Quiz 10 KNES 315

claw, hammer, and mallet toes signs and symptoms

each condition can lead to painful callus formation of the dorsum of the IP joints; this pressure against the shoe and under the metatarsal head, particularly the second toe, is caused by the retrograde pressure on the long toe CHMT 301

second degree ankle sprain (moderate)

INVERSION AND PLANTAR FLEXION: partial tear of anterior talofibular, with calcaneofibular stretched INVERSION: calcaneofibular torn, and anterior talofibular stretched DORSIFLEXION EVERSION: partial tear of tibiofibular, partial tear of deltoid and tibiofibular 305

third degree ankle sprain (severe)

INVERSION AND PLANTAR FLEXION: rupture of anterior talofibular and calcaneofibular, with posterior talofibular and tibiofibular torn INVERSION: rupture of calcaneofibular, and anterior talofibular with posterior talofibular stretched DORSIFLEXION EVERSION: rupture of tibiofibular, rupture of deltoid, and interosseous membrane with possible fibular fracture above syndesmosis 305

Apophysitis

WIKIPEDIA _______________ is an inflammation or stress injury to the areas on or around growth plates in children and adolescents. _______________ is usually caused by repetitive overuse activities like running, jumping, and throwing but can also occur as an acute injury with a fall or rapid, powerful movement WIKIPEDIA

freiberg's disease

________________ is a painful avascular necrosis of the second, or rarely, third metatarsal head, often seen in active adolescents aged 14 to 18 years before closure of the epiphyses FD 311

midfoot trauma signs and symptoms

____________________: the area is painful to touch and, as such, it can be painful with walking mt 303

lower leg contusions gastrocnemius contusion

a compression mechanism, such as a kick, or blow from a thrown ball, can result in a severe injury gc 303

achilles tendon rupture management

a compression wrap should be applied from the toes to the knee; the individual should be referred immediately to a physician; while this situation does not normally warrant summoning EMS, it can require immediate transport to an emergency care facility ATR 309

heel contusion

a contusion to the hindfoot, called a heel bruise, can be a serious injury; elastic adipose tissue lies between the thick skin and the plantar aspect of the calcaneus to cushion and protect the inferior portion of the calcaneus from trauma; it is constantly subjected to extreme stress in running, jumping, and changing directions; *excessive body weight, age, poorly cushioned or worn-out running shoes, increases in training, and hard, uneven training surfaces can predispose an individual to this condition hc 303*

lower leg tibial contusion

a contusion to the tibia, commonly called a shin bruise, may occur in soccer, field hockey, baseball, softball, football, or activities in which the lower leg is subjected to high-impact forces; the shin is particularly void of natural subcutaneous fat, and is vulnerable to direct blows that irritate the periosteal tissue around the tibia tc 304

heel contusion management

application of cold to minimize pain and inflammation, followed by regular use of a heel cup or doughnut pad, can minimize the condition; the individual should be referred to a qualified healthcare practitioner for a definitive diagnosis and treatment options; despite excellent care, the condition may persist for months hc 303

subtalar joint

as the name suggests, the _________________ lies beneath the talus, where facets of the talus articulate with the sustenaculum tali on the superior calcaneus; obliquely crossing the talus and calcaneus is the tarsal canal, a sulcus that allows for the attachment of an intra-articular ligament; because no muscles attach to the talus, *the stability of the subtalar joint is derived from several small ligaments;* the subtalar joint behaves as a flexible structure, with motion only occurring through stretching of the ligaments during weight-beraing; motion at the joint involves male ovid bone surfaces sliding over reciprocally shaped female ovid bone surfaces 292

strains and tendinitis signs and symptoms

common signs and symptoms include a history of stiffness following a period of inactivity (e.g. morning stiffness), localized tenderness over the tendon, possible swelling or thickness in the tendon and peritendon tissues, pain with passive stretching, and pain with active and resisted motion ST 308

tendon injuries

common sites for ________________ include the Achilles tendon just proximal to its insertion into the calcaneus, the tibialis posterior just behind the medial malleolus, the tibialis anterior just under the extensor retinaculum, and the peroneal tendons behind the lateral malleolus or at the distal attachment on the styloid process of the fifth metatarsal

foot contusions midfoot trauma

compression on the midfoot can be painful, and can damage the extensor tendons or lead to a fracture of the metatarsals or phalanges; during weight-bearing, contusions of the plantar aspect of the forefoot may result form a loose cleat or spike irritating the ball of the foot mt 303

special attention

conditions that warrant ________________ include: obvious deformity suggesting a dislocation, fracture, or ruptured Achilles tendon significant loss of motion or weakness in a myotome excessive joint swelling possible epiphyseal or apophyseal injuries abnormal reflexes or sensation, or absent or weak pulse gross joint instability any unexplained pain 317

gastrocnemius contusion signs and symptoms

contusions to the gastrocnemius result in immediate pain, weakness, and partial loss of motion; hemorrhage and muscle spasm quickly lead to a tender, form mass that is easily palpable gc 303

hallus rigidus

degenerative arthritis in the first MTP joint, associated with pain and limited motion, is known as ______________; activities that involve running and jumping may predispose an individual to this condition due to degenerative changes resulting from direct injury, a hyperextension injury, or varus/valgus stress hr 301

subtalar dislocation signs and symptoms

extreme pain and total loss of function is present; gross deformity at the subtalar joint may not be clearly visible; the foot may appear pale and feel cold to the touch if neurovascular damage is present; the individual may show signs of shock SD 307

tibial-fibula fractures signs and symptoms

gross deformity, gross bone motion at the suspected fracture site, crepitus, immediate swelling, extreme pain, or pain with motion should signal immediate action tf 314

syndesmosis sprain

injury to the distial tibiofibular syndesmosis (i.e. a high ankle sprain) often goes undetected, resulting in a longer recovery time and greater disability than the more frequent lateral ankle sprain; the incidence of injury is reported between 1 and 11% of all ankle injuries; the mechanism of injury differs from that of an inversion sprain; often, the foot is dorsiflexed and externally rotated; external rotation injures the structures of the syndesmosis by widening the ankle mortis SS 307

prevention of foot, ankle, and lower leg conditions

several steps can reduce the incidence or severity of injury; these include the use of appropriate protective equipment, footwear, and physical conditioning 299

displaced fractures and fracture dislocations

severe fractures result from direct compression in acute trauma (e.g. falling from a height or being stepped on), or combined compression and shearing forces, as occurs during a severe twisting action; MANAGEMENT because of the proximity of major blood vessels and nerves, many displaced and undisplaced fractures necessitate immediate immobilization and referral to the nearest trauma center; because shock is possible in serious traumatic fractures, the emergency action plan should be activated; in some settings, this will include summoning of EMS to immobilize and transport the individual to the nearest medical facility 313

heel contusion signs and symptoms

severe pain and inability to bear weight on the heel are typical symptoms; walking barefoot is particularly painful hc 303

protective equipment

shin pads can protect the anterior tibial area from direct impact by a ball, bat, stick, or a kick from a foot; commercial ankle braces used to prevent or support a postinjury ankle sprain come in three categories: lace-up brace, semirigid orthosis, or air bladder brace; a lace-up brace can limit all ankle motions, whereas semirigid orthoses and air bladder braces limit only inversion and eversion; in general, ankle braces are more effective than taping the ankle to reduce injuries, are easier for the wearer to apply independently, do not produce some of the skin irritation associated with adhesive tape, provide better comfort and fit, and are more cost-effective and comfortable to wear; specific foot conditions can be padded and supported with a variety of products, including innersoles, semirid orthotics, rigid orthotics, antishock heel lifts, heel cups, or commercially available pads and devices; adhesive felt (e.g. moleskin), felt, and foam can also be cut to construct similar pads to protect specific ares 299

eversion ankle sprains signs and symptoms

signs and symptoms of an isolated __________________ depend on the severity of injury; in mild to moderate injuries, the individual is often unable to recall the mechanism of injury; there may be some initial pain at the ankle when it was everted and dorsiflexed, but as the ankle returns to its normal anatomical position, pain often subsides and the individual contitnues to be active; in attempts to run or put pressure on the area, pain intensifies, but the individual may not make the connection between the pain and the earlier injury; swelling may not be as evident as a lateral strain because hemorrhage occurs deep in the leg and is not readily visible; swelling may occur just posterior to the lateral malleolus, between it and the achilles tendon; point tenderness can be elicited over the DL EAS 307

MP and IP joints

sprains and dislocations to the _________________ of the toes may occur by tripping or stubbing the toe; varus and valgus forces more commonly affect the first and fifth toes, rather than the middle three MPIP 305

forefoot fractures signs and symptoms

swelling, ecchymosis, and pain are present; the individual is able to walk, but may have problems with footwear *metatarsal fractures are classified according to their anatomical location (i.e. neck, shaft, or base);* a single fracture tends to be minimally displaced because of the restraining forces of the IM ligaments; swelling and pain are localized over the fracture site; pain increases with weightbearing ff 313

hindfoot

the _______________ includes the calcaneus and talus; the talus is saddle-shaped and serves as the critical link between the foot and ankle; it has several functional articulatiosn, the two most important being the talocrual joint and the subtalar joint; both serve a unique role in the integrated function of the foot, ankle, and lower leg 292

medial tibial stress syndrome management

the coach should refer this individual to a physician for accurate diagnosis and treatment options; the coach should not permit the individual to continue activity, as doing so could potentially exacerbate the condition; in addition, the coach could suggest the application of cold to the area to decrease pain and potential spasm MTSS 311

claw, hammer, and mallet toes

the following lesser toe deformities may be congenital, but more often develop because of improperly fitted shoes, neuromuscular disease, arthritis, or trauma; a HAMMERTOE is extended at the MTP joint, fixed at the PIP joint, and hyperextended at the DIP joint; CLAW TOE involves hyperextension of the MTP joint and flexion of the DIP and PIP joints; a MALLET TOE is in neutral position at the MTP and PIP joints, but flexed at the DIP joint CHMT 301

exertional compartment syndrome management

the immediate management involves ceasing activity; ultimately, the individual needs to be assessed by a qualified healthcare practitioner; assessment should include both extrinstic factors (e.g. training patterns, technique, shoe design, and training surface) and intrinsic factors (E.g. foot alignment, especially hindfoot pronation, muscle imbalance, and flexibility) ECS 311

plantar arches

the primary supporting structures of the plantar arches, in order of importance, are the calcanoclavicular (i.e. spring) ligament, long plantar ligament, plantar fascia (i.e. plantar aponeurosis), and the short plantar (i.e. plantar CC) ligament; when muscle tension is present, the muscles of the foot, particularly the tibialis posterior, contribute support to the arches and joints as they cross them 293

exertional compartment syndrome signs and symptoms

the typical history of chronic ECS is exercise-induced pain that is often described as a tight, cramp-like, or squeezing ache and a sense of fullness, both over the invovled compartment; *the condition often affects both legs;* symptoms are almost always relieved with rest, usually within 20 minutes of exercise, only to recur if exercise is resumed; activity- related pain begins at a predictable time after starting exercise or after reaching a certain level of intensity and increases if the training persists; many individuals with anterior compartment involvement describe mild foot drop or paresthesia (or both) on the dorsum of the foot, and demonstrate fascial defects or hernias, usually in the distal third of the leg over the intramuscular septum ECS 311

Ankle fracture-dislocations management

this fracture can compromise the posterior tibial artery and nerve because of the traumatic nature of this condition, the emergency plan should be activated, including summoning EMS; while waiting for EMS to arrive, the coach should monitor and treat the individual for shock as necessary afd 314

medial tibial stress syndrome signs and symptoms

typically seen in runners or jumpers, the pain can occur at any point during a workout and is typically characterized as a dull ache, although it occasionally can be sharp and penetrating; as activity progresses, pain diminishes only to recur hours after activity has ceased; in later stages, pain is present before, during, and after activity, and may restrict performance; point tenderness is elicited in a 3 to 6 cm area along the distal posteromedial tibial border; pain is aggravated by resisted plantar flexion or standing on tiptoe; there is often an associated varus alignment of the lower extremity, including a greater Achilles tendon angle MTSS 311

Ankle fracture-dislocations signs and symptoms

typically the foot is displaced laterally at a gross angle to the lower leg and extreme pain is present; this position can compromise the posterior tibial artery and nerve afd 314

turf toe

_____________, a sprain of the plantar capsular ligament of the first MTP joint, results from forced hyperextension or hyperflexion of the great toe (i.e., jamming the toe into the end of the shoe); repetitive overload can also lead to injury, particularly when associated with a valgus stress tt 305

physical conditioning lower leg and foot

___________________ is one of the strongest defenses against injury; unfortunately, the foot and lower leg are often neglected; lack of flexibility an predispose an individual to certain injuries; for example, a tight Achilles tendon has been shown to predispose an individual to plantar fascitis, achilles tendonitis, and lateral ankle sprains; *exercises should focus on ensuring normal range of motion*, and may be performed alone or with a partner 299

acute compartment syndrome signs and symptoms

_____________________ include a recent history of trauma, excessive exercise, a vascular injury, or prolonged, externally applied pressure; the increasing severe pain and swelling appear to be out of proportion to the clinical situation; a firm mass, tight skin (because it has been stretched to its limits), loss of sensation on the dorsal aspect between the great toe and the second toe, and diminished pulse at the dorsalis pedis are delayed and dangerous signs; however, a normal pulse does not rule out the syndrome; ___________________ can produce functional abnormalities within 30 minutes of onset of hemorrhage; immediate action is necessary because irreversible damage can occur within 12 to 24 hours acs 304

FOOT INTRINSIC MUSCLE EXERCISES

_____________________: plantar fascia stretch- place a towel around the toes and slowly overextend the toes; dorsiflex the ankle to stretch the achilles tendon towel crunches- place a dowel between the plantar surfaces of the does and feet; push the toes and feet together crunching the towel between the toes toe curls- with the foot resting on a towel, slowly curl the toes under, bunching the bowel beneath the foot; variation: use too feet or a book or small weight on the towel for added resistance picking up objects- pick up small objects such as marbles or dice with the toes and place in a nearby container, or use therapeutic putty to work the toe flexors shin curls- slide the plantar surface of the foot up the opposite shin, moving distal to proximal unilateral balance activities- stand on uneven surfaces with the eyes first open, then closed BAPS (piomechanical ankle platform system) board- seated position: roll the board slowly clockwise, then counterclockwise 20 times

lower leg, ankle, and foot

because of the essential roles played by the ___________________ during sport and physical activities, injuries to the region are common; sport participation often places both acute and chronic overloads on the lower extremity, leading to sprains, strains, fractures, and overuse injuries; in particular, basketball, soccer, and football participants sustain a high incidence of injury to this region; *lateral ankle sprains are the most comm of all sports-related injures, accounting for about 25% of injuries to the musculoskeletal system;* increasingly, there is recognition that repeated ankle sprains can result in functional instability of the ankle, which predisposes the individual to further injury 290

subtalar dislocation management

because of the potential for peroneal tendon entrapment and neurovascular damage, leading to reduced blood supply to the foot, this dislocation is considered a medical emergency; the coach should activate the emergency action plan, including summoning of EMS; while waiting for EMS to arrive, the coach should monitor the individual for shock and treat as necessary SD 308

toe deformities

most _______________ are minor and can be treated conservatively; a few deformities require surgical intervention to correct serious structural malalignment; common deformities are explained in this section; in each case, the management requires physician referral for accurate diagnosis and treatment options td 301

transverse tarsal joint

the ________________ (or midtarsal) joint consists of two side-by-side articulations, namely the calcaneocuboid (CC) joint on the lateral side and the talonavicular on the medial side; collectively, these two joints are called the transverse tarsal joint because they are adjacent and function as a unit the CC joint is a saddle-shaped joint with a close-packed position in supination; the joint is nonaxial and bermits only limited gliding motion; it is supported by several ligaments; the most important is the long plantar ligament, as it contributes significantly to the transverse tarsal joint stability because the talus moves simultaneously on the calcaneus and navicular, the term talocalcaneonavicular joint (TCN) is often used to describe the combined action of the talonavicular and subtalar joint; the TCN is a modified ball-and-socket joint with a closed packed position in rotation; movements at the joint include *gliding and rotation*; three ligaments support the joint, namely the plantar calcaneonavicular (spring) ligament inferiorly, deltoid ligament (DL) medially, and the bifurcate ligament laterally because the subtalar joint is mechanically linked to the TCN and transverse tarsal joints, any motion at the subtalar joint produces like motions at the transverse tarsal joints; for example, when the TCN is fully supinated and locked, the midfoot region is supinated and rigid; when the TCN is pronated and loose packed, the midfoot region is mobile and lose 292

achilles tendon rupture signs and symptoms

the individual hears and feels a characteristic pop in the posterior ankle and reports a feeling of being shot or kicked in the heel; clinical signs and symptoms include a visible defect in the tendon, inability to stand on the tiptoes or even balance on the affected leg, swelling and bruising around the malleoli, and excessive passive dorsiflexion; because the personeal longus, peroneal brevis, and muscles in the deep posterior compartment are still intact, the individual may limp or walk with the foot and leg externally rotated, since this does not require push-off with the superficial calf muscles ATR 309

hallus rigidus signs and symptoms

the individual presents with a tender, enlarged first MTP joint, loss of motion, and difficulty wearing shoes with an elevated heel; a hallmark sign is restricted toe extension (dorsiflexion) variably less than 60 degrees owing to a ridge of osteophytes that can be palpated easily along the dorsal aspect of the metatarsal head hr 301

on-site assessment of an acute foot, ankle, lower leg injury

HISTORY -Chief complaint what's wrong -Mechanism of injury what happened? what were you doing? was there a direct blow? what was the position of the foot and leg when the injury occurred? are you able to demonstrate how it happened? -Pain Location Where is the pain? Did the pain come on suddenly (acute) or gradually (overuse)? Can you point to a location where it hurts the most? Type-can you describe the pain (e.g. sharp, shooting, dull, achy, diffuse? intensity what is the level of pain on a scale from 1 to 10? can you wear weight on the leg or balance on the leg? -Sounds/ feelings Did you hear anything when the injury happened (e.g. pop, snap, crack)? Did you feel any unusual sensations (e.g. tetaring, knee giving way, locking, cracking) when the injury happened? -Previous history have you ever injured your knee before? If so, what happened? what was the injury? were you treated for it? -Other important/ helpful information How old are you? (remember that many problems are age-related) Have you made any changes in performance (i.e. technique, intensity, playing surface)? Have you changed your training workouts (e.g. increased running distance; increased running intensity)? are you able to perform normal motions/ ADLs? -Is there anything else you would like to tell me about your condition OBSERVATION -General presentation guarding moving easily; hesitant to move walking on toes; walking on heel -Injury site appearance- deformity, swelling, discoloration, position of patella; PALPATION the coach should only perform palpation if there is a clear understanding of what is being palpated and why? a productive assessment appropriate to the standard of care of a coach does not necessitate palpation TESTING Active range of motion (AROM)-bilateral comparison dorsiflexion of the ankle plantar flexion of the ankle pronation supination toe extension toe flexion toe abduction and adduction knee flexion (gastrocnemius) Passive range of motion should not be performed by the coach Resistive Range of motion the coach should only perform resistance range of motion for the muscles that govern the foot, ankle, and lower leg if: instruction and approval for doing so has been obtained in advance from an appropriate health-care practitioner AROM is normal and pain free as a way to assess strength Activity/sport specific functional testing Performance of active movements typical of the movements executed by the individual during sport or physical activity participation (including weight training) should assess strength, agility, flexibility, joint stability, endurance, coordination, balance, and activity-specific skill performance 316

contusions

____________ of the foot and leg result from direct trauma, such as dropping a weight on the foot, or being stepped on, kicked, or hid by a speeding ball or implement; many of these injuries are minor and easily treated with standard acute care; however, a few injuries can result in complications, such as excessive hemorrhage, periosteal irritation, nerve damage, or damage to tendon sheaths, leading to tenosynovitis 302

midfoot

_____________ sprains often result form severe dorsiflexion, plantar flexion, or pronation; although the condition is seen in basketball and soccer players, it is more frequent in activities where the foot is unsupported, such as in gymnastics or dance in which slippers are typically worn, or in track athletes who wear running flats m 305

pes cavus

_______________ is an excessively high arch that does not flatten during weight-bearing; the deformity can involve the forefoot, mid, hindfoot, or combination of those areas; the potential cause of ________________ varies; while some causes are idiopathic, other potential etiologies include heredity, muscle imbalances, and an underlying neuromuscular problem (e.g. muscular dystrophy); *in most cases, _______________ is associated with a rigid foot* pc 302

ankle sprains

________________ are classified as grade I, II, or III based on the progression of anatomical structures damaged and the subsequent disability; inversion sprains involve plantar flexion and inversion, thet AFTL is torn first, followed by the calcaneal fibular ligmament; in eversion ankle sprains, the deltoid ligament is injured; there may also be an associated avulsion fracture of one or both malleoli 317

pes planus

________________ is the opposite of pes cavus; the condition, referred to as flat foot, its the consequence of the arch or instep of the foot collapsing and contacting the ground; in most cases, _________________ is an acquired deformity resulting from injury or trauma involving the soft tissue structures that maintain the normal integrity of the soft arch; _______________ typically results in a mobile foot; pes cavus and _________________ can occur at any age; while both conditions can be asymptomatic, they are often associated with several common injuries 302

stress fractures

________________ of the tibia and fibula result from repetitive stress to the leg leading to muscle fatigue; the resulting loss in shock absorption increases stress on the bone and periosteum; in the tibia, most stress fractures occur at the junction of the middle and distal thirds (most common site), the posterior medial tibial plateau, or just distal to the tibial tuberosity; fibular stress fractures usually occur in the distal metadiaphyseal region; because the fibula has a minimal role in weight bearing, it is believed that fibular ____________________ result form muscle traction and torsional forces SF 312

ankle conditions that warrant immediate physician referral

_________________ include: obvious deformity suggesting a dislocation, fracture, or ruptured Achilles tendon significant loss of motion or muscle weakness excessive joint swelling possible epiphyseal or apophyseal injuries abnormal sensation, or absent or weak pulse gross joint instability any unexplained pain that affects normal function

conditions associated with heel pain in physical active young individuals

_________________ include: plantar fascitis heel fat pad syndrome achilles tendintiis/ strain retrocalcaneal bursiits calcaneal stress fractures calcaneal exostosis contusion infection tarsal coalition tarsal tunnel syndrome 312

plantar fascitis

_________________ is the most common hind foot problem in runners, affecting approximately 10% of runners; extrinsic factors that increase the incidence of the condition include training errors, improper footwear, and participating on unyielding surfaces; intrinsic factors include pes cavus or pes planus, decreased planter flexion strength, reduced flexibility of the plantar flexor muscles (e.g. Achilles tendon), excessive or prolonged pronation and torsional malalignment; these factors can overload the plantar fascia's origin on the anteromedial aspect of the calcaneus during weight-bearing activities pf 310

avulsion fractures

_________________ may occur at the site of any ligamentous or tendinous attachment; severe eversion ankle sprains may cause the deltoid ligament to avulse a portion of the distal medial malleolus rather than tearing the ligmaent; inversion ankle sprains can provide sufficent overload to cause the plantar aponeurosis or peroneus brevis tendon to be pulled from the bone, avulsing the base of the fifth metatarsal, the so-called *dancer's fracture* AF 313 ALSO SEE JONES FRACTURE BELOW

fractures

_________________ of the lower leg, ankle, and foot may involve: Freiber's disease (i.e. avascular necrosis of the second metatarsal head) Sever's disease (i.e. calcaneal apophysis) Stress fractures (neck of the second metatarsal is most common) avulsion fractures (e.g. styloid process of the fifth metatarsal, and medial and lateral malleoli) displaced fractures or fracture dislocation

fractures

_________________- in the foot and lower leg region seldom result from a single traumatic episode; often, repetitive microtraumas lead to apophyseal or stress fractures; tensile forces associated with severe ankle sprains can lead to avulsion fractures of the fifth metatarsal, or severe twisting can lead to displaced and undisplaced fractures in the foot, ankle, or lower leg; a combination of forces can lead to a traumatic facture- dislocation; the management fr the conditions in this section is the same for each, unless otherwise noted; if a fracture is suspected, immediate referral to a physician is warranted; the application of cold and gentle compression to minimize pain adn swelling can be advantageous; crutches should be used if the individual is unable to bear weight 311

medial tibial stress syndrome

_________________- is a periositis along the posteromedial tibial border, usually in the distal third, not associated with a stress fracture or compartment syndrome; signs and symptoms include point tenderness in a 3 to 6 cm area along the distal posteromedial tibial border, and pain and weakness with resisted plantar flexion or standing on tiptoe

ankle sprains

__________________ are the most common injury in recreational and competitive sports; they are classified as Grade I (First degree), Grade II (second degree), and Grade III (third degree), based on the progression of anatomical structures damaged and the subsequent disability; in basketball, ankle sprains comprise more than 45% of all injuries, and in soccer, up to 31% of all injuries are _____________ 305

generalized forefoot pain

__________________ may result from intrinsic factors (e.g. excessive body weight, limited flexibility of the Achilles tendon, pronation, valgus heel, hammer toes, fallen metatarsal arch, pes planus, or pes cavus) or extrinsic factors (e.g. narrow toe box, improperly placed shoe cleats, repetitive jumping or running, or landing poorly from a height)

Ankle fracture-dislocations

___________________ are usually caused by landing from a height with the foot in excessive eversion or inversion or by being kicked from behind while the foot is firmly planted on the ground AFD 314

predisposing factors for tendinitis in the lower leg

___________________ include: TRAINING ERRORS that include: lack of flexibility in the gastrocnemius-soleus muscles poor training surface or sudden change from soft to hard surface or vice versa sudden changes in training intensity or program (e.g. adding hills, sprints, or distance) inadequate work-rest ratio that may lead to early muscle fatigue returning to participation too quickly following injury direct trauma infection from a penetrating wound into the tendon abnormal foot mechanics producing friction among shoe, tendon, and bony structure poor footwear that is not properly fitted to foot

congenital abnormalities

___________________, leg length discrepancy, muscle dysfunction (e.g. muscle imbalance), or a malalignment syndrome (e.g. pes cavus, pes planus, pes equinus, and hammer or claw toes) can predispose an individual to several chronic injuries 316

sever's disease

___________________, or calcaneal apophysitis, is frequently seen in 7 to 10 year olds; it is associated with growth spurts, decreased heel cord and hamstring flexibility, and other biomechanical abnormalities contributing to poor shock absorption (e.g. forefoot varus, hallux valgus, pes cavus, pes planus, and more commonly, forefoot pronation); because the apophyseal plate is vertically oriented, it is particularly susceptible to shearing stresses from the gastrocnemius; hard surfaces, poor-quality or worn-out athletic shoes, being kicked in the region, or landing off-balance may also precipitate the condition SD 312

stress fractures

____________________ are often seen in running and jumping, particularly after a significant increase in training mileage, or a change in surface, intensity, or shoe type; women with amenorrhea of longer than 6 months duration and oligomenorrhea have a higher incidence of stress fractures of the foot and leg during sport activity; however, women who use oral contraceptives tend to have significantly fewer stress fracutres than do nonusers; stress fractures can be generally classified as noncritical and critical; *noncritical stress fractures of the lower leg, foot, and ankle include the medial tibia, fibula, and metatarsals 2, 3, and 4; * the neck of the second metatarsal is the most common location for a stress fracture, although it is also seen on the fourth and fifth metatarsals; treatment usually requires relative rest; physically active individuals may benefit from a short period of immobilization in a walking boot for up to 3 weeks, or in the case of metatarsal stress fractures, from a stiff sole shoe or steel insert; return to activity is generally seen in 6 to 8 weeks; critical stress fractures require special attention due to a higher rate of nonunion; *common site sinclude the anterior tibia, medial malleolus, talus, navicular, fifth metatarsal, and sesamoids* SF 312

exertional compartment syndrome

____________________- is characterized by exercise-indenced pain and swelling that are relieved by rest; the anterior compartment is most frequently affected, and if so, mild foot drop or paresthesia (or both) may be present; fascial defects or hernias also may be present in the distal third of the leg over the anterior intramuscualr septum 317

medial tibial stress syndrome

_____________________ is a periostitis along the posteromedial tibial border, usually in the distal third, not associated with a stress fracture or compartment syndrome; although originally thought to be related to stress along the posterior tibialis muscle and tendon causing myositis, fascitis, and periositis, it is now believed to be related to periositis of the soleus insertion along the posterior medial tibial border; the soleus makes up the medial third of the heel cord as it inserts into the calcaneus; excessive pronation or prolonged pronation of the foot causes an eccentric contraction of the soleus, resulting in the periositis that produces the pain; other contributing factors include recent changes in running distance, speed, form, stretching, footwear, or running surface MTSS 310

exertional compartment syndrome

_____________________ is characterized by exercise induced pain and swelling that is relieved by rest; the compartments most frequently affected are the anterior (50 to 60%) and deep posterior (20 to 30%); the remaining 10 to 20% are divided evenly among the lateral, superficial posterior, and the fifth compartment around the tibalis posterior muscle; whereas acute ECS generally occurs in relatively sedentary people who undertake strenuous exercise, chronic ECS usually is seen in well-conditioned individuals younger than 40 ECS 331

avulsion fractures (Jones fracture)

a much more complicated avulsion fracture seen in sprinters and jumpers involves a transverse fracture into the proximal shaft of the fifth metatarsal at the junction of the diaphysis and metaphysis, called a *___________________;* it is often overlooked in conjunction with a severe adduction force to the forefoot AF 313

coach assessment

although pain, discomfort, or weakness may occur at a specific site, the lower extremities work as a unit to provide a foundation of support for the upright body, propulsion through space, absorption of shock, and adaptation to varying terrain; as such, assessment must include the entire lower extremity; while the coach should restrict their assessment to on-site injuries, it may be appropriate to initiate the history component of an assessment if an individual reports to an activity with complaints of pain or discomfort; in doing so, the coach can confirm the presence of an acute or chronic/overuse injury and proceed accordingly; when it becomes apparent that an injury is overuse in nature, the coach should refrain from any continued assessment and, instead, refer the individual to an appropriate healthcare practitioner 314

talocrual joint

although the joint capsule is thin and especially weak anteriorly and posteriorly, a number of strong ligaments cross the ankle and enhance stability; the four separate bands of the medial collateral ligament, more commonly called the DL, cross the ankle medially; the lateral side of the ankle is supported by three ligaments; the anterior talofibular ligament (ATFL) resists inversion during plantar flexion, and limits anterior translation of the talus on the tibia; the calcaneofibular ligament (CFL) is the primary restraint of talar inversion within the midrange of motion; the posterior talofibular ligament limits posterior displacement of the talus on the tibia; *the relative weakness of these lateral ligaments as compared with the DL, coupled with the fact of less bony stability laterally than medially, contributes to a higher frequency of lateral ankle sprains *292

acute anterior comprartment syndrome

an __________________ is a medical emergency; signs and symptoms include a recent history of trauma, a palpable firm mass in the anterior compartment, tight skin, and a diminished dorsalis pedis pulse 316

acute compartment syndrome

an __________________ occurs when there is a rapid increase in tissue pressure within a nonyielding anatomical space that leads to increased local venous pressure and obstructs the neurovascular network; in the lower leg, it tends to be caused by a direct blow to the anterolateral aspect of the tibia, or a tibial fracture; *the anterior compartment is particularly at risk, because it is bounded by the tibia medially, the interosseous membrane posteriorly, the fibula laterally, and a tough fascial sheath anteriorly; * although an __________________ occurs less frequently than the more common chronic compartment syndrome, the acute syndrome is considered a medial and surgical emergency because of the compromised neurovascular functions acs 304

running gait

differences in ______________ have been documented based on both gender and age; among recreational runners, females appear to have greater hip adduction, hip internal rotation, and knee abduction compared to males a study of elite master sprinters showed an age-related decline in running speed related to reduction in stride length and increase in ground contact time 294- 296

kinematics

evaluation of the _________________ of gait during walking and running can provide important clues for the likelihood of injuries; this section describes the kinematics of the lower leg, ankle, and foot, and identifies muscles responsible for specific movements 294

inversion ankle sprain

excessive supination of the foot (i.e. adduction, inversion, and plantar flexion) results when the plantar aspect of the foot is turned inward toward the midline of the body, commonly referred to as an *inversion sprain;* acute inversion (i.e. lateral) sprains often occur while changing directions rapidly; interestingly, injury typically involves the unloaded foot and ankle (or, more accurately, just at the moment of loading) with a plantar flexion and inversion force; in plantar flexion, the ATFL is taut and the CFL is relatively loose, whereas in dorsiflexion, the opposite is true; the medial and lateral malleoli project downward over the talus to form a mortise-tension joint; the lateral malleolus projects further downward than the medial, thus limiting lateral talar shifts; as stress is initially applied to the ankle during plantar flexion and inversion, the ATFL first stretches; if the strain continues, the ankle loses ligamentous stability in its neutral position; the medial malleolus acts as a fulcrum to further the inversion, and stretches or ruptures the CFL IAS 306

inversion ankle sprain signs and symptoms

in a grade I injury, the individual reports pain but can typically bear weight immediately after injury; in a grade II injury, the individual reports a pop suggesting the tearing of a ligament (i.e. the ATFL); rapid swelling and tenderness are localized over the ATFL and may extend over the CFL, and the individual can bear some weight, but definitely walks with a limp; a grade III injury mimics a grade II injury, except that the person is unable to bear weight as there is a functional instability IAS 306

strains and tendinitis management

in assessing these conditions, it should become apparent to the coach during the history component that the injury is overuse in nature and, as such, the coach should refrain form continuing assessment; rather, the coach should refer this individual to a physician for accurate diagnosis and treatment actions; the coach should not permit the individual to contue activity, as doing so could potentially exacerbate the condition; in addition, the coach could suggest the application of cold to the area to decrease pain and potential spasm ST 309

coach assessment

in continuing the observation component, a bilateral comparison should be performed as a means for recognizing any deformity, swelling, discoloration, or alignment abnormalities; again, if the individual is able to walk, an assessment of gait (e.g. favoring one limb, an inability to perform a fluid motion; toe walking) could aid in identifying the structures involved and the seriousness of the condition 315

gastrocnemius muscle strain management

initial treatment should consist of standard acute care (i.e. cold, compression, elevation, and protected rest) and restricted activity; crutches should be used if the individual is unable to bear weight; if an apparently mild injury does not significantly improve in 3 to 4 days or if the injury is considered moderate to severe, immediate referral to a physician is necessary GMS 309

coach assessment

it is important for the coach to recognzie that many injuries to this region are rarely life-theatening; however, there are some conditions that will require activation of the emergency plan as they require immediate referral to a physician; the assessment begins as the coach approaches the individual or as the individual walks toward the coach; the focus should be on individual's overall presentation, attitude, and general posture; if the person is walking it is important to determine any abnormal actions (e.g. presence of a limp; walking on the does; walking on the heel); the history component of the exam should focus on the major complaint, mechanism of injury, and presence of any unusual sensations (i.e. pain, sounds, feelings); the location and onset of pain should be noted; *an acute onset should lead one to suspect bony trauma or an acute ankle sprain until ruled out;* *a gradual onset of pain may signal inflammation from overuse of a muscle or the plantar fascia or the development of a stress fracture* 315

toe and foot conditions

many individuals are at risk for toe and foot problems because of a leg-length discrepancy, postural deviation, muscle dysfunction (e.g. muscle imbalance), or a malalignment syndrome (e.g. pes cavus, pes planus, and hammer or claw toes); typically, when compared to a man's foot, a woman's foot has a narrower hindfoot, a relatively increased forefoot to hindfoot width, and increased pronation; also, due to fashion trends and societal pressures, women tend to wear shoes that are narrower than the women's feet and have narrow toe boxes; higher heels shift the forefoot forward into the toe box, causing crowing of the toes and a tight heel cord; consequently, women tend to be more prone to hallux valugus deformities, bunionettes, hammer toes, and neuromas 301

first degree ankle sprain (mild)

mechanism INVERSION AND PLANTAR FLEXION: anterior talofibular stretched INVERSION: calcaneofibular stretched DORSIFLEXION EVERSION: tibiofibular stretched, deltoid stretched, or an avulsion fracture of medial malleolus 305

tibial-fibula fractures

nearly 60% of tibial fractures involve the middle and lower third of the tibia; the majority are closed; whether open or closed, this fracture is associated with complications, such as delayed union, nonunion, or malunion; the most common cause of an isolated tibial fracture is torsional force, resulting in either a spiral or an oblique fracture of the lower third of the tibia tf 314

stress fractures signs and symptoms

pain from a stress fracture begins insidiously (gradually), increasing with activity and decreasing with rest; pain is usually limited to the fracture site SF 313

forefoot fractures

phalangeal fractures are caused by an axial load (e.g. jamming the toe into an immovable object) or direct trauma (crushing injury); most are minor injuries, with the exception of a fracture to the great toe ff 313

hallus valgus

prolonged pressure against the medial aspect of the first MTP joint can lead to thickening of the medial capsule and bursa (i.e. bunion), resulting in a severe valgus deformity of the great toe; the condition may be caused by heredity, metatarsus primus varus, pes planus, rheumatoid arthritis, and neurologic disorders; the most common cause is wearing poorly fitted shoes with a narrow toe box hv 301

achilles tendinitis

risk factors for ____________________ include a tight heel cord, foot malaignment deformities, a recent change in shoes or running surface, a sudden increase in workload (E.g. distance or intensity) or changes in the exercise environment (e.g. changing footwear, or excessive hill climbing or impact-loading activities, such as jumping)

inversion and eversion

rotations of the foot in the medial and lateral directions are termed inversion and eversion respectively; these movments occur primarily at the subtalar joint, with secondary contributions from gliding movements at the intertarsal and TM joints; the tibialis posterior is the major inverter, with the tibialis anterior providing a minor contribution; peroneus longus and peroneus brevis, with tendons passing behind the lateral malleolus, are primarily responsible for eversion, with assistance provided by the peroneus tertius 298

toe flexion and extension

several muscles contribute to flexion of the second through fifth toes; these include the flexor digitorum longus, flexor digitorum brevis, quadratus plantae, lumbricals, and interossei; the flexor hallicus longus and brevis produce flexion of the hallux; conversely, the extensor hallucis longus, extensor digitorum longus, and extensor digitorum brevis are responsible for extension and overextension of the toes 296

coach assessment

subsequent to the history and observation components of an assessment, the coach should have established a strong suspicion of the structures that may be damaged; if the coach elects to perform the testing component of the assessment, it should begin with active range of motion; active movements can be performed with the individual in a seated or prone position; the motions should include: dorsiflexion of the ankle plantar flexion of the ankle pronation supination toe extension toe flexion toe abduction and adduction if those motions are pain free, the coach could continue with resisted range of motion and, if there are no positive findings, perform functional testing; otherwise, the assessment should be considered complete 315

primary supporting structures

the _________________ of the plantar arches are the spring (calcaneonavicular) ligament, long plantar ligament, plantar fascia (plantar aponeurosis), and the short plantar (plantar cc) ligament; in addition, the tibialis posterior provides some support 316

syndesmosis sprain signs and symptoms

the area of maximum point tenderness is usually over the anterolateral tibiofibular joint; the degree of pain and swelling can be significant; the individual will have difficulty bearing weight on the injured ankle; the most commonly injured ligament, and a source of anterolateral ankle impingement, is the anterior inferior tibiofibular ligament; the least injured ligament is the posterior inferior tibiofibular ligament, although the interosseous ligament may also be variably injured SS 307

freiberg's disease signs and symptoms

the condition can lead to diffuse pain in the forefoot region FD 311

sever's disease signs and symptoms

the individual complains of unilateral or bilateral, intermittent or continuous, posterior heel pain that occurs shortly after beginning a new sport or season; pain tends to be worse during and after activity, but improves with rest; although gait may be normal, the child may walk with a limp or exhibit a forceful heel strike; point tenderness can be elicited at or just anterior to the insertion of the Achilles tendon along the posterior border of the calcaneus; standing on the tiptoes can elicit pain; other conditions that may also lead to heel pain should be ruled out prior to determining the treatment plan SD 312

other midtarsal joints

the remaining joints of the midoot region include the cuneoavicular, cuboideonavicular, cuneocuboid, and intercuneiform; these joints provide gliding and rotation for the midfoot with a close-packed position in supination 292

nerves and blood vessels of lower leg, ankle, and foot

the sciatic nerve and its branches provide primary innervation for the lower leg, ankle, and foot; just proximal to the popliteal fossa on the posterior lower leg, the sciatic nerve branches into smaller nerves; the major branches are the tibial nerve that innervates the posterior aspect of the leg and the common peroneal nerve that spawns the deep and superficial peroneal nerves, which innervate muscles in the anterior and lateral compartments, respectively 294

toe and foot sprains and dislocations

the toes and feet can be common sites for sprains particularly during an activity in which there is minimal support for the foot; the management for these conditions involves standard acute care as well as referral to a qualified healthcare practitioner for an accurate diagnosis and treatment options 304

plantar arches

the transverse arch runs across the anterior tarsals and metatarsals; the foundation of the arch is the medial cuneiform, with the apex of the arch formed by the second metatarsal; the arch is reduced at the level of the metatarsal heads, with all metatarsals aligned parallel to the weight-bearing surface for even distribution of body weight; structural support is derived from the IM ligaments and the transverse head of the adductor hallucis muscle 293

ankle

the true ________________ (talocrural) joint is between the tibia, fibula, and talus; plantar flexion and dorsiflexion occur at this joint; motion at the subtalar joint involves inversion and eversion; the combination of calcaneal inversion, foot adduction, and plantar flexion is known as supination; calcaneal eversion is called foot adduction, and dorsiflexion is known as pronation 316

common injuries associated with foot deformities

_______________________ include: PES CAVUS plantar fascitis metatarsalgia stress fractures of the tarsals and metatarsals peroneal tendonitis sesamoid disorders iliotibial band friction syndrome PES PLANUS tibialis posterior tendinitis achillies tendinitis plantar fascitis sesamoid disorders medial tibial stress syndrome patellofemoral pain 302

ANKLE LOWER LEG MUSCLE EXERCISES

_______________________: Ankle alphabet- using the ankle of foot only, trace the letters of the alphabet from A to Z, three times with capital letters, and three times with lowercase Triceps surae stretch- keeping the back leg straight and heel on the floor, lean against a wall until tension is felt in the calf muscles (1); to isolate the soleus, bend both knees (2); point the toes outward, straight ahead, and inward to stretch the various fibers of the achilles tendon Thera-Band or surgical tubing exercises- secure the thera-band or tubing around a table leg, and do resisted dorsiflexion, plantar flexion, inversion, and eversion unilateral balance exercises- balance on the opposite leg while doing Thera-band exercises ABPS board- standing position: balance on the involved foot and repeat the process; additional challenges such as using no support, or dribbling with a basketball while balancing, can be added 300

subtalar dislocation

a serious sprain that involves the subtalar joint results from a fall from a height (as in basketball or volleyball); the foot lands in inversion, disrupting the interosseous talocalcaneal and talonavicualr ligaments; if the foot lands in dorsiflexion and inversion, the CFL is also ruptured; when the dislocation occurs, the injury is better known as *basketball foot* SD307

achilles tendon rupture

acute rupture of the ________________ is probably the most severe acute musclar problem in the lower leg; it is more commonly seen in individuals 30 to 50 years old; the usual mechanism is a push-off the forefoot while the knee is extending, a common move in many propulsive activities; tendinous ruptures usually occur 1 to 2 inches proximal to the distal attachment of the tendon on the calcaneus ATR 309

eversion ankle sprains

excessive pronation (i.e. abduction, eversion, and dorsiflexion) results when the plantar aspect of the foot is turned laterally, referred to as an _______________; __________________ i.e. medial) involve injury to the medial, deltoid-shaped talocrural ligaments (DI); although an isolated injury to the DI may result from forced dorsiflexion and eversion, such as landing from a long jump with the foot abducted or landing on another player's foot; these account for less than 10% of all injuries; most injuries in the DL are associated with a fibula fracture, syndesmotic injury, or severe lateral ankle sprains; *individuals with pronated or hypermovile feet tend to be at a greater risk for eversion injuries;* the talar dome is wider anteriorly than posteriorly; during dorsiflexion, the talus fits more firmly in the mortise suported by the distal anterior tibiofibular ligament; during excessive dorsiflexion and eversion, the talus is thrust laterally against the longer fibula, resulting in either a mild sprain to the DL or, if the force is great enough, a lateral malleolar fracture; if the force continues after the fracture occurs, the deltoid ligament may become ruptured, or may remain intact, avulsing a small bony fragment from the medial malleolus and leading to a bimalleolar fracture; in either case, the distal anterior tibiofibular ligament and interosseous membrane may be torn, producing total instability of the ankle joint and eventual degeneration EAS 307

gastrocnemius contusion management

ice should be applied to the area; in doing so, the muscle should be kept stretched to decrease muscle spasm; if the condition does not improve in 2 to 3 days, the individual should be referred to a physician for an accurate diagnosis, including the potential for conditions resulting from the swelling and hemorrhagae associated with the injury gc 303

acute compartment syndrome management

immediate care involves ice and total rest; compression is not recommended because the compartment is already unduly compressed and additional external compression only hastens the deterioration; in addition, the limb must not be elevated, because this decreases arterial pressure and further compromises capillary filling; this condition requires activation of the emergency plan; it will necessitate either immediate referral to an emergency room or summoning of EMS (dependent on the symptoms and the length of time it would take to transport the individual to an emergency room using private transportation) acs 304

gastrocnemius muscle strain signs and symptoms

in an acute strain, the individual experiences a sudden, painful tearing sensation in the calf muscles, primarily at the musculotendinous junction between the muscles and Achilles tendon or in the medial head of the gastrocnemius muscle; immediate pain, swelling, loss of function, and stiffness are common; later, ecchymosis progresses down the leg into the foot and ankle GMS 309

inversion ankle sprain management

initial treatment should consist of standard acute care (i.e. cold, compression, elevation, and protected rest) and restricted activity; crutches should be used if the individual is unable to bear weight; because lateral ankle sprains are common, there may be a tendency to view all injuries around the ankle as ankle sprains; *the coach should not simply dismiss an ankle injury as a sprain;* referral to a physician is warranted for accurate diagnosis and ongoing treatment; a moderate to severe sprain requires immediate referral to a physician IAS 306

hallus valgus signs and symptoms

many individuals with the deformity are asymptomatic; those with symptoms complain of pain over the MTP joint, and have difficulty wearing shoes because of the medial prominence and associated overlapping toe deformity; the condition may also cause the second metatarsal to bear more weight, leading to a callus under the second metatarsal heat hv 301

dorsiflexion and plantar flexion

motion at the ankle occurs primarily in the *sagittal plane*, with ankle flexion and extension being termed dorsiflexion and plantar flexion, respectively; the medial and lateral malleoli serve as pulleys to channel the tendons of the leg muscles either posterior or anterior to the axis of rotation, and, in doing so, enabling their contributions to either plantar flexion or dorsiflexion; muscles with tendons passing anterior to the malleoli (i.e. the tibialis anterior, extensor digitorum longus, and peroneus tertius) are dorsiflexors; those with tendinous attachments running to the malleoli contribute to plantar flexion; the major plantar flexors are the soleus, gastrocnemius, plantaris, and flexor hallicus longus, with assistance provided by the peroneal longus and brevis, and the tibialis posterior 296

strains and tendinitis

muscle strains seldom occur in the lower extremity, except in the gastrocnemius-soleus complex; instead, injury occurs to the musculotendinous junction or the tendon itself; most of the tendons in the lower leg have a synovial sheath surrounding the tendon, except the Achilles tendon, which has a peritendon sheath that is not synovial; several factors can predispose an individual to tendinittis; SEE BOX 16.2 2 slides BELOW common sites for tendon injuries include: the Achilles tendon just proximal to its insertion into the calcaneus the tibialis posterior just behind the medial malleolus the tibialis anterior on the dorsum of the foot just under the extensor retinaculum peroneal tendons just behind the lateral malleolus and at the distal attachment on the base of the fifth metatarsal ST 308

tibial contusion signs and symptoms

pain and swelling are the primary symptoms; unless there is repeated trauma to the area, the condition typically resolves within a couple of days tc 304

midfoot signs and symptoms

pain and swelling is deep on the medial aspect of the foot, and weight bearing may be painful m 305

MP and IP joints signs and symptoms

pain dysfunction, immediate swelling, and , if dislocated, gross deformity are evidend MPIP 305

tibial contusion management

participants should always wear appropriate shin guards to protect this highly vulnerable area; although painful, the condition can be managed effectively with ice, compression, elevation, and rest; a doughnut pad over the area and additional shin protection can allow the individual to participate within pain tolerance levels tc 304

overuse conditions

repetitive microscopic injury to tendinous structures can lead to chronic inflammation that overwhelms the tissue's ability to repair itself; other factors, such as faulty biomechanics, poor cushioning or stiff-soled shoes, or excessive downhill running, can also inflame the tendons; several overuse conditions are common in specific sports, such as plantar fascitis in running; medial tibial stress syndrome in football, dance, or running; and exertional compartment syndrome in soccer or distance running; many individuals complain of vague leg pain, but have no history of a specific injury that caused the pain, diffeerentiating these conditions from an acute muscle strain; a common complaint is pain caused by activity 319

foot and ankle sprain

sprains to the foot and ankle region are common in sports, particularly for those individuals who play on badly maintained fields; in many sports, cleated shoes become fixed to the ground, while the limb continues to rotate around it; in addition, the very nature of changing directions places an inordinate amount of strain on the ankle region; other methods of injury include stepping in a hole, stepping off a curb, stepping on an opponent's foot, or rolling the foot off the surface 304

midfoot trauma management

standard acute care involving the application of cold should reduce swelling and pain; in addition, if the trauma is due to a problem with the shoe, eliminating the mechanism by repairing or replacing the shoe would aid in preventing re-injury; if the condition does not improve within 3 to 4 days, the individual should be referred to a physician mt 303

gastrocnemius muscle strain

strains to the medial head of the gastrocnemius are often seen in tennis players over 40, hence the nickname *tennis leg*; common mechanisms are forced dorsiflexion, while the knee is extended; forced knee extension, while the foot is dorsiflexed; and muscular fatigue with fluid-electrolyte depletion and muscle cramping if related to muscle cramping, the strain is commonly attributed to dehydration (particulalry in the heat), electrolyte imbalance, or *prolonged muscle fatigue that stimulates cramping followed by an actual tear in the muscle fibers* GMS 309

physical conditioning lower leg and foot

strengthening exercises for the intrinsic and extrinsic muscles of the region are essential in injury prevention; foot strength can be improved by picking up marbles or dice with the toes and placing them in a container close to the foot, or placing a tennis ball between the soles of the feet and rolling the ball back and forth from the heel to the forefoot; the lower leg muscles can be strengthening by securing a weight or piece of elastic tubing around the forefoot and moving through the ranges of motion for three sets of 10 to 15 repetitions; bilateral toe raises and heel raises may also be incorporated 299

tendinopathies of the foot and lower leg

tendinopathies of the foot and lower leg are relatively common and encompass a wide spectrum of conditions ranging from tendinitis to tenosynovistis to partial and complete ruptures; the tendons *most often involved in the foot and ankle include the Achilles, posterior tibialis, peroneal brevis, and peroneal longus tendons*; in contrast to acute traumatic tendinous injury, these injuries *most involve repetitive submaximal loading of the tissues, resulting in repetitive microtrauma* 308

talocrual joint

the _____________- (i.e. ankle) is a uniaxial, modified synovial hinge joint formed by the talus, tibia, and lateral malleolus of the fibula; the concave end of the weight-bearing tibia mates with the convex superior surface of the talus to form the roof and medial border of the ankle mortise; the fibula assists with weight-bearing, supporting approximately 17% of the load on the leg, serves as a site for muscle and ligamentous attachments, and forms the lateral border of the ankle mortise; the lateral malleolus extends farther distally than the medial malleolus, and as such, eversion is more seriously limited than inversion; the dome of the talus is wider anteriorly than posteriorly; therefore, the joint's close-packed position is maximum dorsiflexion 292

turf toe signs and symptoms

the individual has pain, tenderness, and swelling on the plantar aspect of the MTP joint of the great toe; extension of the great toe is extremely painful; this condition has the potential to persist for weeks or months; because the sesamoid bones are located in the tendons of the flexor hallucis brevis, this condition sometimes is associated with tearing of the flexor tendons, fracture of the sesamoid bones, bone bruises, and osteochondral fractures in the metatarsal head tt 305

forefoot

the ________________ is composed of five metatarsals and 14 phalanges, along with numerous points; in conjunction with the midfoot region, the ______________ forms interdependent longitudinal and transverse arches to support and distribute body weight throughout the foot 291

midfoot

the ________________ region encompasses the navicular, cuboid, and three cuneiform bones, and their articulations; the navuclar, like its counterpart on the wrist, the scaphoid, helps to bridge movements between the hindfoot and forefoot 291

metatarsophalangeal and interphalangeal joints

the _________________ is a condyloid joint with a close- packed position in full extension; the proximal interphalangeal (PIP) nad disteal interphalangeal (DIP) joints are hing joints with a close-packed position also in full extension; numerous ligaments reinforce both sets of joints; the toes function to smooth the weight shift to the opposite foot during walking and help maintain stability during weight-bearing by pressing against the ground when necessary; *the first digit is referred to as the hallux, or great toe, and is the main body stabilizer during walking or running 291*

tibiofibular joints

the __________________ are supported by the anterior and posterior tibiofibular ligaments, as well as by the crural interosseous tibiofibular ligament; the tibia and fibula are also jointed throughout most of their length by the interosseous membrane; this structural arrangement allows for some rotation and slight abduction (spreading) while still maintaining joint integrity; the interosseous membrane is of such strength that strong lateral stresses often fracture the fibula rather than tear the membrane 292

lower leg, ankle, and foot

the ___________________ compose numerous bones and articulations; the foot, in particular, has three major regions, namely the *forefoot, midfoot, and hindfoot;* they provide a foundation of support for the upright body, enabling propulsion through space, adaptation to uneven terrain, and absorption of shock 290

gait cycle

the _____________________ requires a set of coordinated, sequential joint actions of the lower extremity; despite variation in individual gait patterns, enough commonality exists in human gaits that one can describe as the typical ___________________; the ________________ begins with a period of single-leg support in which body weight is supported by one leg, while the other leg swings forward; the wring phase can be divided into the inial swing, midswing, and terminal swing; the period of double support begins with the contact of swing leg with the ground or floor; as body weight transfers from the support leg to the swing leg, the swing leg undergoes a loading response and becomes the new support leg; a new period of single support then begins as the swing leg loses ground contact; the time through which body weight is balanced over the support leg is referred to as midstance; as the body's center of gravity shifts forward, the terminal stance phase of the support leg coincides with the terminal swing phase of the opposite leg 294

nerves and blood vessels of lower leg, ankle, and foot

the blood supply to the lower leg, ankle, and foot enters the lower extremity as the femoral artery; the femoral artery becomes the popliteal artery proximal and posterior to the knee and then branches into the anterior and posterior tibial arteries just distal to the knee; the anterior tibial artery becomes the dorsalis pedis artery to supply the dorsum of the foot; the posterior tibial artery gives off several branches that supply the posterior and lateral compartments as well as the plantar region of the foot 294

plantar arches

the bones and supporting ligamentous structures in the tarsal and metatarsal regions of the foot form interdependent longitudinal and transverse arches; they function to support and distribute body weight from the talus through the foot, through changing weight-bearring conditions, and over varying terrain; the longitudinar arch runs from the anterior, inferior calcaneus to the metatarsal heads; because the arch is higher medially than laterally, the medial side is usually the point of reference, with the navicular bone serving as the point of reference between the anterior and posterior ascending spans 293

plantar fascitis management

the coach should refer this individual to a physician for accurate diagnosis and treatment options; the coach should not permit the individual to continue activity, as doing so could potentially exacerbate the condition; in addition, the coach could suggest the application of cold to the area to decrease pain and potential spasm PF 310

tarsometatarsal and interphalangeal joints

the deep transverse metatarsal ligament interconnects the five metatarsals; both the tarsometatrsal (TM) and intermetatarsal (IM) joints are of the *gliding type* with the close-packed position in supination; these joints enable the foot to adapt to uneven surfaces during gait 291

footwear

the demands of a particular activity require adaptations in shoe design and selection; in field sports, shoes may have a flat-sole, long cleat, short cleat, or a multi-cleated design; cleats should be positioned under the major weight-bearing joints of the foot, and should not be felt through the sole of the shoe; in individuals with arch problems, the shoe should include adequate forefoot, arch, and heel support; in all cases, individuals should select shoes based on the demands of the activity 299

metatarsophalangeal and interphalangeal joints

the first MTP joint has two sesamoid bones, located on the plantar surface of the joint to share in weight-bearing; the sesamoid bones serve as anatomical pulleys for the flexor hallucis brevis muscle and protect the flexor hallicus longus tendon from weight-bearing trauma as it passes between the two bones 291

plantar fascitis signs and symptoms

the individual reports pain on the plantar, medial heel that is relieved with activity, but recurs after rest; pain increases with weight-bearing; it is particularly severe with the first few steps in the morning, particularly in the proximal, plantar, medial heel, but diminishes with 5 to 10 minutes; pain and stiffness are related to muscle spasm and splinting of the fascia secondary to inflammation; pain can radiate up the medial side of the heel, and occasionally across the lateral side of the foot; normal muscle length is not easily attained, and it leads to additional pain and irritation; point tenderness is elicited over or just distal to the medial tubercle of the calcaneus, and increaes with passive toe extension; passive extension of the great toe and dorsiflexion of the ankle will increase pain and discomfort PF 310

pronation and supination

the lower extremity moves through a cyclical sequence of movements during gait; among these, the action at the subtalar joint during weight-bearing has the most significant implications for lower extremity injury potential; during heel contact, the hindfoot is typically somewhat inverted; as the foot rolls forward and the forefoot initially contacts the ground, the foot is plantar flexed; this combination of calcaneal inversion, foot adduction, and plantar flexion is known as supination; during weight-bearing at midstance, calcaneal eversion and foot abduction tend to occur, as the foot moves into dorsiflexion; these movements are collectively known as pronation; supination of the subtalar joint also results in external rotation of the tibia, with pronation linked to internal tibial rotation although a normal amount of pronation is useful in reducing the peak forces sustained during impact, *excessive or prolonged pronation can lead to several overuse injuries, including: stress fractures of the second metatarsal and irritation of the sesamoid bones, plantar fascitis, achilles tendinitis, and medial tibial stress syndrome;* normal walking gait typically involves about 6 to 8 degrees of pronation 299

eversion ankle sprains management

the management is the same as for an inversion ankle sprain 307 initial treatment should consist of standard acute care (i.e. cold, compression, elevation, and protected rest) and restricted activity; crutches should be used if the individual is unable to bear weight; because lateral ankle sprains are common, there may be a tendency to view all injuries around the ankle as ankle sprains; the coach should not simply dismiss an ankle injury as a sprain; referral to a physician is warranted for accurate diagnosis and ongoing treatment; a moderate to severe sprain requires immediate referral to a physician EAS 306

syndesmosis sprain management

the management is the same as for an inversion ankle sprain; this sprain typically takes longer to heal than an inversion or eversion sprain; participation and sports and physical activity may be delayed for up to 3 months after the initial treatment begins SS 307 initial treatment should consist of standard acute care (i.e. cold, compression, elevation, and protected rest) and restricted activity; crutches should be used if the individual is unable to bear weight; because lateral ankle sprains are common, there may be a tendency to view all injuries around the ankle as ankle sprains; the coach should not simply dismiss an ankle injury as a sprain; referral to a physician is warranted for accurate diagnosis and ongoing treatment; a moderate to severe sprain requires immediate referral to a physician

plantar arches

the plantar fascia, or plantar aponeurosis, is a specialized, thick, interconnected band of fascia that covers the plantar surface of the foot, providing support for the longituidnal arch; it extends from the posterior medial calcaneus to the proximal phalanx of each toe; during the weight-bearing phase of the gait cycle, the plantar fascia stretches on the order of 9 to 12% of resisting length, functioning like a spring to store mechanical energy that is released to help push the foot from the surface; stretching the Achilles tendon may elongate the plantar fascia, because both structures attach to the calcaneus 294