Sports Med 2

 The foot is critical in walking, running, jumping and changing direction 1) Shock absorber 2) Lever that propels the body forward, backward or to the side Foot management is key for the athletic population

 Label review

 Arches support the body weight, shock absorb during weight bearing.

 Write the bones that it supports

 Write the bones that it supports

Please look these up in your own books.  Mortons Toe p 423  Plantar fasciitis p 426  Jones fracture p 418  Bunion p 420  Sesamoiditis p 421

A. Generally caused by sudden lateral or medial twist B. Most common – Inversion (w/Plantar flexion) 1. More bony stability on the lateral side 2. Tight heel cord 3. Graded by the ligaments involved C. Eversion etiology: A. Pronated, hypermobile or depressed arched B. Represents about 10% of ankle sprains C. More serious than lateral ankle sprains

MOI: Foot inversion, PF, with mild stretching of the ATF S/S: - Mild pain and disability - Weight bearing is not impaired - Mild point tenderness - Mild/slight swelling over ligament - No joint laxity (looseness) TX: - PRICE - Progressive Resistance Exercises (PRE’s)

MOI: - Moderate force in inversion, PF - Complete tear of the ATF and stretch of the CF S/S: - c/o pop or snap - Moderate pain and disability - Weight bearing is difficult - Tenderness and edema w/blood in the joint - Ecchymosis - + talar tilt, + anterior drawer tests TX: - PRICE - x-ray, crutches - PF and DF exercises - ROM, PRE’s

MOI: - Severe force in inversion, PF - Involving ATF, CF and PTF S/S: - c/o pain in region of lateral malleolus - Swelling is diffused along w/ discoloration - No possible weight bearing - Major loss of function (LOF) - Severe swelling - + talar tilt, + anterior drawer tests TX: - PRICE - Crutches, refer for x-ray - ROM, PRE’s

Anterior Drawer Test Procedure: stabilize the distal leg with one hand & grasps the patient's calcaneus and rear foot with other hand. Move the foot anteriorly. Positive Test: laxity and pain indicates ATF ligament sprain

Talar (Calcaneal) tilt test Procedure: Grasp the distal fibula and tibia. Grasp the calcaneus and move into inversion. Positive Test: gapping or laxity, and pain indicates sprain of CF ligament

MOI: - Eversion, DF - Avulsion fx of the medial malleolus in 15% of cases S/S: - c/o pain over the foot and lower leg - Unable to bear weight on the foot - Ab/adduction causes pain TX: - x-ray to rule out fx. - PRICE - NSAIDS - PRE’s for posteromedial ankle muscle and for arch, could lead to pronation of the foot.

External rotation test (kleigers) Procedure: Grasp the distal tibia and fibula. Grasp the distal end of the foot and externally rotate (eversion) Positive Test: Pain and laxity indicates deltoid ligament sprain.

Bump Test Procedure: The athlete should be sitting with their foot off the table. Bump the calcaneus with the heel of your hand. Positive Test: Pain at the injury site is indicative of fracture

Relatively common in football MOI: - Forceful external rotation of the ankle - While lying on the field w/ ankle externally rotated, someone falls on the back of the leg and foot, forcing ER - Lateral blow to knee/leg with foot planted, forcing ER - External force can rupture ant. Tibiofibular lig., posterior tibiofibular lig., or fracture the posterior tibial tubercle.

S/S: - c/o severe pain, loss of function - When ankle is passively externally rotated, major pain in lower leg - Pain along the antero-lateral leg TX: - Out of competition - PRICE - NSAIDS - X-ray can reveal fracture or widening of the ankle mortise

Squeeze Test Procedure: compress the tibia and fibula together at mid-shaft. Positive Test: pain indicates injury to the syndesmosis

 Weekend warrior injury  quick acceleration/jumping-type sports  MOI  forceful PF of foot while the knee is extended  Unexpected rapid DF of the foot, stepping into a hole or stepping on a curb  violent dorsiflexion when jumping from a height and landing on a plantar flexed foot  S/S  report feeling a kick in the back of the calf and then severe sharp pain  loud pop or snap sound and swelling.  Limping, cant plantarflex, flat achilles  TX  Immobilize  PRICE, crutches  Refer

Thompsons Test Procedure: Athlete is lying prone with feet hanging off the table. Examiner squeezes the gastrocnemius muscle belly. Positive Test: If the foot does not move into plantarflexion it is indicative of Achilles tendon rupture.

Deep Vein Thrombosis (DVT) test Procedure: athlete is supine with knee in extension. Examiner passively dorsiflexes the foot and squeezes the gastrocnemius. Positive Test: Pain in the gastrocnemius indicates a DVT.

 Please look up these injuries of foot and ankle on your own:  Severs Disease (apophysitis)  Achilles Tendinitis  Medial tibial Stress Syndrome