Chapter 18 Specific Injuries Flashcards
Hammertoe, mallet toe, and claw toe
Hammer: flexion at proximal Interphalangeal joint
Mallet: flexion at distal Interphalangeal joint
Claw: both DIP and PIP are flexed
Often caused by improper footwear over a long period of time
Management: wear better footwear, padding and protective tape, shave calluses. If fixed deformities, then surgery and maintain position with k-wire
Sprained toes
.Etiology
•Generally caused by kicking non-yielding object
•Pushes joint beyond normal ROM or imparting a twisting motion on the toe- disrupting ligaments and joint capsule
–Sign and Symptoms
•Pain is immediate and intense but short lived
•Immediate swelling and discoloration occurring w/in 1-2 days
•Stiffness and residual pain will last several weeks
–Management
•RICE, buddy taping toes to immobilize
•Begin weight bearing as tolerable
Great toe hyperextension
,Etiology
•Hyperextension injury resulting in sprain of 1st metatarsophalangeal joint
•May be the result of single or repetitive trauma
–Signs and Symptoms
•Pain and swelling which increases during push off in walking, running, and jumping
–Management
•Increase rigidity of forefoot region in shoe
•Taping the toe to prevent dorsiflexion
•ultrasound
•RICE
Sprains and strains
RICE
Reduce weight bearing
Fractures and dislocations of the phalanges
.Etiology
•Kicking unyielding object, stubbing toe, being stepped on
•Dislocations are less common than fractures
–Signs and Symptoms
•Immediate and intense pain
•Obvious deformity with dislocation
–Management
•Dislocations should be reduced by a physician
•Casting may occur with great toe or multiple toe fractures
•Buddy taping is generally sufficient
Hallux rigidus
.Etiology
•Development of bone spurs on dorsal aspect of first metatarsophalangeal joint
•Degenerative arthritic process involving articular cartilage and synovitis
•If restricted, compensation occurs with foot rolling laterally
–Signs and Symptoms
•Forced dorsiflexion causes pain
•Walking becomes awkward due to weight bearing on lateral aspect of foot
•Stiffer shoe with large toe box
•Orthosis similar to that worn for turf toe
•NSAID’s (pain relief meds)
•Osteotomy to surgically remove mechanical obstructions in effort to return to normal functioning
Overlapping toes
- congenital or improperly fitted footwear
- Outward projection of great toe articulation or drop in longitudinal arch
- surgery is the only cure
- Taping may prevent some of the contractual tension w/in the sports shoe
Subungual hematoma (blood under the toenail)
.•Direct pressure, dropping an object on toe, kicking another object
•Repetitive shear forces on toenail
–Signs and Symptoms
•Accumulation of blood underneath toenail
•Likely to produce extreme pain and ultimately loss of nail
Management
-Relieve pressure within 12-24 hours (lance or drill nail) – must be sterile to prevent infection
-RICE
Foot rehab
Work on weight bearing gradually
Gradual strengthening
Joint mobilizations
Must maintain or re-establish normal flexibility of the foot
Neuromuscular control, adapting to different surfaces
Exercise sandals
Foot orthotics
Correcting Pronation and Supination
Functional Progression: progression to gradually regain the ability to walk, jog, run, change directions and hop
Pes planus
Flatfoot -Associated with excessive pronation -forefoot varus -being overweight -excessive exercise placing undo stress on arch –Sign and Symptoms •Pain, weakness or fatigue in medial longitudinal arch; calcaneal eversion, bulging navicular, flattening of medial longitudinal arch and dorsiflexion with lateral splaying of 1st metatarsal Management -nothing, or tapping and orthotics
Pes cavus
.Higher arch than normal; associated with excessive supination, accentuated high medial longitudinal arch
–Sign and Symptoms
•Poor shock absorption resulting in metatarsalgia, foot pain, clawed or hammer toes
•Associated with forefoot valgus, shortening of Achilles and plantar fascia; heavy callus development on ball and heel of foot
–Management
•If asymptomatic, no attempt should be made to “correct”
•Orthotics should be used if problems develop (lateral wedge)
•Stretch Achilles and plantar fascia
,Mortons toe
.–Etiology
•Abnormally short 1st metatarsal, making 2nd toe look longer
•More weight bearing occurs on 2nd toe as a result and can impact gait
•Stress fracture could develop
–Signs and Symptoms
•Stress fractures S & S with pain during and after activity with possible point tenderness
•Bone scan positive
•Callus development under 2nd metatarsal head
–Management
•If no symptoms nothing should be done
•If associated with structural forefoot varus, orthotics with a medial wedge would be helpful
Longitudinal arch strain
.Etiology
•Caused by increased stress on arch
•Flattening of foot during midsupport phase causing strain on arch (appear suddenly or develop slowly
–Sign and Symptoms
•Pain with running and jumping, below posterior tibialis tendon, accompanied by pain and swelling
•May also be associated with sprained calcaneonavicular ligament and flexor hallucis longus strain
–Management
•Immediate care, RICE, reduction of weight bearing.
•Weight bearing must be pain free
•Arch taping may be used to allow pain free walking
Plantar fascia
-Plantar fascia, dense, broad band of connective tissue attaching proximal and medially on the calcaneus and fans out over the plantar aspect of the foot
–Works in maintaining stability of the foot and bracing the longitudinal arch
Plantar fasciitis
S&S:
Increased pain in morning, loosens after first few steps
•Increased pain with forefoot dorsiflexion
-Catch all term used for pain in proximal arch and heel
Management:
Extended treatment (8-12 weeks)
•Orthotic therapy is very useful
•Simple arch taping, use of a night splint to stretch
•Vigorous heel cord stretching and exercises that increase great toe dorsiflexion
•Massage of plantar surface of foot using tennis ball or rigid round surface
