Common Foot Injuries - American College of Sports …forms.acsm.org/TPC/PDFs/8 Ott.pdfCommon Foot...
Transcript of Common Foot Injuries - American College of Sports …forms.acsm.org/TPC/PDFs/8 Ott.pdfCommon Foot...
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Common Foot Injuries Diagnosis and Treatment
Susan M. Ott DO FACSM ACSM’s Team Physician Course Miami, Florida 2013
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Common Foot Injuries
Skin/Nails Lacerations Blisters Contusions Nail loss Infection
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Common Foot Injuries : Skin Lacerations Not too common Could have a penetrating injury from
projectile like a javelin Penetrating injury stepping on something in
a shoeless sport Treat like any other laceration Protect from becoming infected
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Common Foot Injuries : Skin Blisters Very common in almost all shoed sports Soccer Endurance sports Shoe fit Can be quite debilitating during the race
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Common foot injuries: Skin
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Common Foot Injuries : Skin Blisters : Treatment Pop but do not unroof Cover with something that will stick J&J blister pads Athletic tape and antibiotic ointment Second skin Duct tape
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Common Foot injuries :Skin
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Common Foot Injuries : Skin Blisters: Prevention Proper shoe fit Proper socks Duct tape Body glide Vaseline Moleskin Second skin
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Common Foot Injuries : Skin Infection Skin: Secondary to blisters or laceration Nails (paronychia ): Secondary to subungual
hematoma or trauma Athlete’s foot Cellulitis Other
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Common Foot Injuries: Skin Infections should be treated with
appropriate antibiotics Sometimes need I&D but rarely in the
athlete Prevent reccurrance
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Common Foot Injuries: Nail injuries
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Common Foot Injuries: Nail injuries Acute or repetitive trauma An occur in any shoed sport Common in endurance athletics Common in dancers Stop and go sports Shoe fit
Injury to the underlying nail bed Crush injury on or off the playing field Can become infected
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Common Foot Injuries: Nail injuries Underlying nail
matrix is damaged Good new nail will
push the bad old nail off the top
Maintain the old nail as long as possible
Subungual hematomas should be sterilely drained
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Common Foot Injuries : Skin Contusions Can happen in almost any sport Off the field injury Hematoma could become infected Treat as you would any other contusion
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Common Foot Injuries
Turf Toe Injury to the first Metatarsophalangeal (MTP)
joint Common MOI is hyperextension injury with a
force on the heel Results in a tear of the capsule on the
metatarsal neck and a compression injury to the dorsal articular surface of the metatarsal
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Common Foot Injuries
Turf Toe Common football
injury Increased incidence
on artificial turf especially if the turf is old
History of a single or multiple injuries to the MTP joint
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Common Foot Injuries
Turf Toe : Grading System Clanton and Ford Grade 1 capsular stretch Grade 2 partial tear of the capsule Grade 3 Complete tear of the
capsuloligamentous complex
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Common Foot Injuries
Turf Toe Treatment RICE Grade 1 taping and stiff insole Grade 2 can require up to 2 weeks of rest Grade 3 may need protected weight bearing and
prolonged rest Surgery for instability, large capsular avulsions,
traumatic bunion, diastasis of bipartite sesamoid or sesamoid fracture, loose body, retraction of sesamoid
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Common Foot Injuries : Ligamentous injuries Other toe ligamentous injuries Rarer Injury to the collateral ligaments of a toe Chronic or acute
Non shoed sport Injuries occuring outside of sport Forced adduction or abduction of a toe Recurrent dislocations
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Common Foot Injuries : Ligamentous injuries Mid foot injuries LisFrancs fracture dislocation Mid foot injury of the tarsal-metatarsal joints Often a stepped in a hole injury Axial load on a plantar flexed foot Severe swelling and pain Almost always a more severe injury than you
think
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Common Foot Injuries : Ligamentous injuries LisFrancs injury Get CT to better
define the injury if it appears nondisplaced
Displaced injuries require surgery
Before surgery get the swelling down Respect the soft
tissues
Can be a sprain without fracture
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Common Foot injuries: LisFrancs Case 1: 34 year old male sustained an
injury to his foot while playing with some children in a park. He jumped up and landed in a hole sustaining the injury. He complains of severe midfoot pain and swelling. Was seen in the ER and told he had a sprain.
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Common Foot Injuries : Ligamentous injuries LisFrancs joint Normal radiograph shows the medial border
of the 2nd metatarsal lines up with the medial border of the second cuneiform on the AP view Normal radiograph shows the medial border
of the forth metatarsal lines up with the medial border of the cuboid
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Common Foot injuries: LisFrancs
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Common Foot injuries: LisFrancs
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Common Foot injuries: LisFrancs
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Common Foot Injuries
Radiographs essentially normal but his physical exam and history are highly suspicious for a LisFrancs injury Placed in a well padded posterior splint Kept non weight bearing Sent for CT scan
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Common Foot injuries: LisFrancs
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Common Foot injuries: LisFrancs
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Common Foot Injuries: LisFrancs CT showed non-
displaced fractures of the 2nd,3rd and 4th metatarsal bases with a non-displaced calcaneous fracture
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Common Foot Injuries : LisFrancs If there is any displacement this is a
surgical problem Non displaced can be treated in a non
weightbearing cast
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Common Foot Injuries : Ligamentous injuries Subtalar joint injury Less common Can have a sprain or dislocation MOI is usually dorsiflexion and supination That position places the calcaneofibular
ligament under stress, and further supination will lead to its rupture
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Common Foot Injuries : Ligamentous injuries Subtalar joint sprains Could also occur as a progression of the
typical inversion ankle sprain Sometimes difficult to distinguish from lateral
ankle instability 10% of chronic lateral ankle instability will
have subtalar instability Essentially treated as an ankle sprain is
treated
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Common Foot Injuries : Tendinous injuries Peroneal tendon injuries Subluxing/dislocating peroneal tendons Slip over the distal fibula Pronation external rotation
Peroneal tendon rupture Partial tears
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Common Foot Injuries: Tendinous Case 2 43 year old special forces officer with
complaints of lateral ankle pain and popping Has had multiple injuries over the years in
combat Relates sliding down a hill in Afganistan and describes a pronation external rotation
injury Plain radiographs and MRIs read “normal”
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Common Foot Injuries: Tendinous Case 2 PE: No swelling or gross deformity No instability Strength is intact Subluxes peroneal tendons with resisted
eversion
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Common Foot Injuries: Tendinous
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Common Foot Injuries: Tendinous
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Common Foot Injuries : Tendinous injuries Flexor Hallucis Longus Common dance injury Passes thru a fibrosseous tunnel between
the medial and lateral tubercles of the talus Tendon can become frayed and torn A nodule can develop which prevents
smooth passage thru the tunnel Usually treated conservatively
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Common Foot Injuries : Tendinous injuries Achilles Tendinitis Typically overuse injury Most common in running sports and soccer 60% of athletes with achilles tendinitis have foot
alignment issues Rupture Requires repair
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Common Foot Injuries : Tendinous injuries Posterior tibialis More common in older adults Acquired flatfoot Too many toes sign Profound weakness to plantar flexion if torn Don’t really have a great surgery for this Want to catch it as a tendinopathy An athlete could have a tendinopathy
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Foot injuries
Can get compartment syndrome in the foot as well Acute or exertional Much less common than in the knee or
leg Surgical emergency in acute cases
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Compartment syndrome
Comparment pressure measuring device device
VERY easy to use Instructions online with
videos If you can give an
injection you can use this
Get one at your hospital and know where it is kept
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Common Foot Injuries : Bony injuries Acute fractures Phalanges Metatarsal Cuboid, navicular, cuneforms Calcaneous, talus
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Common Foot Injuries : Bony injuries Acute fractures : phalanges Usually can be treated conservatively Sometimes require closed reduction Can usually be immobilized with buddy tape Can use a post operative shoe for comfort
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Common Foot Injuries : Bony injuries Acute fractures : Metatarsals 5th Metatarsal fractures are quite
common Usually due to a twisting injury to the foot Jones fracture Pseudo Jones fracture
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Metatarsal fracture
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Common Foot Injuries : Bony injuries Acute fractures : Jones fracture Fracture of the metaphyseal-dyaphyseal
junction of the base of the 5th metatarsal Fussy healer (can use bone stimulator) Treated conservatively with a non
weightbearing cast Intramedullary screw is the surgical
treatment
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Common Foot Injuries : Bony injuries Acute fractures : Pseudo-Jones fracture Fracture of the base of the 5th metatarsal Avulsion at the insertion of the peroneal
brevis tendon Good healer Can be treated in a weightbearing
appliance of choice
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Common Foot Injuries : Bony injuries Acute fractures : other metatarsal
fractures Direct trauma Shaft fracture : oblique, spiral, transverse Typically can be treated conservatively Multiple metatarsal fractures may need
surgical intervention
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Common Foot Injuries : Bony injuries Acute fractures : Midfoot Less commonly injured Most commonly avulsion injuries Usually treated conservatively Immobilization as needed for comfort
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Common Foot Injuries : Bony injuries Acute fractures : Calcaneous Aside from avulsion injuries rarely injured
in sport Typical MOI is a fall from a height Be sure to evaluate lumbar spine as well
Sometimes a crush injury
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Common Foot Injuries : Bony injuries Acute fractures: Talus In athletics typically an osteochondral
injury of the talar dome Often discovered late: The ankle sprain
that does not heal Talar neck injuries can be devastating if
displaced
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Common Foot Injuries : Bony injuries Acute fractures: Talus Lateral talar process fracture Common in snowboarders High index of suspicion Ankle sprain MOI Dorsiflexion with eversion MOI Best diagnosed on CT or MRI
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Common Foot Injuries : Bony injuries Stress fractures Can happen in any bone in any sport Metatarsal and cuboid stress fractures are
most common Navicular Sesamoid especially in dancers Diagnosis via plain radiographs, bone san
and MRI Almost always treated conservatively
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Common Foot Injuries : Bony injuries Freibergs Trabecular stress injury of the metatarsal
head Osteochondrosis More common in females Second metatarsal most frequently affected Complain of pain at the affected metatarsal
head
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Common Foot Injuries
Freibergs Can have soft tissue swelling Sometimes have a history of trauma Several staging systems based on the level
of metatarsal head collapse on radiographs Conservative care of immobilization and
protection
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Common Foot INjuries
Freibergs Surgical treatments: Removal of loose
bodies/osteophytes, restoration of the contour of the metatarsal head, dorsiflexion osteotomy
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Common Foot Injuries
Other stuff Plantar facsitis: More common in older non
athletes Severs: Apophysitis of the calcaneous Kohlers: Irregular ossification of the
navicular Tarsal tunnel
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Common Foot Injuries
Susan M. Ott DO FACSM