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KIN 188 – Prevention and Care of Athletic Injuries Foot, Ankle and Leg Evaluation and Injuries
Anatomy
Foot Anatomy <ul><li>Bony anatomy </li></ul><ul><ul><li>Phalanges (proximal, middle, distal) – 14 </li></ul></ul><ul><ul><...
 
Ankle Anatomy <ul><li>Bony anatomy </li></ul><ul><ul><li>Calcaneus/talus (dome) </li></ul></ul><ul><ul><li>Tibia (medial m...
 
Leg Anatomy <ul><li>Bony anatomy </li></ul><ul><ul><li>Tibia and fibula </li></ul></ul><ul><li>Muscular anatomy </li></ul>...
 
Evaluation
History <ul><li>Mechanism of injury/etiology </li></ul><ul><ul><li>Direct trauma (contusion, fracture, compartment syndrom...
History <ul><li>Change in activity </li></ul><ul><ul><li>Intensity, duration, frequency, surface change, footwear change <...
Inspection/Observation <ul><li>ALWAYS  compare bilaterally </li></ul><ul><li>Obvious deformity </li></ul><ul><ul><li>Pes c...
 
Palpation - Foot <ul><li>Calcaneus </li></ul><ul><li>Talus (dome/head) </li></ul><ul><li>Sustentaculum tali </li></ul><ul>...
Palpation - Ankle <ul><li>Calcaneus </li></ul><ul><li>Tibia (medial malleolus) </li></ul><ul><li>Fibula (lateral malleolus...
Palpation - Leg <ul><li>Tibia (shaft) </li></ul><ul><li>Fibula (proximal/distal 1/3s, head) </li></ul><ul><li>Tendons of <...
Special Tests <ul><li>ROM </li></ul><ul><ul><li>Active – patient/athlete moves joint </li></ul></ul><ul><ul><li>Passive – ...
ROM <ul><li>Toe </li></ul><ul><ul><li>Great toe flexion/extension </li></ul></ul><ul><ul><li>Lateral 4 toes flexion/extens...
Neurovascular <ul><li>Neurological evalation </li></ul><ul><ul><li>Nerve root level and peripheral nerve sensory and motor...
Special Tests <ul><li>Foot </li></ul><ul><ul><li>Tap/bump/longitudinal stress tests – fracture </li></ul></ul><ul><ul><li>...
Injuries
Foot Injuries <ul><li>Hallux valgus (bunion) </li></ul><ul><ul><li>Great toe points toward other toes </li></ul></ul><ul><...
Foot Injuries <ul><li>Fractures </li></ul><ul><ul><li>Toe fractures commonly treated conservatively (like sprains) </li></...
 
Ankle Injuries <ul><li>Lateral ankle sprains </li></ul><ul><ul><li>Associated with inversion or PF/inversion mechanisms – ...
 
Ankle Injuries <ul><li>Syndesmosis (“high ankle”) sprains  </li></ul><ul><ul><li>Typically associated with DF/ER mechanism...
Leg Injuries <ul><li>Compartment syndromes </li></ul><ul><ul><li>Acute (traumatic) vs. exertional </li></ul></ul><ul><ul><...
 
Leg Injuries <ul><li>Muscle strains  </li></ul><ul><ul><li>Severity based upon degree of tissue damage </li></ul></ul><ul>...
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Kin 188 Foot, Ankle And Leg Injuries

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  • Labels are “thigh and leg” not upper and lower leg Pedal/Pes = foot, Genu = knee
  • Transcript of "Kin 188 Foot, Ankle And Leg Injuries"

    1. 1. KIN 188 – Prevention and Care of Athletic Injuries Foot, Ankle and Leg Evaluation and Injuries
    2. 2. Anatomy
    3. 3. Foot Anatomy <ul><li>Bony anatomy </li></ul><ul><ul><li>Phalanges (proximal, middle, distal) – 14 </li></ul></ul><ul><ul><li>Metatarsals (5 – great toe=1, little toe=5, styloid process) </li></ul></ul><ul><ul><li>Tarsals (calcaneus, talus, navicular, cuboid, 1/2/3 cuneiforms) </li></ul></ul><ul><ul><li>Medial/lateral longitudinal and transverse metatarsal arches </li></ul></ul><ul><li>Muscular anatomy </li></ul><ul><ul><li>Extensor digitorum brevis/sinus tarsi </li></ul></ul><ul><ul><li>Tendons from ankle/leg muscles </li></ul></ul><ul><li>Ligamentous anatomy </li></ul><ul><ul><li>Collateral ligaments at PIP/IP/DIP/MP joints </li></ul></ul><ul><ul><li>Spring ligament </li></ul></ul><ul><ul><li>Intertarsal/tarsometatarsal ligaments </li></ul></ul>
    4. 5. Ankle Anatomy <ul><li>Bony anatomy </li></ul><ul><ul><li>Calcaneus/talus (dome) </li></ul></ul><ul><ul><li>Tibia (medial malleolus), fibula (lateral malleolus) </li></ul></ul><ul><li>Muscular anatomy </li></ul><ul><ul><li>Discussed with leg anatomy </li></ul></ul><ul><li>Ligamentous anatomy </li></ul><ul><ul><li>Medial ligament (deltoid) </li></ul></ul><ul><ul><li>Lateral ligaments (anterior/posterior talofibular, calcaneofibular, anterior/posterior tibiofibular) </li></ul></ul>
    5. 7. Leg Anatomy <ul><li>Bony anatomy </li></ul><ul><ul><li>Tibia and fibula </li></ul></ul><ul><li>Muscular anatomy </li></ul><ul><ul><li>Anterior compartment (anterior tibialis, extensor digitorum longus, extensor hallicus longus) </li></ul></ul><ul><ul><li>Lateral compartment (peroneus longus/brevis) </li></ul></ul><ul><ul><li>Deep posterior compartment (posterior tibialis, flexor digitorum longus, flexor hallicus longus) </li></ul></ul><ul><ul><li>Superficial posterior compartment (gastrocnemius, soleus, plantaris) </li></ul></ul><ul><li>Ligamentous anatomy </li></ul><ul><ul><li>Interosseous membrane </li></ul></ul>
    6. 9. Evaluation
    7. 10. History <ul><li>Mechanism of injury/etiology </li></ul><ul><ul><li>Direct trauma (contusion, fracture, compartment syndrome, Achilles rupture) </li></ul></ul><ul><ul><li>Hyperextension of great toe (turf toe) </li></ul></ul><ul><ul><li>Inversion/eversion (ankle sprain, muscle strain) </li></ul></ul><ul><ul><li>Insiduous/unknown (tendonitis, stress fracture) </li></ul></ul><ul><li>Unusual sounds/sensations </li></ul><ul><ul><li>“ Giving way”, pop/snap </li></ul></ul><ul><li>History of previous injury </li></ul>
    8. 11. History <ul><li>Change in activity </li></ul><ul><ul><li>Intensity, duration, frequency, surface change, footwear change </li></ul></ul><ul><li>Acute/gradual onset of symptoms </li></ul><ul><ul><li>Macrotraumatic vs. microtruamatic </li></ul></ul><ul><li>Characterize pain </li></ul><ul><ul><li>Location (point with 1 finger) </li></ul></ul><ul><ul><li>Dull, sharp, burning, throbbing, etc. </li></ul></ul><ul><ul><li>Rate on scale (1-10) </li></ul></ul><ul><ul><li>What increases or decreases? </li></ul></ul><ul><li>Treatment, medication, evaluation to date </li></ul>
    9. 12. Inspection/Observation <ul><li>ALWAYS compare bilaterally </li></ul><ul><li>Obvious deformity </li></ul><ul><ul><li>Pes cavus/planus (high arch/flat feet) </li></ul></ul><ul><ul><li>Bunion (hallux valgus) </li></ul></ul><ul><li>Bleeding </li></ul><ul><li>Discoloration/ecchymosis </li></ul><ul><li>Swelling </li></ul><ul><li>Scars </li></ul>
    10. 14. Palpation - Foot <ul><li>Calcaneus </li></ul><ul><li>Talus (dome/head) </li></ul><ul><li>Sustentaculum tali </li></ul><ul><li>Navicular tuberosity </li></ul><ul><li>1/2/3 cuneiforms </li></ul><ul><li>Cuboid </li></ul><ul><li>Metatarsals </li></ul><ul><li>Phalanges </li></ul><ul><li>PIP/IP/DIP/MP joints </li></ul><ul><li>Plantar fascia </li></ul>
    11. 15. Palpation - Ankle <ul><li>Calcaneus </li></ul><ul><li>Tibia (medial malleolus) </li></ul><ul><li>Fibula (lateral malleolus) </li></ul><ul><li>Dome of talus </li></ul><ul><li>Navicular tuberosity </li></ul><ul><li>Styloid process of 5 th metatarsal </li></ul><ul><li>Sinus tarsi </li></ul><ul><li>Deltoid ligament </li></ul><ul><li>Anterior talofibular ligament </li></ul><ul><li>Calcaneofibular ligament </li></ul><ul><li>Anterior tibiofibular ligament </li></ul>
    12. 16. Palpation - Leg <ul><li>Tibia (shaft) </li></ul><ul><li>Fibula (proximal/distal 1/3s, head) </li></ul><ul><li>Tendons of </li></ul><ul><ul><li>Anterior tibialis </li></ul></ul><ul><ul><li>Extensor digitorum/hallicus longus </li></ul></ul><ul><ul><li>Peroneus longus/brevis </li></ul></ul><ul><ul><li>Gastrocnemius/soleus (Achilles) </li></ul></ul><ul><ul><li>Posterior tibialis </li></ul></ul>
    13. 17. Special Tests <ul><li>ROM </li></ul><ul><ul><li>Active – patient/athlete moves joint </li></ul></ul><ul><ul><li>Passive – clinician moves joint, evaluates end feel </li></ul></ul><ul><ul><li>Resistive – proximal stabilization and distal application of resistance (“break” test vs. resistance through ROM) </li></ul></ul><ul><li>Neurovascular </li></ul><ul><li>Special tests </li></ul>
    14. 18. ROM <ul><li>Toe </li></ul><ul><ul><li>Great toe flexion/extension </li></ul></ul><ul><ul><li>Lateral 4 toes flexion/extension </li></ul></ul><ul><li>Foot/ankle </li></ul><ul><ul><li>Dorsiflexion </li></ul></ul><ul><ul><li>Plantarflexion </li></ul></ul><ul><ul><li>Inversion </li></ul></ul><ul><ul><li>Eversion </li></ul></ul>
    15. 19. Neurovascular <ul><li>Neurological evalation </li></ul><ul><ul><li>Nerve root level and peripheral nerve sensory and motor distributions </li></ul></ul><ul><li>Vascular evaluation </li></ul><ul><ul><li>Skin temperature/color </li></ul></ul><ul><ul><li>Capillary refill </li></ul></ul><ul><ul><li>Dorsal pedal pulse </li></ul></ul><ul><ul><li>Posterior tibial pulse </li></ul></ul>
    16. 20. Special Tests <ul><li>Foot </li></ul><ul><ul><li>Tap/bump/longitudinal stress tests – fracture </li></ul></ul><ul><ul><li>Metatarsal head compression – neuroma </li></ul></ul><ul><ul><li>Toe hyperextension – stress medial arch </li></ul></ul><ul><li>Ankle </li></ul><ul><ul><li>Anterior drawer – anterior talofibular ligament </li></ul></ul><ul><ul><li>Talar tilt/inversion stress – calcaneofibular ligament </li></ul></ul><ul><ul><li>Kleiger’s test (DF/ER) – anterior tibiofibular ligament </li></ul></ul><ul><ul><li>Eversion stress – deltoid ligament </li></ul></ul><ul><li>Leg </li></ul><ul><ul><li>“ Squeeze” test – fracture </li></ul></ul><ul><ul><li>Thompson test – Achilles tendon rupture </li></ul></ul>
    17. 21. Injuries
    18. 22. Foot Injuries <ul><li>Hallux valgus (bunion) </li></ul><ul><ul><li>Great toe points toward other toes </li></ul></ul><ul><ul><li>Almost never traumatic, but associated with biomechanical insufficiencies, poor flexibility, poor fitting shoes </li></ul></ul><ul><ul><li>If severe, often corrected surgically </li></ul></ul><ul><li>Turf toe </li></ul><ul><ul><li>Hyperextension of great toe MP joint </li></ul></ul><ul><ul><li>Pain with active movements and passive extension </li></ul></ul><ul><ul><li>Treat with tape, shoe inserts, conservative measures </li></ul></ul><ul><li>PIP/IP/DIP sprains </li></ul><ul><ul><li>Almost always treated symptomatically with buddy tape, shoe inserts and activity as tolerated </li></ul></ul>
    19. 23. Foot Injuries <ul><li>Fractures </li></ul><ul><ul><li>Toe fractures commonly treated conservatively (like sprains) </li></ul></ul><ul><ul><li>Metatarsal fractures usually easy to identify </li></ul></ul><ul><ul><li>Avulsion fracture – base of 5 th metatarsal, navicular </li></ul></ul><ul><ul><li>Stress fractures – metatarsals (March fractures) </li></ul></ul><ul><li>Plantar fascitis </li></ul><ul><ul><li>Associated with overuse/training errors, tight Achilles, biomechanical insufficiencies </li></ul></ul><ul><ul><li>Often presents with pain at heel, most pain with first few steps in AM </li></ul></ul><ul><ul><li>Treated with taping/strapping, orthotics, conservative measures, anti-inflammatory meds </li></ul></ul>
    20. 25. Ankle Injuries <ul><li>Lateral ankle sprains </li></ul><ul><ul><li>Associated with inversion or PF/inversion mechanisms – can injure ligaments and/or muscles/tendons </li></ul></ul><ul><ul><li>Ligaments affected in descending order based upon positioning and amount of force (ATF-CF-PTF) </li></ul></ul><ul><ul><li>Swelling and point tenderness usually occur quickly </li></ul></ul><ul><ul><li>Positive ligamentous stress tests </li></ul></ul><ul><li>Medial ankle sprains </li></ul><ul><ul><li>Associated with eversion mechanism </li></ul></ul><ul><ul><li>Otherwise similar to lateral sprain symptoms </li></ul></ul>
    21. 27. Ankle Injuries <ul><li>Syndesmosis (“high ankle”) sprains </li></ul><ul><ul><li>Typically associated with DF/ER mechanism </li></ul></ul><ul><ul><li>Shape of talar dome in mortise of ankle </li></ul></ul><ul><ul><li>Longer rehabilitation period, frustrating injury </li></ul></ul><ul><ul><li>Positive Klieger’s test </li></ul></ul><ul><li>Fractures/dislocations </li></ul><ul><ul><li>Associated with obvious deformity </li></ul></ul><ul><ul><li>Occur from excessive forces landing from height in IV/EV position or being kicked from behind with foot planted on ground </li></ul></ul><ul><ul><li>Typically treated surgically for appropriate fixation </li></ul></ul>
    22. 28. Leg Injuries <ul><li>Compartment syndromes </li></ul><ul><ul><li>Acute (traumatic) vs. exertional </li></ul></ul><ul><ul><li>Pressure in closed compartment affects neurological and vascular structures </li></ul></ul><ul><ul><li>Can be limb-threatening emergencies </li></ul></ul><ul><li>Achilles tendon rupture </li></ul><ul><ul><li>Usually associated with “jumping” mechanism and feels like got kicked/shot in leg </li></ul></ul><ul><ul><li>Often hears “pop” in addition to feeling it </li></ul></ul><ul><ul><li>Decreased ability to actively PF ankle and positive Thompson test </li></ul></ul><ul><ul><li>Return to physical activity almost always requires surgical intervention </li></ul></ul>
    23. 30. Leg Injuries <ul><li>Muscle strains </li></ul><ul><ul><li>Severity based upon degree of tissue damage </li></ul></ul><ul><ul><li>Most common to gastroc/soleus, posterior tibialis, peroneus longus/brevis </li></ul></ul><ul><li>Tendonitis </li></ul><ul><ul><li>Overuse condition associated with training changes, biomechanical insufficiencies, poor flexibility, etc. </li></ul></ul><ul><ul><li>Most common to Achilles, anterior/posterior tibialis, peroneus longus/brevis </li></ul></ul><ul><li>Fractures </li></ul><ul><ul><li>Tibia and/or fibular fractures occur secondary to either direct trauma or rotational forces associated with change of direction </li></ul></ul>
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