Foot and Ankle Injuries

Question 1

Turf Toe- MOI, S&S, Management

Answer 1

MOI- forced hyperextension (or hyperflexion)
S&S- pain, point tenderness, swelling on plantar aspect of MP joint, pain with extension
Management- reduce inflammation (elevation, ice, compression, NSAIDs, rest), protect from excessive motion (taping, splint, supportive shoewear)

Question 2

IP&MP Sprains- MOI, S&S, Special Test, Management

Answer 2

MOI- tripping or stubbing the toe
S&S- pain, dysfunction, immediate swelling, dislocation (gross deformity)
Special Test- taking bones that ligament attaches to and moving them apart
Management- reduce inflammation, taping

Question 3

Midfoot Sprains- MOI, S&S, Management

Answer 3

MOI- severe dorsiflexion, plantar flexion, or pronation
S&S- pain and swelling deep on medial aspect of foot, weight-bearing may be too painful
Management- decrease inflammation, limited weight-bearing

Question 4

Lateral Ankle Sprain- MOI, S&S, Special Tests, Management

Answer 4

MOI- inversion, often with plantarflexion
S&S- may feel a snap or pop, pain, local swelling, point tenderness
Special Tests- anterior drawer, talar tilt
Management- PIER, horseshoe pads, ankle taping or brace, proprioception exercise

Question 5

Medial Ankle Sprain- MOI, S&S, Special Test, Management

Answer 5

MOI- eversion, usually with forced dorsiflexion
S&S- pain, local pain and tenderness, local swelling, pain with eversion and dorsiflexion
Special Test- deltoid ligament test (reverse talar tilt)
Management- PIER, horseshoe pads, ankle tape or bracing, proprioception exercise

Question 6

Syndesmosis Sprain- MOI, S&S, Special Tests, Management

Answer 6

MOI- axial loading through the calcaneus, external rotation of the foot with dorsiflexion
S&S- vague pain through the anterior aspect, pain with weight bearing and external rotation, point tenderness, diffuse swelling
Special Tests- Kleiger test, squeeze test
Management- PIER, tensor bandage or taping to control swelling, compression tape during healing

Question 7

Peroneal Tendon Strain- MOI, S&S, Special Test, Management

Answer 7

MOI- strong push off a slightly pronated foot, forceful passive dorsiflexion, direct blow
S&S- cracking sensation followed by intense pain and inability to walk, swelling and point tenderness in posterior superior lateral malleolus, extreme discomfort during attempted eversion against resistance, pain with active and resisted eversion with plantar flexion
Special Test- resisted eversion with plantar flexion
Management- immobilization, control inflammation

Question 8

Tibialis Posterior Tendon Strain- S&S

Answer 8

pain, mild swelling, weakness in plantar flexion and inversion

Question 9

Gastrocnemius Strain- MOI, S&S, Special Test

Answer 9

MOI- forced dorsiflexion while knee is extended, forced knee extension while foot is dorsiflexed
S&S- immediate pain, swelling, loss of function
Special Test- resisted plantar flexion (knee must be in extension)

Question 10

Plantar Fasciitis- S&S, Management

Answer 10

S&S- point tenderness at medial calcaneal tubercle, pain with passive extension of great toe and ankle dorsiflexion, pain with weight bearing
Management- reduce inflammation, lengthen fascia/achilles (keep on stretch at night), strengthen intrinsic muscles, heel lift

Question 11

Tendinitis- MOI, S&S, Management

Answer 11

MOI- training errors/biomechanics, direct trauma, infection from a penetrating wound into tendon, abnormal foot mechanics producing friction between shoe, tendon and bony structure, poor footwear
S&S- history of morning stiffness, localized tenderness over tendon, swelling or thickness in tendon, pain with passive stretching and with active and resisted motion/ROM
Management- decrease inflammation, address cause of problem, address any mechanical problems

Question 12

Achilles Tendinitis- MOI, Acute and Chronic S&S, Special Test, Management

Answer 12

MOI- small microtears overtime, acute tensile force
Acute S&S- aching or burning pain in posterior heel, increasing with passive dorsiflexion and resisted plantar flexion, point tenderness and crepitus, bony nodules
Chronic S&S- pain worsened after exercise, thickened tendon, tightness in gastrocnemius-soleus
Special test- resisted plantar flexion, Thompson test
Management- control inflammation, modify activity

Question 13

Medial Tibial Stress Syndrome- S&S, Management

Answer 13

S&S- dull pain occasionally sharp and penetrating, pain along posteriomedial border of tibia in distal 3rd, pain is relieved with rest, but may recur hours after activity stops, increased pain with plantar flexion
Management- rest, decrease inflammation, analysis of mechanics and training, increase strength and flexibility in lower leg and foot

Question 14

Achilles Tendon Rupture- MOI, S&S, Special Test, Management

Answer 14

MOI- push off of forefoot while knee is extending
S&S- pop sound, inability to stand on toes, visible defect, excessive passive dorsiflexion
Special Test- Thompson test
Management- compression wrap and splint, surgical innervation is likely to be required

Question 15

Stress Fractures- MOI, S&S, Management

Answer 15

MOI- repetitive stress, changes in training load or surface, overload from muscle contraction
S&S- pain begins insidiously, increase with activity, decreases with rest, pain limited to fracture site, pain with percussion, tuning fork or ultrasound
Management- decrease inflammation, don’t let it bear weight (walking cast), physician referral

Question 16

Avulsion Fracture- S&S, Management

Answer 16

S&S- tender over fracture site, increased pain with traction at the joint or attachment site
Management- decrease inflammation, don’t let it bear weight, physician referral, may require surgery

Question 17

Ankle Fracture-Dislocation- MOI, S&S, Management

Answer 17

MOI- landing from a height with foot in excessive eversion or inversion, being kicked from behind while the foot is firmly planted
S&S- foot displaced laterally at a gross angle to the lower leg, extreme pain
Management- physician referral, assess and treat for shock, activate EMS