Week 5: Foot and Ankle Flashcards
Bony/Anatomy + Key Structures to Consider Following Injury (5)
- Talus position- anterior?
- Cuboid position- rotated?
- Navicular position- rotated or dropped?
- Base of 5th metatarsal- tender on palpation (TOP)?
- Sesamoid bones
Sesamoid Bones
-Embedded within flexor hallucis brevis (FHB) tendons
-Allow for more smooth contraction
Plantar Fascia (Aponeurosis)
O: Medial process of calcaneal tuberosity
I: Proximal aspect of digits
*Runs along whole bottom of foot, so can cause a lot of problems
Lateral Ligaments of the Ankle (5)
- Anterior talofibular ligament (ATFL) *most common to injure
- Posterior talofibular ligament (PTFL) *can think it’s Achilles injury but PTFL deeper
- Calcaneofibular ligament (CFL)
- Anterior inferior tibiofibular ligament (AITFL)
- Posterior inferior tibiofibular ligament (PITFL)
Medial Ligaments of the Ankle (2 main, 6 total)
- Deltoid ligament (MCL)- 4 ligaments making a triangle
* 2. Tibionavicular
* 3. Tibiocalcaneal
* 4. Tibiospring
* 5. Tibiotalar (anterior, posterior superficial and posterior deep) - Spring ligament (plantar calcaneonavicular ligament) *supports arch
Key Structures to Consider (T, D, H)
Routes of:
-Tibialis posterior (plantar flexion and inversion)
-Flexor digitorum longus (plantar flexion and toe flexion)
-Flexor hallucis longus (plantar flexion and big toe flexion)
*Tom, Dick and Harry go under medial malleolus and attach on plantar surface of foot, which can cause foot problems or more issues up the chain (post. Leg)
Key Structures to Consider (4)
-Tibialis anterior (dorsiflexion and inversion)- anterior ‘shin-splints’
-Peroneal/fibularis longus (eversion) and brevis (plantar flexion and eversion)- lateral sprains
-Achilles tendon- large tendon that generates lots of force
*rule out base of 5th for ankle injury- most common MT injury
Functions of TA, TP, Plantar Fascia, Anterior Talus
-Tibialis anterior- eccentrically lowers longitudinal arch (slows foot as it comes down)
-Tibialis posterior- stabilizer of longitudinal arch
-Plantar fascia- NB for dynamic longitudinal arch support (absorbs forces)
-Anterior talus- sits in mortise joint, can cause problems up the chain
Ankle Joints and ROM (2)
-Tibiotalar joint: dorsiflexion (extension)/plantar flexion (flexion)
-Subtalar joint: inversion/eversion
Turf Toe
-MOI: Hyperextension of big toe (high incidence on turf field b/c harder than grass/less absorption of force)
-1st metatarsophalangeal sprain of plantar ligament/capsule (acute or overuse)
-S&S: swelling, bruising, pain (pretty localized), loss of toe dorsiflexion ROM, weak hallux flexion
-Can result in instability of 1st metatarsophalangeal with grade 3 sprain- flexor hallucis brevis (insertion)?
-Treatment and prevention- taping is functional and works well, wear stiffer soled shoes. Bracing less functional and not comfortable
Runner’s Toe (Subungual Hematoma)
-MOI: repeat trauma to end of toes
-S&S: pain and pressure under nail, discolouration of nail
-Most common in big toe, nail usually falls off
-Excessive pressure may need to be relieved
-Often results from foot sliding in shoe, tight or loose toe box, toes rubbing against end of shoe or each other, running downhill
-Treatment and prevention: proper shoe fitting, varied course/terrain
Sesamoiditis
-Sesamoid bones (2) embedded in flexor hallucis brevis (FHB) tendons, acts like pulleys
-MOI: repeat trauma to ball of foot, results in inflammation to FHB and possible fracture
-S&S: pain over sesamoids, swelling, limited big toe extension, weak/painful flexion
-Treatment and prevention: rest, treat inflammation, padded insoles
Plantar Fasciitis
-Role of PF is to act as shock absorber and support longitudinal arch
-Inflammation is from degeneration of plantar fascia
-MOI: poor biomechanics/overuse stress
-S&S: TOP medial calcaneus (origin) or along longitudinal arch, c/o pain with 1st steps in morning, ankle/toe dorsiflexion stretch pain
-Often present with associated tight Achilles (or further up the chain)
-Treatment and prevention: retrain biomechanics (stretch posterior chain, strengthen arch stabilizers), night splints? Orthotics? Shockwave, soft tissue mobility of tight structures
*some clinics prescribe orthotics as a selling point, not always good for everyone
*Fascia goes all the way up the chain, just changes name in certain places, so can pull from anywhere up the chain too
Bunions
-MOI: poor foot mechanics, genetics, tight/narrow footwear (e.g. cleats, shoes with narrow toe, high heels)
-S&S: big toe aligns towards 2nd toe, tender bump on medial metatarsophalangeal (MTP) joint. Important consideration in arch taping
-Treatment and prevention: re-train foot mechanics, use toe spreaders, exercises (e.g. hip hinge on one leg and lower extremity proprioception)
*Also known as hallux valgus
*Can use bunions as a red flag to tell if footwear is not right or improper biomechanics (can cause problems up the chain)
Tendonitis & Shin Splints
-MOI: poor mechanics, overuse, poor playing field
-Common structures affected:
-Peroneal tendons, tibialis anterior, T,D,H
-S&S: TOP over inflamed tissues, pain with running (walking), pain with resisted muscle testing of affected structure
-Potential for stress fractures at muscle origin d/t traction on bone
-Treatment and prevention: proper foot/lower extremity mechanics, taping (shin, arch), proper footwear, insoles/orthotics
*find the cause and treat the cause
