FOOT & ANKLE INJURIES

1. FOOT & ANKLE INJURIES ConnieS. Hayes, CCSP, MS, DC

2. Anatomy of the Foot & Ankle

3. LIGAMENTS of the ANKLE

4. MEDIAL LIGAMENTS • Deltoid Ligament • Ant. tibiotalar ligament • Tibionavicular ligament • Tibiocalcaneal ligament • Post. tibiotalar ligament • Limits Eversion • Group = more stability • vs. singular lateral ligaments

5. LATERAL LIGAMENTS • Anterior Talofibular Ligament • primary restraint of Plantar Flexion + INV • Limits ant. displacement of talus • Calcaneofibular Ligament • primary restraint of INV at mid-range • Posterior Talofibular Ligament • primary restraint of Dorsiflexion • Limits posterior displacement of talus • Strongest of the three ligaments

6. TENDONS of the ANKLE

7. FOOT & ANKLE INJURIES • Ankle Sprains • Shin Splints • Compartment Syndrome • Achilles Tendon Rupture • Plantar Fasciitis • Fracture

8. ANKLE SPRAIN • Lateral • Most Common • Anterior Talofibular Ligament • 73% Recurrent (Arnold & Docherty, 2004) • Instability, Weakness & Proprioceptive Loss • Medial • Syndesmosis – High Ankle

9. SPRAIN CLASSIFICATION • Depends on amount of damage to ligaments • Grade 1 • Mild damage without instability • Grade 2 • Partial tear and stretched • Grade 3 • Complete tear • Instability • Bruising

10. TREATMENT PROTOCOLS

11. SYNDESMOSIS SPRAIN

12. Anatomy of the High

13. High Ankle Sprain SQUEEZE TEST

14. MEDIAL TIBIAL STRESS SYNDROME • MTSS aka Shin Splints • caused by repeated trauma to the connective tissue • Ignoring this injury may result in a stress fracture

15. TOM DICK & HARRY

16. TREATMENT • ICE • SOFT TISSUE TECH • ADJUST • TAPE

17. COMPARTMENT SYNDROME • 4 lower leg compartments • Anterior, Lateral, Posterior & Deep posterior • Muscles & Neurovascular structures tightly compartmentalized by fascia • Accumulation of fluid results in: •  compartment pressure-pain •  nerve pressure -paresthesia •  blood flow-cold

18. SIGNS & SYMPTOMS • FIVE P’s” • Pain – within affected compartment • Pallor – redness • Pulse – diminished dorsalis pedis pulse • Paresthesia – numbness between 1st & 2nd toes • Paralysis – drop foot gait

19. TREATMENT • Acute = MEDICAL EMERGENCY • fasciotomy • Chronic = require surgical intervention

20. TREATMENT • Decrease Pain and Swelling • Crutch use • DO NOT use compression • AROM and Flexibility after suture removal • Progress Weight Bearing as ROM improves • Gait training • Strength • Proprioception • Heel Raises

21. Achilles Tendon Rupture • Poorly vascularized tendon • Avascular zone = distal 2-6 cm • Delays healing process

22. Achilles Tendon Rupture • Requires surgical intervention • Reported “popping • Swelling & Ecchymosis near Malleoli • Visible Tendon Defect • Inability to Perform Toe Raises • RTP • 90-95% # of heel raises through full ROM in 30 sec

23. PLANTAR FASCIITIS • Inflammatory process • Causes • overuse • increased activity • weight • age

24. Plantar Fasciitis • Address the Anatomy Train • Soft Tissue Tech • Adjustments • Ice/Heat • Laser • Calcaneal Bar • With or without heel spur • Night Splint

25. FRACTURES • Stress Fracture • Most Common Site = 2ndand 3rd Metatarsal • Boot Other fracture sites • Ottawa Ankle & Foot rules • set of guidelines to help decide if X-ray is needed to DX possible fracture • very high sensitivity, moderate specificity, low rate of false negatives

26. OTTAWA ANKLE RULES X-ray required if there is any pain in the malleolar zone and any one of the following: • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus • Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus • Inability to bear weight both immediately and in the ER for 4 steps

27. OTTAWA FOOT RULES Pain in the midfoot zone and any one of the following: • Bone tenderness at the base of the fifth metatarsal • Bone tenderness at the navicular bone • Inability to bear weight both immediately and in the ER for 4 steps

28. OTTAWA ANKLE RULES

29. QUESTIONS