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ATC 222 CHAPTER 18 & 19: THE FOOT, ANKLE, AND LOWER LEG
Bones zFoot & Ankle y-14 Phalanges y-5 Metatarsals y-7 Tarsals y-2 Sesamoids
Bones zLeg y-Tibia y-Fibula
Joints zTalocrual (ankle joint) z“Ankle Mortise” y-dorsiflexion & plantarflexion
Joints zSubtalar y-pronation and supination
Ligamentous Support zLateral Ligaments y-anterior talofibular (atf) y-posterior talofibular (ptf) y-calcaneofibular (cf)
Ligamentous Support zMedial y-deltoid
Ligamentous Support of the Leg zAnterior and Posterior Tibiofibular y-interroseus membrane
Injuries of the Foot zAcute Conditions
Heel Bruise zEtiology y-sudden stop or go y-change in direction
Heel Bruise zSigns & Symptoms y-focal pain in the heel zManagement y-Ice soaks, rest yNSAID y-heel cup or doughnut pad
Longitudinal Arch Strain zEtiology y-forceful contact with playing surface y-unaccustomed, severe exercise early in the season
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
Plantar Fascia (Aponeurosis) Strain zEtiology y-depressed longitudinal arch or mild pes cavus y-excessive running early coupled with poor calf flexibility
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
Jones Fracture zEtiology y-inversion and plantarflexion of the foot zSigns & Symptoms ysevere pain & tenderness over base of 5th
Jones Fracture zManagement ycast 3-6 weeks
Conditions of the Forefoot & Toe
Bunion (hallux valgus) zEtiology zSigns & Symptoms y-swelling, ruber, & tenderness at the MP joint
Bunion zManagement y-wide toe box y-doughnut pad y-tape splint with wedge
Bunionettes (tailor’s bunion)
Metatarsalgia zEtiology y-poor calf flexibility, pes cavus y-fallen metatarsal arch due to pronation & splayed foot
Metatarsalgia zSigns & Symptoms y-flattened transverse arch
Metatarsalgia zManagement y-metatarsal pad or bar y-aggressive static stretching, strengthening of flexors y-Thomas heel to relieve pronation
Interdigital Neuroma zEtiology -splayed toes & pronated foot zSigns & Symptoms y-swelling y-severe, intermittent & radiating pain with weight bearing
Interdigital Neuroma zManagement y-wide toe box y-metatarsal bar y-steroid injection
Sever’s Disease (Calcaneal Apophysitis) zEtiology yintense activity zSigns & Symptoms posterior heel with activity
Sever’s Disease zManagement y-restricting DF by elevating heel ywill resolve when apophysis closes ymodification of activity level ywalking boot 6-8 weeks
Retrocalcaneal Bursitis zEtiology y-excessive rubbing due to increased pressure zSigns & Symptoms y-ruber, swelling
Plantar Fasciitis (Heel Spur Syndrome) zEtiology y-excessive subtalar joint y-leg length discrepancy y-tight calf, etc
Plantar Fasciitis zSigns & Symptoms y-anterior/medial heel pain y-intense pain in the AM y-pain with DF of toes
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
Metatarsal Stress Fracture zEtiology y-training errors y-morton’s toe or other atypical conditions of foot
Metatarsal Stress Fracture zSigns & Symptoms y-gradual increase in pain zManagement y-rest, walking boot yx-ray vs. walking boot
Conditions of Lower Leg & Ankle
Lateral Ankle Sprain (inversion) zEtiology y-inversion, plantar flexion, adduction zSigns & Symptoms yGrade I, II, III zManagement
Signs & Symptoms
Grade I z-mild stretching of the ATF z-mild pain, weight bearing is not impaired
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
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
Grade I z-RICE z-horseshoe & wrap zgraduated exercises ROM, strength, proprioception
Grade II z-RICE z-x-ray z-crutches prn
Grade III z-possible cast for 3 weeks
Eversion Ankle Sprains zetiology y-eversion, abduction, dorsiflexion ypes planus
Syndesmotic Ankle Spain zEtiology y-inversion=AITF y-eversion=PITF
Syndesmotic Ankle Sprain zSigns & Symptoms y-talus moves 5 degrees y-passive DF causes pain in the ankle mortise
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
Ankle Fracture zSigns & Symptoms y-extreme pain and possible deformity
Acute Achilles Tendon Injuries
Achilles Tendon Strain zEtiology y-sudden excessive DF zSigns & Symptoms y-pain & weakness with PF
Achilles Tendon Strain zManagement y-ICE y-compressive wrap y-heel lift
Achilles Tendon Rupture zEtiology ysudden stop-&-go y-30+ y-chronic inflammation
Achilles Tendon Rupture zSigns & Symptoms y-immediate pain & snap y-indentation & soft achilles y-+Thompson
Achilles Tendon Rupture zManagement z-surgery vs. repair z-cast with foot in PF = 4 weeks
Chronic Ankle Tendon Injuries
Achilles Tendinitis zEtiology y-training errors, tight calf, pes cavus, tight hamstrings zSigns & Symptoms y-crepitus, point tenderness, weakness, decreased ROM
Achilles Tendinitis zManagement y-gentle stretching, ice soaks, NSAIDS y-heel lift
Retocalcaneal Bursitis zEtiology y-undue pressure on achilles tendon zManagement
Anterior/Posterior Tibial Tendinitis zEtiology y-anterior=excessive downhill running yposterior=hyperpronated foot
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
Acute Leg Injuries
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
Acute Compartment Syndrome zManagement y-medical emergency y-decompress fascia y-NEVER apply a compressive wrap
Leg Fractures zfibula=middle third ztibia=lower third zEtiology y-direct vs. indirect
Leg Fractures zSigns & Symptoms y-deformity, crepitus, y-leg is hard & swollen from internal hemorrhaging y-volkmann’s contracture
Overuse Leg Injuries
Medial Tibial Stress Syndrome zEtiology y-pes planus, overuse, lack of reciprocal muscle coordination
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
Medial Tibial Stress Syndrome zManagement y-NSAIDS y-ice massage y-aggressive stretching before & after
Stress Fracture of the Tibia & Fibula zEtiology y-pronated foot= fibula y-pes cavus= tibia y-overuse
Stress Fracture of the Tibia & Fibula zSigns & Symptoms y-intense pain after practice y-focal tenderness y-+ percussion
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