Foot and Ankle Evaluation

History

A thorough history MUST be takenMechanismPainSounds/ SensationsChangesPast

Observation

DeformityDiscolorationSoundsGait

Heel StrikeMidstanceHeel offToe off

Shoe WearArches

Pes Planus – flat archShin splints

Pes Cavus – high archMetatarsal fxTurf toe

Arches

• Structural Deformities

• Pes Planus = flat footed/ no arch

• Pes Cavus = high arch

The Gait Cycle

Heel Strike – shock absorptionToe-off – propel forward

PalpationUsed to confirm or deny assessments.

Start away from the injury and move toward the site of pain (about 2-3 inches when appropriate)

Palpate Bilaterally (both sides)

Start w/ light pressure then move to deeper palpation

PalpationNoticePoint Tenderness

Trigger Points

Crepitus

Density

Symmetry/ Deformity

Temperature

Special Tests1st Special Tests

– Fracture Tests

____________

____________

____________

– ________ ___ ____________

____________

____________ or ____________

Range of motion

Passive

LeverBump

Compression

Active

Resistive

Typ

es o

f Inju

ries

• Sprain • tear of a ligament

• “-itis” • irritation of

• Tendonitis – irritation of a tendon (joins muscle to bone)• Bursitis – irritation of a bursae (fluid filled sac under tendons)

• Fracture • – break of a bone (complete or

incomplete• Dislocation

• Joint pops out and stays out• Subluxation

• joint pops out and goes back in

• Strain • tear/ pull of a muscle

(Overuse 0r Overstretch)

Gra

din

g

Inju

ries

Grade 1– Stretching or slight tear – Mild pain

Little to no disability/ loss of function

Grade 2– Moderate tear

Moderate pain and disabilityTrouble weight bearing (PWB)Swelling and Bruising may occur

Grade 3– Severe/Total tear of the ligament– Often causes ankle to subluxate

DisablingCannot weight-bear (NWB) – put weight/ pressure on it.

Sprains

1. Anterior Talo-fibular Ligamenta. Closely followed by Calcaneofibular

2. Anterior Tibio-fibular ligament - “high” ankle sprain or syndesmotic sprain

3. Deltoid

Anterior Talo-fibular sprain*Most common first sprain

*2nd lig to go is Calcaneofibular

- Pain on lateral side under fibula

Caused by Inversion

Anterior Drawer

Positioning– Have the athlete sit with their leg off the table .

– Grasp calcaneus w/ one hand– Let foot lie on your forearm– Other hand on tibia

Test– Dorsiflex foot slightly– Pull Calcaneus forward while push tibia backward

http://www.youtube.com/watch?v=kbqzRWhirOI

Specifi

c Specia

l Tests

Anterior Drawer cont• Positive Test

–Foot slides forward (laxity)–Makes a clunking sound/ sensation

–Pain

Deltoid sprain • Tibio-fibular sprain (syndesmotic/ high)

Caused by Eversion

Caused by Dorsiflexion and Eversion

Specifi

c Specia

l Tests

Talar TiltAthlete sit or lie on table with the feet hanging over the edge

Hold the heel and stabilize the lower leg

Invert the foot (Deltoid) OR Evert the foot (Tibfibs)

Positive Test = pain and/or laxity

https://www.youtube.com/watch?v=1IrI6Bks6hY

Managem

ent

of A

nkle

In

jurie

sSwelling Management

RICE – Rest Ice Compression ElevationMETH – Mobility Elevation Traction Heat

Inversion Ankle SprainsLight Compression with HorseshoeMassageBegin ROM exercises

Syndesmotic Sprain– Takes MUCH longer to heal– Rest/ Immobilize for at least 6-10 days

before beginning ROM exercises

Achilles InjuriesTendonitis – irritation of the tendon

Initially slight painOnly hurts after practice/ activity

As it progresses pain lasts longer and gets irritated with even regular walkingHurts to dorsiflex (stretch/ lengthen the tendon)Painful to the touch

Achilles Tendon Rupture (complete tear)– *Common w/ athletes

30+– Cannot “see” the tendon– Gastroc/ Soleus recoil

(ball up) towards knee– Athlete cannot

plantarflex the foot/ push off

Specia

l Test –

Ach

illes

Ruptu

re

Thompson Test– Positioning

Athlete prone with leg off the tableBoth hands on the calf

– TestSqueeze calf at proximal 1/3

of lower leg– Positive

Foot does not plantarflex

TRY IT!!

http://www.youtube.com/watch?v=HPkaNdG2uus

Tendinitis sites

Foot InjuriesBunion

– Caused by poorly fitting shoes

Hammertoe

– Flexion contracture of toes

Turf Toe

– Hyperextension

Management of Ingrown Toe Nail

In-Grown Toe NailSoak in hot water for 10-15 minutes

Lift edge of nail and put small piece of cotton under to elevate the nail

Apply antiseptic and cover with a sterile dressing

Or cut a “v” into middle of nail (grows and pulls toward center)

If pus present, refer to MD for antibiotics

Other Conditions/ InjuriesShin splints

– Catch-all term for anterior pain

Stress fractures, muscle strains and chronic compartment syndrome

Medial Tibial Stress Syndrome

– Due to repetitive microtrauma

– Weak muscles - Poor shoes

– Overtraining -Running surface

– Malalignment

Grades of MTSSGrade 1

– pain after activity

Grade 2 – pain during and after activity

– No performance affects

Grade 3– Before during and after

– Affects performance

Grade 4– Activity impossible/ too painful