1. Injury Assessment: Lower Extremity

2. I-Tunes Injury Eval Software - $29.99

3. Foot & Ankle

4. Anatomy Talar Dome Calcaneus Tibia/Fibula 5th Metatarsal ATFL/CLF/PTFL
Deltoid Ligament
Achilles Tendon
Plantar Fascia
Dorsal Pedis Pulse
Post. Tibialis Pulse

6. Adductor hallucis, flexor digitorum brevis, abductor digiti minimi

8. Deformities
Pes cavus/planus
Bunion (hallux valgus)

9. Special Tests: ROM Ankle: Dorsiflexion Plantarflexion Inversion
Eversion

10. Evaluation, Treatment, and Prevention of Foot & Ankle Injuries

11. Ankle Sprain: Treatment: RTP: Prevention:
Mild to moderate pain around ankle
80-90%: Lateral ankle sprains (ATFL, CFL, PTFL)
Felt or heard pop
Swelling and bruising
Treatment:
RICE, NSAID’s
Crutches if limping
RTP:
Pain free
Full strength/ROM
Min. to no swelling
Able to perform sport-specific testing
Prevention:
Ankle strengthening/balance exercises
Bracing as needed

12. Turf Toe: Treatment: RTP: Prevention:
Forced extension or flexion of great toe
Sprain/strain both possible
Mild to severe pain superior or inferior
Pain with (or inability to) walking/running/jumping
Treatment:
Rest, ice, NSAID’s, taping
RTP:
Pain free or to tolerance
Able to complete sport-specific testing
Prevention:
Proper footwear

13. Achilles Tendonitis: Treatment: RTP: Prevention:
Repeated forceful contraction/stretch of gastroc-soleus complex
Mild to severe pain over achilles tendon
Pain with dorsi- and plantarflexion
Pain with contraction of calf/running/jumping
Treatment:
Rest, ice, NSAID’s
Stretching
Crutches/boot as needed
RTP:
Pain free, taping, full strength/ROM
Prevention:
Stretching/strengthening, proper warm-up

14. Achilles Rupture: Most severe muscular injury to lower leg
Most common: y/o
MOI: explosive push-off
Hear and feel pop/Severe pain
May be able to walk/limp
Inability to dorsiflex foot
Positive Thompson test
Swelling/bruising
Visible defect in tendon
Treatment:
Ice, compression wrap (toes to knee), immobilize in posterior splint, immediate referral to orthopedic
Surgery usually required for athletes
RTP:
Cleared by MD
6+ months for full strength/ROM
Prevention:
Strength/stretch gastroc-soleous complex
Allow overuse injuries to completely heal

15. Plantar Fasciitis: Treatment: RTP: Prevention:
Inflammation of plantar fascia
Caused by: pes cavus, pes planus, no arch support, tight calf muscles, sudden increases in activity
Mild to severe pain on bottom of foot
Pain with walking/running/jumping
Swelling possible
Treatment:
Ice, rest, NSAID’s
RTP:
Pain free
Prevention:
Proper footwear/orthotics
Gradual increases in activity

16. Hip & Knee

17. Anatomy Femur Tibia Fibular Head Patella (“knee cap”) ACL/PCL/LCL/MCL
Tibial Tuberosity
Tibial Plataeu
Fibular Head
Patella (“knee cap”)
ACL/PCL/LCL/MCL
Meniscus
IT Band
Patellar Tendon
Quad/Hip Flexor/Hamstring/Gastroc-Soleus Complex

24. Deformities
Genu Recurvatum
Genu Varum
Genu Valgum

25. ROM Knee: Hip: Flexion/extension Flexion/extension
Adduction/abduction
Internal/external rotation
Knee:
Flexion/extension
Internal/external rotation
Measure tibial torsion prone w/ knee flexion to 90 degrees.

26. Evaluation, Treatment, and Prevention of Hip & Knee Injuries

27. Hip Subluxation Hip Dislocation
Moderate to severe pain
Limping
Possible neurovascular signs
Treatment:
Ice, monitor, immobilize leg, call 911?
Hip Dislocation
Severe pain
Unable to walk
70-80% posterior dislocations
Injured leg shorter
Neurovascular signs
Ice, monitor, immobilize leg,
call 911
RTP:
Pain free, full ROM, full strength, released by MD
Prevention:
Strengthening ex’s

28. Hip Pointer: Treatment: RTP: Prevention:
Bruise of iliac crest (hip bone)
Mild point tenderness to severe pain
May not be able to perform hip flexion
Swelling possible
Treatment:
Ice, rest, monitor
RTP:
To tolerance, may need to pad, pain may last up to 2 months
Prevention:
Wear padding when appropriate

29. Femur Fracture Treatment: RTP: Prevention: Severe pain
Neurovascular signs
Deformity
Limb shortness
Heard or felt pop
Unable to move leg
Involves significant trauma
Not common in sports
Treatment:
Call 911, ice, immobilize leg, monitor
RTP:
Full ROM & strength, cleared by MD
Prevention:
Wear protective pads

30. Muscle Strains: Treatment: RTP: Prevention:
Mild, moderate, or severe pain
Pain or inability to lift leg
Possibly felt or heard pop
Pain or inability to run/sprint
Possible deformity: Refer
Treatment:
Ice, light stretch, rest, crutches?
RTP:
Full strength & ROM, pain free
Prevention:
Stretch & proper warm-up

31. Muscle Contusions: Treatment: RTP: Prevention: Mild to severe pain
Pain w/ walking/running/
moving leg
Possible inability to move leg
Decreased strength
Treatment:
RICE, crutches?
RTP:
Full strength & ROM, min. to
no pain
Prevention:
Wear protective equipment

32. Knee Sprain: Treatment: RTP: Prevention: ACL, PCL, MCL, or LCL
Mild to severe pain
Felt or heard a pop
Instability
Swelling (ACL especially)
Treatment:
RICE, immobilize, crutches, refer
RTP:
Full strength & ROM, no pain, cleared, brace
Prevention:
Brace, strengthening ex’s

33. Degree of MCL Sprains
MOI of MCL Sprain

34. Dislocated/Subluxated Patella:
Felt patella out of place
Lateral most common
Mild to severe pain
Obvious deformity
Swelling
Treatment:
RICE, crutches, immobilize, monitor, refer if necessary, straiten leg if possible-if patella does not relocate…call 911
RTP:
Full strength & ROM, no pain, cleared if seen by MD,
Prevention:
Quad strengthening ex’s

35. Stages of Patellar Dislocation

36. Meniscus Tear: Treatment: RTP: Prevention:
Knee locks, gives out, feels unstable
Pain at joint line
Felt or heard a pop
May swell
Treatment:
Rest, Ice, crutches?, refer
RTP:
Full ROM & strength,
pain tolerable
Prevention:
Strengthening ex’s

37. Other Meniscus Tears

39. Patellar Tendonitis: Treatment: RTP: Prevention:
Overuse injury caused by repeated contractions of quad and/or weak/tight quad/hamstring/calf
Mild to severe pain below patella w/ running/jumping/extension
Possible localized swelling
Treatment:
Rest, ice, NSAID’s
Patellar strap or tape
RTP:
Pain free or pain is tolerable
Prevention:
Strengthen/stretch quads, hamstrings, and calf
Proper warm-up prior to activity

40. Osgood Schlatter’s: Treatment: RTP: Prevention:
Traction injury were patellar tendon attaches to tibial tuberosity
Beginning of growth spurt:
Girls: 8-13
Boys: (more common)
Pain at tibial tuberosity w/ enlargement due to extra bone growth
Full ROM
Treatment:
Self Limiting (12-24 months)
Ice
Padding (i.e. wrestling)
Shock absorbent insoles
RTP:
To pain tolerance
Prevention:
Quad/hamstring stretching
Early padding and ice

41. IT Band Friction Syndrome:
Common in runners, cyclists, and volleyball
Thick fibers tighten and cause pain at the lateral femoral epicondyle and/or greater trochanter of the femur
Predisposing factors:
Genu varus, excessive pronation, leg-length, over-training
Initial pain late in run, then occurs earlier
May occur running up/down hill or climbing stairs
Treatment:
Ice, ice massage, NSAID’s, rest, stretching, avoid hills, modify activity, orthotics, swim for CV maint.
RTP:
Pain free
Prevention:
Stretching, gradual increases in training, proper footwear, correct predisposing factors if possible

42. Lower Leg Fracture: Treatment: RTP: Prevention: Severe pain
Pain is point specific
Deformity possible
Numbness/tingling
Heard or felt pop
Treatment:
Ice, immobilize, 911, monitor/treat for shock
RTP:
Cleared by MD
4-6 weeks + rehab
Prevention:
Protective padding

43. Shin Splints: Treatment: RTP: Prevention:
MTSS: inflammation of periosteum of the medial tibial border
Usually distal 1/3
3-6 cm long
Pain relieved by rest
Pain increases standing on toes
Caused by:
Sudden increase in activity
Poor footwear
Running on hard surfaces
Treatment:
Ice, ice massage, rest, NSAID’s, compression/tape
RTP:
Pain free
Prevention:
Achilles stretching, orthotics, proper footwear, gradual increases in activity, LL strengthening

44. Stress Fracture: Treatment: RTP: Prevention:
Repetitive running/jumping
Sudden increase in mileage
Pain begins slowly: increasing with activity and decreasing with rest
Pain is limited to the fracture site
Positive squeeze test/compression
or US, tuning fork
Treatment:
Refer to MD
Rest 4-6 weeks (or longer)
Ice, NSAID’s
Strengthening/stretching
NWB CV workouts (i.e. bike, pool)
RTP:
Pain free
Released by MD
Prevention:
Proper footwear/arch support, gradual increase in activity

45. Exertional Compartment Syndrome:
Unknown etiology: possibly tight fascia
Pain, burning, aching, cramping during activity
May subsides after activity
Tingling in foot or toes possible
Loss of circulation possible
Tightness of LL
Exercise induced swelling
Possible muscle weakness
Common bilat.
Treatment:
Rest, Ice, elevation, NSAID’s
DO NOT COMPRESS
Stretching/strengthening
Orthotics, activity modification
RTP:
Pain/sx free
Released by MD
Prevention:
Gradual increase in activity, stretching both may help

46. Fascial Compartments