foot and ankle evaluation. history a thorough history must be taken mechanism pain sounds/...
TRANSCRIPT
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Foot and Ankle Evaluation
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History
A thorough history MUST be takenMechanismPainSounds/ SensationsChangesPast
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Observation
DeformityDiscolorationSoundsGait
Heel StrikeMidstanceHeel offToe off
Shoe WearArches
Pes Planus – flat archShin splints
Pes Cavus – high archMetatarsal fxTurf toe
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Arches
• Structural Deformities
• Pes Planus = flat footed/ no arch
• Pes Cavus = high arch
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The Gait Cycle
Heel Strike – shock absorptionToe-off – propel forward
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PalpationUsed to confirm or deny assessments.
Start away from the injury and move toward the site of pain (about 2-3 inches when appropriate)
Palpate Bilaterally (both sides)
Start w/ light pressure then move to deeper palpation
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PalpationNoticePoint Tenderness
Trigger Points
Crepitus
Density
Symmetry/ Deformity
Temperature
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Special Tests1st Special Tests
– Fracture Tests
____________
____________
____________
– ________ ___ ____________
____________
____________ or ____________
Range of motion
Passive
LeverBump
Compression
Active
Resistive
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Typ
es o
f Inju
ries
• Sprain • tear of a ligament
• “-itis” • irritation of
• Tendonitis – irritation of a tendon (joins muscle to bone)• Bursitis – irritation of a bursae (fluid filled sac under tendons)
• Fracture • – break of a bone (complete or
incomplete• Dislocation
• Joint pops out and stays out• Subluxation
• joint pops out and goes back in
• Strain • tear/ pull of a muscle
(Overuse 0r Overstretch)
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Gra
din
g
Inju
ries
Grade 1– Stretching or slight tear – Mild pain
Little to no disability/ loss of function
Grade 2– Moderate tear
Moderate pain and disabilityTrouble weight bearing (PWB)Swelling and Bruising may occur
Grade 3– Severe/Total tear of the ligament– Often causes ankle to subluxate
DisablingCannot weight-bear (NWB) – put weight/ pressure on it.
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Sprains
1. Anterior Talo-fibular Ligamenta. Closely followed by Calcaneofibular
2. Anterior Tibio-fibular ligament - “high” ankle sprain or syndesmotic sprain
3. Deltoid
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Anterior Talo-fibular sprain*Most common first sprain
*2nd lig to go is Calcaneofibular
- Pain on lateral side under fibula
Caused by Inversion
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Anterior Drawer
Positioning– Have the athlete sit with their leg off the table .
– Grasp calcaneus w/ one hand– Let foot lie on your forearm– Other hand on tibia
Test– Dorsiflex foot slightly– Pull Calcaneus forward while push tibia backward
http://www.youtube.com/watch?v=kbqzRWhirOI
Specifi
c Specia
l Tests
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Anterior Drawer cont• Positive Test
–Foot slides forward (laxity)–Makes a clunking sound/ sensation
–Pain
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Deltoid sprain • Tibio-fibular sprain (syndesmotic/ high)
Caused by Eversion
Caused by Dorsiflexion and Eversion
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Specifi
c Specia
l Tests
Talar TiltAthlete sit or lie on table with the feet hanging over the edge
Hold the heel and stabilize the lower leg
Invert the foot (Deltoid) OR Evert the foot (Tibfibs)
Positive Test = pain and/or laxity
https://www.youtube.com/watch?v=1IrI6Bks6hY
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Managem
ent
of A
nkle
In
jurie
sSwelling Management
RICE – Rest Ice Compression ElevationMETH – Mobility Elevation Traction Heat
Inversion Ankle SprainsLight Compression with HorseshoeMassageBegin ROM exercises
Syndesmotic Sprain– Takes MUCH longer to heal– Rest/ Immobilize for at least 6-10 days
before beginning ROM exercises
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Achilles InjuriesTendonitis – irritation of the tendon
Initially slight painOnly hurts after practice/ activity
As it progresses pain lasts longer and gets irritated with even regular walkingHurts to dorsiflex (stretch/ lengthen the tendon)Painful to the touch
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Achilles Tendon Rupture (complete tear)– *Common w/ athletes
30+– Cannot “see” the tendon– Gastroc/ Soleus recoil
(ball up) towards knee– Athlete cannot
plantarflex the foot/ push off
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Specia
l Test –
Ach
illes
Ruptu
re
Thompson Test– Positioning
Athlete prone with leg off the tableBoth hands on the calf
– TestSqueeze calf at proximal 1/3
of lower leg– Positive
Foot does not plantarflex
TRY IT!!
http://www.youtube.com/watch?v=HPkaNdG2uus
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Tendinitis sites
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Foot InjuriesBunion
– Caused by poorly fitting shoes
Hammertoe
– Flexion contracture of toes
Turf Toe
– Hyperextension
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Management of Ingrown Toe Nail
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In-Grown Toe NailSoak in hot water for 10-15 minutes
Lift edge of nail and put small piece of cotton under to elevate the nail
Apply antiseptic and cover with a sterile dressing
Or cut a “v” into middle of nail (grows and pulls toward center)
If pus present, refer to MD for antibiotics
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Other Conditions/ InjuriesShin splints
– Catch-all term for anterior pain
Stress fractures, muscle strains and chronic compartment syndrome
Medial Tibial Stress Syndrome
– Due to repetitive microtrauma
– Weak muscles - Poor shoes
– Overtraining -Running surface
– Malalignment
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Grades of MTSSGrade 1
– pain after activity
Grade 2 – pain during and after activity
– No performance affects
Grade 3– Before during and after
– Affects performance
Grade 4– Activity impossible/ too painful