Week 5 Flashcards
Key structures of the foot and ankle to consider following injury
- talus position (anterior?)
- cuboid position (rotated?)
- navicular position (rotated or dropped?)
- base of the 5th (tender on palpation)
- sesamoid bones
Where are the sesamoid bones located in the foot?
- flexor hallucis brevis tendons
Origin of the plantar fascia
- medial process of calcaneal tuberosity
Insertion of plantar fascia
- proximal aspect of digits
Lateral ligaments of the foot
- anterior talofibular (ATFL)
- calcaneofibular (CFL)
- posterior talofibular (PTFL)
- anterior inferior tibiofibular (AITFL)
- posterior inferior tibiofibular (PITFL)
What are the two most common ligaments impacted in a lateral ankle sprain?
- ATFL
- CFL
Ligaments of the medial ankle
- deltoid ligament
- spring ligament
4 Ligaments making up deltoid ligament
- Tibionavicular
- Tibiocalcaneal
- Tibiospring
- Tibiotalar
Role of the spring ligament
- supports medial arch
Types of tibiotalar ligaments
- anterior tibiotalar
- posterior superficial tibiotalar
- posterior deep tibiotalar
Key structures to consider of the medial ankle (tom, dick and harry)
- tibialis posterior
- flexor digitorum longus
- flexor hallicus longus
- tibialis anterior
- achilles
- peroneal tendons
What are the deep plantar flexors?
- tibialis posterior
- flexor digitorum longus
- flexor hallicus longus
Action of tibialis posterior
- plantarflexion
- inversion
Action of flexor digitorum longus
- plantarflexion
- toe flexion
Action of flexor hallucis longus
- plantar flexion
- big toe flexion
Action of tibialis anterior
- dorsiflexion
- inversion
Action of achilles
- plantarflexion
What are the two peroneal tendons?
- peroneus longus
- peroneus brevis
Action of peroneus longus
- eversion
Action of peroneus brevis
- plantarflexion
- eversion
Functional anatomy of tibialis anterior
- eccentrically lowers longitudinal arch
Functional anatomy of tibialis posterior
- stabilizer of longitudinal arch
Functional anatomy of plantar fascia
- dynamic longitudinal arch support
Functional anatomy of anterior talus (what happens up the chain?)
- limits dorsiflexion
- leads to pronation at foot to compensate
- causes internal rotation at tibia
- valgus at knee
- femur internally rotates
- drop in hip
- back pain
Range of motion of the toes
- flexion
- extension
- abduction
- adduction
Range of motion of the ankle- tibiotalar joint
- dorsiflexion
- plantarflexion
Range of motion of the ankle- subtalar joint
- inversion
- eversion
What is supination?
- combination of plantarflexion, inversion, adduction
- causes sole of foot to face medially
What is pronation?
- combination of dorsiflexion, eversion and abduction
- causes sole of foot to face laterally
Mechanism of injury of turf toe
- hyperextension of big toe
What is sprained in turf toe?
- sprain of 1st MTP plantar ligament
What are the signs and symptoms of turf toe?
- swelling
- brusing
- pain
- loss of toe dorsiflexion ROM
- weal hallux flexion
What can turf toe result in?
- instability of 1st MTP with gr 3 sprain
Treatment for turf toe?
- limit hyperextension
- decrease inflammation
What is the mechanism of injury of runner’s toe (subungual hematoma)?
- repeat trauma to end of toes
Signs and symptoms of runner’s toe?
- pain and pressure under nail
- discoloration of nail
- nail falls off
What does runner’s toe result from?
- foot sliding in shoe
- tight or loose toe box
- toes rubbing against end of shoe or each other
- running downhill
Prevention of runner’s toe
- proper shoe fitting
- varied course/terrain
Where are the sesamoid bones located?
- embedded in flexor hallucis brevis tendons
Mechanism of injury of sesamoiditis
- repeat trauma to ball of foot
What does sesamoiditis result in?
- inflammation of sesamoid bones and FHB tendons
Signs and symptoms of sesamoiditis
- pain over sesamoids
- swelling
- limited big toe extension
- weak/painful flexion
Treatment of sesamoiditis
- rest
- treat inflammation
- padded insoles
Role of plantar fascia
- shock absorber
- support long arch
What can happen after inflammation of plantar fascia?
- degeneration of the plantar fascia
Mechanism of injury of plantar fasciitis
- poor biomechanics/overuse stress
Signs and symptoms of plantar fasciitis
- tender on palpation of medial calcaneus or along longitudinal arch
- pain with 1st steps in morning
- ankle/toe dorsiflexion stretch pain
What is the plantar fasciitis associated with?
- tight achilles
Treatment of plantar fasciitis
- find cause
- retrain biomechanics
- night splints
- orthotics
- shockwave
- soft tissue mobility
Signs and symptoms of bunions (hallux valgus)
- big toe aligns towards 2nd toe
- tender bump on medial metatarsophalangeal joint
What can bunions result from?
- genetics
- poor foot mechanics
- tight/narrow footwear
How can bunions be used as a red flag?
- signal of pronation which could be causing problems up the chain
How can we retrain foot mechanics?
- create a stable base
- ie. balance exercises
How can a stable base be created?
- abduct toes
- stack hip over knee over ankle
- tighten core, chest up
- pick other foot up
Tendonitis and shin splints mechanism of injury
- poor mechanics
- overuse
Common structures affected in tendonitis and shin splints
- peroneal tendons
- tibialis anterior
- tom, dick and harry
- achilles
Signs and symptoms of tendonitis and shin splints
- tender on palpation over inflamed tissues
- pain with running
- pain with resisted muscle testing or stretch of affected tissue
Treatment for tendonitis and shin splints
- correct mechanics
- taping
- proper footwear
- insoles/orthotics
What is there a potential for with tendonitis and shin splints?
- stress fractures at muscle origin
Lateral ankle sprain mechanism of injury
- ankle inversion
Possible structures affected in a lateral ankle sprain
- ATFL
- CFL
- PTFL
- AITFL
- PITFL
- peroneals
- cuboid position?
- base of 5th metatarsal?
Signs and symptoms of lateral ankle sprain
- “pop”
- giving out
- swelling
- bruising
- limping
Treatment for lateral ankle sprain
- sideline management
- reduce inflammation
- healing
- return to play
Return to play test
- figure 8 test
- start with large loop and get smaller and smaller
Mechanism of injury of medial ankle sprain
- ankle eversion
Possible structures affected in medial ankle sprain
- deltoid ligament
- spring ligament
- tom, dick, harry
- navicular position
Signs and symptoms of medial ankle sprain
- “pop”
- giving out
- swelling
- bruising
- limping
Treatment of medial ankle sprain
- similar as lateral
- retrain medial contractile tissues
Common fractures of foot and ankle
- jones fracture
- metatarsal fractures
- talus
- calcaneus
- fibula
- tib-fib (often with dislocation)
Things to consider for injury management of fractures
- urgent vs non-urgent?
- distal circulation?
- monitor for shock
- splint and send for x-rays
Surgical management of unstable fractures
- reduction
- fixation
Surgical management of stable fractures
- immobilization
What is impacted in a Jones fracture?
- peroneus brevis avulsion of base of 5th metatarsal
**always rule this out in a lateral ankle sprain
Mechanism of injury of Jones fracture?
- inversion sprain
Signs and symptoms of Jones fracture
- tender on palpation of base of 5th metatarsal
- pain in weightbearing
Why should you always rule out lateral ankle sprain?
- ankle sprain symptoms may distract from jones fracture
Mechanism of injury of talus fracture
- severe ankle sprains
- land from height
- forced dorsiflexion
Signs and symptoms of talus fracture
- vary with severity
- pain with weight bearing
- loss of ROM
Mechanism of injury of calcaneus fracture
- fall/jump from height
Signs and symptoms of calcaneus fracture
- extreme pain
- unable to WB
Mechanism of injury of fibula fracture
- direct blow
- ankle sprain mechanism
Signs and symptoms of fibula fracture
- vary with severity
What to do as part of pre-tape assessment
- explain chosen tape job and why
- ask permission
- clear contraindications
- check ROM that you want to limit (pre and post test)
- check cap refill
Contraindications of taping (when not to tape)
- allergies to adhesives
- immediately after injury
- injury hasnt been fully assessed
- return to play criteria not met
- to areas of altered skin sensation
- overnight
- check that sport governing body allows tape
Indication of ankle taping (when to tape)
- chronic ankle instability from previous sprains
- RTP following treatment of recent ankle sprain
- when ankle bracing doesnt fit in athletic shoe properly or a sport does not permit bracing
Ankle testing
- drawer sign
- talar tilt and eversion talar tilt
- wedge test
Which ligament does the drawer sign test test?
- anterior talofibular ligament
Which ligament does the talar tilt test test?
- calcaneofibular ligament
Which ligament does the eversion talar tilt test test?
- deltoid ligament
Which ligament does the wedge test test?
- anterior inferior tibiofibular ligament
Indications of prowrap
- sensitivity to adhesives
- hair
Indications of arch taping
- arch pain
- medial tendonitis/osis
- shin splints
- bunions
