Transcript Foot and ankle - Doral Academy Preparatory

FOOT AND ANKLE
COMMON INJURIES
SQUEAMISH?
• Roll/twisted ankle:
• http://www.youtube.com/watch?v=lgNttdd7UIc
• Breaking ankle:
• http://www.youtube.com/watch?v=vA5BU045gi4
• Kevin Ware
• https://www.youtube.com/watch?v=6PSV0AV1BI0
• Luis Garrido
• https://www.youtube.com/watch?v=EZi4MhKS9Lk
BONES INJURIES
• S&S
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Pain
Decreased ROM
Swelling
Bruising
NWB
Obvious deformity
• Any bone
• Acute fx
• How many types of acute fx do we have? ___
• Stress fx
• Avulsion fx
• Epiphyseal Fx
• Fx to the growth plate (typically tib/fib)
• MOI: Plantarflexion and inversion
• Serious – potential to stunt growth
• Jones Fx
• Avulsion fx of the styloid process of the 5th MT
• Forceful muscle contraction w/ ankle inversion
• Union vs. non-union
NON-UNION
• Knock-off Fx
• Fx to lateral malleolus
• Forced dorsiflexion & inversion
• Stress Fx
• Most commonly tib/fib and MT
• Reptative stress (usually from running)
• Pain becomes more intense at night and following activity
• Usually Dx w/ bone scan (Dexa-Scan) or MRI
Knock-off fx
Bi-malleolar fx
Bone
Scan
GRADING SYSTEM
• Ligament: bone to bone
• Tendon: muscle to bone
• Grading system:
• 1+/-: stretched, but no tearing/fraying of fibers
• 2+/-: tearing, but incomplete
• 3: complete tear
SOFT TISSUE INJURY
• S&S:
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Pain
Swelling
Decreased ROM
Increased temp of skin
Bruising
NWB
+ laxity test
LIGAMENT/TENDON INJURIES
• ATFL–
• Most commonly sprained
• MOI – “rolling ankle”, stepping in hole
• Accounts for 85%
• Deltoid Ligament
• Keep ankle from evertion; stronger than ATF
• MOI – Stepping in hole
• High Ankle Sprain – Syndesmotic Sprain
• MOI - Dorsiflexion and evertion
• Accounts for 15%
• Achilles Tendon Tendinitis/Rupture
• More commonly torn with age
• MOI – Forced Dorsiflexion with knee bent
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• Great-Toe Sprain
• Forced Flexion/Extension
• “Turf Toe”
• Arch Sprain
• Repetitive stress, running on hard surface, or improper
footwear
• Pain with running and swelling over affected arch
• Plantar Faciitis
• Inflammation of the thick connective tissue
• The next slide is ….graphic…..
MUSCLE INJURIES
• Strain
• Grade 1, 2, 3
• Common muscles affected:
• Peroneals
• Gastrocnemius/Soleus complex
• Tibialis Anterior
“SHIN SPLINTS”
• Medial tibial stress syndrome (MTSS)
• Irritated and swollen muscles, often from
overuse, ramping up workout intensity,
changing the surface, improper/old footwear
• Caused by:
• Over-pronation or ''flat feet" -- when the impact of a
step makes your foot's arch collapses
• If left un-treated can cause:
• Stress fractures, which are tiny breaks in the
lower leg bones
• Tx:
• Rest your body. It needs time to heal.
• Ice your shin to ease pain and swelling. Do it for 20’
every 3 to 4 hours for 2 to 3 days, or until the pain is
gone.
• Anti-inflammatory painkillers. NSAIDs
• Arch supports for your shoes. Orthotics -- which can be
custom-made or bought off the shelf -- may help with
flat feet.
• Range-of-motion exercises
• Neoprene sleeve for support.
• Physical therapy to strengthen the muscles in your shins.
YOU KNOW IT’S HEALED WHEN..
• Your injured leg is as flexible as your other
leg.
• Your injured leg feels as strong as your other
leg.
• Your can jog, sprint, and jump without pain.
• Your X-rays are normal or show healed stress
fx.
• There's no way to say exactly when your shin
splints will go away. It depends on what's
causing them. People also heal at different
rates; 3 to 6 months is not unusual.
MISC
INJURIES
• Ankle dislocation
• Force applied to joint
stronger than joint could
withstand
• Reduction: https://www.youtube.com/watch?v=ANA2bg3qaw
• Contusion – broken blood vessels leaking into soft
tissue.
• MOI – Blunt force trauma
• Toe Abnormalities
• Hammertoe
• Middle Phalanyx flexed while Distal and Proximal are
hyperextended
• MOI- Rupture of Extensor Digitorum Longus due to BFT
• Ingrown Toenail
• Nail grows into surrounding soft tissue
• often result of poor trimming
• May need to be surgically excised
DIAGNOSIS PROCESS
• HOPS:
• History
• Observation
• Palpation – Provides a reference for the comparison of
bilateral symmetry of bones, alignment, tissue temperature,
or other deformity as well as the presence of increased
tenderness
• Joint and Muscle Functional Assessment – impairment due to
ROM, Strength, P with movement
• Joint Stability Tests – reference for laxity, gapping,
hypo/hypermobility, end-feel
• Special Test
MANUAL MUSCLE TESTING
• Patient position: Muscle tested must be against
gravity
• Examiner position: stabilize proximal to the joint
being tested and provide resistance to the distal
joint
• “Break test”
• Positive test: weakness and/or pain compared
contralateral
GRADING
• 5/5 Normal: can resist max pressure with no pain
• 4/5 Good: can resist moderate pressure
• 3/5 Fair: Can move body part against gravity thru
full ROM
• 2/5 poor: Can move body part in gravity-eliminated
position thru full ROM
• 1/5 Trace: cannot produce movement, but muscle
contraction is palpable
• 0/5 Zero: No contraction is felt
END-FEEL (NORMAL)
• Soft: soft tissue approximation (ex: knee flexion)
• Firm: Muscular stretch/Capsular
Stretch/Ligamentous Stretch (ex: MCP extension)
• Hard: bone to bone ex: Elbow ext
END-FEEL (PATHOLOGICAL)
• Soft: occurs sooner or later in ROM than normal in a joint
that normally has a firm or hard end-feel ex:
edema/synovitis
• Firm: occurs sooner or later in ROM than normal in a joint
that normally has soft or hard end-feel ex:
Capsular/muscular/ligamentous shortening
• Hard: occurs sooner or later in ROM than normal in a
joint that normally has soft or firm end-feel; feels like a
bony block ex: Loose bodies in joint/myositis ossificans/fx
• Spasm: Joint motion is stopped involuntarily or voluntary
muscle spasm ex: inflammation/strain/joint instability
• Empty: no end-feel bc end of ROM is never reached; no
resistance felt (except for patient’s protective muscle
splinting or muscle spams called “muscle guarding”)
HOMEWORK
• Pages 4 and 5 in coloring packet