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Foot and Ankle

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Lindsey Pugh

on 8 December 2015

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Transcript of Foot and Ankle

The Foot
Anatomy
Achilles Tendon
Injuries
Functional Anatomy
Contraction of the muscles in the lower leg produces movement at the ankle joint.
The muscles in the lower leg are divided into 4 groups and separated by a thick fascia.
The muscles that dorsiflex are in the anterior compartment, the muscles that plantarflex are in the superficial posterior compartment, the muscles that evert are in the lateral compartment, and the muscles that invert are in the deep posterior compartment.
Bones of the Ankle
Tibia
Fibula
Talus
Calcaneus
Bones of the Foot
Phalanges
*Distal, Middle and Proximal
Metatarsals
* 1st through 5th
Tarsals
*Calcaneus
*Navicular
*Cuboid
*Talus
Ligaments and Soft Tissue
Interosseous Membrane
Anterior Tibiofibular Ligament
Posterior Tibiofibular Ligament
Deltoid Ligament
Anterior Talofibular Ligament
Posterior Talofibular Ligament
Calcaneofibular Ligament
Gait
1gait noun \gāt\

Definition of GAIT
1: a manner of walking or moving on foot
Stance or support phase which starts at initial heel strike and ends at toe-off
Swing or recovery which represents time from toe-off to heel strike
Two Phases
Transverse Arch
Metatarsal Arch
Medial Longitudinal Arch
Lateral Longitudinal Arch
Phalanges
Metatarsals
Tarsals
medial cuneiform
intermediate cuneiform
lateral cuneiform
cuboid
navicular
talus
calcaneus
Ligaments are named after the bones they are connected to. So....
Lateral Ligaments
Anterior Talofibular Ligament
Calcaneofibular Ligament
Posterior Talofibular Ligament
Medial Ankle Ligament
Deltoid Ligament
Foot Problems are usually associated with improper footwear, poor hygiene, anatomical structural deviations or abnormal stresses
Apophysitis of the Calcaneus (Sever’s Disease)
Etiology
Traction (pulling) injury on the calcaneus, where Achilles attaches
Sign and Symptoms
Pain occurs at posterior heel below Achilles attachment in children and adolescent athletes
Pain occurs during activity and improves following activity
Management
Best treated with ice, rest, stretching and NSAID’s
Heel lift could also relieve some stress
Retrocalcaneal Bursitis (Pump Bump)
Etiology
Caused by inflammation of bursa beneath Achilles tendon
Result of pressure and rubbing of shoe heel counter of a shoe
Chronic condition that develops over time and may take a long time to heal
Sign and Symptoms
Pain w/ palpation above and in front of the Achilles insertion on the calcaneus, swelling on both sides of the heel cord
Management
RICE and NSAID’s used as needed, ultrasound can reduce inflammation
Routine stretching of Achilles, heel lifts to reduce stress, donut pad to reduce pressure
Possibly invest in larger shoes with wider heel contours - Treat the cause not the symptoms!
Pes Planus Foot (Flatfoot)
Etiology
Associated with excessive pronation, wearing tight shoes (weakening supportive structures) being overweight, excessive exercise placing undo stress on arch
Sign and Symptoms
Pain, weakness or fatigue in medial longitudinal arch; calcaneal eversion, bulging navicular, flattening of medial longitudinal arch and dorsiflexion with lateral splaying of 1st metatarsal
Management
If not causing athlete pain or symptoms, nothing should be done to correct “problem”
If problems develop, orthotic should be constructed with medial wedge, taping of arch can also be used for additional support
Heel Contusion
Etiology
Caused by sudden starts, stops or changes of direction, irritation of fat pad
Pain often on the lateral aspect due to heel strike pattern
Sign and Symptoms
Severe pain in heel and is unable to withstand stress of weight bearing
Often warmth and redness over the tender area
Management
Reduce weight bearing for 24 hours, RICE and NSAID’s
Resume activity with heel cup or doughnut pad after pain has subsided (be sure to wear shock absorbent shoes
Pes Cavus (High Arch Foot)
Etiology
Higher arch than normal; associated with excessive supination, accentuated high medial longitudinal arch
Sign and Symptoms
Poor shock absorption resulting in metatarsalgia, foot pain, clawed or hammer toes
Associated with forefoot valgus, shortening of Achilles and plantar fascia; heavy callus development on ball and heel of foot
Management
If asymptomatic, no attempt should be made to “correct”
Orthotics should be used if problems develop (lateral wedge)
Stretch Achilles and plantar fascia
Plantar Fasciitis
Common in athletes and nonathletes
Attributed to heel spurs, plantar fascia irritation, and bursitis
Catch all term used for pain in proximal arch and heel
Plantar fascia, dense, broad band of connective tissue attaching proximal and medially on the calcaneus and fans out over the plantar aspect of the foot
Works in maintaining stability of the foot and bracing the longitudinal arch
Jones Fracture
Etiology
Fracture of metatarsal caused by inversion and plantar flexion, direct force (stepped on) or repetitive trauma
Most common = base of 5th metatarsal
Sign and Symptoms
Immediate swelling, pain over 5th metatarsal
High nonunion rate and course of healing is unpredictable
Management
Crutches with no immobilization, gradually progressing to weight bearing as pain subsides
May allow athlete to return in 6 weeks
If nonunion occurs, internal fixation may be required
Metatarsal Stress Fractures
Etiology
2nd metatarsal fracture (March fracture)
Change in running pattern, mileage, hills, or hard surfaces
Flatfoot or short 1st metatarsal
Occasional 5th metatarsal fracture at base and insertion of peroneus brevis
S/S
Pain and point tenderness along 2nd metatarsal
Pain during running and walking
Can also feel aching and on going pain during non-weight bearing movements.
Management
Bone scan may be necessary
3-4 days of partial weight bearing followed by 2 weeks rest
Return to running should be gradual and orthotics should be used to correct excessive pronation
Longitudinal Arch Strain
MOI
Plantar aspect of the foot is subject to unaccustomed stresses and forces.
Can be acute or chronic
S/S
Pain only when running and is on the medial side of the foot.
Swelling and point tenderness on medial aspect
Management
PRICE
Reduce weight bearing
arch taping
Fractures and Disolcations of the Phalanges
MOI -
Kicking an object
Stubbing a toe
Dropping a heavy object on the toes
S/S -
PAIN!
Swelling/discoloration
possible deformity
Tx -
Refer to Dr.
Buddy tape
3-4 weeks of inactivity although they may be tender for longer
Wear a shoe with a wide box and a stiff sole
Bunions (Hallux Valgus Deformity)
MOI -
Painful deformity on the head of the 1st metatarsal
Eventually the great toe become malaligned and points towards the 2nd toe.
associated with a flattened transverse arch.
Often occurs from wearing shoes that are too small
S/S
Pain, tenderness, swelling
Enlargement of the MPJ
Tx
Select properly fitting shoes
Donut
Surgery
Morton's Neuroma
MOI -
Mass occuring in the plantar nerve
Most common between the 3rd and 4th metatarsal heads
S/S -
Pain radiating from the distal metatarsals to the toes
Often feels better when not bearing weight and worse during toe hyperextension
Tx -
tear drop pad between 3rd and 4th metatarsal heads
wear a shoe with a wide toe.
rest
surgery
Turf Toe
MOI -
Hyperextension sprain to the great toe
can be repetetive overuse or trauma
S/S -
Inflammation (5 signs)
Tx -
RICE
Turf Toe taping
Rigid insoles or a rigid insert can help as well
Calluses
MOI -
Wearing shoes that are too narrow or short
Develop from friction under the fatty layer
often blisters can develop under the callus
Tx -
Shave them
Massage lanolin in order to maintain tissue elasticity
Sanding or pumicing can work as well
Corn
MOI -
Caused by improperly fitting shoes
Usually formed on the tops of deformed or hammer toes
S/S -
A circular area of thickened white skin
sometimes has a black dot at the center
Usually has pain and inflammation
Tx -
wear properly fitting shoes
keep skin between toes clean and dry
soak feet daily in warm soapy water to soften
protect with a donut
Blisters
MOI -
Shearing forces on the skin causes the skin to separate from the layer beneath it.
Fluid will accumulate between the separation
Can be clear or bloody
Tx -
Skin lube protects the skin from abnormal friction
Cover with bandage
donut
Second Skin
Can cut open if severe pain is present, but only by ATC or physician due to infection concerns
Ingrown Toenail
MOI -
The edge of the toenail grows into the skin on the side of the nail.
Can be from cutting nails too short or rounding them instead of cutting strait across
S/S -
Swelling
Heat
Pain/aching
Pus
Tx -
Make sure shoes fit properly
Trim nails correctly
Cut a "V" at the end of the toenail will allow the affected side to grow towards the middle of the toe
Put a rolled up piece of cotton under the nail, pulling it out of the nail bed.
Remove toenail by Dr.
Subungual Hematoma (blood under the nail)
MOI -
Blunt force trauma to the toe
Repetitive shearing forces on the nail
S/S -
Blood under the nail
Extreme pain due to increased pressure
Tx -
Ice, Elevate
Release blood by drilling a hole in the nail within 24 post injury (only by ATC or Dr.)
Tinea Pedis (Athlete's Foot)
MOI -
Fungus that thrives in warm, dark, moist areas of the body
Fungus can be spread from person to person through direct or indirect contact (walking bear foot)
S/S -
Dry skin on soles of feet
Itching, burning, redness
Peeling or cracking skin
Tx -
Eliminate the environment that the fungus thrives in (keep it clean and dry)
Wear clean, dry absorbent socks (cotton) and change them often
Tinactin or Lotrimin powders or sprays
Plantar Warts
MOI -
noncancerous skin growths on the soles of your feet
caused by the human papillomavirus (HPV)
enters your body through tiny cuts and breaks in your skin
S/S -
Foot warts :)
Gray or brown lumps with one or more black pinpoints, which are actually small, clotted blood vessels, not "wart seeds"
Pain or tenderness when walking
Tx -
Plantar warts don't require treatment, but you may want to treat them if they're painful or to prevent their spread
Salicylic acid
duct tape
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1. Name the 4 arches in the foot
2. How can you determine if there is a stress fracture?
3. What does HOPS stand for
4. Name 4 of the 7 tarsal bones
5. Which bone is on top of the calcaneus
6. What is a s/s of a bunion
7. Name a chronic condition that could be caused by running

1) Name the bones in the ankle
2) Name the three lateral ligaments
3) Name the medial ligament
4) Name the 2 calf muscles and the tendon they
connect to.
Full transcript