Kin191 A. Ch.4. Foot. Toes. Inuries. Fall 2007[1]
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Transcript of Kin191 A. Ch.4. Foot. Toes. Inuries. Fall 2007[1]
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FOOT/TOESFOOT/TOES COMMON INJUIRES COMMON INJUIRES
KIN 191AKIN 191AAdvanced Assessment of Advanced Assessment of Lower Extremity InjuriesLower Extremity Injuries
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INTRODUCTIONINTRODUCTION
COMMON INJUIRES FOOT/TOE PATHOLOGIES GREAT TOE INJURIES METATARSAL/PHALANGEAL INURIES TARSAL INURIES PLANTAR SURFACE INJURIES SOFT TISSUE INJURIES ARCH INJURIES/CONDITIONS NEUROGICAL INJURIES
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FOOT/TOE PATHOLOGIESFOOT/TOE PATHOLOGIES
Many foot/toe injuries/conditions relative to Many foot/toe injuries/conditions relative to either biomechanics at the foot or as either biomechanics at the foot or as compensation for abnormal biomechanics compensation for abnormal biomechanics elsewhere in the lower extremityelsewhere in the lower extremity
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GREAT TOE INJURIESGREAT TOE INJURIES
MMTTP joint sprain (aka “turf toe”)P joint sprain (aka “turf toe”) Typically associated with hyperextensionTypically associated with hyperextension Especially problematic during push-off and Especially problematic during push-off and
change of direction activitieschange of direction activities
Hallux valgus (aka “bunion”)Hallux valgus (aka “bunion”) A typical for traumatic onsetA typical for traumatic onset
Hallux rigidusHallux rigidus Ankylosis (joint fusion)Ankylosis (joint fusion) Secondary to arthritis or exostosis formationSecondary to arthritis or exostosis formation
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METATARSAL/PHALANGEAL METATARSAL/PHALANGEAL INJURIESINJURIES
Metatarsal fracturesMetatarsal fractures Typically traumatic onset Typically traumatic onset Jone’s fractureJone’s fracture
• A fracture of the 5A fracture of the 5thth MT, 1cm distal to the proximal MT, 1cm distal to the proximal diaphysisdiaphysis
• Often require surgical fixationOften require surgical fixation
Metatarsal stress fracturesMetatarsal stress fractures Known as “march” fractures from high incidence Known as “march” fractures from high incidence
in military recruitsin military recruits
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Avulsion fracturesAvulsion fractures Most common at base of 5Most common at base of 5thth metatarsal metatarsal Also occur at navicular and calcaneal Also occur at navicular and calcaneal
tuberositytuberosity
Phalangeal fracturesPhalangeal fractures Typically from blunt trauma, usually treated Typically from blunt trauma, usually treated
conservativelyconservatively
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TARSAL INJUIRESTARSAL INJUIRES Lisfranc sprain, fracture/dislocationLisfranc sprain, fracture/dislocation
Characteristic location, extended treatment and Characteristic location, extended treatment and rehab period, frustrating injuryrehab period, frustrating injury
Cuboid syndromeCuboid syndrome Pain at cuboid/4Pain at cuboid/4thth and 5 and 5thth metatarsal region from metatarsal region from
subluxation of cuboid during over pronationsubluxation of cuboid during over pronation
Navicular fractureNavicular fracture Stress fracture most common due to placement Stress fracture most common due to placement
in medial longitudinal archin medial longitudinal arch Can see accessory navicular which is congenital Can see accessory navicular which is congenital
presentation of medial prominence on navicularpresentation of medial prominence on navicular
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Calcaneal fractureCalcaneal fracture Typically high velocity injuries (fall from height, Typically high velocity injuries (fall from height,
MVA, etc.)MVA, etc.)
Calcaneal apophysitis (Sever’s disease)Calcaneal apophysitis (Sever’s disease) Traction injury to growth plate at calcaneal Traction injury to growth plate at calcaneal
tuberositytuberosity
Talus fracture/OCDTalus fracture/OCD Most common location is dome, typically not Most common location is dome, typically not
isolated condition but secondary to other injuryisolated condition but secondary to other injury
Retrocalcaneal bursitis (“pump bumps”)Retrocalcaneal bursitis (“pump bumps”)
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PLANTAR SURFACE INJURIESPLANTAR SURFACE INJURIES
Plantar fasciitisPlantar fasciitis Biomechanical and structural issues predispose Biomechanical and structural issues predispose
tissue to injurytissue to injury Presents typically at calcaneal attachment but Presents typically at calcaneal attachment but
may be along length of structuremay be along length of structure Plantar fascia rupture can occur with forces toe Plantar fascia rupture can occur with forces toe
hyperextension to a dorsiflexed anklehyperextension to a dorsiflexed ankle Pain when stepping out of bed in the morningPain when stepping out of bed in the morning
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Fat pad contusionFat pad contusion Associated with direct trauma (falls from Associated with direct trauma (falls from
height, etc.)height, etc.)
Heel spurHeel spur Bony exostosis (Wolff’s law)Bony exostosis (Wolff’s law) May or may not be associated with plantar May or may not be associated with plantar
fasciitisfasciitis
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SOFT TISSUE INJURIESSOFT TISSUE INJURIES
Muscle strainsMuscle strains Eccentric overload vs. forceful concentric contractionEccentric overload vs. forceful concentric contraction
TendinitisTendinitis Posterior/anterior tibialis, peroneal, Achilles, Posterior/anterior tibialis, peroneal, Achilles,
flexor/extensor tendonsflexor/extensor tendons Repetitive stress injuries (microtrauma) associated Repetitive stress injuries (microtrauma) associated
with biomechanics and changes in training patternwith biomechanics and changes in training pattern
SynovitisSynovitis Can occur in any synovial joint, in foot most common Can occur in any synovial joint, in foot most common
at the great toe MTP jointat the great toe MTP joint
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ARCH INJURIES/CONDITIONSARCH INJURIES/CONDITIONS
Pes planus (“flat feet”)Pes planus (“flat feet”) Congenital, biomechanical or traumatic onsetCongenital, biomechanical or traumatic onset Rigid (structure) pes planusRigid (structure) pes planus
• Tarsal coalition: absence of medial longitudinal arch Tarsal coalition: absence of medial longitudinal arch when the foot is both WB or NWBwhen the foot is both WB or NWB
Flexible (supple) pes planusFlexible (supple) pes planus• The arch appears normal during NWB but The arch appears normal during NWB but
disappears when the foot is WBdisappears when the foot is WB
Pes cavusPes cavus Poor ability to attenuate ground reaction forcesPoor ability to attenuate ground reaction forces High incidence of stress fracturesHigh incidence of stress fractures
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Transverse metatarsal arch conditionsTransverse metatarsal arch conditions Pain under heads of 2Pain under heads of 2ndnd-5-5thth metatarsals due to metatarsals due to
abnormal weight bearingabnormal weight bearing
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NEUROLOGICAL INJURIESNEUROLOGICAL INJURIES
Tarsal tunnel syndromeTarsal tunnel syndrome Tibial nerve entrapment/compression Tibial nerve entrapment/compression
posterior to medial malleolusposterior to medial malleolus Neuro symptoms along distal distributionNeuro symptoms along distal distribution
Intermetatarsal neuromaIntermetatarsal neuroma Interdigital nerve entrapmentInterdigital nerve entrapment Morton’s neuroma (between 3Morton’s neuroma (between 3rdrd and 4 and 4thth
metatarsal heads)metatarsal heads) Pain at site and neuro symptoms distal to Pain at site and neuro symptoms distal to
injury siteinjury site
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Tarsal Tunnel Syndrome SurgeryTarsal Tunnel Syndrome Surgery