1. Foot and Ankle Injuries

2. Objectives Recognize various injuries to the foot and ankle
Identify causes and signs/symptoms of various foot and ankle injuries
Be able to perform a basic ankle evaluation

3. Terminology Review Plantar Flexion Dorsiflexion Inversion Eversion
Varus
Valgus

4. Motions of the foot/ankle
Plantar Flexion (pointing the toes)
Dorsiflexion (bring toes back)
Inversion (turn the foot inward)
Eversion (turn the foot outward)
Pronation – rolling the foot inward; combination movement (dorsiflexion, eversion)
Supination – rolling the foot outward; combination movement (plantar flexion, inversion)
Pronation/Supination only occur when the foot is in contact with the ground.

5. Pes Planus (flatfoot) Abnormal loss of the medial longitudinal arch
“Flexible Flatfoot” disappears when NWB
Don’t confuse w/ hyperpronation
Can lead to MANY lower extremity injuries.

6. Pes Cavus (high arch) Abnormally high arch
Does not disappear with weight bearing
Keeps the midfoot in a “locked” position.
Causes “clawing” of the toes
Foot becomes a very poor shock absorber.
Prone to stress injuries of both feet and legs

7. Plantar Fasciitis Inflammation of plantar fascia
Caused by prolonged abnormal stress on the fascia.
Characterized by heel pain in the AM.
Treatments include rest, soft tissue mobilization, gastroc/soleus stretching, orthotics?

8. Turf Toe A sprain of the 1st MTP joint. Caused by hyperextension
Downward force to the foot while weight bearing on the toes.
NOT specific to turf playing surfaces

9. Turf Toe (cont’d) S/S: pain and swelling of 1st MTP joint.
Pain with weight bearing
Inability to “push off”
Inability to actively flex or extend the big toe

10. Turf Toe (cont’d) Treatment:
Consists of rest, cryotherapy, and a period of immobilization
Shoes w/ rigid sole
Turf toe taping
…limit 1st MTP hyperextension

11. Hallux Valgus (Bunion)
“HAV”
Valgus deformity of the 1st MTP joint.
Mostly genetic
Can also occur from wearing pointed shoes.
More common in females
Pain/swelling over medial MTP joint
Callus formation (due to shearing forces)

12. HAV (cont’d) Usually treated conservatively Rest, modality tx.
Custom padding and/or orthotics
Properly fitted shoes
Surgical correction is necessary if there is no response to conservative treatment

13. Morton’s Neuroma Inflammation of nerve tissue between metatarsals
Usually b/t 2nd and 3rd or 3rd and 4th.
Exact cause is unknown
Abnormal bone structure; flat feet; bunions; high arches; poor footwear
Causes pain and numbness in forefoot and toes, usually with weight bearing

14. Jones Fracture Fx. to base of the 5th metatarsal (styloid)
Usually caused by direct impact to lateral side of the foot.
S/S: pain and swelling over styloid process
Poor healing bone due to poor vascularization

15. Jones Fracture (cont’d)

16. Lisfranc fracture
Fracture in which one or all of the metatarsals become displaced from the tarsals.
Rare….usually occurs in sports where feet are fixated.
Occurs occasionally in football (Matt Schaub, Darren McFadden)
Similar mechanism to turf toe.
S/S include severe pain through the midfoot; inability to bear weight; possible deformity; swelling and discoloration on both the top and bottom of the foot
This is a severe injury….may take months to heal…..may require surgical intervention.

17. Lisfranc Fracture

18. Ankle joint Made up of the distal tibia (medial malleolus)
Distal fibula (lateral malleolus)
Talus bone

19. Ankle Ligaments Anterior Talofibular (ATF)
Connects the talus to the lateral malleolus
Prevents anterior movement of the foot on the ankle.

20. Ankle Ligaments Calcaneofibular ligament (CF)
Connects the calcaneus to the lateral malleolus
Prevents inversion of the foot

21. Ankle Ligaments Deltoid Ligament
Connects the medial malleolus to the calcaneus and navicular bone on the medial side.
Prevents eversion of the foot

22. Ankle Ligaments Anterior Tibiofibular Ligament (syndesmosis)
Connects distal ends of tibia and fibula
Prevents external rotation of the foot on the ankle

23. Ankle Sprains Inversion most common mechanism Grade 1-3
S/S: pain, swelling, loss of motion, loss of strength, instability
Not always a time-loss injury
(+) Anterior Drawer test

24. Ankle Sprains - Inversion

25. Inversion Ankle Sprain

26. Ankle Sprains Syndesmotic Sprain “high ankle sprain”
Caused by an external rotation mechanism
Causes severe pain and dysfunction
Even minor sprains may take 2-4 weeks to heal.

27. Ankle Sprain - Syndesmotic

28. Peroneal Tendon Subluxation
Tearing of the retinaculum that holds peroneal tendons in place.
Tendons sublux anteriorly/posteriorly around the lateral malleolus