FOOT AND ANKLE
COMMON INJURIES
SQUEAMISH?
• Roll/twisted ankle:
• http://www.youtube.com/watch?v=lgNttdd7UIc
• Breaking ankle:
• http://www.youtube.com/watch?v=vA5BU045gi4
BONES
• S&S
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•
•
•
•
•
Pain
Decreased ROM
Swelling
Bruising
NWB
Obvious deformity
BONES
• Any bone
• Acute fx
• Stress fx
• Avulsion fx
• Jones Fx
• Fx of the styloid process of the 5th Metatarsal
• Union vs non-union
• Knock-Off Fx
LIGAMENTS/TENDONS
• Ligament: bone to bone
• Tendon: muscle to bone
• Grading system:
• 1+/-: stretched, but no tearing/fraying of fibers
• 2+/-: tearing, but incomplete
• 3: complete tear
CONT’D
• Signs & Symptoms:
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•
•
•
•
•
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Pain
Swelling
Decreased ROM
Increased temp of skin
Bruising
NWB
+ laxity test
CONT’D
• ATFL– Candy if you can name it!
• Most commonly sprained
• MOI – “rolling ankle”, stepping in hole
• Deltoid Ligament
•
•
•
•
Keep ankle from evertion; stronger than ATF
MOI – Stepping in hole
High Ankle Sprain – Syndesmotic Sprain
MOI - Dorsiflexion and evertion
• Achilles Tendon
• More commonly torn with age
• MOI – Forced Dorsiflexion with knee bent
MUSCLES
• Strain
• Grade 1, 2, 3
• Common muscles affected:
• Peroneals
• Calf
“SHIN SPLINTS”
• Medial tibial stress syndrome (MTSS)
• Caused by:
• Irritated and swollen muscles, often from
overuse
• Stress fractures, which are tiny breaks in the
lower leg bones
• Overpronation or ''flat feet" -- when the impact
of a step makes your foot's arch collapses
• Runners might get them after ramping up their
workout intensity, or changing the surface they
run on
• Treatment:
• Rest your body. It needs time to heal.
• Ice your shin to ease pain and swelling. Do it for 2mins
every 3 to 4 hours for 2 to 3 days, or until the pain is
gone.
• Anti-inflammatory painkillers. NSAIDs
• Arch supports for your shoes. These orthotics -- which
can be custom-made or bought off the shelf -- may help
with flat feet.
• Range-of-motion exercises
• Neoprene sleeve for support.
• Physical therapy to strengthen the muscles in your shins.
YOU KNOW IT’S HEALED WHEN..
• Your injured leg is as flexible as your other
leg.
• Your injured leg feels as strong as your other
leg.
• Your can jog, sprint, and jump without pain.
• Your X-rays are normal or show any stress
fractures have healed.
• There's no way to say exactly when your shin
splints will go away. It depends on what's
causing them. People also heal at different
rates; 3 to 6 months is not unusual.
DIAGNOSIS PROCESS
• HOPS:
• History
• Observation
• Palpation – Provides a reference for the comparison of
bilateral symmetry of bones, alignment, tissue temperature,
or other deformity as well as the presence of increased
tendernesss
• Joint and Muscle Functional Assessment – impairment due to
ROM, Strength, P with movement
• Joint Stability Tests – reference for laxity, gapping,
hypo/hypermobility, end-feel
• Special Test
MANUAL MUSCLE TESTING
• Patient position: Muscle tested must be against
gravity
• Examiner position: stabilize proximal to the joint
being tested and provide resistance to the distal
joint
• “Break test”
• Positive test: weakness and/or pain compared
contralateral
GRADING
• 5/5 Normal: can resist max pressure with no pain
• 4/5 Good: can resist moderate pressure
• 3/5 Fair: Can move body part against gravity thru
full ROM
• 2/5 poor: Can move body part in gravity-eliminated
position thru full ROM
• 1/5 Trace: cannot produce movement, but muscle
contraction is palpable
• 0/5 Zero: No contraction is felt
END-FEEL (NORMAL)
• Soft: soft tissue approximation ex: knee flexion
• Firm: Muscular stretch/Capsular
Stretch/Ligamentous Stretch ex: Hip flexion, Ext of
MCP joints in fingers, forearm supination
• Hard: bone to bone ex: Elbow ext
END-FEEL (PATHOLOGICAL)
• Soft: occurs sooner or later in ROM than normal in a joint that
normally has a firm or hard end-feel ex: edema/synovitis
• Firm: occurs sooner or later in ROM than normal in a joint that
normally has soft or hard end-feel ex:
Capsular/muscular/ligamentous shortening
• Hard: occurs sooner or later in ROM than normal in a joint that
normally has soft or firm end-feel; feels like a bony block ex:
Loose bodies in joint/myositis ossificans/fx
• Spams: Joint motion is stopped involuntarily or voluntary
muscle spasm ex: inflammation/strain/joint instability
• Empty: no end-feel bc end of ROM is never reached due to
pain; no resistance felt except for patient’s protective muscle
splinting or muscle spams ex: fx/brusitis/abscess
HOMEWORK
• Pages 4 and 5 in coloring packet