Injuries

Metatarsal Arch Strain

-MOI: Fallen metatarsal arch or pes cavus foot may susceptible to strain. -Excessive pronation may compromise metatarsal head positioning and weight distribution. -Signs & symptoms Pain or cramping in metatarsal region Point tenderness Weakness Numbness/ tingling in toes + Morton's test

Fractures & Dislocations of the Phalanges

-Occur by longitudinal force applied to the bone, such as kicking an object or stubbing a toe. Can also occur from a crushing force; something falling on the toes. -Dislocations are less common. -Dislocation is likely to be a dorsal dislocation of the middle phalanx proximal joint (medial or lateral) -Signs and Symptoms intense pain, deformity, crepitus, swelling and subsequent discoloration in the area of injury.

Ingrown Toe Nail (moderate)

-The lateral and/or medial aspects of the nail grow into the skin bed, most often affecting the great toe. -Symptoms include pain, mild swelling and redness in the affected area. -Result from pressure applied to the lateral and/or medial aspect of a toe nail from either poor fitting shoes, improper nail trimming or trauma (repeated pressure).

Subungal Hematoma

A condition where blood and fluid collect underneath the fingernail or toenail. MOI: - Hitting your thumb with a hammer - Stubbing your toe/kicking an object Wearing tight-fitting shoes (trap blood in the toes leading to an increased pressure within the blood vessels of the toes) Nail bed laceration and bone fracture hidden under the nail bed Anatomy • Nail Bed • Nail Plate • Eponychium (Cuticle) Signs and Symptoms:Initially the injury may only hurt. The nail may feel sore or tender to the touch. As the blood pools under the nail the pressure from the blood can cause severe pain.

Apophysitis of the calcaneus (Sever's Disease)

Anatomy Achilles Tendon Calcaneus Epiphyseal Plate Apophysitis: tendon is connecting to the bone Only happen when body is going rapidly Epophysitis: Is a growth plate MOI/Etiology Inflammation of the calcaneal apophysis growth plate in the heel Achilles Tendon is tight & can't keep up with the growth plate Repetitive motion to the heel Stress Growth plate is sensitive due to impact on hard surfaces Wrong shoe sizes growing up Signs/Symptoms Swelling & Redness in the heel Difficulty in walking & running Discomfort when heel is squeezed on both sides Limping (Toe Walking) Special Tests Squeeze Test - Calcaneus Radiology

Medial Tibial Stress syndrome (shin splints)

Anatomy Pain located on the medial aspect of the lower leg just posterior to the tibia. Most common: Tibialis posterior muscle Soleus muscle Fibula Tibia Interosseous membrane Flexor digitorum longus and the Flexor hallucis longus Anterior Shin Splints: Tibialis Anterior Extensor Digitorum longus Exterior Hallucis Longus It is a condition in which pain is caused along the inside of the lower leg (shin). MTSS are microscopic tears within the muscle. The pain felt is caused by inflammation of the surrounding muscles, tendons, and bone tissue around the shin bone.

Gastrocnemius Strain VS. Soleus strain

Common; Gastrocnemius strains usually occur at the middle head High risk for strains because the muscle crosses two joints (knee and ankle) Composed of two fast twitch fibers High risk for injury Uncommon; it location is deep in the Gastrocnemius Only crosses on joint (ankle) Sometimes mistaken for a Gastrocnemius Strain Comprised of one slow twitch fiber Low risk for injury Signs and symptoms: Variable amount of pain above Achilles Tendon Swelling Muscle disability Edema Point tenderness Functional strength loss Unable to fully weight bear Tightness Snap or pop sound Weak plantar flexion Passive dorsiflexion may cause pain Special test: MMT for Gastrocnemius and Soleus Thompson Test

Pes Cavus

Less common than pes planus Excessive supination Calcaneus inverted greater than 3 inches Anatomy: All the bones on the medial side (not the phalanges) Soft tissue: the spring ligament Muscles involved: TOM ,DICK, HARRY Plantar fasciitis Signs/Symptoms: General foot pain Drop in the forefoot relative to the rearfoot Dorsal pads under calcaneus and the MT heads appear smaller Lateral 4 toes may be clawed Calluses form over the PIP joints Sesamoid Pain Abnormal shortening of the Achilles tendon Stiffness in foot and lower leg Special Tests: Feiss Line Windlass test Navicular drop

Cuboid Subluxation

MOI- Insidious or after traumatic event -Displacement of the cuboid -Can be plantar or dorsal, most are plantar and medial -4th metatarsal may subluxate on cuboid, confused with cuboid subluxation -Affects Calcaneocuboid joint (CC) nearby ligaments, joint capsules -Inversion ANKLE sprain symptoms, abnormal spot of pain Signs and Symptoms: -Pain along 4th and 5th metatarsals, cuboid, and heel area -Pain increases during standing after a long non-weight bearing period -Lateral midfoot pain -Weakness at push-off -Jumping and vigorous dance not feasible (sharp, localized pain) -May leave depression on dorsum of cuboid -Edema and ecchymosis Management & Treatment: Manipulate cuboid to original position (Cuboid Squeeze and Cuboid Whip

Peroneal Tendon Subluxation

MOI: Acute dorsiflexion combined with an inversion ankle sprain Signs & Symptoms -Tenderness and swelling behind the lateral malleolus -Pain following along side the tendon on lateral side of foot -Abnormal movements of the tendon during MMT -Instability of the ankle -Pops or click on lateral side of ankle -AROM: Clinician can see, hear, and feel tendon when it dislocate during the ankles movement from plantarflexion and inversion to dorsiflexion and eversion Gould Bröstrom procedure "Curt Schilling Bloody sock"

Achilles Tendinopathy

MOI: Acute onset Large increase in load or blow to tendon Repetitive stressors Local tissue degeneration Improper shoe fit Eccentric loading Signs and Symptoms: "Squeaking" sensation Burning Asymptomatic :( showing no symptoms) Tender to the touch Crepitus Pain with Plantarflexion Grade I, II, III

Medial or lateral ankle dislocation

Medial and lateral ankle dislocations are caused by forced eversion, inversion or rotational mechanisms. These are usually associated with malleolar fractures.

Fractures, Dislocations and Sprains of the Phalanges

-Applying a force that extends the joints beyond their normal range of motion (jamming it or twisting), resulting in a tear of the ligament and joint capsule. -Signs and Symptoms Immediate and intense, but short lived pain. Swelling and discoloration (1st or 2nd day). Stiffness and residual pain that may last several weeks.

Bunion

-Exostosis of 1st metatarsal head: associated with forefoot foot varus: shoes that are too narrow, pointed or short. -Bursa becomes inflamed and thickens, enlarging joint and causing lateral malalignment of great toe -Bunionette (Tailor's bunion) impacts 5th metatarsophalangeal joint- causes medial displacement of 5th toe -Signs & Symptoms Tenderness, swelling, and enlargement of joint initially

Sesamoiditis

-MOI: Caused by repetitive hyperextension of the great toe resulting in inflammation -Signs & Symptoms Pain under great toe, especially during push off Tenderness under 1st metatarsal head

Calf Cramps

Anatomy: Gastrocnemius Soleus Achilles tendon Not localize but systemic Decrease in fluids, decrease in electrolytes Etiology: Fatigue Excess loss of fluid through sweating (Electrolytes: potassium and calcium) Inadequate muscle coordination Gastrocnemius is more prone Symptoms: Cramping and pain with the tonic contraction of the calf muscle

Plantar Fasciitis

Anatomy: Plantar aponeurosis (Plantar fascia) Calcaneus MT heads Etiology: Tension develops during: Extension of the toes During depression of longitudinal arch because of weight bearing Overuse--Repetitive Impact Activity Very high arch Tight calf muscles Obesity Special Tests: Windlass signs and symptoms: Sharp pain in the anterior medial heel Increased pain in the morning or when first bears weight (first 10 steps) Pain will intensify when the toes and forefoot are forcibly dorsiflexed Greater pain after (not during) exercise or activity If irritation persists, a painful heel spur can develop at the attachment of the plantar fascia

Anterior ankle dislocation

Anterior ankle dislocations occur with forced ankle dorsiflexion, when the foot is stabilized, and the lower leg is forced posteriorly. The dorsalis pedis arterial supply is at risk due to the anteriorly displaced talus. This mechanism is rarely reported.

Posterior Tibialis Syndrome

Chronic MOI- mechanical overuse Common cause of pes planus Signs & Symptoms Pain on the medial aspect of the foot Mild inflammation Pain along the Tibialis Posterior Tendon Severe deformity (Pes Planus) Flatfoot and the degression of rearfoot joint Weak plantarflexion Pronation of foot Weakness of medial ankle Special Test: Navicular Drop Feiss Line Windlass

Hammer toes

Deformities of the 2nd , 3rd , and 4th small toe A flexible deformity that becomes fixed Caused by hyperextension of MTP and DIP joints and flexion of PIP joint Often occur after injury Rupture of plantar fascia Signs and Symptoms MP, PIP, and DIP joints become fixed Swelling, blistering, pain, and callus

Eversion Ankle Sprain

Deltoid Ligaments- Anterior Tibiotalar, Posterior Tibiotaler, Tibionavicular, Tibiocalcaneal Tom, Dick, an Harry- Tibialis Posterior, Flexor digitorum longus, Flxor hallus longus -MOI: Excessive eversion of the talus and calcaneous. Tensile forces on medial aspect and compression on lateral Signs and Symptoms Trauma to medial ligaments Pain (probably severe) over foot and lower leg Along medial joint line PPT Unable to bear weight Pain with ankle movements (inversion, eversion, plantarflexion, dorsiflexion) Ecchymosis and Swelling Grade I, II,III Special test: Eversion Stress Test (Talar Tilt) External Rotation Test (Kleiger's)

Peroneal Tendonitis

Inflammation of the Peroneus brevis and longus following an acute injury such as a sprain Stabilize foot and ankle during walking After one ankle injury MOI: Overuse Trauma such as inversion ankle sprain Repetitive use Signs/symptoms: Localized pain behind the ankle Swelling behind lateral malleoli Tenderness pain with inversion

Inversion Ankle Sprain

Injury to the lateral ligaments of the ankle (ATF, CF, PTF) MOI - Forceful inversion in combination with plantarflexion -Tightness in the Achilles tendon or triceps surae muscle group increase the risk as they place the ankle in a plantarflexed position. Grade I, II, III -Grade I: (+)Anterior drawer test w/ pain and no laxity -Trouble w/ weight-bearing Swelling, pain and point tenderness over the ligament(s) affected.

Gout

What is gout? form of inflammatory arthritis that develops in some people who have high levels of uric acid in the blood The acid can form needle-like crystals in a joint and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling Anatomy: Gout usually affects the big toe- MTP joint Gout also affects other joints such as knees, ankles, elbows, wrists, and fingers. Etiology: Gout is caused by altered purine metabolism leading to excess uric acid in body. When the limits of uric acid are exceeded, urate crystals deposit in the joints Signs & symptoms: Redness Swelling For many people, the first symptom of gout is excruciating pain, discoloration, and swelling in the big toe Special tests: Joint aspiration Blood test X-ray

Clubfoot

Anatomy Shorting of Muscles: Tibilas Posterior Flexor Hallucis Longus Flexor Digitorum Longus Achilles Tendon 2. Joint capsules, Ligaments, Fascia Involves both the bony structures and the soft tissue Forefoot bones (Varus position) Ankle joint: Talocrural joint Talus (deformed) Tibionavicular ligament Calcaneus (inverted) Is an abnormal congenital condition of the foot and ankle Cause: The tendons that connect the muscles to bone are shorter and tight therefore, leads the foot to turn inward (Varus) and downward (Equinus). The condition can range from mild to severe. In extreme cases the foot may appear as if its upside down MOI: Birth Defect (Congenital Condition) Signs & Symptoms: The calf muscle might be smaller than normal (not fully developed) Stiff- Rigid foot: Deformity might differ Short/tight Achilles tendon which cause the downward of the foot Supination/Adduction of the calcaneus Plantar flexion in the ankle joint Talus is also plantar flexed beneath the tibia

stress fractures of the tibia or fibula

Anatomy Tibia Fibula Talus Metatarsals Navicular bones *Most common in the lower third of the leg MOI: Repeated and overuse stress conditions Common among: Distance runners (lower 3rd of leg) and ballet dancers (middle 3rd of leg) Individuals with structural deformities in the foot Inexperienced/ nonconditioned individuals Individuals w/ hypermobile pronated feet are more susceptible to fibular stress fractures Rigid pes cavus to Tibial stress fractures Signs & Symptoms: Pain along the shaft of the bone Pain is more intense after an activity Point- tenderness Fibular Stress fracture: Pain proximal to the lateral malleolus Increases w/ activity , decreases w/ rest May also experience: Decreased muscular strength and cramping during activity Special Test: Percussion Test: Used to distinguish bone pain and soft-tissue pain Percussive technique: Upward hit to the heel Squeeze Test (Particularly for Fibular stress fracture) Tuning Fork Navicular drop test (+) Findings: Localized pain w/ palpation

Os Trigonum Fracture

Anatomy Tibia Talus Calcaneus Stieda Process Os Trigonum - small bone growth on the stieda's process, which is attached to the talus, which is also formed from a separate ossification which fails to attach to the talus itself. Stieda Process - an elongated lateral tubercle of the talus (associated with posterior ankle impingement syndrome) MOI/Etiology Acute Injury (Micro-Trauma) Chronic Injury (Repetitive in Sports) Hyperplanterflexion Inversion When the Stieda Process separate from talus Asymptomatic & Symptomatic Os Trigonum Appears between ages 8-11 years Injuries Os Trigonum Syndrome Aka Impingement or Nutcracker Phenomenon Fracture Signs /Symptom Sudden onset pain after forced plantarflexion Report to the Achilles tendon anteriorly as tender & posteriorly to talus Swelling to the Achilles tendon either lateral or medial Special Test MMT RROM - Plantarflexion AROM - Plantarflexion PROM - Plantarflexion Tuning Fork Radiograph Tap Test

Achilles Tendon Rupture

Anatomy: Calcaneus and talas serve as a lever arm when in plantar flexion It's the insertion of the gastrocnemius, and plantaris The retrocalcaneal bursa prevents friction between them two Forms the triceps surae muscle Occur in the tendon's avascular zone Attaches the soleus and gastrocnemius together MOI: Acute Eccentric overload on the Achilles tendon Forceful dorsiflexion or plantarflexion Plyometric contractions of the calf Less blood flow; leads to reduce its ability to heal Popping or snapping sound at the moment of the injury Ex: getting kicked in the back of the leg Signs/ Symptoms: Crepitus Weak plantarflexion Experience of pain in the lower leg Acute intense pain Swelling near the calcaneal or have discoloration Inability to plantar flex, do heel raises, push off when walking or during gait, or stand on toes Tendonopathy Site of injury is tender Might be a gap or depression where the ends of the tendon is separated Ultrasound are used to reduce inflammation (+) Thompson Test

Tibia and Fibula Fractures

Anatomy: Made up of Tibia (medial side) Fibula (lateral side) Interosseous membrane Medial and Lateral malleolus Etiology: Occurs below the knee and above the ankle Tibial fractures include gross deformity Inversion, eversion, or rotational forces Low energy forces( i.e. fall to the ground) High energy forces (i.e. getting hit by a car, etc.) Blunt force trauma Avulsion fracture: Some or no deformity requires splinting occurs, the tendon or ligament pulls off a piece of the bone. Potts Fracture: Also known as bimalleolar fracture no surgery is required The injury is caused by a combined abduction external rotation from an eversion force. Maisonneuve fracture: A spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane surgical treatment Signs/symptoms: Instant and rapid swelling Bruising Difficulty weight bearing Tenderness to touch Special Tests: Ottowa Rules: clinical decision making rules Sensitivity and specificity *Not for a on field evaulation Getting an x-ray: No more than 4 consecutive step both at the time of injury and time of examination Plus they have to have point-tenderness (Starkey 70) Navicular, styloid process, posterior edge if the medial malleolus, posterior edge or tip of lateral malleolus.

Gastrocnemius and Soleus Strain

Anatomy: The Gastrocnemius and Soleus form the Tricep Surae Muscle Group. The Gastrocnemius, Soleus, and Plantaris have a common insertion on the Calcaneus via the Achilles Tendon. The Gastrocnemius and Soleus are prime movers during plantarflexion. The Gastrocnemius is the most active in plantarflexing the ankle when knee is extended. The Tibial Nerve runs between the medial and lateral heads of the Gastrocnemius to lie deep between the Soleus and Tibialis Posterior. Mechanism of injury (MOI): -Activity that requires quick starts and stops, and/or jumping. -Quick stop made while foot is flat and planted into the ground and extends the knee, which would place a stretch on the medial head of the gastrocnemius -Tripping Grade I,II,III

Ankle dislocations

Anatomy: The ankle is made up of 4 distinct bones, the tibia, fibula, talus and calcaneus. The ankle is made up of 3 separate joints: Talocrural Joint, Inferior tibiofibular Joint, Subtalar Joint Mechanism of injury (MOI): Acute Sudden trauma to the ankle Excessive inversion and eversion Inversion injuries account for 85% of traumatic conditions of the ankle Low energy rotational motion in sports or daily activities High energy injuries with axial loading result in more serious injuries such as fractures of long bones, talus, or malleoli Signs and symptoms: Gross deformity Intense pain Unable to weight bear Numbness and tingling Swelling Tenderness Ecchymosis special test: Doing a neurovascular assessment: 2 ways of doing this 1)palpate the artery 2) posterior tibial artery , cappillary refill: press on nail bed and release to see if blood is going back

Turf toe

Anatomy: The big toe is made up of 2 joints The metatarsophalangeal joint ( MTP) This is joint that is in between the Phalanx and the Metatarsal Plantar Complex Plantar Plate-( volar plante) thick tissue under the MTP joint. Prevents the big toes from bending to far in dorsiflexion Collateral Ligaments - each side of the big toe. Connect the Phlanax bone to the metatarsal and prevent the toe from going side to side Flexor Hallucis Brevis& longus- the tendon runs under the first metatarsal bone and attach to the phalanx. Gives strength and stability to push off. Sesamoids-help the tendons move more easily. Helps weight bearing MOI: Hyperextension of the Big Toe. Example: Would be when you are sprinting on turf and the ball of your foot gets stuck Turf Toe is an injury to the soft tissue. Might also include the plantar or the collateral ligament. Special Tests: Range of Motion Test. Looking for instability to help determine a tear.

Anterior compartment syndrome

Anatomy: Tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneus tertius Deep peroneal nerve Anterior tibial artery Dorsalis pedis artery 2 categories: Acute compartment syndrome is considered medical emergency chronic extertional compartment syndrome occurs without any trauma and can develop with little activity MOI: -Caused by direct trauma to the anterior aspect of the lower leg -Intracompartmental pressure leads to a lack of blood supply causing tissue to die Signs and Symptoms: Deep aching pain, tightness and swelling, and pain along the involved muscles Reduced circulation causing loss of feeling in the foot Treatment: For acute compartment syndrome a physician performs a emergency fasciotomy to release pressure May not return to full play for 2-4 months Chronic compartment syndrome is more conservative: rest and stretching. If fails then perform fasciotomy

Morton's Neuroma

Anatomy: 3rd and 4th MT Nerve Bundles between 3rd and 4th Deep transverse metatarsal ligament Dorsal and Plantar Tarsometatarsal ligaments Lateral plantar nerve Interosseus membrane -MOI Irritation, trauma, excessive pressure Fallen transverse arch Insidious -Fallen transverse arch causes the nerve to be pinched between metatarsal heads Signs and Symptoms: Swelling Burning sensation and Pain when WB Pain relieved by non-weight bearing Numbness Palpable nodule may be noted Special Tests: Active and passive ROM (may not be remarkable) May be some pain with MMT for toe flexion -Mulder Sign for Intermetatarsal Neuroma -(+) A click, pain, and/or reproduction of symptoms

Hallux Rigidus

Arthritis of the metatarsophalangeal joint (MTP) Known as "stiff big toe" MOI: -True cause of hallux rigidus is not known. Signs and Symptoms: -Patient will complain about pain in the big toe joint while active, especially when pushing off to walk. -Swelling and stiffness around the big toe joint -Inability to bend the toe up or down -A bump, like a bunion or bone spur, can develop on top of the big toe joint and be aggravated by rubbing against the inside of a shoe.

Deep Vein Thrombophlebitis/ Thrombosis

Blood clot Potentially life-threatening condition associated risk of pulmonary embolism if the clot should dislodge Pulmonary Embolism-sudden blockage in a lung artery that can cause death Thrombophlebitis: inflammation of a vein and the subsequent formation of blood clots Anatomy: Occur in any of the veins in the body- most commonly in the legs Can affect heart Signs and Symptoms: Presents unexplained: Warmth Swelling Tightness of calf musculature Pain during palpation Special Test: Some signs/symptoms are unreliable in detecting; clinical prediction rule: Homan's Test: Pain in the calf when foot is passively dorsiflexed Whole-leg vascular duplex ultrasonography

Retrocalcaneal Bursitis

Bursa between the Bone - tendon Function: Protects Achilles tendon from trauma and decreases friction. Lies between the anterior surface of the Achilles tendon and the bare posterior superior angle of the calcaneus MOI:Overload because of excessive tensile stress. Ex. Running, Lifting Signs and Symptoms Any palpable thickening or tenderness suggest the presence of bursitits Generalized pain in achilles tendon or over calcaneous

Claw toes

Flexion at DIP and PIP joint and also hyperextension at MTP joint Callus may develop over PIP joint May be congenital Mostly caused by wearing unfitted shoes for a long period of time Signs and Symptoms MP, PIP, and DIP joints become fixed Swelling, blistering, pain, and callus

Metatarsal Stress Fracture

MOI: Exact cause is not known Related to biomechanical abnormalities of the foot Likely possibilities: Overload caused by muscle contraction Altered stress distribution in the bone accompanying muscle fatigue Anatomy: Metatarsal Bones Interosseous muscles Injuries: Marchs Fracture-Morton's Toe Also possible to have 5th metatarsal stress fracture at the insertion of the peroneus brevis tendon This is not a Jones Fracture Stress Fracture to any MT bone Signs and Symptoms: Swelling Focal tenderness Pain Crepitus Early stages: Complains of pain when active but not at rest Later pain becomes constant and more intense at night Over 2-3 week period, dull pain begins during exercise, then progresses to pain during rest Pain is initially diffuse, then localizes to the site of the fracture Special Test: Percussion Test Squeeze Test Tuning Fork

Posterior Tibial Tendinitis

MOI: Pes planus Over pronation Overuse of the tendon Excessive use Sudden overload of the tendon Signs and symptoms Pain over the medial aspect of the ankle Navicular Collapse of medial arch Pain and tenderness at site of PTT

Chondral Lesions to Talus/Tibia

MOI: Traumatic injury (Fracture) Microtrauma Repeated trauma Axial loading of the foot in inversion and dorsiflexion can cause a lateral talar lesion Signs and symptoms: Pain deep in the ankle/ swelling Stiffness Tenderness Clicking/ popping Pain with inversion or dorsiflexion

Morton's Toe

MOI: Because Morton's Toe is not an actual injury it does not have an MOI In certain patients, it can lead to specific injuries -Uneven weight distribution -Running gait -Stress fractures This is because instead of the 1st MTP bearing most of the weight, it is the 2nd that picks up the slack Signs and Symptoms: 1st phalanx is shorter than the second Calluses under the 2nd metatarsal Symptoms of stress fracture can be attributed to Morton's Toe -Pain during and after activity -Point tenderness

Metatarsalgia

MOI: Common overuse injury - Running, walking, and jumping can contribute to metatarsalgia -High-impact sports such as soccer Sign & symptoms: Sharp, aching, or burning pain "Pebble in the shoe" Pain at the end of metatarsal bone(s), especially when applying pressure May feel numbness or tingling

Syndesmotic Ankle Sprains

MOI: External rotation, dorsiflexion, Eversion account for 10% of all ankle sprains SIGNS AND SYMPTOMS: -Severe pain and loss of function in the ankle region -Passive external rotation or dorsiflexed -Anterior aspect of the ankle and proximally along the interosseous membrane -Pain and PT over Tib/Fib joint Special Tests: Squeeze test: dull aching is positive test for high ankle sprain Kleiger's test: reproducing the injury

MTSS Continue

MOI: Repetitive Microtrauma/Overuse Contributing factors include: Incorrect footwear (little support or cushioning) Running on hard surfaces/ Training errors Varus foot A hypermobile pronated foot Forefoot supination Biomechanical abnormalities Other factors: stress fractures, exertional compartment symptoms Signs and Symptoms: Pain: May describe the pain as sharp, dull, or aching Pain covers a span of (greater than 5 cm) alongside the posteromedial tibial border May experience tenderness/inflammation to the touch May describe pain at rest Four grades of pain that can characterize MTSS: Grade 1. Pain occurring after the activity Grade 2. Pain occurring before/after activity Grade 3. Pain occurring before, during, and after activity and affected performance Grade 4. Pain is severe that activity is impossible Palpation: MMT: Symptoms reproduce involving posterior tibialis, soleus, flexor digitorum longus and hallucis PROM: Increased pain with ankle dorsiflexion, pronation or toe flexion Selective Tissue Test: Navicular drop test *Doesn't't specifically test for it but indicates location of pain

LisFranc Sprain/Fracture

MOI: The ankle is plantarflexed with the rear foot locked and a forceful hyperplantarflexion of the forefoot results in dorsal displacement of the proximal end of the metatarsals. -From a crushing force, from a fall -Landing from a jump Signs and Symptoms: -Inability to bear weight -Swelling and tenderness over dorsum of the foot -Obvious gross deformity -Athlete may describe a snapping, popping, or tearing sensation -Ecchymosis on plantar surface of foot Grade I,II, III

Jones Fracture

Mechanism of Injury- direct force on the forefoot during plantar flexion of the ankle. Jones Fracture takes about 2 months to heal. There should be immobilization as part of the initial treatment. Along with a cast or non weight bearing for 6 to 8 weeks. The fracture can get worse if it continues in regular day activity. Jones fx the fault line is going into Stress fx: doesn't not go into the joint Avulsion fx: the fault line goes into the taromatatral Jones: why it doesn't heal well There is no blood supply Peroneal buris and peroneal tritious is pulling and wont aloud the ostoblast to heal the injury.

Pes Planus Foot - Flatfoot

Pes Planus: If the medial longitudinal arch is not adequately supported, the medial aspect of the talus rotates inward and the navicular drops inferiorly- giving you flat feet Anatomy: Medial Longitudinal Ligament Plantar Fascia Long and short plantar ligaments Calcaneonavicular (Spring) ligament Tibialis Posterior Tibialis Anterior Navicular Talus Intrinsic muscles- flexor hallucis brevis, flexor digitorum brevis Etiology: The onset of pes planus can be traced to a congenital origin (born with), biomechanical changes, or acute trauma Acute pes planus trauma includes: Trauma to the structures supporting the medial longitudinal ligament rupture of the plantar fascia tears of the plantar ligaments calcaneonavicular (spring) ligament sprains, or the rupture of the tibialis posterior or tibialis anterior tendon fracture of the navicular tuberosity, including an accessory navicular Footwear- comfort, insoles Signs & symptoms: A flatfoot may cause no symptoms. Symptoms of flatfoot include pain that may be in the inside arch, heel, or ankle and on the outside of the foot just below the ankle. Flattening of the arch can lead to rolling in of the foot and ankle and tilting outward of the heel Special tests: Feiss Line Navicular Drop test Supple pes planus (Windlass) test Positive Test- Medial longitudinal arch disappears when weight bearing

Posterior ankle dislocation

Posterior ankle dislocations are most common. These injuries occur when a high-energy axial force drives the inverted foot backwards. These injuries are commonly accompanied by syndesmotic failure or fracture of the lateral malleolus This dislocation can potentially compromise the posterior tibial neurovascular structures.

Superior ankle dislocation

Posterior ankle dislocations are most common. These injuries occur when a high-energy axial force drives the inverted foot backwards. These injuries are commonly accompanied by syndesmotic failure or fracture of the lateral malleolus This dislocation can potentially compromise the posterior tibial neurovascular structures.

Tarsal Tunnel Syndrome

Supplies the deep muscles of the posterior leg Assist in movement and flexing of the foot Branches off from the sciatic nerve to the lower leg of the ankle and foot Anatomy: Location: by the medial malleolus and the flexor retinaculum; lies inside of the ankle with soft tissues Tibial nerve gives off to the superficial posterior compartment of the leg Associated with the gastrocnemius, popliteus and plantaris The tunnel is covered superiorly by the flexor retinaculum Also includes: Nerve: Tibial Nerve, Tarsal Nerves, Medial and Lateral Nerve Artery: Posterior Tibial Artery Tendons: Tibialis Posterior (TOM), Flexor Digitorum Longus (DICK), and Flexor Hallucis Longus (Harry) MOI: Acute or insidous Prolonged standing or walking Overuse Excessive pronation Compression of the tibial nerve or branches of the tarsal tunnel Benign bony growth and enlarged veins Inflammation of the synovial membrane Stress from pes plantus from the medial longitudinal arch - leads to compresses the tibial nerve Footwear Space- occupying lesions or masses; pressure in the tunnel Sign/ Symptoms: Paresthesia, numbness, pain (sharp, shooting) in the foot; along the medial and/ or plantar aspect if the foot; as well as the lateral arch May describe cold intolerance from the injured foot Limping - affects the heel, foot, and ankle Point tenderness (tendonopathy) - proximal, distal and over the flexor retinaculum Plantar fasciitis Talocalcaneal coalition Calcaneal stress fracture Weak in toe flexion Abnormal structure: Bone spur Dorsiflexion- eversion test to test for the soft tissue of the flexor reinaculum The straight leg raise test can assist in differential diagnosis for tarsal tunnel syndrome and plantar fasciitis.