1. Foot and Ankle Injuries

2. Ankle Sprains Most common lower leg injury
Classified as to degree of ligamentous severity

3. Lateral ankle sprain Mechanism:
Inversion and plantar flexion
Anterior talofibular ligament (ATF) usually first structure to injury
Calcaneofibular ligament (CF) is usually secondary
Posterior talofibular ligament (PTF) rarely injured

4. Lateral ankle sprain Signs/Symptoms: Obvious mech. of injury
Report of “popping” or “tearing” of tissue
Rapid swelling and point tenderness over soft tissue
Be careful of possible fracture

5. Medial ankle sprain Less common Mechanism: Eversion
Deltoid ligament injury

6. Medial ankle sprain Signs/Symptoms: Pain and swelling not as evident
Point tenderness over deltoid

7. Syndesmosis ankle sprain
Separation/widening of distal tibiofibular joint
Injury to Anterior/Posterior tibiofibular ligaments
Usually very disabling
“High” ankle sprain
Mechanism:
Dorsiflextion with inversion or eversion

8. Syndesmosis ankle sprain
Signs/Symptoms:
Similar to lateral/medial ankle sprains
Point tender at bony junction – top of ankle
Swelling over medial/lateral malleoli

9. Fractures May occur anywhere in foot
Common at the base of 5th Metatarsal (Jones Fracture)
Usually result of forceful landing from jumping
May be considered an avulsion fracture from an inversion ankle sprain
Treatment is extremely controversial

10. Turf Toe First Metatarsaophalangeal (MTP) Sprain
Common with artificial surfaces
Mechanism:
Hyperextending the MTP join or
Contact with the shoe end

11. Turf Toe Signs/Symptoms: Treatment Pain and Tenderness
Swelling on the Plantar joint aspect
Discomfort with toe extension
Treatment
Cryotherapy, NSAIDS, Rest
Protection from mechanism

12. Chronic Conditions

13. Bunions (Hallux valgus)
Inflammation and thickening of the medial aspect of the MTP joint of the hallux
MTP joint becomes inflamed and causes lateral displacement of the hallux
As the condition progresses the 1st toe may overlap the 2nd toe
Predisposing factors
High heels, pointed shoe box, poor shoe fit
Management
Strapping of the hallux
Wider toe box
Surgical correction

14. Plantar Fasciitis (Bone spur)
Most common hindfoot problem in runners
Main support for longitudinal arch
Structurally weak near the origin attachment
Predisposing factors
Significant increase in training
Excessive tightness in Achilles tendon
Abnormal change in body weight
Pes cavus (high arch)

15. Plantar Fasciitis (Bone spur)
Signs/Symptoms
Pain is usually most sever during the first step in the morning
Discomfort is reduced throughout the duration of the day
Extreme point tenderness over origin
Management
Therapeutic modalities (e-stim, ultrasound)
Achilles tendon stretching
NSAIDS
Heel lifts, taping, orthodics
Night splints
MD referral

16. Achilles Tendonitis
Result of repetitive jumping or running (Loooooong distance runners)
Signs/Symptoms
Thickening of surrounding tissues
Crepitation with tendinous movement
Reduced ROM
Management
Ice therapy, NSAIDS
Active stretching, Heel lifts
Complete resolution of symptoms prior to return
A chronic weakness will progress to rupture

17. Medial Tibial Stress Syndrome (Shin splints)
Early, painful component of first part of a training activity
Associated with repetitive activity on hard surfaces
Contributing factors
Muscled inflexibility
Pes Planus (Low arch)
Poor footwear
Dramatic change in training or surface
Signs/Symptoms
Pain along medial tibial border
Usu. Lower 1/3 of shin
Common for bilateral symptoms

18. Medial Tibial Stress Syndrome (Shin splints)
Management
Rule out stress fractures
Cryotherapy, NSAIDS
Modification in training
Pain free stretching of ankle/foot
Change in footwear

19. Acute and Chronic

20. Compartment Syndrome
Acute compartment syndrome results from a direct blow to the lower leg.
Chronic compartment syndrome results from increase in the intramuscular pressure during exercise
Most common in Anterior Leg Compartment

21. Compartment Syndrome Signs/Symptoms
Decreased distal pulse
Swelling
Pain and tenderness
Numbness, significant muscle weakness
Tight skin
Chronic – symptoms will reduce post-exercise

22. Compartment Syndrome Treatment/Management ACUTE CHRONIC
Medical Emergency
Immediate Referral to MD
Ice
CHRONIC
Ice, NSAIDS, Stretching, Alter activities
If severe (or not improving) refer to MD
Surgical Fascia Release