1. Common Injuries to the Foot, Ankle and Lower Leg

4. Peroneus Brevis Peroneus Longus

6. Retrocalcaneal Bursitis A.K.A ( Pump Bump ) A bony growth located in the posterior calcaneal tuberosity. Only after months of irritation. Results from local irritation caused by rigid, poorly fitting heel counters. S + S- –Pain and swelling over the heel –Worsens during exercise –Tenderness and thickening of the overlying tissues –Signs of inflammation Treatment- –Rest and ice –Reduce friction and pressure in the area (donut pad and sometimes heel lifts)

7. Retrocalcaneal bursae This is where the boney spur will form.

8. Plantar Fascitis Inflammation of the fasica Could be caused from: –Leg length discrepancy, inflexibility of longitudinal arch, tightness of the gastrocnemius and soleus unit, wearing shoes without sufficient arch supports, a lengthened stride during running and running on soft surfaces S + S –Tenderness and a tight feeling on the plantar surface of the foot, worsen with walking, running and in the morning Treatment –Could persist for 8- 12 weeks –Stretching of the achillies and the fascia –Heel cup for cushioning of the area of irritation –Longitudinal arch taping can help for relief –For chronic situations orthotics may be an answer

9. This is where irritation usually begins.

10. Jones Fracture Fracture of the 5 th Metatarsal Causes: –Twisting the foot wrong or repeated stress like in running S + S: –Pain and point tenderness –Usually doesn’t swell –Sometimes will feel a sharp pain and hear a pop Treatment: –Send to MD –Non weight bearing cast for 6-8 weeks –May need internal stabilization

11. This is the normal foot. Do you see the break?

13. Internal Stabilization

14. March Fracture Fracture to the 2 nd Metatarsal Causes: –Sometimes by wearing high heels or pointed shoes that change the force distribution. Can make a person more at risk for Morton’s Toe S + S –Pain and point tenderness over the plantar surface of the distal head of the 2 nd metatarsal –Pain during walking and running and may feel pain during non- weight bearing Treatment –Send to MD –Proper footwear

16. Metatarsal Fractures Causes: –By direct force –Twisting or torsional forces S + S –Difficult to differentiate between a sprain and a fracture –Swelling and pain –Maybe deformity Treatment –Send to MD –Walking cast will be applied for 3-6 weeks –Shoe with large toe box should be worn

18. Heel Contusion Causes –Bye suddenly changing from horizontal to vertical –Land on heel from a vertical distance S + S –Discoloration –Point tenderness Treatment –Pad it

20. Metatarsal Arch Sprain Causes: –Hyper mobility of the foot Hyper mobility allows for the metatarsal heads to spread apart –Splayed foot- given the appearance of a fallen arch S + S –Pain and cramping in metatarsal region –Signs of inflammation and weakness –Point tenderness Treatment –Pad to elevate depressed arch (place in center just behind ball of foot) –Strengthen muscles and stretch Achilles –Longitudinal arch taping

21. Longitudinal Arch Strain Causes –Muscles of the plantar region are subjected to unaccustomed stresses and forces –Flattening or depression of the longitudinal arch in mid support phase of running S + S –Pain experienced only when running –Pain is found just below the medial malleolus –Swelling and tenderness along medial aspects of the foot –May appear suddenly or over and extended period of time Treatment –Treat for inflammation –Limit weight bearing –Arch taping

22. Force on Arch

23. Hammer Toes Causes –Can be congenital –Long term wearing of shoes that are too short and cramp the toes –Usually only involves the second or third toes S + S –Toes become malaligned and the foot develops overly contracted flexor tendons and overly stretched extensor tendons Treatment –Surgery –Properly fitted shoes and taping can help with irritation –Orthodics sometimes

25. Turf Toe AKA- Sprain of Great Toe Mechanism of Injury –Landing on the end of the toe and either hyper extending or hyper flexing S + S –Pain and point tenderness over MP joint –Signs of inflammation –Pain with either extension or flexion of the MP joint Treatment –Ice –Rest –Tape to limit movement –May send for x-rays

26. Turf Toe

27. Fractures and Dislocations of the Toes Causes –Kicking an object –Dropping a heavy object on your toes S + S –Swelling –Discoloration –Sometimes deformity Treatment –If it is found in the Great toe, usually refer to the MD –Buddy taping –If more the one toe is suspected may need to be casted –Inactivity for 3-4 weeks –Shoe with a wide toe box –With dislocation usually reduces easily by MD

28. This is the fracture of the proximal phalange on the pinky toe.

29. Bunions A.K.A ( Hallux Valgus Deformity ) A painful deformity of the distal head of the first metatarsal. Boney enlargement of the head of the first metatarsal that progresses to a point where the great toe becomes malaligned and moves laterally towards the second toe. Causes –Deformity or flattened transverse arch –wearing shoes that are pointed, too narrow, too short or have high heels –Over pronation S + S –Tenderness, swelling enlargement with calcification of the head of the first metatarsal. Poorly fitted shoes increase irritation and pain Treatment –Shoe selection –Doughnut pad –Orthodics –Surgery

32. Ankle Sprain Causes –Inversion sprain: Lateral ligament damage –Eversion sprain: medial ligament damage –Dorsiflexion sprain: damage to the anterior and posterior tibiofibular ligaments or to the syndesmosis. S + S –Swelling, tenderness over specific ligaments, discoloration, laxity of the joint Treatment –Depending on the degree of injury Treat for inflammation (RICE) If severe enough casting will occur Rehabiliation: active, resistive, proprioception, functional

33. Inversion Sprain

34. Lateral and Medial Sprains

35. Ankle Fractures Causes –Excessive inversion ankle sprain- fx of medial malleolus –Excessive eversion ankle sprain- fx of the lateral malleolus (Pott’s Fx) –Avulsion Fx- occurs in younger athletes usually the excessive sprain will take a piece of bone along S + S –Immediate swelling –Pain and point tenderness –Apprehension to bear weight Treatment –Splint ankle and send to MD –Short walking cast for about 6 weeks

36. Pott’s Fracture Pott’s Fracture- Fracture to the distal end of the fibula

37. Tendinitis Causes –Bad foot mechanics –Improper footwear –Actue trauma to the area –Training errors –Tightness of the Achilles S + S –Pain with active movement and passive stretching, swelling around the area, crepitius, stiffness and pain following inactivity Treatment –Reduce inflammation –Taping

38. Tibial and Fibular Fractures Causes –Tibia is the most common fractured long bone –Direct trauma to the area –A combination rotatory/compressive force S + S –Immediate pain, swelling, possible deformity, may be open or closed –Fibular are usually closed, pain and point tenderness, with the ability to walk Treatment –Immediate medical referral and most likely period of immobilization

40. Stress Fractures Causes –Repetitive loading during training –Tibia stress fx prevelant in sports that jump and distance running S + S –Pain with activity and sometimes gets worse with stopping activity –Pain and point tenderness over specific spot –Tibia usually in the shaft, fibula usually at the distal end Treatment –Should be referred to MD –Bone scan –Stopping activity for a period of time

41. Medial Tibial Stress Syndrome A.K.A ( Shin Splints ) Causes –A strain to the posterior tibialis and its fasical sheath at the attachment Faulty foot mechanics, tightness of the achillies, muscle weakness, improper shoewear, training errors S + S –Pain along the distal 2/3 of the medial tibia –Pain after an intense workout –More severe causes pain during regular ambulation Treatment –Activity modification –Correct abnormal mechanics –Proper shoe ware –Supportive taping

43. Compartment Syndrome Increased pressure within one of the four compartments (usually found in the anterior or deep posterior) Causes –Acute compartment syndrome- secondary to direct trauma –Actue exterional compartment syndrome- no trauma, occur with moderate activity –Chronic compartment syndrome- activity related, symptoms arise at a certain point in activity, symptoms stop when activity is stopped S + S –Deep aching pain –Tightness and swelling –Pain with passive stretching –Reduced circulation and sensory changes in the foot Treatment –Activity modification –Ice and elevation –Surgery

45. Achillies Tendon Rupture Largest Tendon in the body Causes –Usually in athletes above the age of 30 –Occures in sports with ballistic movement (basketball, tennis, etc.) S + S –Feel or hear a pop –Feel as though they have been kicked in the back of the calf –Ability to plantarflex is painful or non-existant –A notable defect will be present with palpation Treatment –Casting –surgery

47. Ankle Dislocation