1. Ankle/Foot and Lower Leg

2. Abbreviations Fx: Fracture MOI: Mechanism of Injury
ROM: Range of Motion
Inv: Inversion
EV: Eversion
PF: Plantarflexion
DF: Dorsiflexion
Rx: Management
Lig: ligament
c/o: complains of

3. Foot Injuries Fractures Dislocations Plantar Facsiitis Avulsion FX:
Jones Fracture: Peroneus brevis pulls off proximal 5th metatarsal with forced inversion.
Stress FX:
March Fx: Stress Fx to metatarsals due to repetitive activity
Dislocations
Plantar Facsiitis

4. Ankle Injuries Fractures Dislocations
Avulsion fx ATF Lig: A fracture to the lateral malleolus (looks like 3rd Degree sprain)
Dislocations
Sprains: Lateral, Medial, and High
Strains and Tendonitis

5. Lower Leg Injuries Fractures Strains and Tendonitis
Growth Plate (Epiphyseal) Fractures
Distal plated in fibula and tibia may fracture with inversion/eversion
Strains and Tendonitis
Achilles Tendon Rupture
Compartment Syndrome
Medial Tibial Stress Syndrome

6. Foot Conditions
Morton’s Toe: Longer 2nd phalange then 1st due to a shorter 1st metatarsal.
Pes Planus: Flat foot, it is a lowering of the medial longitudinal arch
Pes Cavus: High medial longitudinal arch
Jones FX: Fx to the diaphysis of the 5th metatarsal.
Retrocalcaneal Bursitis: Pump Bump inflammation of the bursa behind the achilles tendon.

7. Foot Conditions
Lisfranc Injury: tarsometatarsal injury can be a fracture or a sprain of this area.
Morton’s Neuroma: the nerve sheath at the plantar nerve becomes thick at the 4th and 5th met heads, causing pain.
Turf Toe: Hyperextension of the great toe, spraining the metatarsophalangeal joint

8. Lateral Ankle Sprains
Also known as Inversion ankle sprains, it is the most common type of ankle sprain.
The injury is to the lateral ligaments, the weakest being the anterior talofibular ligament.
Sprains are classified into 3 different grades
1 is a slight stretching of the ligaments, mild pain
2 is micro tearing or stretch of the ligament, hear a pop
3 is a complete tear of the ligament, extremely disabling

9. Lateral Ankle Sprains MOI: Stress Test:
Anterior Talofibular (ATF) Ligament- plantarflexion and inversion
Calcaneofibular Ligament- inversion
Posterior Talofibular Ligament- severe inversion or dislocation (rare)
Stress Test:
Anterior Drawer Test: ATF ligament
Talar Tilt Test: CF and Deltoid ligaments

10. Medial Ankle Sprains
Also known as eversion ankle sprain, less common then a inversion sprain due to the bony structure of the ankle.
Follows the same grading system as other sprains.
MOI:
Deltoid Ligaments: eversion and dorsiflexion
Stress Test:
Talar Tilt Test- CF and Deltoid ligaments

11. High Ankle Sprain
Syndesmotic Sprain is the other name for a high ankle sprain.
Syndesmosis injury is an injury to the distal tibiofibular joint, injuring the interosseous or syndesmotic ligaments.
MOI:
Anterior Inferior Tib/fib Ligament: excessive dorsiflexion or plantarflexion
Stress Test:
Kleiger’s Test

12. Ankle Sprains General Signs and Symptoms: Management: Swelling
Pain with WB (weight bearing)
Instability
Ecchymosis (bruising/discoloration)
Management:
RICE with horseshoe
NSAIDs
Crutches: Depend on the severity of the injury
Referral to Doctor for further evaluation and xrays

13. Osteochondritis Dissecans
OCD lesions is when one or several fragments of articular cartilage and its underlying subchondral bone are either partially or completely detached and moving within the joint space. Can be from a single injury or repeated episodes.
Signs: pain, swelling, and may c/o catching or locking
Management: x-ray for diagnosis, immobilization or surgery depending on severity.

14. Achilles Tendon Rupture
Signs and Symptoms:
Pain
inability to plantarflex
Feels like they were “kicked in calf”
Positive Thompson Test
Deformity
Management:
RICE
Referral is rupture is suspected
Surgery needed to repair full rupture

15. Muscle Strains MOI: Signs and Symptoms: Management:
Due to violent contraction/twisting of foot
Awkward landing
Signs and Symptoms:
Pain with ROM or RROM
Possible pain with WB
Swelling or crepitus
Management:
RICE
Taping/bracing
Monitor for acute compartment syndrome

16. Contusions MOI: direct blow to the extremity Signs and Symptoms:
Limited ROM
Swelling
Ecchymosis
Management:
RICE
Padding for protection
Monitor for acute compartment syndrome with contusions to the lower leg

17. Dislocations Rare in ankle, but common in phalanges MOI:
Traction or twisting
Signs and Symptoms:
Deformity
Possible fractures
Inability to move extremity
Management:
Immobilize
Cold
Referral for reduction or Emergency Action Plan (EAP)

18. Acute Fractures
In lower leg fractures there is a higher incidence of fibular fractures.
Fractures to both the tibia and fibula can occur from direct or indirect forces

19. Acute Fractures MOI: Signs and Symptoms: Direct blows Twisting
Associated with avulsions/dislocations
Signs and Symptoms:
Localized Pain
Deformity: may or may not be obvious
Swelling
Ecchymosis
Crepitus
Pain with WB

20. Acute Fracture Stress Tests: Management:
Tap Test (Bump or Flick Test): phalanges, tibia, fibula, talus or calcaneus
Compression or Squeeze Test: tibia or fibula
Management:
RICE
Referral for x-ray
Be prepared to activate Emergency Action Plan (EAP) if open fracture or signs of shock

21. Stress Fractures
Extremely common due to repetitive action, seen in distance runners
S/S: point tenderness; especially in WB position
Rx:
NWB (non-weight bearing) > week or more
Walking boot or cast possible
Out of activity 3-4 weeks
Gradual resumption of activity

22. Compartment Syndrome
Is excessive swelling within the confines of a fascia compartment compresses muscles, blood vessels, and nerves.
MOI: direct blow or tearing of muscle fibers causing swelling in the compartments of the lower leg
Leads to increased fluid pressure causing muscle ischemia.

23. Compartment Syndrome Signs and Symptoms: Management:
Pain becoming worse; eventually numbness
Loss of foot ROM
Leg swelling
Management:
Medical Emergency! Refer Immediately
Apply cold and elevate the limb
Surgical intervention is probably necessary

24. Plantar Fasciitis
Is a catchall term that is commonly used to describe pain in the proximal arch and heel. It is inflammation of the plantar aponeurosis, that runs the length of the sole of the foot.
MOI:
Shoes
Overweight
Activity on hard surfaces
Overuse
Poor mechanics
Fatigue

25. Plantar Fasciitis Signs and Symptoms : Management: Morning pain
Swelling
Pain with WB
Crepitus
Management:
Good shoes/orthotics
Stretching
Ice
Taping
Referral to podiatrist

26. Shinsplints
Shinsplints is a catch-all term for tendonitis, chronic compartment syndrome or a stress fracture
Medial Tibial Stress Syndrome (MTSS) is the more appropriate term for shinsplint-type pain
MTSS is caused by repetitive microtrauma and may evolve to be a stress fracture or compartment syndrome if not taken care of .

27. Medial Tibial Stress Syndrome
MOI:
Pes planus (flat feet)
Overweight
Poor conditioning
Poor shoes
Activity on hard surfaces
Overuse/Muscle weakness
Poor running technique
Genetics

28. Medial Tibial Stress Syndrome
Signs and Symptoms:
Pain: usually found on medial side of leg
Pain with activity that gets progressively worse over time
Management:
RICE before/after
Check shoes
Stretch
Strengthen
NSAIDs
Cross Train
Rest
Refer for fracture or compartment syndrome

29. Gait Two Phases of Gait: Stance or Support Phase – weight bearing
Swing Phase – non-weight bearing