derbyshire sports injuries clinic presents
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Derbyshire Sports Injuries Clinic presents. The foot and ankle . Anatomy- bones. Anatomy- ligaments . Anatomy- tendons. Anatomy- tendons . Anatomy- syndesmosis & capsule. The Ankle joint. Hinge joint Locomotion Proprioception Movements at this joint include Dorsiflexion - PowerPoint PPT PresentationTRANSCRIPT
Derbyshire Sports Injuries Clinic presentsThe foot and ankle
Anatomy- bones
Anatomy- ligaments
Anatomy- tendons
Anatomy- tendons
Anatomy- syndesmosis & capsule
The Ankle jointHinge jointLocomotionProprioceptionMovements at this joint include
DorsiflexionPlantarflexionEversionInversion
Supination is a combination of plantarflexion, inversion and forefoot adduction
Pronation is a combination of dorsiflexion, eversion and forefoot abduction
Movements of the ankle
Pronated, supinated or neutral
Patient walks in c/o ankle painWhat is the mechanism of injury?What position was the foot in at time of injury?
Most common is the inversion injury: Plantar flexed Inverted Adducted
This can injure ATFL Anterolateral capsule Distal tibiofibular ligament Can cause a malleolar/ talar dome fracture/ medial
ankle pain through compression
Patient walks in c/o Ankle painWas there any deformity after injury?Transitory locking indicating a loose body?Able to continue?
Usually a grade 1 ankle sprain can continue with running (painfully)
A grade 2 ankle sprain can walk (painfully)A grade 3 ankle sprain cannot weightbear
Staging the injury is important... Acute, subacute or chronic. Is this acute on chronic?
Does pain increase or decrease with activity?What does the patient do for work and leisure and are there
any contributing factors?
Patient walks in c/o Ankle painGait: have they walked/ limped in?Check for:
Swelling- usually quick onset Bruising- can be delayed NumbnessPins and Needles Weakness: could this actually be an L4 nerve
root compression?
Ottawa Ankle rules Patient requires an ankle X-ray if:
Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus
Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus
An inability to bear weight both immediately and in the rooms for four steps
Ottawa foot rules The patient requires a foot x-
ray if:Bone tenderness at the base
of the fifth metatarsalBone tenderness at
the navicular boneAn inability to bear weight
both immediately and in the rooms for four steps
AssessmentAssess in standing, ability to load through
joint, foot position. Always comparing side-side
In lying check range of movement relative to uninjured side.
Palpate the painful area and surrounding soft tissue and joints
Ligament testsATFL- Anterior drawer test
at 20° plantarflexionCalcaneofibular ligament-
talar tilt at 90° into adduction
Deltoid ligament- talar tilt at 90° into abduction
Squeeze test- syndesmosis injury
Thompson’s Test- Achilles
Other injuries to noteFractured calcaneum (a ‘Lovers’ or ‘Don Juan’ fracture!)- fall
from height or occasionally with an inversion injury.Fractured sub-talar surface can occur also. Check out
‘Sanders’ classification system.Sub-talar joint dislocation... Urgent relocation requiredLis-Franc fracture-dislocation.
Direct: crush injury Indirect: requires a longitudinal force sustained while the foot
is plantarflexed. A backward fall with the foot entrapped, and a fall on the point of the toes is also a common mechanism.
Persistent midfoot pain for >5 days should raise suspicionTenderness of the midfoot on palpation and pain on
eversion+abduction of forefoot while calcaneus is still
More injuries to noteNavicular fracture: can be an avulsion, a
fracture of the body, or a stress fracture. Point tender over the ‘N’ spot. Pain with passive eversion and active inversionVery difficult to see on plain films
Cuboid syndrome- subluxation of the cuboid... Needs manipulation. Patient can’t walk barefoot.
Stress fractures: any bone, any age. Caused by a spike in training or loading.
Severe’s disease: growth plate enthesopathy
More stillHallux valgus: pain
can be unbearable, need to see a podiatrist.
Morton’s neuroma: pain in toes with pins & needles and numbness... Need to see a podiatrist/ physio/ foot surgeon.
Plantar fasciitis Patient complains of heel pain and/or pain through the arch Often chronic, and is not inflammatory so is actually a fasciosis/
fasciopathy Not able to rise up on the balls of the feet from flat foot Risk factors include:
Running and dancing Very high arches or very flat feet Poor shoe choices Obesity Poor dorsiflexion range Tight posterior fascial lines
Patient MUST be referred for quality physiotherapy- at least one session to teach how to self massage, stretches, foot strengthening exercises, taping, shoe education.
Advice for a ‘mild’ sprained ankleGet rid of the swellingAvoid running until pain-free hopping on one foot is
possibleWalking (pain-free), cycling, cross-training and stepping
can be done to keep active, must ice afterwardsAnkle braces should not be worn, not supportive enough
to prevent damage and offer ‘false’ sense of security, while creating a biomechanical alteration
Proprioception exercises should be done prior to return to sport
Theraband strengthening exercises are a good idea to prevent future injuries.
Advice for ‘plantar fasciitis’Ice the area, sometimes using a frozen plastic bottle of
water is useful to roll the foot (roll away from the toes towards the heel)
Don’t walk around barefoot, supportive shoes with good arch support can help relieve pain.
Avoid flat shoes like flip flops... ‘fitflops’ offer a good alternative.
Stretching the soleus can help: stretch against a doorframe. Strengthening the foot through exercises with a towel on
the floor and theraband for the ankle. Lose weightAvoid exercising on hard surfaces