Foot and Ankle Injuries

Ankle Sprains Most common lower leg injury Classified as to degree of ligamentous severity

Lateral ankle sprain Mechanism: Inversion and plantar flexion Anterior talofibular ligament (ATF) usually first structure to injury Calcaneofibular ligament (CF) is usually secondary Posterior talofibular ligament (PTF) rarely injured

Lateral ankle sprain Signs/Symptoms: Obvious mech. of injury Report of “popping” or “tearing” of tissue Rapid swelling and point tenderness over soft tissue Be careful of possible fracture

Medial ankle sprain Less common Mechanism: Eversion Deltoid ligament injury

Medial ankle sprain Signs/Symptoms: Pain and swelling not as evident Point tenderness over deltoid

Syndesmosis ankle sprain Separation/widening of distal tibiofibular joint Injury to Anterior/Posterior tibiofibular ligaments Usually very disabling “High” ankle sprain Mechanism: Dorsiflextion with inversion or eversion

Syndesmosis ankle sprain Signs/Symptoms: Similar to lateral/medial ankle sprains Point tender at bony junction – top of ankle Swelling over medial/lateral malleoli

Fractures May occur anywhere in foot Common at the base of 5th Metatarsal (Jones Fracture) Usually result of forceful landing from jumping May be considered an avulsion fracture from an inversion ankle sprain Treatment is extremely controversial

Turf Toe First Metatarsaophalangeal (MTP) Sprain Common with artificial surfaces Mechanism: Hyperextending the MTP join or Contact with the shoe end

Turf Toe Signs/Symptoms: Treatment Pain and Tenderness Swelling on the Plantar joint aspect Discomfort with toe extension Treatment Cryotherapy, NSAIDS, Rest Protection from mechanism

Chronic Conditions

Bunions (Hallux valgus) Inflammation and thickening of the medial aspect of the MTP joint of the hallux MTP joint becomes inflamed and causes lateral displacement of the hallux As the condition progresses the 1st toe may overlap the 2nd toe Predisposing factors High heels, pointed shoe box, poor shoe fit Management Strapping of the hallux Wider toe box Surgical correction

Plantar Fasciitis (Bone spur) Most common hindfoot problem in runners Main support for longitudinal arch Structurally weak near the origin attachment Predisposing factors Significant increase in training Excessive tightness in Achilles tendon Abnormal change in body weight Pes cavus (high arch)

Plantar Fasciitis (Bone spur) Signs/Symptoms Pain is usually most sever during the first step in the morning Discomfort is reduced throughout the duration of the day Extreme point tenderness over origin Management Therapeutic modalities (e-stim, ultrasound) Achilles tendon stretching NSAIDS Heel lifts, taping, orthodics Night splints MD referral

Achilles Tendonitis Result of repetitive jumping or running (Loooooong distance runners) Signs/Symptoms Thickening of surrounding tissues Crepitation with tendinous movement Reduced ROM Management Ice therapy, NSAIDS Active stretching, Heel lifts Complete resolution of symptoms prior to return A chronic weakness will progress to rupture

Medial Tibial Stress Syndrome (Shin splints) Early, painful component of first part of a training activity Associated with repetitive activity on hard surfaces Contributing factors Muscled inflexibility Pes Planus (Low arch) Poor footwear Dramatic change in training or surface Signs/Symptoms Pain along medial tibial border Usu. Lower 1/3 of shin Common for bilateral symptoms

Medial Tibial Stress Syndrome (Shin splints) Management Rule out stress fractures Cryotherapy, NSAIDS Modification in training Pain free stretching of ankle/foot Change in footwear

Acute and Chronic

Compartment Syndrome Acute compartment syndrome results from a direct blow to the lower leg. Chronic compartment syndrome results from increase in the intramuscular pressure during exercise Most common in Anterior Leg Compartment

Compartment Syndrome Signs/Symptoms Decreased distal pulse Swelling Pain and tenderness Numbness, significant muscle weakness Tight skin Chronic – symptoms will reduce post-exercise

Compartment Syndrome Treatment/Management ACUTE CHRONIC Medical Emergency Immediate Referral to MD Ice CHRONIC Ice, NSAIDS, Stretching, Alter activities If severe (or not improving) refer to MD Surgical Fascia Release