Foot Ankle Lower Leg Injuries by mikesanye


									Foot, Ankle, & Lower Leg Injuries

             Unit 6
Anatomy of the Ankle
        Evaluation of Injuries

•   S – Taking a History
•   O – Palpation, ROM, Special Tests
•   A – Assessment
•   P – Plan
    Evaluation of Ankle Injuries
• Surface Anatomy & Palpation
  – Lateral & medial malleoli
  – Tibialis Anterior tendon
  – Achilles tendon & Gastrocnemius
  – Base of 5th metatarsal
• Range of Motion
  – Dorsiflexion & plantar flexion
  – Inversion & eversion
          Common Injuries

•   Mechanism
•   Typical Presentation
•   Evaluation Questions
•   Special Tests
•   Treatment
           Refer to M.D.
• Fractures
  – Jones’ Fracture
  – Metatarsal Stress Fracture
• Dislocation
• Compartment Syndrome
  – Increased pressure in lower leg
  – Often caused by trauma (hard kick)
• Morton’s Neuroma
           Jones’ Fracture
• Fracture of base of
  the 5th metatarsal
• Typical mechanism =
  excessive inversion
  of ankle or overuse
Ankle Fracture

       • 3 Common Sites
       Talus, fibula, tibia
       • 2 Special Tests
       Compression, Tap
        Morton’s Neuroma
• Between the 3rd &
  4th metatarsals
• Symptoms –
  burning numbness
  & severe pain to
  tips of toes
     Inversion Ankle Sprain
• Mechanism of Injury - Inversion
• Typical presentation
  –Pain on or near lateral malleolus
  –PT over ATFL, CFL, &/or PTFL
  –Swelling around lateral malleolus
  –Pain increases with cutting &
   lateral movements
Inversion Ankle Sprain
     Inversion Ankle Sprain
• Evaluation Questions
  –Can you put weight on it?
  –Have you hurt it before?
• Special Tests
  –Anterior Drawer Test
  –Stabilize tibia & fibula and pull
   heel in an anterior direction
      Inversion Ankle Sprain
  –YES – Taping
  –NO – R.I.C.E., see ATC ASAP
   • Rest
   • Ice – 15 minutes on, 45 minutes off
   • Compression – often with foam horseshoe
   • Elevation
         Inversion Ankle Sprain

•    When refer to M.D.?
    1. Unable to bear weight
    2. Significant pain or swelling right
    3. Deformity or other suspicion of
Inversion Ankle Sprain
         High Ankle Sprain

• Mechanism of Injury – plant & pivot
• Typical presentation
  –Similar to inversion ankle sprain
  –Pain on anterior aspect of ankle
  –Pain with pivoting or twisting
         High Ankle Sprain
• Evaluation Questions
  –Can you put weight on it?
  –Does this feel like other sprains?
• Special Test
  –Swivel Test
  –Athlete should stand on one foot &
• Treatment – Same as inversion sprain
           Shin Splints

• Mechanism = CHRONIC
• Typical presentation
  –Location of pain = Anterior,
   medial, or lateral shin
  –Pain typically worse at beginning
   or end of activity
            Shin Splints
• Evaluation questions
  –Is it early in the season?
  –How old are your shoes?
  –Do you have flat feet?
  –Have you tried using ice after
  –Have you changed running surfaces
   or training techniques lately?
           Shin Splints

• Treatment
  –Ice massage before & after
  –Correct underlying problems
  –Gradual return to activity
  –Taping technique
         Shin Contusions

• Mechanism – direct hit to shin
• Potential Complication –
  compartment syndrome
• Padding technique
   –Purpose – to prevent additional
      Achilles Tendon Injuries
• Mechanism – Can be muscle strain
  (ACUTE) or tendonitis (CHRONIC)
• Typical presentation
   –Pain over or around Achilles tendon,
    especially at insertion
   –Pain with jumping, landing, or
    explosive motions
    Achilles Tendon Injuries
• Special Test
  –Thompson test for rupture
  –Athlete should lay prone and
    then the ATC squeezes the
• Treatment
  –Heat before, ice after
  –Taping & padding techniques
     Retro-calcaneal Bursitis

• Mechanism
  –What is a bursa? Fluid-filled sac
   that decrease friction in a joint
  –Caused by constant rubbing or
   pressure so it is a chronic
     Retro-calcaneal Bursitis
• Typical presentation
  –Tenderness, swelling, redness
  –Palpable bump on posterior heel
• Treatment
  –Donut -type padding
  –Heel lift to change site of
“Pump Bump”
•    Mechanism = Friction
•    Typical presentation = DUH!
•    Treatment
    – Prevention – 2 layers of socks,
       skin lube
    – Treatment – skin lube, 2nd skin,
       donut padding
    – Popping blisters?
            Arch Issues
• Mechanism – usually chronic and
  often structural
  –Plantar fascitiis
  –Arch strains (acute or chronic)
• Typical presentation
  –Pain along arch or heel
  –Often worse in AM & later in day
  –Pain often lessens after a few steps
Plantar Fasciitis
           Arch Issues
• Evaluation Questions
  –How old are your shoes?
  –Do you have flat feet?
  –Do you walk or play in bare feet?
• Treatment
  –Ice before and after
  –Taping and padding techniques
  –Rest? Correct contributing factors?
• Mechanism
  –Problems with shoe fitting
  –Faulty mechanics
• Typical presentation = thick layer of
  dead skin
• Treatment
  –By athlete – socks, shoes, Skin Lube
  –By ATC – shaving or sanding
             Turf Toe
• Mechanism = forcible
  hyperextension of great toe
• Typical presentation
  –Pain at base of great toe
• Treatment
  –Taping techniques
(AKA Hallux Valgus deformity)
• Mechanism – often caused by
  shoes that are too small or a
  flattened transverse arch
• Typical presentation
   –Bony enlargement of head of 1st
   –Can even cross over 2nd toe
Hallux Valgus deformity
• Treatment
  –Selection of proper shoes
  –Donut type pad to decrease
          Ingrown Toenails
• Mechanism – leads to inflammation &
• Typical presentation
• Treatment
   –Soak in hot water & insert cotton
   –Cut nails straight across
   –Check fit of shoes
   –Refer to MD if signs of infection!
Ingrown Toenail
       Toenail Hematoma
• Mechanism
  –Acute – Dropping object on toe
  –Chronic – Repetitive shearing
• Typical presentation
• Treatment
Toenail Hematoma

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