1. Sports Injury Management Foot / Ankle

2. Ankle Anatomy Tendon of the tibialis anterior muscle Extensor digitorum longus muscle Hallucis longus muscle Anterior talofiblular muscle Fibularis longus muscle Fibula Calcaneal tendon Calcaneus Cuboid boneMetatarsal bone

3. Anatomy - Joints -Made up of two joints – ankle joint and subtalar joint ANKLE JOINT – tibia and fibula, allows the foot to bend up and down SUBTALAR JOINT – talus and calcaneus, allows the foot to move side to side TARSAL BONES connect to the 5 long bones of the foot, the metatarsals

5. Anatomy – Ligaments and Tendons ACHILLES TENDON – most important tendon for walking, running, and jumping - attaches the calf muscles to the heel bone to allow pushing up and off on the toes - 12 additional tendons cross the ankle; responsible for other movements of the foot, including supporting the arches of the foot

6. Anatomy - Muscles Muscles are classified as intrinsic and extrinsic. INTRINSIC MUSCLES – located within the foot and cause movement of the toes: flexors (plantar flexor), extensors (dorsiflexor), abductors, and adductors; also help support the arches of the foot EXTRINSIC MUSCLES – located outside the foot in the lower leg, the GASTROCNEMIUS is the largest. They have long tendons that cross the ankle to attach to the bones of the foot and assist movement.

7. Ankle Sprains Most common of all ankle injuries, occurs with stretching and tearing of LIGAMENTS surrounding the ankle joint is forced into a position not normally encountered. Most common cause of ankle sprain is applying weight to the foot when it is in an inverted (turned in) or everted (turned out) position.

8. Inversion Sprain Eversion Sprain High Ankle Sprain

9. Inversion Sprain

10. Eversion Sprain

11. Immediate Treatment for Ankle Sprains Rest, Ice, Compression and Elevation are the best immediate treatment for all sprains and strains. After applying ice, wrap the ankle with an elastic wrap to keep it supported and compressed. REST: avoid weight bearing for 24 hours or longer ICE: Apply ice (wrapped in a thin towel), no longer than 20 minutes at a time, apply 20 minutes every 2 hours for the first 24 hours to control swelling. COMPRESSION: Wrap the ankle starting at the toes and wrap up toward the calf ELEVATION: Raise the ankle above the hip or heart to reduce swelling

12. Ankle Sprains – con’t If swelling doesn’t subside in 48 - 72 hours, seek medical treatment for a complete evaluation. If unable to bear weight within 48 hours, seek medical treatment. ***BECAUSE I don’t have x-ray vision, I ALWAYS suggest a visit to their family physician before I allow them to return to practice.

13. Achilles Tendonitis / Rupture The Achilles Tendon is the largest and most vulnerable tendon in the body. -joins the gastrocnemius (calf) muscle and the soleus muscle to the heel of the foot. - gastroc muscle crosses the knee, ankle, and subtalar joints and can create stress and tension in the Achilles Tendon

14. Achilles Tendon Gastrocnemius muscle Achilles tendon with inflammation Tibia Soleus muscle Surgical view of torn Achilles Tendon

15. Achilles Tendinitis Causes CAUSES: - chronic injury that occurs primarily from overuse, ignoring early warning signs and pushing through pain - tendon has limited blood supply, making injury slow to heal TREATMENT: - at first sign of AT pain, cut back and reduce your training

16. TREATMENT – con’t. - begin gentle calf stretching after exercise when muscle and tendon are still warm and flexible - post-exercise ice may be helpful - strengthen calf muscle by toe raises, balancing on toes, and wall stretching

17. Achilles Tendon Rupture CAUSES: can help suddenly, without warning, or following Achilles tendonitis - if foot is dorsiflexed while lower leg moves forward and the calf muscles contract SIGNS AND SYMPTOMS - classic sign is the feeling of being hit in the Achilles area - there is often a “pop” sound, little pain, but the person cannot lift up onto toes while weight bearing

18. ACHILLES RUPTURE TREATMENT - complete rupture requires surgery and up to 12 weeks in a cast -because the tendon shortens as it heals, a heel lift is used for 6 months or more after the cast comes off - Physical Therapy should be started as soon as the cast comes off

19. Athlete’s Foot – aka Tinea Pedis A common fungal infection of the skin of the feet. It is contagious and is usually picked up through direct OR INDIRECT contact in public places. Once picked up, the fungus grows in warm, moist places. It can disappear quickly or it may become a long lasting and recurring problem.

20. Athlete’s Foot – Tinea Pedis SIGNS AND SYMPTOMS: - Itching, most often between your toes - Redness and scaling of the skin in the affected areas - A rash, cracks, blisters, or open sores - Discoloration, thickening, crumbling of the nails as the fungus grows

21. Mild case of Athlete’s Foot Severe case of Athlete’s Foot

22. Athlete’s Foot - Treatment #1 Treatment is PREVENTION! - wash your feet and socks after each workout - let your shoes air out completely, limit moisture and dampness - make sure you wash your feet with soap and DRY THEM COMPLETELY! Once you have it, don’t ignore it!

23. Athlete’s Foot Treatment – con’t. Keep feet clean and dry. Wash well with soap and water, and RINSE completely. Pat dry rather than rub. Put on clean socks and change them often. If this doesn’t work…use an over-the-counter anti- fungal powder or cream. Talk to the pharmacist for best information then follow the instructions. It may take several weeks to get rid of a severe case of Athlete’s Foot. As always, consult your physician with a severe case of Athlete’s Foot.

24. BLISTERS Blisters develop due to friction on the skin. It can be from the rubbing of clothing or sports equipment on the surface layer of the skin. Over time, continued friction can cause the top layer of skin to separate from the second layer of the skin.

25. BLISTERS - Prevention You must minimize friction on the skin. Wear appropriately fitting footwear. Some moisture-wicking socks made from synthetic blends help reduce friction. Wear two pairs of socks, one inside-out so that friction happens between the two pairs rather than on the skin. Use petroleum jelly, 2 nd Skin, or talcum powder before exercise to reduce friction. Some runners even use Duct Tape!

26. BLISTERS - Treatment The goal is to keep the blister from getting bigger, and avoiding infection. SIGNS OF INFECTION: - pus draining from the blister - red, warm skin around the blister - red streaks leading away from the blister

27. BLISTER – Treatment – con’t. Small, unbroken blisters that don’t cause discomfort should be left alone to heal because the best protection against infection is a blister’s own skin. Large, painful blisters can be drained as long as the top layer of the skin is intact and covering the blister. To safely drain a blister, first clean the blister and surrounding area with rubbing alcohol or antibiotic soap and water. Next, sterilize a needle over a flame until the tip glows red and allow it to cool. Finally, puncture a very small hole at the edge of the blister and drain the fluid by applying gentle pressure. Once drained, place antibiotic ointment on the blister, cover it with a bandage, and allow it to heal naturallly.

28. BIBLIOGRAPHY http://sportsmedicine.about.com www.google.com/images