1. Foot and Ankle Evaluation

2. History  A thorough history MUST be taken  Mechanism  Pain  Sounds/ Sensations  Changes  Past

3. Observation  Deformity  Discoloration  Sounds  Gait  Heel Strike  Midstance  Heel off  Toe off  Shoe Wear  Arches  Pes Planus – flat arch  Shin splints  Pes Cavus – high arch  Metatarsal fx  Turf toe

4. Arches Structural Deformities Pes Planus = flat footed/ no arch Pes Cavus = high arch

5. The Gait Cycle Heel Strike – shock absorption Toe-off – propel forward

6. Palpation Used to confirm or deny assessments. Start away from the injury and move toward the site of pain (about 2-3 inches when appropriate) Palpate Bilaterally (both sides) Start w/ light pressure then move to deeper palpation

7. Palpation Notice Point Tenderness Trigger Points Crepitus Density Symmetry/ Deformity Temperature

8. Special Tests 1 st Special Tests – Fracture Tests ____________ – ________ ___ ____________ ____________ ____________ or ____________ Range of motion Passive Lever Bump Compression Active Resistive

9. Types of Injuries Sprain tear of a ligament “-itis” irritation of Tendonitis – irritation of a tendon (joins muscle to bone) Bursitis – irritation of a bursae (fluid filled sac under tendons) Fracture – break of a bone (complete or incomplete Dislocation Joint pops out and stays out Subluxation joint pops out and goes back in Strain tear/ pull of a muscle (Overuse 0r Overstretch)

10. Grading Injuries Grade 1 – Stretching or slight tear – Mild pain Little to no disability/ loss of function Grade 2 – Moderate tear Moderate pain and disability Trouble weight bearing (PWB) Swelling and Bruising may occur Grade 3 – Severe/Total tear of the ligament – Often causes ankle to subluxate Disabling Cannot weight-bear (NWB) – put weight/ pressure on it.

12. Sprains 1. Anterior Talo-fibular Ligament a. Closely followed by Calcaneofibular 2. Anterior Tibio-fibular ligament - “high” ankle sprain or syndesmotic sprain 3. Deltoid

13. Anterior Talo-fibular sprain *Most common first sprain *2 nd lig to go is Calcaneofibular - Pain on lateral side under fibula Caused by Inversion

14. Anterior Drawer Positioning – Have the athlete sit with their leg off the table. – Grasp calcaneus w/ one hand – Let foot lie on your forearm – Other hand on tibia Test – Dorsiflex foot slightly – Pull Calcaneus forward while push tibia backward http://www.youtube.com/watch?v=kbqzRWhirOI Specific Special Tests

15. Anterior Drawer cont Positive Test – Foot slides forward (laxity) – Makes a clunking sound/ sensation – Pain

16.  Deltoid sprain Tibio-fibular sprain (syndesmotic/ high) Caused by Eversion Caused by Dorsiflexion and Eversion

17. Specific Special Tests  Talar Tilt  Athlete sit or lie on table with the feet hanging over the edge  Hold the heel and stabilize the lower leg  Invert the foot (Deltoid) OR Evert the foot (Tibfibs)  Positive Test = pain and/or laxity https://www.youtube.com/watch?v=1IrI6Bks6hY

18. Management of Ankle Injuries  Swelling Management  RICE – Rest Ice Compression Elevation  METH – Mobility Elevation Traction Heat  Inversion Ankle Sprains  Light Compression with Horseshoe  Massage  Begin ROM exercises  Syndesmotic Sprain – Takes MUCH longer to heal – Rest/ Immobilize for at least 6-10 days before beginning ROM exercises

19. Achilles Injuries Tendonitis – irritation of the tendon Initially slight pain Only hurts after practice/ activity As it progresses pain lasts longer and gets irritated with even regular walking Hurts to dorsiflex (stretch/ lengthen the tendon) Painful to the touch

20. Achilles Tendon Rupture (complete tear) – *Common w/ athletes 30+ – Cannot “see” the tendon – Gastroc/ Soleus recoil (ball up) towards knee – Athlete cannot plantarflex the foot/ push off

21. Special Test – Achilles Rupture Thompson Test – Positioning Athlete prone with leg off the table Both hands on the calf – Test Squeeze calf at proximal 1/3  of lower leg – Positive Foot does not plantarflex  TRY IT!! http://www.youtube.com/ watch?v=HPkaNdG2uus

22. Tendinitis sites

23. Foot Injuries Bunion – Caused by poorly fitting shoes Hammertoe – Flexion contracture of toes Turf Toe – Hyperextension

24. Management of Ingrown Toe Nail

25. In-Grown Toe Nail Soak in hot water for 10-15 minutes Lift edge of nail and put small piece of cotton under to elevate the nail Apply antiseptic and cover with a sterile dressing Or cut a “v” into middle of nail (grows and pulls toward center) If pus present, refer to MD for antibiotics

26. Other Conditions/ Injuries Shin splints – Catch-all term for anterior pain Stress fractures, muscle strains and chronic compartment syndrome Medial Tibial Stress Syndrome – Due to repetitive microtrauma – Weak muscles - Poor shoes – Overtraining -Running surface – Malalignment

27. Grades of MTSS Grade 1 – pain after activity Grade 2 – pain during and after activity – No performance affects Grade 3 – Before during and after – Affects performance Grade 4 – Activity impossible/ too painful