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Foot and Ankle Injuries. Ankle Sprains. Most common lower leg injury Classified as to degree of ligamentous severity. Lateral ankle sprain . Mechanism: Inversion and plantar flexion Anterior talofibular ligament (ATF) usually first structure to injury
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Ankle Sprains • Most common lower leg injury • Classified as to degree of ligamentous severity
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
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
Medial ankle sprain • Less common • Mechanism: • Eversion • Deltoid ligament injury
Medial ankle sprain • Signs/Symptoms: • Pain and swelling not as evident • Point tenderness over deltoid
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
Syndesmosis ankle sprain • Signs/Symptoms: • Similar to lateral/medial ankle sprains • Point tender at bony junction – top of ankle • Swelling over medial/lateral malleoli
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
Turf Toe • First Metatarsaophalangeal (MTP) Sprain • Common with artificial surfaces • Mechanism: • Hyperextending the MTP join or • Contact with the shoe end
Turf Toe • Signs/Symptoms: • Pain and Tenderness • Swelling on the Plantar joint aspect • Discomfort with toe extension • Treatment • Cryotherapy, NSAIDS, Rest • Protection from mechanism
Bunions (Halluxvalgus) • 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
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 • Pescavus (high arch)
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
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
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 • PesPlanus (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
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
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
Compartment Syndrome • Signs/Symptoms • Decreased distal pulse • Swelling • Pain and tenderness • Numbness, significant muscle weakness • Tight skin • Chronic – symptoms will reduce post-exercise
Compartment Syndrome • Treatment/Management • ACUTE • Medical Emergency • Immediate Referral to MD • Ice • CHRONIC • Ice, NSAIDS, Stretching, Alter activities • If severe (or not improving) refer to MD • Surgical Fascia Release