2. ATC 222 CHAPTER 18 & 19: THE FOOT, ANKLE, AND LOWER LEG

3. Bones zFoot & Ankle y-14 Phalanges y-5 Metatarsals y-7 Tarsals y-2 Sesamoids

4. Bones zLeg y-Tibia y-Fibula

5. Joints zTalocrual (ankle joint) z“Ankle Mortise” y-dorsiflexion & plantarflexion

6. Joints zSubtalar y-pronation and supination

7. Ligamentous Support zLateral Ligaments y-anterior talofibular (atf) y-posterior talofibular (ptf) y-calcaneofibular (cf)

8. Ligamentous Support zMedial y-deltoid

9. Ligamentous Support of the Leg zAnterior and Posterior Tibiofibular y-interroseus membrane

10. Injuries of the Foot zAcute Conditions

11. Heel Bruise zEtiology y-sudden stop or go y-change in direction

12. Heel Bruise zSigns & Symptoms y-focal pain in the heel zManagement y-Ice soaks, rest yNSAID y-heel cup or doughnut pad

13. Longitudinal Arch Strain zEtiology y-forceful contact with playing surface y-unaccustomed, severe exercise early in the season

14. Longitudinal Arch Strain zSigns & Symptoms y-pain just below the medial malleolus y-swelling & tenderness medially zManagement y-ice soaks, arch taping for support, reduce weight bearing

15. Plantar Fascia (Aponeurosis) Strain zEtiology y-depressed longitudinal arch or mild pes cavus y-excessive running early coupled with poor calf flexibility

16. Plantar Fascia Strain zSigns & Symptoms y-sudden pain in the arch relieved with non-weight bearing y-pain when getting out of bed in the AM y-point tenderness over calcaneal epicondyle

17. Jones Fracture zEtiology y-inversion and plantarflexion of the foot zSigns & Symptoms ysevere pain & tenderness over base of 5th

18. Jones Fracture zManagement ycast 3-6 weeks

19. Metatarsal Fracture

20. Conditions of the Forefoot & Toe

21. Bunion (hallux valgus) zEtiology zSigns & Symptoms y-swelling, ruber, & tenderness at the MP joint

22. Bunion zManagement y-wide toe box y-doughnut pad y-tape splint with wedge

23. Bunionettes (tailor’s bunion)

24. Sesamoiditis

25. Metatarsalgia zEtiology y-poor calf flexibility, pes cavus y-fallen metatarsal arch due to pronation & splayed foot

26. Metatarsalgia zSigns & Symptoms y-flattened transverse arch

27. Metatarsalgia zManagement y-metatarsal pad or bar y-aggressive static stretching, strengthening of flexors y-Thomas heel to relieve pronation

28. Interdigital Neuroma zEtiology  -splayed toes & pronated foot zSigns & Symptoms y-swelling y-severe, intermittent & radiating pain with weight bearing

29. Interdigital Neuroma zManagement y-wide toe box y-metatarsal bar y-steroid injection

30. Morton’s Toe

31. Sever’s Disease (Calcaneal Apophysitis) zEtiology yintense activity zSigns & Symptoms y-pain @ posterior heel with activity

32. Sever’s Disease zManagement y-restricting DF by elevating heel ywill resolve when apophysis closes ymodification of activity level ywalking boot 6-8 weeks

33. Retrocalcaneal Bursitis zEtiology y-excessive rubbing due to increased pressure zSigns & Symptoms y-ruber, swelling

34. Plantar Fasciitis (Heel Spur Syndrome) zEtiology y-excessive pronation @ subtalar joint y-leg length discrepancy y-tight calf, etc

35. Plantar Fasciitis zSigns & Symptoms y-anterior/medial heel pain y-intense pain in the AM y-pain with DF of toes

36. Plantar Fasciitis zManagement y-longitudinal arch support y-friction massage y-aggressive stretching of calf & DF of great toe y-shoe with firm arch support

37. Metatarsal Stress Fracture zEtiology y-training errors y-morton’s toe or other atypical conditions of foot

38. Metatarsal Stress Fracture zSigns & Symptoms y-gradual increase in pain zManagement y-rest, walking boot yx-ray vs. walking boot

39. Conditions of Lower Leg & Ankle

40. Lateral Ankle Sprain (inversion) zEtiology y-inversion, plantar flexion, adduction zSigns & Symptoms yGrade I, II, III zManagement

41. Signs & Symptoms

42. Grade I z-mild stretching of the ATF z-mild pain, weight bearing is not impaired

43. Grade II z-complete tear of ATF & stretch or tear of CF z-”pop” or tear felt z-moderate pain, weight bearing is difficult z-tenderness, effusion, & ecchymosis

44. Grade III z-very rare, usually associated with talar subluxation z-ATF, CF, PTF & joint capsule affected z-severe pain noted laterally zdiffuse effusion, ecchymosis, major loss of function

45. Management

46. Grade I z-RICE z-horseshoe & wrap zgraduated exercises ROM, strength, proprioception

47. Grade II z-RICE z-x-ray z-crutches prn

48. Grade III z-possible cast for 3 weeks

49. Eversion Ankle Sprains zetiology y-eversion, abduction, dorsiflexion ypes planus

50. Syndesmotic Ankle Spain zEtiology y-inversion=AITF y-eversion=PITF

51. Syndesmotic Ankle Sprain zSigns & Symptoms y-talus moves 5 degrees y-passive DF causes pain in the ankle mortise

52. Ankle Fracture zEtiology y-forcible abduction and adduction of the foot y-a planted foot with forcible IR of the leg y-avulsion fx with 2nd or 3rd degree sprain

53. Ankle Fracture zSigns & Symptoms y-extreme pain and possible deformity

54. Acute Achilles Tendon Injuries

55. Achilles Tendon Strain zEtiology y-sudden excessive DF zSigns & Symptoms y-pain & weakness with PF

56. Achilles Tendon Strain zManagement y-ICE y-compressive wrap y-heel lift

57. Achilles Tendon Rupture zEtiology ysudden stop-&-go y-30+ y-chronic inflammation

58. Achilles Tendon Rupture zSigns & Symptoms y-immediate pain & snap y-indentation & soft achilles y-+Thompson

59. Achilles Tendon Rupture zManagement z-surgery vs. repair z-cast with foot in PF = 4 weeks

60. Chronic Ankle Tendon Injuries

61. Achilles Tendinitis zEtiology y-training errors, tight calf, pes cavus, tight hamstrings zSigns & Symptoms y-crepitus, point tenderness, weakness, decreased ROM

62. Achilles Tendinitis zManagement y-gentle stretching, ice soaks, NSAIDS y-heel lift

63. Retocalcaneal Bursitis zEtiology y-undue pressure on achilles tendon zManagement

64. Anterior/Posterior Tibial Tendinitis zEtiology y-anterior=excessive downhill running yposterior=hyperpronated foot

65. Anterior/Posterior Tibial Tendinitis zSigns & Symptoms y-pain over the muscle or tendon zManagement y-anterior=avoid hills & decrease mileage y-correct pronation y-ice and aggressive stretching

66. Acute Leg Injuries

67. Acute Compartment Syndrome zEtiology y-direct blow to the leg zSigns & Symptoms y-weakness with DF & toe extension y-paresthesia of dorsum of foot or between1st & 2nd toe

68. Acute Compartment Syndrome zManagement y-medical emergency y-decompress fascia y-NEVER apply a compressive wrap

69. Leg Fractures zfibula=middle third ztibia=lower third zEtiology y-direct vs. indirect

70. Leg Fractures zSigns & Symptoms y-deformity, crepitus, y-leg is hard & swollen from internal hemorrhaging y-volkmann’s contracture

71. Overuse Leg Injuries

72. Medial Tibial Stress Syndrome zEtiology y-pes planus, overuse, lack of reciprocal muscle coordination

73. Medial Tibial Stress Syndrome zSigns & Symptoms y-Grade I: pain during exercise y-Grade II: before & after y-Grade III: before, during, & after y-Grade IV: no pain

74. Medial Tibial Stress Syndrome zManagement y-NSAIDS y-ice massage y-aggressive stretching before & after

75. Stress Fracture of the Tibia & Fibula zEtiology y-pronated foot= fibula y-pes cavus= tibia y-overuse

76. Stress Fracture of the Tibia & Fibula zSigns & Symptoms y-intense pain after practice y-focal tenderness y-+ percussion