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Published byRosemary Nicholson Modified over 9 years ago
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Original Author: Sabino Sports Medicine Connie Rauser, Instructor
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Tibia Fibula Tarsals Metatarsals Phalanges Sesamoid Bones Calcaneus
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Weight bearing bone Articulates with fibula both inferiorly and superiorly Landmarks Tibial tuberosity (proximal) Tibial Plateau Medial Malleolus Shaft
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Non-weight bearing bone Extends down past calcaneus providing bony support to prevent eversion Serves as site for muscle attachments Landmarks Head of fibula (proximal) Lateral malleolus
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Talus—articulates with the tibia/fibula Calcaneus Navicular Cuboid Medial, intermediate and lateral cuneiforms
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Tibiofibular joint--syndesmosis Ankle joint (talocrural) Ankle mortise Subtalar joint Metatarsalphalangeal joints (MP) Interphalangeal joints PIP DIP
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Transverse: proximal across tarsals Medial longitudinal arch: from calcaneus to 1 st metatarsal Strengthened by spring ligament (plantar calcaneonavicular ligament) Lateral longitudinal arch: from calcaneus to 5 th metatarsal Metatarsal arch: shaped by distal heads of metatarsals
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Peroneus longus Peroneus brevis Both do eversion and plantarflex Peroneus tertius Dorsiflex and evert
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Tibialis Anterior Extensor Digitorum Longus Extensor Hallicus Longus All do dorsiflexion and some inversion EDL—extension of toes 2-5 EHL—extension of great toe **EDB—extends toes 2-4 (dorsum of foot)
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Tibialis Posterior (Tom) Flexor Digitorum Longus (Dick) Flexor Hallicus Longus (Harry) All do Plantar Flexion and Inversion FDL– flexion of toes 2-5 FHL—flexion of great toe
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Gastrocnemius—crosses knee and ankle joint. Knee flexion/plantar flexion Soleus---crosses ankle joint. Plantarflexion Join together at the Achilles tendon Plantaris—cross ankle and knee joints. Knee flexion/plantar flexion Tendon run parallel to the Achilles tendon medially
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Plantar Fascia From calcaneus to heads of metatarsals. Maintain stability of foot and supports medial longitudinal arch Interosseus Membrane Thick connective tissue runs length of tib/fib and holds them together
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Plantar fasica
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Deltoid ligament 4 parts Very strong Not injured as often
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Anterior talofibular Posterior talofibular Calcaneofibular
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Anterior inferior tibiofibular ligament Posterior inferior tibiofibular ligament
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Wear properly fitting shoes Ankle support Protective equipment Maintain adequate strength and flexibility Heel cord stretching Strengthening in inversion, eversion, plantar and dorsiflexion Proprioception (balance training)
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MOI: 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 TX: ice, rest/non weight bearing til pain subsides, heel cup or doughnut when returning Complication: inflammation of periosteum
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MOI: tight heel cord, inflexibility of longitudinal arch, improper footwear, leg length discrepancy, rapid increase/change in training
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S/S: Pt tender 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
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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
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MOI: 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
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S/S: Pt. tender over metatarsal, swelling, pain, “pop” or “crack”, possible deformity
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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 Complication: Non union fracture. May require surgery to fix
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MOI: Unaccustomed stresses/forces placed on foot when in contact with a hard playing surface. Flattening of the foot (arch) when in midsupport phase May occur suddenly or over a longer period of time
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S/S: Pain felt just distal to the medial malleolus when running Swelling and Pt. tender along the calcaneonavicular ligament (spring ligament) and the first cuneiform Pt. tender over the FHL tendon as a result of compensation for stress on ligament
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TX: Rest, ice, reduction of weight bearing until relatively pain free Ultrasound Arch taping
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Sprain of the MP joint of the great toe MOI: Hyperextension of great toe—trauma or overuse Usually occurs on an unyielding surface such as turf Kicking an unyielding object
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S/S: Pt. tender over MP joint of great toe Swelling Discoloration Pain with movement especially pushing off big toe when taking a step
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TX: Rest, ice, compression Insert a hard insole into shoe to prevent hyperextension of MP joint Tape for hyperextension
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MOI: being stepped on or something being dropped onto the toe Toes being jammed into the end of the shoe while running
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S/S: Bleeding into the nail bed (under nail) Throbbing pain Pressure against nail exacerbates the problem
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TX: drain the blood from the nail
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MOI: shearing force on the skin that causes fluid to accumulate below top layer of skin May be clear, bloody or become infected
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S/S: area of fluid under skin Can be painful May break open May become infected—redness, heat, pus
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TX: cover with skin lube, bandage, foam or felt doughnut around it. If large, then drain, but clean it and treat as open wound Cover prior to practices/competitions
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Inversion Eversion (Syndesmotic) High Ankle Sprain
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Most common, resulting in injury to the lateral ligaments ATF ligament is the weakest of the 3 MOI: “rolling” the ankle, landing on another athlete’s foot, stepping in a hole, etc. Inversion/plantar flexion
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ATF lig. injured with the plantar flexion/inversion MOI Calcaneofibular lig. and posterior talofibular lig. injured when then inversion force is increased
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3 rd degree Lateral Ankle sprain
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S/S: Pain, Swelling, discoloration, Pt. tender 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 Anterior Drawer Test – Tests ATF Talar Tilt – Calcaneofib and Deltoid Ligaments Kleiger Test – High Ankle Calcaneus (Bump) Test – Calcaneus Fx
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Tx: RICE, “horseshoe” shaped felt/foam pad fit around the lateral malleolus Treat for shock (only in severe cases) crutches if necessary Medical attention if severe or possibility of fracture
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Avulsion fracture of lateral malleolus Avulsion fracture of base of 5 th metatarsal Push-off fracture of medial malleolus
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Less common due to bony structure of ankle Deltoid ligament damage (any or all 4 portions )
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MOI: 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, Pt. tender over medial malleolus and deltoid ligament Will vary depending on severity Tests: Talar Tilt
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Tx: RICE, “horseshoe” shaped felt/foam pad, crutches if necessary Treat for shock Medical attention with severe sprain or if fracture is suspected
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Avulsion fracture of medial malleolus Contused deltoid ligament due to impingement between medial malleolus and calcaneus Fracture of lateral malleolus
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Also called syndesmotic Anterior and posterior tibiofibular ligaments damage
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MOI: forced dorsiflexion or extreme plantar flexion/inversion Someone landing on the back of the leg with the foot in contact with the ground (dorsiflexion)
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S/S: may be swelling or not, may have discoloration or not pain Pt. tender over ATF and proximal to that at the junction of the tibia and fibula painful to bear weight, unable to go up on toes
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Tx: RICE, Crutches, medical attention if unable to bear weight or if significant swelling occurs Treat for shock Hard to treat and can take weeks to heal
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Fracture to the dome of the talus Tear of the interosseus membrane
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MOI: similar to those of the ankle sprains but generally more force is applied Can be open or closed
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After the MOI See the placement of the foot?
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Sliding into base He’s there!
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Open Fx/dislocation Open fracture
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S/S: Immediate swelling immense pain possible deformity and/or open wound Pt. tender over the bone + compression and percussion tests
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Tx: Splint in the position you find it Care for open wound if necessary Treat for shock Call 911 if the injury is severe/open ER visit
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Tendons most often affected Tibialis posterior Tibialis anterior Peroneals Achilles
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MOI: faulty foot biomechanics Inappropriate or poor/worn footwear Acute trauma to tendon Tightness of heel cord Training errors Excessive running, jumping, hills
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S/S: pain with active movements and passive stretching Pt. tender over insertion of tendon warmth Crepitus Thickening of tendon (achilles) Stiffness and pain following periods of inactivity
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Tx: Rest Modalities: ice, heat, ultrasound NSAIDS Exercise to strengthen muscle(s) involved Stretching Orthotics or taping to relieve stress on tendon
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Shin splints What is it? Theories Fascia pulling off of the bone (Soleus) Bone Reaction (bone not being able to keep up between osteoclasts and osteoblasts) Posterior tibialis pulling off of the medial surface of the bone
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MOI: strain of tibialis posterior tendon and its fascial sheath at attachment to periosteum of distal tibia due to running/etc. Faulty biomechanics Improper footwear Tight heel cord/Achilles tendon Training errors
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S/S: diffuse pain along the distal tibia (2/3) medially Pt. tender in the same area Pain after activity—then before/after—then all the time
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Tx: Modify activity Correct foot biomechanics (orthotics) Heel cord stretching (slant board) Strengthening of muscles in Posterior compartment Ice massage Friction massage Taping—arch support/ankle Demonstrate Arch Taping
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Tibia is most commonly fractured long bone in the body
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MOI: direct trauma to the tibia/fibula or both Indirect trauma such as combination rotation/compressive force
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S/S: Immediate pain Swelling Possible deformity May be open or closed
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Tx: Splint in the position you find it Treat for shock Call 911 if necessary ER visit
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Tibial (mid shaft) Fibular (distal third) Metatarsal (2 nd is most common )
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MOI: repetitive loading during training and conditioning and jumping Faulty biomechanics combined with excessive/change in training
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S/S: pain with activity Increase in pain when activity is finished Gradually gets worse Pt. tender on one specific point on the bone Can limit ability to participate
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Tx: stop activity (2-4 weeks) Alternate conditioning—non weight bearing Ice Crutches/protective footwear Medical referral Xrays Bone scan
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Increased pressure in the compartment(s) of the leg Causes compression of the muscles & neurovascular structures Anterior, lateral, deep posterior common 3 types Acute Acute exertional Chronic
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MOI: direct blow to the anterior compartment S/S: deep aching pain Tightness & swelling Pain with passive stretching Reduced circulation/sensory changes in foot May have LOM
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Tx: initially ice to reduce swelling If circulation/sensory changes occur—MEDICAL EMERGENCY Fasciotomy Return to activity 2-4 months post surgery
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Largest tendon in body Most common in athletes over 30 yrs Seen in sports with ballistic movements—tennis, raquetball, basketball, etc. MOI: sudden forceful plantar flexion of ankle
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S/S: felt/heard a “pop” at back of leg (sounds like a twig snap or gun shot) Felt as is someone hit them with a rock Pain with plantar flexion/dorsiflexion Inability to plantar flex Palpable/visible defect at the achilles tendon + Thompson test
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Tx: immobilize ice Send to ER Requires surgery w/ 6-8 weeks immobilization Rehab to regain full ROM/Strength
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MOI: direct trauma to area S/S: pain, swelling, increased warmth, hematoma Tx: RICE, protective padding, modify activity if necessary
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Immoblize object Cut object at each end to allow for transport Treat for shock Surgery to remove impaled object
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Apply Tuf-Skin Heel and Lace Pads Pre-wrap from midfoot to 2 finger widths below calf belly 2 anchor strips
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Begin 3 Stirrups In between each stirrup is a horseshoe/C strip ALWAYS GO MEDIAL TO LATERAL….unless
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Once 3 stirrups and C strips are in place 4 heel locks 2 medial 2 lateral 2 figure 8s
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Once all parts are on the ankle Close out Make it Pretty
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1.Spray 2.Heel and Lace Pads 3.Pre-Wrap 4.2 Anchors 5.3 Stirrups 6.3 C Strips 7.4 Heel locks 1.2 medial 2.2 lateral 8. 2 Figure 8s 9. Close Out
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