This document provides an overview of common ankle and foot injuries. It describes the anatomy of the ankle joint and surrounding ligaments. The most frequent acute sports injury is ankle sprains, which typically occur due to foot inversion and result in ligament tears. Ankle sprains are classified into grades 1-3 based on severity. Other common injuries include peroneal tendon injuries, talar dome fractures, and plantar fasciitis. The document outlines symptoms, diagnostic techniques and treatment approaches for each of these injuries.
Prosthetic management of symes and partial foot amputationSmita Nayak
prosthetic management of partial foot and syme's amputation is a very challenging task. Now a days the availability of advanced technology some how fulfilling the need of the amputee but not the fully.
Collapse of medial longitudinal arch, with the entire sole of the foot coming into complete or near-complete contact with the ground.
Books Refered :
Text Book Of ANATOMY - Vishram Singh
Joint Structure And Function – Cynthia Norkin
Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different soft tissue injuries are the part of curriculum for the undergraduate students at KUSMS.
Prosthetic management of symes and partial foot amputationSmita Nayak
prosthetic management of partial foot and syme's amputation is a very challenging task. Now a days the availability of advanced technology some how fulfilling the need of the amputee but not the fully.
Collapse of medial longitudinal arch, with the entire sole of the foot coming into complete or near-complete contact with the ground.
Books Refered :
Text Book Of ANATOMY - Vishram Singh
Joint Structure And Function – Cynthia Norkin
Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different soft tissue injuries are the part of curriculum for the undergraduate students at KUSMS.
Apresentação sobre deformidades no pulso devido a Exostoses multiplas hereditárias.
Apresentação feita pelo Dr. Jeff Auyeung, cirurgião consultor do Hospital Universitário de North Dunham.
MADELUNG
AND MULTIPLE EXOSTOSES
Jeff Auyeung
Consultant Hand Surgeon
University Hospital of North Durham
Apresentação sobre deformidades no pulso devido a Exostoses multiplas hereditárias.
Apresentação feita pelo Dr. Jeff Auyeung, cirurgião consultor do Hospital Universitário de North Dunham.
MADELUNG
AND MULTIPLE EXOSTOSES
Jeff Auyeung
Consultant Hand Surgeon
University Hospital of North Durham
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
Anatomy of the ankle and joints of footAkram Jaffar
Objectives:
After completion of this presentation, it is expected that the students will be able to
Musculoskeletal Anatomy
Describe the distal end of the tibia and be able to identify:
• the shaft
• the sharp anterior border
• the subcutaneous anteromedial surface or “shin”
• the interosseous border
• the medial malleolus
• articular surfaces
Describe the distal end of the fibula and be able to identify:
• the shaft
• the interosseous border
• the lateral malleolus with grooves for peroneal tendons
• articular surface
Identify the key features of the seven tarsal bones:
• the calcaneus
calcaneal tuberosity
medial, lateral and anterior tubercles
the sustentaculum tali
peroneal trochlea
• the talus:
head
neck
body
dome
posterior tubercle with groove for flexor hallucis longus
• the cuboid with groove for peroneus longus on the plantar surface
• the navicular with tuberosity for the insertion of tibialis posterior
• the five metatarsals with fifth tuberosity for peroneus brevis
• the phalanges with 2 on big toe, 3 on others
• sesamoid bones at base of 1st metatarsals
Describe the structure, function and maintenance (bones, muscles, tendons, ligaments) of the arches of the foot:
medial longitudinal
lateral longitudinal
transverse
Identify the attachments and understand the functions of the deep fascia:
• plantar aponeurosis
• fibrous septa of the sole
• extensor, flexor and peroneal retinaculae
Describe the components & function of the foot & ankle joints:
• ankle joint:
articular surfaces
fibrous capsule
synovial membrane
Ligaments (medial/deltoid, lateral/tri-fascicular)
Movements (plantar/dorsi flexion)
• subtalar joints:
• distal tibiofibular joint
• talo-calcaneo-navicular (mid-tarsal) joint
• tarso-metatarsal joints
• metatarsophalangeal
• interphalangeal
Recognise the shape, size and attachments of:
• the long plantar ligament
• the short plantar (plantar calcaneocuboid) ligament
Clinical Anatomy
Explain the relevant anatomy of:
• the differences between the superior and inferior tibiofibular joints
• fracture of the second & fifth metatarsals
• ankle sprain with fractured shaft of fibula
• the three degrees of ankle sprain
• the ratio of lateral to medial ankle ligament sprains
• plantar fasciitis and calcaneal spur
• pes planus
• hallux valgus and its predominance in females
• the ankle jerk and plantar reflex
Radiological Anatomy
Identify:
• the antero-posterior and lateral views of the distal tibia, fibula and foot bones
• the ankle joint space
Brief discussion regarding management of physiotherapy, pharmacotherapy, orthosis, principles of orthopedic surgical managements, addressing problems at hip, knee and ankle, soft tissue release procedures, osteotomies, timing of surgery, complications, prognosis, hip at risk signs, birthday syndrome, role of botulinum toxin, upper extremity involvement, contracture release.
a painful knee can be classified into arthritic and non-arthatic. Many doctor forget non-arthic knee pain. This non-arthritic pain affect many pat.. younger more affected than old pat.,
complete Knee joint assessment from physiotherapeutic point of view. Includes observation , palpation , assessment, special test, differential diagnosis of knee joint .
2. ANATOMY
• 1) Distal end of tibia
• : ankle mortise
• Distal end of fibula
• 2) Talus – trochlea of talus dome
• 3) Ligaments – a) lateral ligament
complex b) medial ( deltoid
ligament )
• c) syndesmosis
3. ANKLE SPRAINS
• - The most common acute sport
injuries, 25% in every running or
jumping sport
• - Mechanism of injury: inversion and
plantar flexion of the foot when
landing off balance or clipping
another player’s foot
4. ANKLE SPRAINS
• Sequence of injury: anterior
talofibular ligament, calcaneofibular
ligament, posterior talofibular
ligament, musculotendinous units
supporting the ankle joint
5. ANKLE SPRAINS
• Incidence increased in :
• - individuals with varus
malalignment of lower limbs
• - calf muscle tightness
• - previous incompletely rehabilitated
ankle sprains
6. ANKLE SPRAINS
• - Diagnosis: x-rays, stress x-rays
• ( inversion stress, anterior drawer
test), ? MRI scan
• - acute phase ( first 72 hours ):
• RICE, then varies according to the
severity of injury
7. GRADE 1 ( Mild ) SPRAINS
• - The anterior talofibular ligament
affected
• - stress: minimal change on inversion,
normal anterior drawer
• - treatment by encouraging early active
movement:
• a) stationary cycling
• b) walking with protective taping or semi-rigid
brace ( Aircast splint )
8. GRADE 1 ( Mild ) SPRAINS
• c) NSAIDS (anti-inflammatory medication)
• d) physiotherapy: electrotherapy,
strengthening exercises, propreoception
(1 legged stand )
• e) functional progression to running,
jumping, hopping, swerving and cutting,
recovery into 6 weeks
9. GRADE 2 (Moderate)
SPRAINS
• - Complete tear of anterior talofibular
ligament with some damage of the
calcaneofibular ligament
• - laxity when inversion, anterior drawer
present
• - treatment: a) 1 week crutches, joint
taped or in aircast splint
• b) follow grade 1 rehabilitation
10. GRADE 3 ( Severe )
SPRAINS
• - Uncommon severe injuries,
associated with fractures
• - treatment: 10 days NWB in aircast
brace or POP, then PWB with the
brace up to 6 weeks. Aggressive
rehabilitation follows
• - surgical reconstruction must be
considered
11. PERONEAL TENDON
INJURIES
• - Strong everters and weak plantar
flexors of the foot
• - mechanism of injury:
• a) associated with lateral ligament
injuries
• b) forced dorsiflexion with slight
inversion and reflex contraction of the
tendons ( sprinting, uneven ground,
ballet)
12. PERONEAL TENDON
INJURIES
• - O/E: Behind lat.malleolus discomfort or
swelling. Subluxation on resisting
dorsiflexion with eversion
• - treatment: a) acute phase – well-moulded
short NWB cast with pad over
lat.malleolus b) chronic phase – surgical
correction, POP 4 weeks c) rupture of
peroneal tendons – surgical correction
13. PERONEAL TENDON
INJURIES
• TENDINITIS:
• - occurs in dancers, basketball,
volleyball
• - combined cause of the
lat.malleolus pulley action and foot
malalignment
14. PERONEAL TENDON
INJURIES
• TENDINITIS:
• - TREATMENT – a) rest from sport,
temporary use of heel wedge
• b) physiotherapy, extreme cases: local
injection into the sheath
• c) gradual coaching programme, avoid
rapid direction changes or sprinting – 6
weeks
• d) failure of conservative treatment:
tenolysis of peroneal tendons
15. TALAR DOME
FRACTURES
• - Suspicion if ankle sprains failed to
recover
• - can present later: damage of
subchondral bone (bone bruising),
later separation and displacement
of an osteochondral fragment
16. TALAR DOME
FRACTURES
• - Symptoms: locking, instability,
weakness, discomfort
• - Diagnosis: x-rays in 6 weeks, bone
scan, MRI scan
• - Treatment: removal of loose body
and defect curettage
17. ANTERIOR
IMPINGEMENT
SYNDROME • - Mechanism: repetitive traction or injury
over anterior capsule – exostoses
produced on the anterior margin of distal
tibia and talus
• - “ footballer’s ankle”, basketball,ballet
• - pain on dorsiflexion, reduced
dorsiflexion later on
• - x-rays: lateral view – exostoses, loose
bodies
• - treatment: NSAIDS, local inj. Surgical
excision
18. POSTERIOR
IMPINGMENT
SYNDROME • - Congenital: talar spur (trigonal
process) or a separate un-united
ossification centre of talus (OS
trigonum )
• - ballet, fast cricket bowling,
jumping, swimming
• - NSAIDS, surgical excision ( difficult
cases )
20. ENTRAPMENT
NEUROPATHIES IN THE
FOOT • MORTON’S NEURALGIA ( NEUROMA )
• - Mechanism: fibrous enlargement of a
plantar interdigital nerve with
entrapment between metatarsal heads
(usually 3rd and 4th )
• - repetitive trauma, “ dropped” metatarsal
heads, tight shoes, hard surfaces. Stress
fractures also considered in the
differential diagnosis
21. ENTRAPMENT
NEUROPATHIES IN THE
FOOT
• - Pain in the web, loss of sensation
• - metatarsal neck pads, other
orthotic correction, local injection,
surgery
22. ENTRAPMENT
NEUROPATHIES IN THE
FOOT
• Other neuropathies:
• - dorsal cutaneous branch of the
deep peroneal nerve on the dorsum
of the foot
• - sural nerve behind the lateral
malleolus or over the styloid
process of the fifth metatarsal
23. SINUS TARSI
SYNDROME
• - Sinus tarsi: concavity at the lateral tarsal
canal of the subtalar joint
- discomfort in front of lat.malleolus,
running
- differential diagnosis from chronic
lat.ligament sprain
• - treatment: control of over pronation,
strengthening of post.tibialis muscle,
local injection
24. BURSITIS ABOUT THE
HEEL
- Over achilles tendon: posterior calcaneal
bursa
- Below achilles tendon: retrocalcaneal
bursa
- running with ill-fitting shoes
Haglund’s syndrome: (bony bossing) on the
posterior aspect of calcaneum
- treatment: rest, low friction
taping,NSAIDS, physio, local inj.,
footwear attention
25. HEEL FAT PAD
SYNDROME (BRUISED
HEEL ) • - Disruption of the fibrofatty protective
tissue over the sensitive periosteum of
calcaneum
• - veteran runners: age and repeated
trauma
• - treatment: decreased weight bearing
activity, weight loss, orthotics: use of a
semi rigid moulded heel cup, shoes with
a snug firm heel counter
• DON’T USE: local inj., flat or convex pads
26. PLANTAR FASCIITIS
• - Running on hard surfaces, tennis,
netball, jumping
• - mechanism: MTP extension
produces a “windlass” stress over
plantar fascia lifting the longitudinal
arch of the foot
• - Periosteal reaction may produce a
heel spur ( x-rays )
27. PLANTAR FASCIITIS
• - Pain under medial aspect of the
heel, worse on tip toeing, early in
the morning, stairs
• - treatment: NSAIDS, 4-8mm heel
raise, physiotherapy, orthotics to
modify over pronation
28. CALCANEONAVICULAR
LIGAMENT SPRAIN
( Spring Ligament )
• - Acute twisting injuries of the foot
in football, jumping
• - pain and tenderness over medial
arch of the foot
• - Ice, NSAIDS, electrotherapy,
orthotics
29. CUBOID SYNDROME
• - Cuboid bone: pulley for peroneus
longus tendon, stabilizer of the
transverse arch of the foot
• - lateral mid foot pain. Tenderness with
pressure proximal of the 5th metatarsal
• - orthotics to support in flexion the
cubometatarsal joint and control
pronation. Physio for strength of the toes
long flexors and anterior tibialis
30. REFLEX SYMPATHETIC
DYSTROPHY OF THE
FOOT • - Associated with minor strains,
sprains, laceration or foot surgery
• - painful, swollen, hypersensitive to
touch, hot or cold, moist foot. Stiff
joints, atrophic muscles, anxious
patient
• - x-rays: osteopenia and soft tissue
swelling
31. REFLEX SYMPATHETIC
DYSTROPHY OF THE
FOOT
• - Treatment: aggressive
physiotherapy, tubigrip,
sympathectomy by epidural
injection
• - recovery from 8 weeks to 2 years
32. ANTERIOR
METATARSALGIA
• - Tenderness at plantar aspect of
metatarsal heads
• - over pronated feet, excessive mobility
of 1st metatarsal
• - callus formation under 2nd and 3rd
metatarsal heads
• - treatment: callus care, weight loss,
orthotics incorporating metatarsal bars,
correct pronation. Physio ( tight triceps
surae ) Attention to shoes
33. SESAMOIDITIS
• - Sesamoid bones in the tendon of flexor
hallucis brevis
• - dancers, ice skaters, gymnasts,
basketball
• - crush fractures, avulsion, bipartite
sesamoid, osteonecrosis
• - x-rays and bone scan imaging
• - shoes with elevated heels avoided,
orthotics. Dancers, gymnasts: adhesive
padding and rest, surgical excision
34. ACHILLES TENDON
INJURIES
• - Common tendon of gastrocnemius
and soleus muscles
• - tendon twists laterally from 15cm
above insertion becoming more
pronounced at 2-5cm above
insertion. Blood supply reduced at
this level
35. ACHILLES TENDON
INJURIES
• - Aetiology factors: lack of rear foot
support in shoes, terrain, excessive
training loads, biomechanical
factors of foot: over pronation, rear
foot varus or valgus, pes cavus,
tight calf muscles
37. FRACTURES
• - Ankle fractures: intarticular, if
displaced ORIF
• -talus fracture: surgical treatment to
avoid osteonecrosis
• - calcaneum fractures: most
conservative, early ROM
38. FRACTURES
• - Metatarsal fractures: reduce
dislocations, most common fracture
5th metatarsal base ( Jones )
• - toe fractures: most treated
conservative, strapping with next
toe for 3 weeks