Ankle/Foot and Lower Leg

Abbreviations Fx: Fracture MOI: Mechanism of Injury ROM: Range of Motion Inv: Inversion EV: Eversion PF: Plantarflexion DF: Dorsiflexion Rx: Management Lig: ligament c/o: complains of

Foot Injuries Fractures Dislocations Plantar Facsiitis Avulsion FX: Jones Fracture: Peroneus brevis pulls off proximal 5th metatarsal with forced inversion. Stress FX: March Fx: Stress Fx to metatarsals due to repetitive activity Dislocations Plantar Facsiitis

Ankle Injuries Fractures Dislocations Avulsion fx ATF Lig: A fracture to the lateral malleolus (looks like 3rd Degree sprain) Dislocations Sprains: Lateral, Medial, and High Strains and Tendonitis

Lower Leg Injuries Fractures Strains and Tendonitis Growth Plate (Epiphyseal) Fractures Distal plated in fibula and tibia may fracture with inversion/eversion Strains and Tendonitis Achilles Tendon Rupture Compartment Syndrome Medial Tibial Stress Syndrome

Foot Conditions Morton’s Toe: Longer 2nd phalange then 1st due to a shorter 1st metatarsal. Pes Planus: Flat foot, it is a lowering of the medial longitudinal arch Pes Cavus: High medial longitudinal arch Jones FX: Fx to the diaphysis of the 5th metatarsal. Retrocalcaneal Bursitis: Pump Bump inflammation of the bursa behind the achilles tendon.

Foot Conditions Lisfranc Injury: tarsometatarsal injury can be a fracture or a sprain of this area. Morton’s Neuroma: the nerve sheath at the plantar nerve becomes thick at the 4th and 5th met heads, causing pain. Turf Toe: Hyperextension of the great toe, spraining the metatarsophalangeal joint

Lateral Ankle Sprains Also known as Inversion ankle sprains, it is the most common type of ankle sprain. The injury is to the lateral ligaments, the weakest being the anterior talofibular ligament. Sprains are classified into 3 different grades 1 is a slight stretching of the ligaments, mild pain 2 is micro tearing or stretch of the ligament, hear a pop 3 is a complete tear of the ligament, extremely disabling

Lateral Ankle Sprains MOI: Stress Test: Anterior Talofibular (ATF) Ligament- plantarflexion and inversion Calcaneofibular Ligament- inversion Posterior Talofibular Ligament- severe inversion or dislocation (rare) Stress Test: Anterior Drawer Test: ATF ligament Talar Tilt Test: CF and Deltoid ligaments

Medial Ankle Sprains Also known as eversion ankle sprain, less common then a inversion sprain due to the bony structure of the ankle. Follows the same grading system as other sprains. MOI: Deltoid Ligaments: eversion and dorsiflexion Stress Test: Talar Tilt Test- CF and Deltoid ligaments

High Ankle Sprain Syndesmotic Sprain is the other name for a high ankle sprain. Syndesmosis injury is an injury to the distal tibiofibular joint, injuring the interosseous or syndesmotic ligaments. MOI: Anterior Inferior Tib/fib Ligament: excessive dorsiflexion or plantarflexion Stress Test: Kleiger’s Test

Ankle Sprains General Signs and Symptoms: Management: Swelling Pain with WB (weight bearing) Instability Ecchymosis (bruising/discoloration) Management: RICE with horseshoe NSAIDs Crutches: Depend on the severity of the injury Referral to Doctor for further evaluation and xrays

Osteochondritis Dissecans OCD lesions is when one or several fragments of articular cartilage and its underlying subchondral bone are either partially or completely detached and moving within the joint space. Can be from a single injury or repeated episodes. Signs: pain, swelling, and may c/o catching or locking Management: x-ray for diagnosis, immobilization or surgery depending on severity.

Achilles Tendon Rupture Signs and Symptoms: Pain inability to plantarflex Feels like they were “kicked in calf” Positive Thompson Test Deformity Management: RICE Referral is rupture is suspected Surgery needed to repair full rupture

Muscle Strains MOI: Signs and Symptoms: Management: Due to violent contraction/twisting of foot Awkward landing Signs and Symptoms: Pain with ROM or RROM Possible pain with WB Swelling or crepitus Management: RICE Taping/bracing Monitor for acute compartment syndrome

Contusions MOI: direct blow to the extremity Signs and Symptoms: Limited ROM Swelling Ecchymosis Management: RICE Padding for protection Monitor for acute compartment syndrome with contusions to the lower leg

Dislocations Rare in ankle, but common in phalanges MOI: Traction or twisting Signs and Symptoms: Deformity Possible fractures Inability to move extremity Management: Immobilize Cold Referral for reduction or Emergency Action Plan (EAP)

Acute Fractures In lower leg fractures there is a higher incidence of fibular fractures. Fractures to both the tibia and fibula can occur from direct or indirect forces

Acute Fractures MOI: Signs and Symptoms: Direct blows Twisting Associated with avulsions/dislocations Signs and Symptoms: Localized Pain Deformity: may or may not be obvious Swelling Ecchymosis Crepitus Pain with WB

Acute Fracture Stress Tests: Management: Tap Test (Bump or Flick Test): phalanges, tibia, fibula, talus or calcaneus Compression or Squeeze Test: tibia or fibula Management: RICE Referral for x-ray Be prepared to activate Emergency Action Plan (EAP) if open fracture or signs of shock

Stress Fractures Extremely common due to repetitive action, seen in distance runners S/S: point tenderness; especially in WB position Rx: NWB (non-weight bearing) > week or more Walking boot or cast possible Out of activity 3-4 weeks Gradual resumption of activity

Compartment Syndrome Is excessive swelling within the confines of a fascia compartment compresses muscles, blood vessels, and nerves. MOI: direct blow or tearing of muscle fibers causing swelling in the compartments of the lower leg Leads to increased fluid pressure causing muscle ischemia.

Compartment Syndrome Signs and Symptoms: Management: Pain becoming worse; eventually numbness Loss of foot ROM Leg swelling Management: Medical Emergency! Refer Immediately Apply cold and elevate the limb Surgical intervention is probably necessary

Plantar Fasciitis Is a catchall term that is commonly used to describe pain in the proximal arch and heel. It is inflammation of the plantar aponeurosis, that runs the length of the sole of the foot. MOI: Shoes Overweight Activity on hard surfaces Overuse Poor mechanics Fatigue

Plantar Fasciitis Signs and Symptoms : Management: Morning pain Swelling Pain with WB Crepitus Management: Good shoes/orthotics Stretching Ice Taping Referral to podiatrist

Shinsplints Shinsplints is a catch-all term for tendonitis, chronic compartment syndrome or a stress fracture Medial Tibial Stress Syndrome (MTSS) is the more appropriate term for shinsplint-type pain MTSS is caused by repetitive microtrauma and may evolve to be a stress fracture or compartment syndrome if not taken care of .

Medial Tibial Stress Syndrome MOI: Pes planus (flat feet) Overweight Poor conditioning Poor shoes Activity on hard surfaces Overuse/Muscle weakness Poor running technique Genetics

Medial Tibial Stress Syndrome Signs and Symptoms: Pain: usually found on medial side of leg Pain with activity that gets progressively worse over time Management: RICE before/after Check shoes Stretch Strengthen NSAIDs Cross Train Rest Refer for fracture or compartment syndrome

Gait Two Phases of Gait: Stance or Support Phase – weight bearing Swing Phase – non-weight bearing