Treating Foot, Ankle, and Lower Leg injuries Sports Medicine 2

Anatomy Bony components Tibia, fibula 26 Foot bones

Arches Medial longitudinal, Lateral longitudinal, anterior metatarsal, and transverse Shock absorbers Support body weight Provide rigid lever for propulsion Accommodation to uneven surfaces

Ligaments Plantar aponeurosis Medial (Deltoid) Lateral ~ anterior talofibular ~ calcaneofibular ~ posterior talofibular

Muscles Foot (4 layers) Leg (4 compartments) Anterior Lateral Superficial posterior Deep posterior

Motions Foot ~ flexion/extension ~ abduction/adduction ~ inversion/eversion Ankle ~ plantarflexion/dorsiflexion

Ankle joints 1) Tibiofibular joint Made up of the tibia and fibula 2)Talocrural Joint True Ankle Joint Made up of the tibia, fibula, and the talus Movement -Plantar and dorsiflexion 3) Subtalar joint Made up of the talus and calcaneus. Movement – inversion and eversion

Foot Injuries MOI Signs and Symptoms Treatment Special Test

Fracture of the Calcaneous MOI – landing after a jump or fall S&S – Immediate swelling and pain Inability to weight bear Dull pain Localized swelling Management – RICE Immobilization Early ROM Exercises

Apophysitis of the Calcaneus (Sever’s Disease) Apophysis – boney outgrowth where muscles attach MOI – overuse or high stresses due to plantarflexion against resistance S & S – Pain at posterior heel Usually in children Only painful during activity Management – RICE Heel lifts Stretching Anti-inflammatory drugs

Retrocalcaneal Bursitis MOI – Overuse Rubbing of heel cup S & S – Pain over the bursa Swelling over both sides of the Achilles Management – RICE and NSAIDS Ultrasound Stretching Heel lifts

Pes Planus AKA – “Flat feet” MOI – excessive foot pronation Structural deformity Shoe that are to tight Weakness Overweight Severe pounding S & S – Pain on medial longitudinal arch Obvious deformity Management – ****If it doesn’t cause pain or symptoms don’t try to fix it**** Orthotics taping

Pes Cavus AKA – “High Arch” MOI – congenital Neurological disorder S & S – Foot pain Metatarsalgia – pain in metatarsals Clawed or hammer toes Management – ****If it doesn’t cause pain or symptoms don’t try to fix it**** Stretching plantar fascia and Achilles

Plantar Fasciitis MOI – Overuse Other causes – leg length discrepancy, pronation, inflexibility of longitudinal arch S & S – Pain in anterior medial heel Pain early in the morning and eases off during day Pain increases during forced dorsiflexion Management – Long treatment time Heel cup Orthotics Night splint - to stretch Walking boot Rolling over something cold

Jones Fracture MOI – inversion and plantarflexion of foot Repetitive stress Compression landing S & S – Immediate swelling and pain over 5 th metatarsal Management – Slow healer Crutches –NWB with progression to WB Surgery

Bunion Tailors bunion – “Bunionette” Bunion on the 5th MOI – Deformity Wearing shoes that are to tight S & S – Tenderness Painful ambulation Management – Wear properly fitting shoes Tape Orthotic Doughnut pad Splint Surgery

Turf Toe MOI – Hyperextension of the great toe S & S – Pain and swelling Push off causes pain Management – steel insoles Tape RICE

Metatarsal Fracture Cause: Direct force or twisting or torsion stresses S/S: Swelling and pain. More pt tender and sometimes palpable. TX: RICE, casting ST: Compression test, Tap Test

Ankle Sprains MOI – Inversion or eversion twisting S & S – Swelling Pain Weakness Point tenderness Discoloration Management – RICE Strengthen the area Tape Brace Surgery Depends on the severity

Grade of ankle sprains Grade 1 – anterior talofibular ligament Grade 2 – ATF, and calcaneofibular ligament Grade 3 – ATF, CF, and Posterior talbofibular ligament

Syndesmotic Sprain AKA – “High ankle sprain” “The Devil” MOI – Internal rotation and excessive plantarflexion S & S – Severe pain and loss of function Pain when dorsiflexed and externally rotated Management –Months to heal Walking boot Strengthen RICE

Tibia/Fibula Fractures Cause: Direct Force, rotary force S/S: Immediate pain, swelling, possible deformity TX: Immediate referral to MD ST: Heel bump test, compression squeeze test

Medial Tibial Stress Syndrome Causes: Changes in any kind of training. Abnormal strength in Antagonist muscle S/S: Anterior medial shin pain TX: Eliminate bad changes, modified rest, cryotherapy, arch tape job ST: Pain upon palpation

Achilles Tendonitis MOI – Overuse Change of surface, shoe, exercise routine, intensity, etc. S & S – Generalized pain over the Achilles Strength loss Swelling Crunching movement Management – Orthotics RICE NSAIDS Stretching Patients

Achilles Tendon Rupture Cause: Sudden, forceful plantar flexion of the ankle with a chronically tight tendon. S/S: Feel or hear a pop. Feel as if they’ve been kicked in the leg. Inability to plantar flex foot. TX: Surgery vs. Cast ST: Thompson Test

Compartment Syndrome Cause: Increased pressure within one of four compartments of lower leg causes compression of the structures in the leg. S/S: Deep aching pain, tightness, and swelling. Pain with stretching. TX: Acute~ immediate surgery Chronic~ activity modification & ice and sometimes surgery ST: Pressure check test