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Module 3: Foot and Ankle, plantar capsule and 1st MTP joint is injured,…

- - - - position of vulnerability for the ankle
    - - contact- someone else stepping on your foot
      - noncontact- rolls into inversion
  - - - stabilizing distal tib fib, reaching behind the calcaneus and attempting to apply anterior pressure at ankle joint
      - seeing if you can displace region beneath talus anteriorly
        
        looking for disruption in lateral ligaments
    - - squeezing and see if there is pain (more likely to be positive for syndesmosis)
    - - fully intact ligaments would allow a hop on a foot
    - - little sorsiflexion and attempt to externally rotate (tests integrity of medial ankle ligaments)
    - - test integrity of syndesmosis tib fib
    - - creating inversion, eversion motion at subtalar joint
      - would be increased laxity on one side
    - - can they balance
  - - - return of full ROM
      - Strengthening in all directions
        
        therabands in dorsiflexion, plantar and inversion and eversion
      - resolution of swelling
      - Proprioceptive/balance training
      - early mobilization
        
        ankle pumps to keep down swelling
      - Functional activities (hopping/running)
      - Sport specific activities
    - - expected in 2-8 weeks
      - re injury rates are high in the following 6-12 months
      - ongoing proprioceptive training plus bracing or taping are recommended
    - - if there is still pain or dysfunction 3-6 wks after injury thee may be
        
        ligament, tendon, synovial dysfunction
        
        neurological dysfunction
        
        an undiagnosed fracture
    - - Fracture
        
        tibial plafond
        
        distal tibia
        
        base of the 5th MT
        
        malleolar (potts)
        
        If we disrupt ligaments on either side sometimes ligament can pull piece of the bone off with them
        
        Talus
        
        syndesmotic sprain
      - Dislocation
        
        difficult to differentiate from a sprain
- - - - talar dome fractures can occur along with medial ankle sprains
  - - - often with a fixed foot
        
        cleats
  - - - squeeze and external rotation can differentiate it
  - - - Functional Rehab
        
        similar to that listed for lateral ankle sprain
      - Return to play
        
        approximately 2x as long as a lateral ankle sprain
- - - - talus drives upards and disrupts this ligament to separate distal tibia and fibula
    - - more common than previously thought
    - - fibula (proximal or distal)
      - Malleoli
  - - - expected recovery time = 12+ weeks
      - with good management, prognosis is good
- - - - poor footwear
      - can be caused by high or low arches
    - - dancing
      - gymnastic
      - running
  - - - heavier=more stress
    - - soleus
      - hamstring
      - gastroc
      - gluteals
      - hip stabilizers
  - - - after enough time, pain may be present throughout the day
    - - toe clawing
  - - - Activity reduction
      - Taping
      - Ice
      - Corticosteroid injection
      - massage of PF
      - Orthoses
      - stretching posterior structures
    - - ankle and hip strengthening
      - New footwear/orthoses
      - Intrinsic foot muscle strengthening
      - night splint
      - surgery may be indicated if no success with conservative treatment
- - - - Treat- walking boot, crutches if needed
      - RTP- up to 2 weeks, taping or bracing during activity
    - - Treat- long term immobilization in boot or cast, surgery
      - RTP- 6-10 weeks depending on sport and position, likely need taping or bracing
    - - treat- symtomatic
      - RTP- return as tolerated by pain
  - - - difficult and painful to push off
- - - - 2nd MT most common
        
        common in dancers
      - 3rd also susceptible
      - insufficient energy/nutrition increases likelihood
    - - gastroc
      - flexor digitorum
      - Flexor hallicus longus
    - - pain in forefoot that worsens over time
      - pain reproduced with activity and loading
    - - Fracture line may appear on xray
      - if not, bone scan or MRI may be helpful
    - - aircast/walking boot if needed 1-2 wk
      - graduated return to play as long as pain-free
      - 4 wks avoiding sport or activity
      - address underlying issues
  - - - can occur with forceful inversion while in plantarflexion or can occur with overuse
    - - Point tenderness
      - Pain with weight bearing and activity
      - Depends on mechanism
    - - non weight bearing in cast for 8 weeks
      - may require screw fixation
        
        earlier return to play observed with surgery
- - - - b/w talus, calcaneus, navicular
      - saddle joint
    - - b/w calcaneus and cuboid
      - planar joint
    - - b/w talus and calcaneus
      - planar joint
  - - - planar joints
      - permit a small amount of gliding