2Abbreviations Fx: Fracture MOI: Mechanism of Injury ROM: Range of MotionInv: InversionEV: EversionPF: PlantarflexionDF: DorsiflexionRx: ManagementLig: ligamentc/o: complains of
3Foot 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 activityDislocationsPlantar Facsiitis
4Ankle Injuries Fractures Dislocations Avulsion fx ATF Lig: A fracture to the lateral malleolus (looks like 3rd Degree sprain)DislocationsSprains: Lateral, Medial, and HighStrains and Tendonitis
5Lower Leg Injuries Fractures Strains and Tendonitis Growth Plate (Epiphyseal) FracturesDistal plated in fibula and tibia may fracture with inversion/eversionStrains and TendonitisAchilles Tendon RuptureCompartment SyndromeMedial Tibial Stress Syndrome
6Foot ConditionsMorton’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 archPes Cavus: High medial longitudinal archJones FX: Fx to the diaphysis of the 5th metatarsal.Retrocalcaneal Bursitis: Pump Bump inflammation of the bursa behind the achilles tendon.
7Foot ConditionsLisfranc 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
8Lateral Ankle SprainsAlso 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 grades1 is a slight stretching of the ligaments, mild pain2 is micro tearing or stretch of the ligament, hear a pop3 is a complete tear of the ligament, extremely disabling
9Lateral Ankle Sprains MOI: Stress Test: Anterior Talofibular (ATF) Ligament- plantarflexion and inversionCalcaneofibular Ligament- inversionPosterior Talofibular Ligament- severe inversion or dislocation (rare)Stress Test:Anterior Drawer Test: ATF ligamentTalar Tilt Test: CF and Deltoid ligaments
10Medial Ankle SprainsAlso 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 dorsiflexionStress Test:Talar Tilt Test- CF and Deltoid ligaments
11High Ankle SprainSyndesmotic 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 plantarflexionStress Test:Kleiger’s Test
12Ankle Sprains General Signs and Symptoms: Management: Swelling Pain with WB (weight bearing)InstabilityEcchymosis (bruising/discoloration)Management:RICE with horseshoeNSAIDsCrutches: Depend on the severity of the injuryReferral to Doctor for further evaluation and xrays
13Osteochondritis 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 lockingManagement: x-ray for diagnosis, immobilization or surgery depending on severity.
14Achilles Tendon Rupture Signs and Symptoms:Paininability to plantarflexFeels like they were “kicked in calf”Positive Thompson TestDeformityManagement:RICEReferral is rupture is suspectedSurgery needed to repair full rupture
15Muscle Strains MOI: Signs and Symptoms: Management: Due to violent contraction/twisting of footAwkward landingSigns and Symptoms:Pain with ROM or RROMPossible pain with WBSwelling or crepitusManagement:RICETaping/bracingMonitor for acute compartment syndrome
16Contusions MOI: direct blow to the extremity Signs and Symptoms: Limited ROMSwellingEcchymosisManagement:RICEPadding for protectionMonitor for acute compartment syndrome with contusions to the lower leg
17Dislocations Rare in ankle, but common in phalanges MOI: Traction or twistingSigns and Symptoms:DeformityPossible fracturesInability to move extremityManagement:ImmobilizeColdReferral for reduction or Emergency Action Plan (EAP)
18Acute FracturesIn 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
19Acute Fractures MOI: Signs and Symptoms: Direct blows Twisting Associated with avulsions/dislocationsSigns and Symptoms:Localized PainDeformity: may or may not be obviousSwellingEcchymosisCrepitusPain with WB
20Acute Fracture Stress Tests: Management: Tap Test (Bump or Flick Test): phalanges, tibia, fibula, talus or calcaneusCompression or Squeeze Test: tibia or fibulaManagement:RICEReferral for x-rayBe prepared to activate Emergency Action Plan (EAP) if open fracture or signs of shock
21Stress FracturesExtremely common due to repetitive action, seen in distance runnersS/S: point tenderness; especially in WB positionRx:NWB (non-weight bearing) > week or moreWalking boot or cast possibleOut of activity 3-4 weeksGradual resumption of activity
22Compartment SyndromeIs 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 legLeads to increased fluid pressure causing muscle ischemia.
23Compartment Syndrome Signs and Symptoms: Management: Pain becoming worse; eventually numbnessLoss of foot ROMLeg swellingManagement:Medical Emergency! Refer ImmediatelyApply cold and elevate the limbSurgical intervention is probably necessary
24Plantar FasciitisIs 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:ShoesOverweightActivity on hard surfacesOverusePoor mechanicsFatigue
25Plantar Fasciitis Signs and Symptoms : Management: Morning pain SwellingPain with WBCrepitusManagement:Good shoes/orthoticsStretchingIceTapingReferral to podiatrist
26ShinsplintsShinsplints is a catch-all term for tendonitis, chronic compartment syndrome or a stress fractureMedial Tibial Stress Syndrome (MTSS) is the more appropriate term for shinsplint-type painMTSS is caused by repetitive microtrauma and may evolve to be a stress fracture or compartment syndrome if not taken care of .
27Medial Tibial Stress Syndrome MOI:Pes planus (flat feet)OverweightPoor conditioningPoor shoesActivity on hard surfacesOveruse/Muscle weaknessPoor running techniqueGenetics
28Medial Tibial Stress Syndrome Signs and Symptoms:Pain: usually found on medial side of legPain with activity that gets progressively worse over timeManagement:RICE before/afterCheck shoesStretchStrengthenNSAIDsCross TrainRestRefer for fracture or compartment syndrome
29Gait Two Phases of Gait: Stance or Support Phase – weight bearing Swing Phase – non-weight bearing