Foot and Ankle
Content
SUBUNGUAL HEMATOMA
MORTON’S, INTERDIGITAL OR PLANTAR NEUROMA
1
Longitudinal
ARCHES
Transverse
NORMAL NERVES
2
Severe intermittent pain radiating from the distal metatarsal heads to the tips of the toes. • Pain relieved when not bearing weight. • Burning numbness made worse with running, squatting and stairs.
•
Signs and Symptoms
CAUSES
Tight Shoes
Dropped Transverse Arch of the Foot.
3
TREATMENT
Mobilization of foot. Test strength of Peroneus Longus and Tib. Posterior. Metatarsal Pad.
INGROWN TOE NAIL
4
CONSERVATIVE TREATMENT
5
NORMAL
ANATOMY
6
FOOT MOTION and PLANTAR FASICIA
7
HEEL SPURS
TREATMENT PLANS
Foot taping. • Orthotics? • Strengthen weak muscles. • Stretch tight muscles.
•
MOST COMMON INJURY
8
BONY ANKLE JOINT
F T
Ta
Achilles Tendon P. Longus P. Brevis P. Tertius Ext. Digitorum Longus
Flex. Hallucis Longus Flex. Digitorum Longus Tib. Posterior Tib. Anterior Ext. Hallucis Longus
9
LATERAL LIGAMENTS
ANKLE MOVEMENT AND THE EFFECTS ON LIGAMENTS
Plantar
Neutral
Dorsi
10
INVERSION SPRAIN
BOTH INVERSIONS?
A
B
INVERSION SPRAIN 85% of all sprains Happens during loading and unloading of the ankle.
11
What ligament is the first line of defence?
Depends on ankle position
Peroneus Brevis Base 5th
Post. Talofib.
Lateral Structures Ankle
Anterior Inf. Tib-fib. Ant. Talofibular. Calcaneofibular P. Brevis Base 5
12
MANDATE ON PLAYING SURFACE
HOW SEVERE IS THE INJURY. HOW DO WE REMOVE THEM FROM THE FIELD
WEIGHT BEARING
OR
NON-WEIGHT BEARING
13
FIELD ASSESSMENT Ankle Sprains - General Mechanism of Injury Pain …… where? Hear/feel anything? Injured before? Continue with activity?
Metatarsal
3 Calcaneofibular Lig. Base of 5th 4
Anterior Inferior 1 Tibiofibular Ligament 2 Anterior Talofibular
PALPATION
Least common sprain. • Most fractures happen in eversion. • Stability of the medial ankle depends upon the Deltoid Ligament and the lateral malleolus.
•
EVERSION SPRAIN
14
Slight medial tenderness. • Pain and slight limitation on active eversion. • Stand to determine if there is leg pain. • Walk off playing surface if not antalgic.
•
EVERSION
ANKLE SPRAIN SEVERE Rigid, high footwear. Unable to continue on with the activity. Leg pain on standing.
15
3. Fracture 2. Ant. Inf. Tib-fib.
1. Deltoid
Eversion and External Rotation of the ankle without Deltoid Ligament tear.
16
Hockey Player Inversion Minimal Pain Mild swelling Mild bruising Return in five days
17
Day 6
Can this athlete return to play during this contest? Pain changes the way you do things!
THE MINOR SPRAIN
Definition… Discomfort versus pain?
18
Dissect the sport into its’ components starting from the most simple on the ankle and progress to the most difficult. If they can perform the test without pain… then return. (Following taping?)
NON-RETURNING ATHLETE C.I.C.E.R.
Crutches for proper gait. Referral for physio. Prepare for return.
19
PREPARE FOR RETURN
Aside from the ‘formal’ rehabilitation, the athlete must work on maintaining conditioning and doing whatever sport skills they can.
WHEN DO I KNOW THAT I AM READY TO RETURN?????
20
WALK Pain JOG FIGURE 8 SHUTTLE RUN
Figure 8 and Shuttle Run
FIGURE 8
½ Speed
SHUTTLE
L
¾ Speed 25 m
R
???
21
MORTON’S, INTERDIGITAL OR PLANTAR NEUROMA
1
Longitudinal
ARCHES
Transverse
NORMAL NERVES
2
Severe intermittent pain radiating from the distal metatarsal heads to the tips of the toes. • Pain relieved when not bearing weight. • Burning numbness made worse with running, squatting and stairs.
•
Signs and Symptoms
CAUSES
Tight Shoes
Dropped Transverse Arch of the Foot.
3
TREATMENT
Mobilization of foot. Test strength of Peroneus Longus and Tib. Posterior. Metatarsal Pad.
INGROWN TOE NAIL
4
CONSERVATIVE TREATMENT
5
NORMAL
ANATOMY
6
FOOT MOTION and PLANTAR FASICIA
7
HEEL SPURS
TREATMENT PLANS
Foot taping. • Orthotics? • Strengthen weak muscles. • Stretch tight muscles.
•
MOST COMMON INJURY
8
BONY ANKLE JOINT
F T
Ta
Achilles Tendon P. Longus P. Brevis P. Tertius Ext. Digitorum Longus
Flex. Hallucis Longus Flex. Digitorum Longus Tib. Posterior Tib. Anterior Ext. Hallucis Longus
9
LATERAL LIGAMENTS
ANKLE MOVEMENT AND THE EFFECTS ON LIGAMENTS
Plantar
Neutral
Dorsi
10
INVERSION SPRAIN
BOTH INVERSIONS?
A
B
INVERSION SPRAIN 85% of all sprains Happens during loading and unloading of the ankle.
11
What ligament is the first line of defence?
Depends on ankle position
Peroneus Brevis Base 5th
Post. Talofib.
Lateral Structures Ankle
Anterior Inf. Tib-fib. Ant. Talofibular. Calcaneofibular P. Brevis Base 5
12
MANDATE ON PLAYING SURFACE
HOW SEVERE IS THE INJURY. HOW DO WE REMOVE THEM FROM THE FIELD
WEIGHT BEARING
OR
NON-WEIGHT BEARING
13
FIELD ASSESSMENT Ankle Sprains - General Mechanism of Injury Pain …… where? Hear/feel anything? Injured before? Continue with activity?
Metatarsal
3 Calcaneofibular Lig. Base of 5th 4
Anterior Inferior 1 Tibiofibular Ligament 2 Anterior Talofibular
PALPATION
Least common sprain. • Most fractures happen in eversion. • Stability of the medial ankle depends upon the Deltoid Ligament and the lateral malleolus.
•
EVERSION SPRAIN
14
Slight medial tenderness. • Pain and slight limitation on active eversion. • Stand to determine if there is leg pain. • Walk off playing surface if not antalgic.
•
EVERSION
ANKLE SPRAIN SEVERE Rigid, high footwear. Unable to continue on with the activity. Leg pain on standing.
15
3. Fracture 2. Ant. Inf. Tib-fib.
1. Deltoid
Eversion and External Rotation of the ankle without Deltoid Ligament tear.
16
Hockey Player Inversion Minimal Pain Mild swelling Mild bruising Return in five days
17
Day 6
Can this athlete return to play during this contest? Pain changes the way you do things!
THE MINOR SPRAIN
Definition… Discomfort versus pain?
18
Dissect the sport into its’ components starting from the most simple on the ankle and progress to the most difficult. If they can perform the test without pain… then return. (Following taping?)
NON-RETURNING ATHLETE C.I.C.E.R.
Crutches for proper gait. Referral for physio. Prepare for return.
19
PREPARE FOR RETURN
Aside from the ‘formal’ rehabilitation, the athlete must work on maintaining conditioning and doing whatever sport skills they can.
WHEN DO I KNOW THAT I AM READY TO RETURN?????
20
WALK Pain JOG FIGURE 8 SHUTTLE RUN
Figure 8 and Shuttle Run
FIGURE 8
½ Speed
SHUTTLE
L
¾ Speed 25 m
R
???
21
