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27 Cards in this Set
- Front
- Back
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Fracture of the Talus
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Etiology -
Occurs either laterally from severe inversion/dorsiflexion force or medially from inversion/plantarflexion force with tibial external rotation Sign & Symptoms - History of repeated ankle trauma, pain with weight bearing, intermittent swelling, catching/snapping, talar dome tender upon palpation Management - X-ray required for diagnosis, placed on weight bearing progression, rehab focuses on ROM and strengthening. If conservative management unsuccessful, surgery may be required (return to play in 6-8 months following surgery) |
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Fractures of the Calcaneus
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Etiology
Occurs from jump or fall from height and often results in avulsion fractures anteriorly or posteriorly. May present as posterior tibialis tendinitis Sign and Symptoms Immediate swelling, pain and inability to bear weight, minimal deformity unless comminuted fracture occurs Management RICE immediately, refer for X-ray for diagnosis For non-displaced fracture, immobilization and early ROM exercises when pain and swelling subside |
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Calcaneal Stress Fracture
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Etiology
Occurs due to repetitive trauma and is characterized by sudden onset in plantar-calcaneal area Sign and Symptoms Weight bearing (particularly at heel strike) causes pain, pain continues following exercise, May require bone scan for diagnosis Management Conservative for 2-3 weeks, including rest AROM Non-weight bearing cardio training should continue As pain subsides, activity can be returned gradually |
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Apophysitis of the Calcaneus (Sever's Disease)
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Etiology
Traction injury at apophysis of calcaneus, where Achilles attaches Sign and Symptoms Pain occurs at posterior heel below Achilles attachment in children and adolescent athletes Pain occurs during vigorous activity and ceases following activity Management Best treated with ice, rest, stretching and NSAID’s Heel lift could also relieve some stress |
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Retrocalcaneal Bursitis (Pump Bump)
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Etiology
Inflammation of bursa beneath Achilles tendon Result of pressure and rubbing of shoe heel counter Chronic condition that develops over time; may take extensive time to resolve; exostosis may develop (Haglund’s deformity) Sign and Symptoms Pain w/ palpation superior and anterior to Achilles insertion, swelling on both sides of the heel cord Management RICE and NSAID’s used as needed, ultrasound can reduce inflammation Routine stretching of Achilles, heel lifts to reduce stress, donut pad to reduce pressure Possibly invest in larger shoes with wider heel contours |
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Heel Contusion
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Etiology
Caused by sudden starts, stops or changes of direction, irritation of fat pad Pain on the lateral aspect due to heel strike pattern Sign and Symptoms Severe pain in heel and is unable to withstand stress of weight bearing Often warmth and redness over the tender area Management Reduce weight bearing for 24 hours, RICE and NSAID’s Resume activity with heel cup or doughnut pad after pain has subsided (be sure to wear shock absorbent shoes) |
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Cuboid Subluxation (Dysfunction)
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Etiology
Pronation and trauma injury Often confused with plantar fascitis Primary reason for pain is stress on long peroneal muscle with foot in pronation Sign and Symptoms Displacement of cuboid causes pain along 4th and 5th metatarsals and over the cuboid May refer pain to heel area and pain may increase following long periods of weight bearing Management Dramatic results may be obtained with jt. mobilization Orthotic can be used to maintain position of cuboid |
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Tarsal Tunnel Syndrome
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Area behind medial malleolus forming tunnel with osseous floor and roof composed of flexor retinaculum
Etiology Any condition that compromises tibialis posterior, flexor hallucis longus, flexor digitorum, tibial nerve, artery or vein May result from previous fracture, tenosynovitis, acute trauma or excessive pronation Sign and Symptoms Pain and paresthesia along medial and plantar aspect of foot, motor weakness and atrophy may result Increased pain at night with positive Tinel’s sign Management NSAID’s and anti-inflammatory modalities, orthotics and possibly surgery if condition is recurrent |
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Tarsometatarsal Facture Dislocation (Lisfranc Injury)
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Etiology
Occurs when foot hyperplantar-flexed with foot already plantar-flexed and rearfoot locked resulting in dorsal displacement of metatarsal bases Sign and Symptoms Pain and inability to bear weight, swelling and tenderness localized on dorsum of foot Possible metatarsal fractures, sprains of 4th and 5th tarsometatarsal joints, may cause severe disruption of ligaments Management Key to treatment is recognition (refer to physician), realignment and maintaining stability Generally requires open reduction with fixation Complications include metatarsalgia, decreased metatarsophalangeal joint ROM and long term disability |
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Pes Planus Foot (Flatfoot)
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Etiology
Associated with excessive pronation, forefoot varus, wearing tight shoes (weakening supportive structures) being overweight, excessive exercise placing undo stress on arch Sign and Symptoms Pain, weakness or fatigue in medial longitudinal arch; calcaneal eversion, bulging navicular, flattening of medial longitudinal arch and dorsiflexion with lateral splaying of 1st metatarsal Management If not causing athlete pain or symptoms, nothing should be done to correct “problem” If problems develop, orthotic should be constructed with medial wedge, taping of arch can also be used for additional support |
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Pes Cavus (High Arch Foot)
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Etiology
Higher arch than normal; associated with excessive supination, accentuated high medial longitudinal arch Sign and Symptoms Poor shock absorption resulting in metatarsalgia, foot pain, clawed or hammer toes Associated with forefoot valgus, shortening of Achilles and plantar fascia; heavy callus development on ball and heel of foot Management If asymptomatic, no attempt should be made to “correct” Orthotics should be used if problems develop (lateral wedge) Stretch Achilles and plantar fascia |
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Longitudinal Arch Strain
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Etiology
Caused by increased stress on arch Flattening of foot during midsupport phase causing strain on arch (appear suddenly or develop slowly Sign and Symptoms Pain with running and jumping, below posterior tibialis tendon, accompanied by pain and swelling May also be associated with sprained plantar calcaneonavicular ligament and flexor hallucis longus strain Management Immediate care, RICE, reduction of weight bearing. Weight bearing must be pain free Arch taping may be used to allow pain free walking |
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Plantar Fasciitis
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Etiology
Increased tension and stress on fascia (particularly during push off of running phase) Change from rigid supportive footwear to flexible footwear Poor running technique Leg length discrepancy, excessive pronation, rearfoot valgus, inflexible longitudinal arch, tight gastroc-soleus complex Running on soft surfaces, shoes with poor support Sign and Symptoms Pain in anterior medial heel, along medial longitudinal arch Increased pain in morning, loosens after first few steps Increased pain with forefoot dorsiflexion Management Extended treatment (8-12 weeks) Orthotic therapy is very useful (soft orthotic with deep heel cup) Simple arch taping, use of a night splint to stretch Vigorous heel cord stretching and exercises that increase great toe dorsiflexion Massage of plantar surface of foot using tennis ball or rigid round surface NSAID’s and occasionally steroidal injection |
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Jones Fracture
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Etiology
Fracture of metatarsal caused by inversion and plantar flexion, direct force (stepped on) or repetitive trauma Most common = base of 5th metatarsal Sign and Symptoms Immediate swelling, pain over 5th metatarsal High nonunion rate and course of healing is unpredictable Management Controversial treatment Crutches with no immobilization, gradually progressing to weight bearing as pain subsides May allow athlete to return in 6 weeks If nonunion occurs, internal fixation may be required Bone stimulators have also been suggested |
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Metatarsal Stress Fractures
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Etiology
2nd metatarsal fracture (March fracture) Change in running pattern, mileage, hills, or hard surfaces Forefoot varus, hallux valgus, flatfoot or short 1st metatarsal Occasional 5th metatarsal fracture at base and insertion of peroneus brevis Signs and Symptoms Over 2-3 weeks dull ache during exercise, progressing to pain at rest Progresses from diffuse to localized pain Patient often reports increase in duration/intensity of training Management Bone scan may be necessary 3-4 days of partial weight bearing followed by 2 weeks rest Return to running should be gradual and orthotics should be used to correct excessive pronation |
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Bunion (Hallux Valgus Deformity)
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Etiology
Exostosis of 1st metatarsal head; associated with forefoot varus; shoes that are too narrow, pointed or short Bursa becomes inflamed and thickens, enlarging joint, and causing lateral malalignment of great toe Bunionette (Tailor’s bunion) impacts 5th metatarsophalangeal joint - causes medial displacement of 5th toe Sign and Symptoms Tenderness, swelling, and enlargement of joint As inflammation continues, angulation increases causing painful ambulation Tendinitis in great toe flexors may develop Management Early recognition and care is critical Wear correct fitting shoes, appropriate orthotics, pad over 1st metatarsal head, tape splint between 1st and 2nd toe Engage in foot exercises for flexor and extensor muscles Bunionectomy may be necessary |
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Sesamoiditis
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Etiology
Caused by repetitive hyperextension of the great toe resulting in inflammation Sign and Symptoms Pain under great toe, especially during push off Palpable tenderness under first metatarsal head Management Treat with orthotic devices, including metatarsal pads, arch supports, and even metatarsal bars Decrease activity to allow inflammation to subside |
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Metatarsalgia
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Etiology
Pain in ball of foot (2nd and 3rd metatarsal heads) Restricted extensibility of gastroc-soleus complex Typically emphasizes toe off phase during gait Fallen metatarsal arch Sign and Symptoms Transverse arch flattened, depressing 2nd, 3rd, 4th metatarsal bones and resulting in pain Cavus foot may also cause problem Management Elevate depressed metatarsal heads or medial aspect of calcaneus Remove excessive callus build-up Stretching heel cord and strengthening intrinsic foot muscles |
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Metatarsal Arch Strain
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Etiology
Fallen metatarsals or pes cavus foot Excessive pronation may compromise metatarsal head positioning and weight distribution Signs and Symptoms Pain or cramping in metatarsal region Point tenderness, weakness, positive Morton’s test Management Pad to elevate metatarsals just behind ball of foot |
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Morton's Neuroma
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Etiology
Thickening of nerve sheath (common plantar nerve) at point where nerve divides into digital branches Commonly occurs between 3rd and 4th met heads; medial and lateral plantar nerves come together Irritated by collapse of transverse arch of foot, putting transverse metatarsal ligaments under stretch, compressing digital nerves and vessels Excessive pronation can be a predisposing factor Signs and Symptoms Burning paresthesia and severe intermittent pain in forefoot Pain relieved with non-weight bearing Toe hyperextension increases symptoms- Metatarsalgia/stress fx-2-4 metatarsal heads and shafts Management Must rule out stress fracture Teardrop pad can be placed between met heads to increase space, decreasing pressure on neuroma Shoes with wider toe box would be appropriate Surgical excision may be required |
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Sprained Toes
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Etiology
Generally caused by kicking non-yielding object Pushes joint beyond normal ROM or imparting a twisting motion on the toe- disrupting ligaments and joint capsule Sign and Symptoms Pain is immediate and intense but short lived Immediate swelling and discoloration occurring w/in 1-2 days Stiffness and residual pain will last several weeks Management RICE, buddy taping toes to immobilize Begin weight bearing as tolerable |
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Great Toe Hypertension (Turf Toe)
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Etiology
Hyperextension injury resulting in sprain of 1st metatarsophalangeal joint May be the result of single or repetitive trauma Signs and Symptoms Pain and swelling which increases during push off in walking, running, and jumping Management Increase rigidity of forefoot region in shoe Taping the toe to prevent dorsiflexion Ice and ultrasound Rest and discourage activity until pain free |
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Fractures and Dislocations of the Phalanges
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Etiology
Kicking unyielding object, stubbing toe, being stepped on Dislocations are less common than fractures Signs and Symptoms Immediate and intense pain Obvious deformity with dislocation Management Dislocations should be reduced by a physician Casting may occur with great toe or multiple toe fractures Buddy taping is generally sufficient |
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Hallux Rigidus
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Etiology
Development of bone spurs on dorsal aspect of first metatarsophalangeal joint resulting in impingement and loss of active and passive dorsiflexion Degenerative arthritic process involving articular cartilage and synovitis If restricted, compensation occurs with foot rolling laterally Signs and Symptoms Forced dorsiflexion causes pain Walking becomes awkward due to weight bearing on lateral aspect of foot Management Stiffer shoe with large toe box Orthosis similar to that worn for turf toe NSAID’s Osteotomy to surgically remove mechanical obstructions in effort to return to normal functioning |
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Hammer Toe, Mallet Toe, or Claw Toe
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Etiology
Hammer toe is a flexible deformity that becomes fixed due to a flexion contracture in the PIP joint Mallet toe is a flexion contracture of the DIP which also can become fixed Claw toe is a flexion contracture of the DIP joint but there is hyperextension at the MP joint Often time conditions caused by wearing short shoes over and extended period of time Signs and Symptoms The MP, DIP, and PIP can all become fixed Exhibit swelling, pain, callus formation and occasionally infection Management Conservative treatment involves wearing footwear with more room for toes Use padding and taping to prevent irritation Shave calluses Once fixed, surgery will be required to correct |
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Overlapping Toes
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Etiology
May be congenital or brought upon by improperly fitting footwear (narrow shoes) Signs and Symptoms Outward projection of great toe articulation or drop in longitudinal arch Management In cases of hammer toe, surgery is the only cure Some modalities, such as whirlpool baths can assist in alleviating inflammation Taping may prevent some of the contractual tension w/in the sports shoe |
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Subungual Hematoma
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Etiology
Direct pressure, dropping an object on toe, kicking another object Repetitive shear forces on toenail Signs and Symptoms Accumulation of blood underneath toenail Likely to produce extreme pain and ultimately loss of nail Management RICE immediately to reduce pain and swelling Relieve pressure within 12-24 hours (lance or drill nail) – must be sterile to prevent infection |
