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Injury Assessment: Lower Extremity

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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

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6 Adductor hallucis, flexor digitorum brevis, abductor digiti minimi

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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

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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

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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


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