1. Breaks and BooBoos Color of the Day

2. History Location of pain Acute or insidious (chronic) onset Mechanism of injury Playing surface Running distance Running duration Shoes

3. Observation Calluses and blisters Arches Foot alignment Gait

4. Observation Calluses and Blisters

5. Inspection Arches of the Foot Medial longitudinal arch Lateral longitudinal arch Transverse metatarsal arch

7. Hammer Toe Deviation: contractures of the associated toe extensors and flexors; inability of the interosseous muscles to hold the proximal phalanx in a neutral position Posture: hyperextension of the MTP and DIP joints and flexion of the PIP joints S&S: callus where shoes rub

8. Mallet Toe Flexion contracture at DIP joint involving flexor digitorum longus tendon Eventually becomes fixed where a callus develops at the DIP joint or on the tip of the toe

9. Claw Toe Deviation: Contracture of the interosseous or lumbrical muscles or both Posture: hyperextension of the MTP joint and flexion of the PIP and DIP joints

10. Morton’s Toe Deviation: Shortened first metatarsal in relation to the second metatarsal Posture: Second toe extends longer than first toe

11. Hallux Valgus Deviation: lateral deviation of the great toe, often mistakenly described as an enlargement of bone or tissue around the joint at the head of the big toe Posture: The great toe turns in toward the second toe and the tissues surrounding the joint may become swollen and tender. AKA Bunion

12. Tailor’s Bunion Deviation: Inflammation of the fifth metatarsal bone at the base of the little toe Posture: inflammation, pain and redness of the little toe

13. Corns Calluses that form on the toes because the bones push up against the shoe and put pressure on the skin. The surface layer of the skin thickens and builds up, irritating the tissues underneath

14. Ingrown Toenail The nail grows so that it cuts into one or both sides of the nail bed.

15. Subungual Hematoma A collection of blood underneath a toenail It can be extremely painful for an injury of its size although otherwise it is not a serious medical condition.

16. Treatment for Toe Injuries/Conditions Appropriate footwear Pads and/or taping Shave off any callus formation Surgery in extreme cases

17. Turf Toe MOI: Hyperextension of the Hallux Sprain of the MTP joint Population: Athletes who compete on synthetic turf S&S: Pain and swelling in the joint Pain increases during the push off phase Tx: Orthotics Steel plated shoe Tape Ultrasound

19. Plantar Fasciitis MOI: Poor mechanics Repetitive cutting Special population: High or low arches S&S: Pain in the anterior medial heel, Pain that increases in the morning Pain toes and forefoot are dorsiflexed Tx: Orthotics Heel cup Arch tape Night splint

20. Plantar Fasciitis MRI Normal Inflamed Plantar fasciitis surgery

21. Metatarsal Stress Fracture March Fracture – occurs at the 2 nd -4 th MT shafts S&S: pain, swelling, redness, unable to weight bear Tx: bone scan, Rest, orthotics, cast/boot

22. Jones Fracture MOI: Inversion and plantarflexion of foot Repeated stress S&S: Swelling and pain Base of the 5 th MT Tx: Non-weight bearing Open reduction internal fixation

23. Jones Fracture surgery

24. Lisfranc Fracture MOI: S&S: Cannot weight bear Swelling Hypermobile MTs Tx: Refer Open reduction internal fixation

25. Lisfranc Fracture Surgery

26. Retrocalcaneal Bursitis MOI: inflammation of bursa between Achilles and calcaneus Special population: females who wear high heels frequently S&S: pain caused by squeezing between the tendon on calcaneus; edema, bony callus Tx: Rest, NSAIDS, ultrasound, stretching of Achilles, heel lift, heel pad, properly fitting shoes

27. Severs Disease MOI: Traction injury Special population: occurs in a child or adolescent athlete S&S: pain at posterior heel below attachment of Achilles; pain occurs during activity Tx: Stretching, NSAIDS, heel lift

28. Severs Disease

29. Achilles Tendinitis MOI: excessive repetitive overload of the Achilles tendon Special population: running sports, soccer players, females Risk factors: overuse stresses, poor vascularity, lack of flexibility, genetic make up, sex, endocrine and metabolic factors, and forefoot varus Imaging- ultrasound and MRI Tx: NSAIDS, deep friction massage, gentle static stretching, eccentric strengthening, orthotics, surgery

30. Calcaneus Fracture MOI: landing from a jump or falling from a height S&S: swelling, pain, inability to bear weight Tx: Rest, x ray, immobilize

31. Calcaneal Stress Fracture MOI: Repetitive impact during heel strike S&S: constant pain in plantar-calcaneal area, increased pain while weight bearing c/o pain that continues after activity Tx: Rest, stretching, NSAIDS, heel lift

32. Anterior Process Fractures of the Calcaneus Compression MOI: forceful abduction of forefoot with compression of calcaneocuboid joint The anterior surface is fractured and a fragment can be displaced superiorly and posteriorly Avulsion MOI: adduction, plantarflexion, tension placed on bifurcate ligament S&S for both: pain in sinus tarsi, pain 2cm anterior and 1 cm inferior to the anterior talofibular ligament Tx: immobilize in short leg cast for 4 weeks

33. Talus Fracture MOI: laterally with severe inversion and dorsiflexion force or medially with an inversion and plantarflexion force with eternal rotation of the tibia on the talus Special population: patient has a history of repeated trauma to the ankle S&S: pain while weight beating, c/o catching or snapping, swelling, talar dome is tender Tx: x ray, immbolization

34. Subluxating Peroneal Tendons MOI: forceful, sudden dorsiflexion and eversion or plantarflextion and inversion causing stretch or rupture of superior peroneal retinaculum S&S: peroneal tendon may be seen, felt, or heard as it subluxes during PF and DF Tx: Rehab for stretched retinaculum; surgery for completely disrupted retinaculum

35. Os Trigonum MOI: forced hyper plantarflexion with repetitive activity. May involve: Inflammation in posterior joint Inflammation of ligament surrounding os trigonum Fx of os trigonum Pathology involving steida process S&S: swelling, point tender, pain with palpation

36. Os Trigonum B C

37. Foot Fractures

39. Ankle Impingement MOI: the presence of a painful mechanical limitation during eversion because of dynamic entrapment of the soft-tissue mass due to repeated minor injuries. S&S: pain on the lateral side of the ankle Tx: debridement of anterolateral soft-tissue impingement lesions

40. Ankle Sprain Inversion MOI: inversion, plantarflexion, talar rotation Eversion MOI: eversion and rotation of the foot S&S: swelling, ecchymosis, decreased strength Tx: CEM, rehab, taping or bracing

41. Syndesmotic Ankle Sprain MOI: external rotation of talus in ankle mortis and/or dorsiflexion S&S: pain over anterior distal tib/fib syndesmosis, swelling of anterior ankle, limited dorsiflexion and eversion Tx: CEM, immobilization, possible surgery

42. Syndesmotic Ankle Sprain

43. Ottawa Ankle Rules

44. Predictors of Ankle Sprains Possible intrinsic factors include: postural sway, range of motion, muscle strength, proprioception, and previous sprains. Athletes with prior injures have a significantly greater baseline range of motion for subtalar eversion People with inflexible ankles (34° dorsiflexion range of motion) have nearly five times the risk of ankle sprain of people with an average flexibility (45°)

46. Broken Lower Leg

47. Medial Tibial Stress Syndrome MOI: pain that arises in the posterior border of the distal 2/3 of the tibia Risk factors: anatomical structure, training errors, and shoe/surface interactions S&S: dull aching to intense pain, mild edema, pain with RROM in PF and PROM in DF, symptoms may decrease initially and then increase during activity

48. Medial Tibial Stress Syndrome Treatment Correction of biomechanical abnormalities, relative reset, NSAIDS Myofascial or trigger point release Identify location of trigger points Hold foot in a position that shortens the muscle Apple pressure to the point producing symptoms not exceeding an 8 Hold pressure for up to 2 mins. Until symptoms decrease to a 4 Slowly apply a passive stretch and release pressure

49. Stress Fractures MOI: 10% of all sports overuse injuries; bone fracture resulting from repetitive microtrauma Risk factors: poor health, diet and nutrition, genetics, endocrine and hormonal factors, long distance runner S&S: night pain, pain with each foot contact, and intense, dull ache Tx: bone scan, MRI, x ray Relative rest, NSAIDS, addressing the root cause of the fracture, cardio, athlete must be able to walk pain-free for 45 mins before progressing to jogging

50. Deep Vein Thrombosis MOI: condition in which a blood clot forms in the deep veins of the body; can be dangerous if the clot breaks loose and enters the lungs Special population: postsurgical patients and females who take oral contraceptives S&S: pain and tightness in the calf during walking, swelling, warmth and tightness of the calf

51. Deep Vein Thrombosis