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ATC 222

ATC 222. CHAPTER 18 & 19: THE FOOT, ANKLE, AND LOWER LEG. Bones. Foot & Ankle -14 Phalanges -5 Metatarsals -7 Tarsals -2 Sesamoids. Bones. Leg -Tibia -Fibula. Joints. Talocrual (ankle joint) “Ankle Mortise” -dorsiflexion & plantarflexion. Joints. Subtalar

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ATC 222

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  1. ATC 222 CHAPTER 18 & 19: THE FOOT, ANKLE, AND LOWER LEG

  2. Bones • Foot & Ankle • -14 Phalanges • -5 Metatarsals • -7 Tarsals • -2 Sesamoids

  3. Bones • Leg • -Tibia • -Fibula

  4. Joints • Talocrual (ankle joint) • “Ankle Mortise” • -dorsiflexion & plantarflexion

  5. Joints • Subtalar • -pronation and supination

  6. Ligamentous Support • Lateral Ligaments • -anterior talofibular (atf) • -posterior talofibular (ptf) • -calcaneofibular (cf)

  7. Ligamentous Support • Medial • -deltoid

  8. Ligamentous Support of the Leg • Anterior and Posterior Tibiofibular • -interroseus membrane

  9. Injuries of the Foot • Acute Conditions

  10. Heel Bruise • Etiology • -sudden stop or go • -change in direction

  11. Heel Bruise • Signs & Symptoms • -focal pain in the heel • Management • -Ice soaks, rest • NSAID • -heel cup or doughnut pad

  12. Longitudinal Arch Strain • Etiology • -forceful contact with playing surface • -unaccustomed, severe exercise early in the season

  13. Longitudinal Arch Strain • Signs & Symptoms • -pain just below the medial malleolus • -swelling & tenderness medially • Management • -ice soaks, arch taping for support, reduce weight bearing

  14. Plantar Fascia (Aponeurosis) Strain • Etiology • -depressed longitudinal arch or mild pes cavus • -excessive running early coupled with poor calf flexibility

  15. Plantar Fascia Strain • Signs & Symptoms • -sudden pain in the arch relieved with non-weight bearing • -pain when getting out of bed in the AM • -point tenderness over calcaneal epicondyle

  16. Jones Fracture • Etiology • -inversion and plantarflexion of the foot • Signs & Symptoms • severe pain & tenderness over base of 5th

  17. Jones Fracture • Management • cast 3-6 weeks

  18. Metatarsal Fracture

  19. Conditions of the Forefoot & Toe

  20. Bunion (hallux valgus) • Etiology • Signs & Symptoms • -swelling, ruber, & tenderness at the MP joint

  21. Bunion • Management • -wide toe box • -doughnut pad • -tape splint with wedge

  22. Bunionettes (tailor’s bunion)

  23. Sesamoiditis

  24. Metatarsalgia • Etiology • -poor calf flexibility, pes cavus • -fallen metatarsal arch due to pronation & splayed foot

  25. Metatarsalgia • Signs & Symptoms • -flattened transverse arch

  26. Metatarsalgia • Management • -metatarsal pad or bar • -aggressive static stretching, strengthening of flexors • -Thomas heel to relieve pronation

  27. Interdigital Neuroma • Etiology • -splayed toes & pronated foot • Signs & Symptoms • -swelling • -severe, intermittent & radiating pain with weight bearing

  28. Interdigital Neuroma • Management • -wide toe box • -metatarsal bar • -steroid injection

  29. Morton’s Toe

  30. Sever’s Disease (Calcaneal Apophysitis) • Etiology • intense activity • Signs & Symptoms • -pain @ posterior heel with activity

  31. Sever’s Disease • Management • -restricting DF by elevating heel • will resolve when apophysis closes • modification of activity level • walking boot 6-8 weeks

  32. Retrocalcaneal Bursitis • Etiology • -excessive rubbing due to increased pressure • Signs & Symptoms • -ruber, swelling

  33. Plantar Fasciitis (Heel Spur Syndrome) • Etiology • -excessive pronation @ subtalar joint • -leg length discrepancy • -tight calf, etc

  34. Plantar Fasciitis • Signs & Symptoms • -anterior/medial heel pain • -intense pain in the AM • -pain with DF of toes

  35. Plantar Fasciitis • Management • -longitudinal arch support • -friction massage • -aggressive stretching of calf & DF of great toe • -shoe with firm arch support

  36. Metatarsal Stress Fracture • Etiology • -training errors • -morton’s toe or other atypical conditions of foot

  37. Metatarsal Stress Fracture • Signs & Symptoms • -gradual increase in pain • Management • -rest, walking boot • x-ray vs. walking boot

  38. Conditions of Lower Leg & Ankle

  39. Lateral Ankle Sprain (inversion) • Etiology • -inversion, plantar flexion, adduction • Signs & Symptoms • Grade I, II, III • Management

  40. Signs & Symptoms

  41. Grade I • -mild stretching of the ATF • -mild pain, weight bearing is not impaired

  42. Grade II • -complete tear of ATF & stretch or tear of CF • -”pop” or tear felt • -moderate pain, weight bearing is difficult • -tenderness, effusion, & ecchymosis

  43. Grade III • -very rare, usually associated with talar subluxation • -ATF, CF, PTF & joint capsule affected • -severe pain noted laterally • diffuse effusion, ecchymosis, major loss of function

  44. Management

  45. Grade I • -RICE • -horseshoe & wrap • graduated exercises ROM, strength, proprioception

  46. Grade II • -RICE • -x-ray • -crutches prn

  47. Grade III • -possible cast for 3 weeks

  48. Eversion Ankle Sprains • etiology • -eversion, abduction, dorsiflexion • pes planus

  49. Syndesmotic Ankle Spain • Etiology • -inversion=AITF • -eversion=PITF

  50. Syndesmotic Ankle Sprain • Signs & Symptoms • -talus moves 5 degrees • -passive DF causes pain in the ankle mortise

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