1. Foot and ankle
Common injuries

2. Squeamish? Roll/twisted ankle: Breaking ankle:
Breaking ankle:
Kevin Ware
Luis Garrido

3. Bones injuries S&S Pain Decreased ROM Swelling Bruising NWB
Obvious deformity

4. Any bone Epiphyseal Fx Jones Fx Acute fx Stress fx Avulsion fx
How many types of acute fx do we have? ___
Stress fx
Avulsion fx
Epiphyseal Fx
Fx to the growth plate (typically tib/fib)
MOI: Plantarflexion and inversion
Serious – potential to stunt growth
Jones Fx
Avulsion fx of the styloid process of the 5th MT
Forceful muscle contraction w/ ankle inversion
Union vs. non-union

6. Non-Union

7. Knock-off Fx Stress Fx Fx to lateral malleolus
Forced dorsiflexion & inversion
Stress Fx
Most commonly tib/fib and MT
Repetitive stress (usually from running)
Pain becomes more intense at night and following activity
Usually Dx w/ bone scan (Dexa-Scan) or MRI

8. Knock-off fx
Bi-malleolar fx

9. Bone Scan

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

12. Soft Tissue Injury S&S: Pain Swelling Decreased ROM
Increased temp of skin
Bruising
NWB
+ laxity test

13. Ligament/tendon injuries
ATFL–
Most commonly sprained
MOI – “rolling ankle”, stepping in hole
Accounts for 85%
Deltoid Ligament
Keep ankle from evertion; stronger than ATF
MOI – Stepping in hole
High Ankle Sprain – Syndesmotic Sprain
MOI - Dorsiflexion and evertion
Accounts for 15%
Achilles Tendon Tendinitis/Rupture
More commonly torn with age
MOI – Forced Dorsiflexion with knee bent

15. Great-Toe Sprain Arch Sprain Plantar Faciitis
MOI - Forced Flexion/Extension
“Turf Toe”
Arch Sprain
Repetitive stress, running on hard surface, or improper footwear
Pain with running and swelling over affected arch
Plantar Faciitis
Inflammation of the thick connective tissue

16. Muscle Injuries Strain Common muscles affected: Grade 1, 2, 3
Peroneals
Gastrocnemius/Soleus complex
Tibialis Anterior

17. “shin Splints” If left un-treated can cause: Caused by:
Medial tibial stress syndrome (MTSS)
Irritated and swollen muscles, often from overuse, ramping up workout intensity, changing the surface, improper/old footwear
Caused by:
Over-pronation or ''flat feet" -- when the impact of a step makes your foot's arch collapses
If left un-treated can cause:
Stress fractures, which are tiny breaks in the lower leg bones

18. Tx: Rest your body. It needs time to heal.
Ice your shin to ease pain and swelling. Do it for 20’ 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. 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.

19. 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 healed stress fx.
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.

20. Misc Injuries Ankle dislocation
Force applied to joint stronger than joint could withstand
Reduction:

21. Contusion – broken blood vessels leaking into soft tissue.
MOI – Blunt force trauma

22. Toe Abnormalities Hammertoe
Middle Phalanyx flexed while Distal and Proximal are hyperextended
MOI- Rupture of Extensor Digitorum Longus due to BFT

23. Ingrown Toenail Nail grows into surrounding soft tissue
often result of poor trimming
May need to be surgically excised

24. 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 tenderness
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

25. 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

26. 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

27. End-Feel (Normal) Soft: soft tissue approximation (ex: knee flexion)
Firm: Muscular stretch/Capsular Stretch/Ligamentous Stretch (ex: MCP extension)
Hard: bone to bone ex: Elbow ext

28. 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
Spasm: 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; no resistance felt (except for patient’s protective muscle splinting or muscle spams called “muscle guarding”)