Presentation is loading. Please wait.

Presentation is loading. Please wait.

Injuries to the Foot, Ankle and Lower Leg SPHS Sports Medicine John Hardin, Instructor.

Similar presentations


Presentation on theme: "Injuries to the Foot, Ankle and Lower Leg SPHS Sports Medicine John Hardin, Instructor."— Presentation transcript:

1 Injuries to the Foot, Ankle and Lower Leg SPHS Sports Medicine John Hardin, Instructor

2 Bony Anatomy Tibia Tibia Fibula Fibula Tarsals Tarsals Metatarsals Metatarsals Phalanges Phalanges Sesamoid Bones Sesamoid Bones

3 Tibia Weight bearing bone Weight bearing bone Articulates with fibula both inferiorly and superiorly Articulates with fibula both inferiorly and superiorly Landmarks Landmarks Tibial tuberosity (proximal) Tibial tuberosity (proximal) Tibial Plateau Tibial Plateau Medial Malleolus Medial Malleolus Shaft Shaft

4 Fibula Non-weight bearing bone Non-weight bearing bone Extends down past calcaneus providing bony support to prevent eversion Extends down past calcaneus providing bony support to prevent eversion Serves as site for muscle attachments Serves as site for muscle attachments Landmarks Landmarks Head of fibula (proximal) Head of fibula (proximal) Lateral malleolus Lateral malleolus

5 Tarsals Talus—articulates with the tibia/fibula Talus—articulates with the tibia/fibula Calcaneus Calcaneus Navicular Navicular Cuboid Cuboid Medial, intermediate and lateral cuneiforms Medial, intermediate and lateral cuneiforms

6 Joints Tibiofibular joint--syndesmosis Tibiofibular joint--syndesmosis Ankle joint (talocrural) Ankle mortise Ankle joint (talocrural) Ankle mortise Subtalar joint Subtalar joint Metatarsalphalangeal joints (MP) Metatarsalphalangeal joints (MP) Interphalangeal joints Interphalangeal joints PIP PIP DIP DIP

7 Arches Transverse: proximal across tarsals Transverse: proximal across tarsals Medial longitudinal arch: from calcaneus to 1 st metatarsal Medial longitudinal arch: from calcaneus to 1 st metatarsal Strengthened by spring ligament (plantar calcaneonavicular ligament) Strengthened by spring ligament (plantar calcaneonavicular ligament) Lateral longitudinal arch: from calcaneus to 5 th metatarsal Lateral longitudinal arch: from calcaneus to 5 th metatarsal Metatarsal arch: shaped by distal heads of metatarsals Metatarsal arch: shaped by distal heads of metatarsals

8 Muscles of lateral compartment Peroneus longus Peroneus longus Peroneus brevis Peroneus brevis Both do eversion Both do eversion

9 Muscles of the anterior compartment Tibialis Anterior Tibialis Anterior Extensor Digitorum Longus Extensor Digitorum Longus Extensor Hallicus Longus Extensor Hallicus Longus All do dorsiflexion and some inversion All do dorsiflexion and some inversion EDL—extension of toes 2-5 EDL—extension of toes 2-5 EHL—extension of great toe EHL—extension of great toe **EDB—extends toes 2-4 (dorsum of foot) **EDB—extends toes 2-4 (dorsum of foot)

10

11

12 Muscles of Superficial Posterior compartment Tibialis Posterior (Tom) Tibialis Posterior (Tom) Flexor Digitorum Longus (Dick) Flexor Digitorum Longus (Dick) Flexor Hallicus Longus (Harry) Flexor Hallicus Longus (Harry) All do Plantar Flexion and Inversion All do Plantar Flexion and Inversion FDL– flexion of toes 2-5 FDL– flexion of toes 2-5 FHL—flexion of great toe FHL—flexion of great toe

13 Muscles of Deep Posterior Compartment Gastrocnemius—crosses knee and ankle joint. Knee flexion/plantar flexion Gastrocnemius—crosses knee and ankle joint. Knee flexion/plantar flexion Soleus---crosses ankle joint. Plantarflexion Soleus---crosses ankle joint. Plantarflexion Join together at the Achilles tendon Join together at the Achilles tendon Plantaris—cross ankle and knee joints. Knee flexion/plantar flexion Plantaris—cross ankle and knee joints. Knee flexion/plantar flexion Tendon run parallel to the Achilles tendon medially Tendon run parallel to the Achilles tendon medially

14

15 Miscellaneous Plantar Fascia Plantar Fascia From calcaneus to heads of metatarsals. From calcaneus to heads of metatarsals. Maintain stability of foot and supports medial longitudinal arch Maintain stability of foot and supports medial longitudinal arch Interosseus Membrane Interosseus Membrane Thick connective tissue runs length of tib/fib and holds them together Thick connective tissue runs length of tib/fib and holds them together

16 Plantar fasica

17 Medial Ligaments Deltoid ligament Deltoid ligament 4 parts 4 parts Very strong Very strong Not injured as often Not injured as often

18 Lateral ligaments Anterior talofibular Anterior talofibular Posterior talofibular Posterior talofibular Calcaneofibular Calcaneofibular

19 Other ligaments Anterior inferior tibiofibular ligament Anterior inferior tibiofibular ligament Posterior inferior tibiofibular ligament Posterior inferior tibiofibular ligament

20 Prevention of Injuries Wear properly fitting shoes Wear properly fitting shoes Ankle support Ankle support Protective equipment Protective equipment Maintain adequate strength and flexibility Maintain adequate strength and flexibility Heel cord stretching Heel cord stretching Strengthening in inversion, eversion, plantar and dorsiflexion Strengthening in inversion, eversion, plantar and dorsiflexion Proprioception (balance training) Proprioception (balance training)

21 Heel Bruise (Stone Bruise) Mxn: Landing on heels, hitting heel on something hard—causing a contusion to the bottom of calcaneus Mxn: Landing on heels, hitting heel on something hard—causing a contusion to the bottom of calcaneus S/S: Severe pain in heel, difficulty weight bearing, POT S/S: Severe pain in heel, difficulty weight bearing, POT TX: ice, rest/non weight bearing til pain subsides, heel cup or doughnut when returning TX: ice, rest/non weight bearing til pain subsides, heel cup or doughnut when returning Complication: inflammation of periosteum Complication: inflammation of periosteum

22 Plantar Fasciitis Mxn: tight heel cord, inflexibility of longitudinal arch, improper footwear, leg length discrepancy, rapid increase/change in training Mxn: tight heel cord, inflexibility of longitudinal arch, improper footwear, leg length discrepancy, rapid increase/change in training

23 S/S: POT over the anteriomedial calcaneus and plantar fascia, stiffness and pain in AM or after prolonged sitting, pain with passive extension of toes combined with dorsiflexion S/S: POT over the anteriomedial calcaneus and plantar fascia, stiffness and pain in AM or after prolonged sitting, pain with passive extension of toes combined with dorsiflexion

24 TX: long term—8-12 weeks TX: long term—8-12 weeks vigorous heel cord stretching, ice massage, heel cup, taping, ultrasound, NSAIDS, Last resort: surgery to cut the fascia Complications: can develop a bone spur if not cared for—surgery to remove it

25 Metatarsal Fracture Mxn: direct force or twisting/torsion force or overuse Mxn: direct force or twisting/torsion force or overuse Most common is the Jone’s fracture—near base of 5 th, avulsion (at the base), midshaft Most common is the Jone’s fracture—near base of 5 th, avulsion (at the base), midshaft

26 S/S: POT over metatarsal, swelling, pain, “pop” or “crack”, possible deformity S/S: POT over metatarsal, swelling, pain, “pop” or “crack”, possible deformity

27 Tx: Ice, Compression wrap, crutches, send to Dr. for x-ray. Tx: Ice, Compression wrap, crutches, send to Dr. for x-ray. Possibly on crutches for 6-8 weeks, non- weight bearing to allow for healing Possibly on crutches for 6-8 weeks, non- weight bearing to allow for healing Complication: Non union fracture. May require surgery to fix Complication: Non union fracture. May require surgery to fix

28 Longitudinal Arch Strain Mxn: Unaccustomed stresses/forces placed on foot when in contact with a hard playing surface. Mxn: Unaccustomed stresses/forces placed on foot when in contact with a hard playing surface. Flattening of the foot (arch) when in midsupport phase Flattening of the foot (arch) when in midsupport phase May occur suddenly or over a longer period of time May occur suddenly or over a longer period of time

29 S/S: Pain felt just distal to the medial malleolus when running S/S: Pain felt just distal to the medial malleolus when running Swelling and POT along the calcaneonavicular ligament (spring ligament) and the first cuneiform Swelling and POT along the calcaneonavicular ligament (spring ligament) and the first cuneiform POT over the FHL tendon as a result of compensation for stress on ligament POT over the FHL tendon as a result of compensation for stress on ligament

30 TX: Rest, ice, reduction of weight bearing until relatively pain free TX: Rest, ice, reduction of weight bearing until relatively pain free Ultrasound Ultrasound Arch taping Arch taping

31 Turf Toe Sprain of the MP joint of the great to Sprain of the MP joint of the great to Mxn: Hyperextension of great toe— trauma or overuse Mxn: Hyperextension of great toe— trauma or overuse Usually occurs on an unyielding surface such as turf Usually occurs on an unyielding surface such as turf Kicking an unyielding object Kicking an unyielding object

32 S/S: POT over MP joint of great toe S/S: POT over MP joint of great toe Swelling Swelling Discoloration Discoloration Pain with movement especially pushing off big toe when taking a step Pain with movement especially pushing off big toe when taking a step

33 TX: Rest, ice, compression TX: Rest, ice, compression Insert a hard insole into shoe to prevent hyperextension of MP joint Insert a hard insole into shoe to prevent hyperextension of MP joint Tape for hyperextension Tape for hyperextension

34 Subungual Hematoma Mxn: being stepped on or something being dropped onto the toe Mxn: being stepped on or something being dropped onto the toe Toes being jammed into the end of the shoe while running Toes being jammed into the end of the shoe while running

35 S/S: Bleeding into the nail bed (under nail) S/S: Bleeding into the nail bed (under nail) Throbbing pain Throbbing pain Pressure against nail exacerbates the problem Pressure against nail exacerbates the problem

36 TX: drain the blood from the nail TX: drain the blood from the nail Use a drill bit Use a drill bit Heat a paperclip and burn through nail Heat a paperclip and burn through nail Use a scalpel to make hole in nail Use a scalpel to make hole in nail

37 Blisters Mxn: shearing force on the skin that causes fluid to accumulate below top layer of skin Mxn: shearing force on the skin that causes fluid to accumulate below top layer of skin May be clear, bloody or become infected May be clear, bloody or become infected

38 S/S: area of fluid under skin S/S: area of fluid under skin Can be painful Can be painful May break open May break open May become infected—redness, heat, pus May become infected—redness, heat, pus

39 TX: cover with skin lube, bandage, foam or felt doughnut around it. TX: cover with skin lube, bandage, foam or felt doughnut around it. If large, then drain, but clean it and treat as open wound If large, then drain, but clean it and treat as open wound Cover prior to practices/competitions Cover prior to practices/competitions

40 Ankle Sprains Inversion Inversion Eversion Eversion High Ankle Sprain High Ankle Sprain

41 Inversion Ankle Sprain Most common, resulting in injury to the lateral ligaments Most common, resulting in injury to the lateral ligaments ATF ligament is the weakest of the 3 ATF ligament is the weakest of the 3 Mxn: “rolling” the ankle, landing on another athlete’s foot, stepping in a hole, etc. Mxn: “rolling” the ankle, landing on another athlete’s foot, stepping in a hole, etc. Inversion/plantar flexion Inversion/plantar flexion

42 The inversion mxn

43 Structures injured ATF lig. injured with the plantar flexion/inversion mxn ATF lig. injured with the plantar flexion/inversion mxn Calcaneofibular lig. and posterior talofibular lig. injured when then inversion force is increased Calcaneofibular lig. and posterior talofibular lig. injured when then inversion force is increased

44 3 rd degree Lateral Ankle sprain

45

46 S/S: Pain, Swelling, discoloration, POT over the sinus tarsi, the distal end of the lateral malleolus and posterior of the lateral malleolus, joint instability, joint stiffness, decreased ROM, “+” anterior drawer test S/S: Pain, Swelling, discoloration, POT over the sinus tarsi, the distal end of the lateral malleolus and posterior of the lateral malleolus, joint instability, joint stiffness, decreased ROM, “+” anterior drawer test Will vary with the degree of the injury Will vary with the degree of the injury

47 Tx: RICE, “horseshoe” shaped felt/foam pad fit around the lateral malleolus Tx: RICE, “horseshoe” shaped felt/foam pad fit around the lateral malleolus Treat for shock Treat for shock crutches if necessary crutches if necessary Medical attention if severe or possibility of fracture Medical attention if severe or possibility of fracture

48 Complications Avulsion fracture of lateral malleolus Avulsion fracture of lateral malleolus Avulsion fracture of base of 5 th metatarsal Avulsion fracture of base of 5 th metatarsal Push-off fracture of medial malleolus Push-off fracture of medial malleolus

49 Eversion Ankle Sprain Less common due to bony structure of ankle Less common due to bony structure of ankle Deltoid ligament damage (any or all 4 portions Deltoid ligament damage (any or all 4 portions

50 Mxn: ankle everts due to---- someone/something landing on the lateral aspect of leg during weight bearing or--- Mxn: ankle everts due to---- someone/something landing on the lateral aspect of leg during weight bearing or--- S/S: Pain, swelling, discoloration, joint instability, joint stiffness, decreased ROM, POT over medial malleolus and deltoid ligament S/S: Pain, swelling, discoloration, joint instability, joint stiffness, decreased ROM, POT over medial malleolus and deltoid ligament Will vary depending on severity Will vary depending on severity

51 Tx: RICE, “horseshoe” shaped felt/foam pad, Tx: RICE, “horseshoe” shaped felt/foam pad, crutches if necessary crutches if necessary Treat for shock Treat for shock Medical attention with severe sprain of if fracture is suspected Medical attention with severe sprain of if fracture is suspected

52 Complications Avulsion fracture of medial malleolus Avulsion fracture of medial malleolus Contused deltoid ligament due to impingement between medial malleolus and calcaneus Contused deltoid ligament due to impingement between medial malleolus and calcaneus Fracture of lateral malleolus Fracture of lateral malleolus

53 “High” Ankle Sprain Also called syndesmotic Also called syndesmotic Anterior and posterior tibiofibular ligaments damage Anterior and posterior tibiofibular ligaments damage

54 Mxn: forced dorsiflexion or extreme plantar flexion/inversion Mxn: forced dorsiflexion or extreme plantar flexion/inversion Someone landing on the back of the leg with the foot in contact with the ground (dorsiflexion) Someone landing on the back of the leg with the foot in contact with the ground (dorsiflexion)

55 S/S: may be swelling or not, may have discoloration or not S/S: may be swelling or not, may have discoloration or not pain pain POT over ATF and proximal to that at the junction of the tibia and fibula POT over ATF and proximal to that at the junction of the tibia and fibula painful to bear weight, unable to go up on toes painful to bear weight, unable to go up on toes

56 Tx: RICE, Crutches, medical attention if unable to bear weight or if significant swelling occurs Tx: RICE, Crutches, medical attention if unable to bear weight or if significant swelling occurs Treat for shock Treat for shock Hard to treat and can take weeks to heal Hard to treat and can take weeks to heal

57 Complications Fracture to the dome of the talus Fracture to the dome of the talus Tear of the interosseus membrane Tear of the interosseus membrane

58 Ankle Fractures and Dislocations Mxn: similar to those of the ankle sprains but generally more force is applied Mxn: similar to those of the ankle sprains but generally more force is applied Can be open or closed Can be open or closed

59 What do these injuries look like? After the mxn See the placement of the foot?

60 Sliding into base He’s there!

61 Getting help

62 And the open ones? Open Fx/dislocation Open fracture

63 And some x-rays

64 S/S: Immediate swelling S/S: Immediate swelling immense pain immense pain possible deformity and/or open wound possible deformity and/or open wound POT over the bone POT over the bone + compression and percussion tests + compression and percussion tests

65 Tx: Splint in the position you find it Tx: Splint in the position you find it Care for open wound if necessary Care for open wound if necessary Treat for shock Treat for shock Call 911 if the injury is severe/open Call 911 if the injury is severe/open ER visit ER visit

66 Tendonitis Tendons most often affected Tendons most often affected Tibialis posterior Tibialis posterior Tibialis anterior Tibialis anterior Peroneals Peroneals Achilles Achilles

67 Mxn: faulty foot biomechanics Mxn: faulty foot biomechanics Inappropriate or poor/worn footwear Inappropriate or poor/worn footwear Acute trauma to tendon Acute trauma to tendon Tightness of heel cord Tightness of heel cord Training errors Training errors Excessive running, jumping, hills Excessive running, jumping, hills

68 S/S: pain with active movements and passive stretching S/S: pain with active movements and passive stretching POT over insertion of tendon POT over insertion of tendon warmth warmth Crepitus Crepitus Thickening of tendon (achilles) Thickening of tendon (achilles) Stiffnes and pain following periods of inactivity Stiffnes and pain following periods of inactivity

69 Tx: Rest Tx: Rest Modalities: ice, heat, ultrasound Modalities: ice, heat, ultrasound NSAIDS NSAIDS Exercise to strengthen muscle(s) involved Exercise to strengthen muscle(s) involved Stretching Stretching Orthotics or taping to relieve stress on tendon Orthotics or taping to relieve stress on tendon

70 Tib/Fib fracture Tibia is most commonly fractured long bone in the body Tibia is most commonly fractured long bone in the body

71 Mxn: direct trauma to the tibia/fibula or both Mxn: direct trauma to the tibia/fibula or both Indirect trauma such as combination rotation/compressive force Indirect trauma such as combination rotation/compressive force

72 S/S: Immediate pain S/S: Immediate pain Swelling Swelling Possible deformity Possible deformity May be open or closed May be open or closed

73 Tx: Splint in the position you find it Tx: Splint in the position you find it Treat for shock Treat for shock Call 911 if necessary Call 911 if necessary ER visit ER visit

74 Stress Fractures Tibial (mid shaft) Tibial (mid shaft) Fibular (distal third) Fibular (distal third) Metatarsal (2 nd is most common) Metatarsal (2 nd is most common)

75 Mxn: repetitive loading during training and conditioning and jumping Mxn: repetitive loading during training and conditioning and jumping Faulty biomechanics combined with excessive/change in training Faulty biomechanics combined with excessive/change in training

76 S/S: pain with activity S/S: pain with activity Increase in pain when activity is finished Increase in pain when activity is finished Gradually gets worse Gradually gets worse POT on one specific point on the bone POT on one specific point on the bone Can limit ability to participate Can limit ability to participate

77 Tx: stop activity (2-4 weeks) Tx: stop activity (2-4 weeks) Alternate conditioning—non weight bearing Alternate conditioning—non weight bearing Ice Ice Crutches/protective footwear Crutches/protective footwear Medical referral Medical referral Xrays Xrays Bone scan Bone scan

78 Medial Tibial Stress Syndrome Shin splints Shin splints

79 Mxn: strain of tibialis posterior tendon and its fascial sheath at attachment to periosteum of distal tibia due to running/etc. Mxn: strain of tibialis posterior tendon and its fascial sheath at attachment to periosteum of distal tibia due to running/etc. Faulty biomechanics Faulty biomechanics Improper footwear Improper footwear Tight heel cord/achilles tendon Tight heel cord/achilles tendon Training errors Training errors

80 S/S: diffuse pain along the distal tibia (2/3) medially S/S: diffuse pain along the distal tibia (2/3) medially POT in the same area POT in the same area Pain after activity—then before/after— then all the time Pain after activity—then before/after— then all the time

81 Tx: Modify activity Tx: Modify activity Correct foot biomechanics (orthotics) Correct foot biomechanics (orthotics) Heel cord stretching Heel cord stretching Strengthening of muscles in Posterior compartment Strengthening of muscles in Posterior compartment Ice massage Ice massage Friction massage Friction massage Taping—arch support/ankle Taping—arch support/ankle

82 Compartment Syndromes Increased pressure in the compartment(s) of the leg Increased pressure in the compartment(s) of the leg Causes compression of the muscles & neurovascular structures Causes compression of the muscles & neurovascular structures Anterior, lateral, deep posterior common Anterior, lateral, deep posterior common 3 types 3 types Acute Acute Acute exertional Acute exertional Chronic Chronic

83 Anterior compartment syndrome Mxn: direct blow to the anterior compartment Mxn: direct blow to the anterior compartment S/S: deep aching pain S/S: deep aching pain Tightness & swelling Tightness & swelling Pain with passive stretching Pain with passive stretching Reduced circulation/sensory changes in foot Reduced circulation/sensory changes in foot May have LOM May have LOM

84 Tx: initially ice to reduce swelling Tx: initially ice to reduce swelling If circulation/sensory changes occur— emergency room visit If circulation/sensory changes occur— emergency room visit Fasciotomy Fasciotomy Return to activity 2-4 months post surgery Return to activity 2-4 months post surgery

85 Achille Tendon Rupture Largest tendon in body Largest tendon in body Most common in athletes over 30 yrs Most common in athletes over 30 yrs Seen in sports with ballistic movements— tennis, raquetball, basketball, etc. Seen in sports with ballistic movements— tennis, raquetball, basketball, etc. Mxn: sudden forceful plantar flexion of ankle Mxn: sudden forceful plantar flexion of ankle

86 S/S: felt/heard a “pop” at back of leg S/S: felt/heard a “pop” at back of leg Felt as is someone hit them with a rock Felt as is someone hit them with a rock Pain with plantar flexion/dorsiflexion Pain with plantar flexion/dorsiflexion Inability to plantar flex Inability to plantar flex Palpable/visible defect at the achilles tendon Palpable/visible defect at the achilles tendon + Thompson test + Thompson test

87 Achilles tendon defect

88 Thompson Test

89 Tx: immobilize Tx: immobilize ice ice Send to ER Send to ER Requires surgery w/ 6-8 weeks immobilization Requires surgery w/ 6-8 weeks immobilization Rehab to regain full ROM/Strength Rehab to regain full ROM/Strength

90 Open achilles tendon rupture

91 Contusions Mxn: direct trauma to area Mxn: direct trauma to area S/S: pain, swelling, increased warmth, hematoma S/S: pain, swelling, increased warmth, hematoma Tx: RICE, protective padding, modify activity if necessary Tx: RICE, protective padding, modify activity if necessary

92 And other weird things

93 Another view

94 Treatment for this? Immoblize object Immoblize object Cut object at each end to allow for transport Cut object at each end to allow for transport Treat for shock Treat for shock Surgery to remove impaled object Surgery to remove impaled object


Download ppt "Injuries to the Foot, Ankle and Lower Leg SPHS Sports Medicine John Hardin, Instructor."

Similar presentations


Ads by Google