atc 222 chapter 18 & 19: the foot, ankle, and lower leg
TRANSCRIPT
Ligamentous Support
Lateral Ligaments -anterior talofibular (atf) -posterior talofibular (ptf) -calcaneofibular (cf)
Heel Bruise
Signs & Symptoms -focal pain in the heel
Management -Ice soaks, rest NSAID -heel cup or doughnut pad
Longitudinal Arch Strain
Etiology -forceful contact with playing surface -unaccustomed, severe exercise early in
the season
Longitudinal Arch Strain
Signs & Symptoms -pain just below the medial malleolus -swelling & tenderness medially
Management -ice soaks, arch taping for support,
reduce weight bearing
Plantar Fascia (Aponeurosis) Strain
Etiology -depressed longitudinal arch or mild pes
cavus -excessive running early coupled with
poor calf flexibility
Plantar Fascia Strain
Signs & Symptoms -sudden pain in the arch relieved with
non-weight bearing -pain when getting out of bed in the AM -point tenderness over calcaneal
epicondyle
Jones Fracture
Etiology -inversion and plantarflexion of the foot
Signs & Symptoms severe pain & tenderness over base of
5th
Metatarsalgia
Etiology -poor calf flexibility, pes cavus -fallen metatarsal arch due to pronation
& splayed foot
Metatarsalgia
Management -metatarsal pad or bar -aggressive static stretching,
strengthening of flexors -Thomas heel to relieve pronation
Interdigital Neuroma
Etiology -splayed toes & pronated foot
Signs & Symptoms -swelling -severe, intermittent & radiating pain
with weight bearing
Sever’s Disease (Calcaneal Apophysitis)
Etiology intense activity
Signs & Symptoms -pain @ posterior heel with activity
Sever’s Disease
Management -restricting DF by elevating heel will resolve when apophysis closes modification of activity level walking boot 6-8 weeks
Retrocalcaneal Bursitis
Etiology -excessive rubbing due to increased
pressure
Signs & Symptoms -ruber, swelling
Plantar Fasciitis (Heel Spur Syndrome)
Etiology -excessive pronation @ subtalar joint -leg length discrepancy -tight calf, etc
Plantar Fasciitis
Signs & Symptoms -anterior/medial heel pain -intense pain in the AM -pain with DF of toes
Plantar Fasciitis
Management -longitudinal arch support -friction massage -aggressive stretching of calf & DF of
great toe -shoe with firm arch support
Metatarsal Stress Fracture
Etiology -training errors -morton’s toe or other atypical
conditions of foot
Metatarsal Stress Fracture
Signs & Symptoms -gradual increase in pain
Management -rest, walking boot x-ray vs. walking boot
Lateral Ankle Sprain (inversion)
Etiology -inversion, plantar flexion, adduction
Signs & Symptoms Grade I, II, III
Management
Grade II
-complete tear of ATF & stretch or tear of CF
-”pop” or tear felt-moderate pain, weight bearing is
difficult-tenderness, effusion, & ecchymosis
Grade III
-very rare, usually associated with talar subluxation
-ATF, CF, PTF & joint capsule affected-severe pain noted laterallydiffuse effusion, ecchymosis, major
loss of function
Syndesmotic Ankle Sprain
Signs & Symptoms -talus moves 5 degrees -passive DF causes pain in the ankle
mortise
Ankle Fracture
Etiology -forcible abduction and adduction of the
foot -a planted foot with forcible IR of the leg -avulsion fx with 2nd or 3rd degree
sprain
Achilles Tendon Rupture
Signs & Symptoms -immediate pain & snap -indentation & soft achilles -+Thompson
Achilles Tendinitis
Etiology -training errors, tight calf, pes cavus,
tight hamstringsSigns & Symptoms
-crepitus, point tenderness, weakness, decreased ROM
Anterior/Posterior Tibial Tendinitis
Etiology -anterior=excessive downhill running posterior=hyperpronated foot
Anterior/Posterior Tibial Tendinitis
Signs & Symptoms -pain over the muscle or tendon
Management -anterior=avoid hills & decrease
mileage -correct pronation -ice and aggressive stretching
Acute Compartment Syndrome
Etiology -direct blow to the leg
Signs & Symptoms -weakness with DF & toe extension -paresthesia of dorsum of foot or
between1st & 2nd toe
Acute Compartment Syndrome
Management -medical emergency -decompress fascia -NEVER apply a compressive wrap
Leg Fractures
Signs & Symptoms -deformity, crepitus, -leg is hard & swollen from internal
hemorrhaging -volkmann’s contracture
Medial Tibial Stress Syndrome
Signs & Symptoms -Grade I: pain during exercise -Grade II: before & after -Grade III: before, during, & after -Grade IV: no pain