Chap 18

An AT working in a sports medicine clinic observes a forefoot valgus deformity in a soccer player during a preseason screening. why might this deformity be a problem? What can be done to manage this condition?

A forefoot valgus deformity can cause excessive or prolonged supination. This condition may limit the ability of the foot and lower extremity to absorb ground reaction forces, resulting in injury. These injuries include inversion ankle sprains, tibial stress syndrome, peroneal tendinitis, iliotibial band friction syndrome, and trochanteric bursitis. The athlete can use an orthotic to correct this biomechanical problem or wear proper footwear with extra cushioning and flexibility.

A basketball player playing in a recreation league game sustains a grade 2 lateral sprain of the left ankle. What metatarsal fracture may be associated with this type of sprain?

A lateral sprain can produce an avulsion fracture of the proximal head of the fifth metatarsal bone.

While roughhousing in the locker room, an athlete inadvertently kicks a locker and injures his right great tow. What should the AT be concerned with in this type of injury mechanism?

Kicking the locker with the great toe could cause a fracture of the proximal or distal phalanx. This injury may develop swelling, discoloration, and point tenderness.

A 12-year-old physically amateur patient complains of pain in his right heel where the Achilles' tendon attaches. This condition is in apophysitis known as Sever's disease. Why and how does severs disease occur?

Sever's disease is a traction injury to the apophysis of the calcaneal tubercle where the achilles tendon attaches. The circulation becomes disrupted, resulting in a defeneration of the epiphyseal region.

A police officer who stand on his feet many hours a day complains of severe intermittent pain in the region between the third and fourth toes of the left foot. Inspection reveals that the pain radiates from the base to the tip of the toes. There is numbness of the skin between the toes. What is this condition and how should it be conservatively managed?

The police officer has a Morton's neuroma. Conservatively, it is treated by having the patient wear a broad-toed shoe, a transverse arch support, and a metatarsal bar or teardrop pad.

A dancer complains to the athletic trainer of swelling, tenderness, and aching and the head of the first metatarsophalangeal joint of her left foot. On inspection, athletic trainer observes that the great toe is deviated laterally. What is this condition, Me called and why does it occur?

This condition is a bunion, or hallux valgus deformity. It is associated with wearing adance shoes that are too pointed, narrow, or short. It may begin with an inflamed bursa over the metatarsophalangeal joint. It can be associated with a depressed transverse arch or pronated foot.

A distance runner is experiencing pain in the left arch. There is palpable tenderness in the left foot's aponeurosis, primarily in the epicondyle region of the calcaneus. What condition is the scenario described and how should it be managed?

This condition is characteristic of a plantar fascial strain. It should be managed symptomatically. A doughnut placed over the epicondyle region, a heel lift, and a shoe with a stiff shank may relieve some pain. The patient should stretch the plantar muscles and gastrocnemius and perform arch exercises. Application of LowDye taping for pronation can also relieve pain.

A football player who common plays on artificial turf complains of pain in his right great toe. What type of injury frequently occurs to the great toe of an athlete who plays on artificial turf?

A sprain of the first metatarsophalangeal joint (turf toe) stems from hyperextension, usually because of the unyielding surface of artificial turf. This injury is a tear of the joint capsule from the metatarsal head.

A patient to comes to an outpatient clinic in the hospital complaining of her flat feet and that she has pain in her knees and a big callus on her second metatarsal. What is likely causing this problem and how can It usually be corrected

It is likely that this athlete has a forefoot varus. To correct a structural forefoot varus deformity wher the foot excessively pronates, the orthotic should be the rigid type and should have a medial wedge under the head of the first metatarsal. It is also advisable to add a small wedge under the medial calcaneus to make the orthotic more comfortable. The AT should also recommend that this patient purchase a board-lasted shoes with a medial heel wedge and a firm heel counter.

A triathlete changes her running patterns by increasing distance in performing more hill work. She complains to the athletic trainer of a gradually worsening pain in her forefoot. inspection reveals the point tenderness in the region of the fourth meta-tarsal bone. X-ray reveals a stress fracture. How should this condition be managed?

Management of this stress fracture usually consists of 3 or 4 days' partial weight bearing followed by 2 weeks of rest. Return to running should be very gradual. An orthotic that corrects excessive pronation can help take stress off the second metatarsal.

A tennis player complains of pain the ball of the right foot. Inspection reveals a heavy callus formation under the second metatarsal head. This condition produces a metatarsalgia. What is the probable cause of this condition?

Metatarsalgia can be caused by a restricted gastrocnemiussoleus complex that produces a pes cavus. It can also be caused by a fallen metatarsal arch that abnormally depresses the second or third metatarsal head and causes heavy callus to develop.

A pro male soccer player is complaining about pain in the toes. Upon inspection, the AT observes that the second and third toes are heavily callused on the dorsal surface and on palpation realizes that the toes are stuck in a flexed, or clawlike, position. What is this condition, and what steps can be taken to correct this problem?

This condition could be either hammertoes, mallet toes, or claw toes. It is likely that this condition developed from years of wearing shoes that were too tight or small. The AT could try padding the toes and recommend that the player wear a pair of shoes that has a larger toe box for the rest of the season. It is likely that, to permanently correct this problem, the soccer player will have to have surgery after the season.