Pain in the legs Tx- Medical Emergency Hospital Homan’s Sign 1/4/201622