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1) Distal end of tibia : ankle mortise Distal end of fibula 2) Talus ² trochlea of talus dome 3) Ligaments ² a) lateral ligament complex b) medial ( deltoid ligament ) c) syndesmosis
- The most common acute sport injuries, 25% in every running or jumping sport - Mechanism of injury: inversion and plantar flexion of the foot when landing off balance or clipping another player·s foot
musculotendinous units supporting the ankle joint . calcaneofibular ligament. posterior talofibular ligament.ANKLE SPRAINS Sequence of injury: anterior talofibular ligament.
previous incompletely rehabilitated ankle sprains .individuals with varus malalignment of lower limbs .calf muscle tightness .ANKLE SPRAINS Incidence increased in : .
anterior drawer test).ANKLE SPRAINS . ? MRI scan . stress x-rays ( inversion stress.acute phase ( first 72 hours ): RICE.Diagnosis: x-rays. then varies according to the severity of injury .
The anterior talofibular ligament affected .GRADE 1 ( Mild ) SPRAINS .treatment by encouraging early active movement: a) stationary cycling b) walking with protective taping or semirigid brace ( Aircast splint ) . normal anterior drawer .stress: minimal change on inversion.
propreoception (1 legged stand ) e) functional progression to running. recovery into 6 weeks . strengthening exercises. swerving and cutting. jumping. hopping.GRADE 1 ( Mild ) SPRAINS c) NSAIDS (anti-inflammatory medication) d) physiotherapy: electrotherapy.
anterior drawer present .Complete tear of anterior talofibular ligament with some damage of the calcaneofibular ligament .treatment: a) 1 week crutches.GRADE 2 (Moderate) SPRAINS . joint taped or in aircast splint b) follow grade 1 rehabilitation .laxity when inversion.
treatment: 10 days NWB in aircast brace or POP.GRADE 3 ( Severe ) SPRAINS .surgical reconstruction must be considered . Aggressive rehabilitation follows . associated with fractures . then PWB with the brace up to 6 weeks.Uncommon severe injuries.
Strong everters and weak plantar flexors of the foot . uneven ground. ballet) .mechanism of injury: a) associated with lateral ligament injuries b) forced dorsiflexion with slight inversion and reflex contraction of the tendons ( sprinting.PERONEAL TENDON INJURIES .
O/E: Behind lat.malleolus b) chronic phase ² surgical correction. Subluxation on resisting dorsiflexion with eversion .PERONEAL TENDON INJURIES .treatment: a) acute phase ² wellmoulded short NWB cast with pad over lat.malleolus discomfort or swelling. POP 4 weeks c) rupture of peroneal tendons ² surgical correction .
occurs in dancers.malleolus pulley action and foot malalignment . volleyball .combined cause of the lat.PERONEAL TENDON INJURIES TENDINITIS: . basketball.
extreme cases: local injection into the sheath c) gradual coaching programme.TREATMENT ² a) rest from sport. avoid rapid direction changes or sprinting ² 6 weeks d) failure of conservative treatment: tenolysis of peroneal tendons .PERONEAL TENDON INJURIES TENDINITIS: . temporary use of heel wedge b) physiotherapy.
can present later: damage of subchondral bone (bone bruising).Suspicion if ankle sprains failed to recover .TALAR DOME FRACTURES . later separation and displacement of an osteochondral fragment .
Diagnosis: x-rays in 6 weeks. weakness. bone scan. instability.Treatment: removal of loose body and defect curettage .TALAR DOME FRACTURES . discomfort .Symptoms: locking. MRI scan .
´ footballer·s ankleµ. basketball. local inj. reduced dorsiflexion later on . loose bodies .treatment: NSAIDS.Mechanism: repetitive traction or injury over anterior capsule ² exostoses produced on the anterior margin of distal tibia and talus . Surgical excision .x-rays: lateral view ² exostoses.pain on dorsiflexion.ballet .ANTERIOR IMPINGEMENT SYNDROME .
swimming .NSAIDS.POSTERIOR IMPINGMENT SYNDROME . jumping.ballet. surgical excision ( difficult cases ) . fast cricket bowling.Congenital: talar spur (trigonal process) or a separate un-united ossification centre of talus (OS trigonum ) .
FOOT INJURIES .
hard surfaces. ´ droppedµ metatarsal heads. tight shoes.repetitive trauma. Stress fractures also considered in the differential diagnosis ENTRAPMENT NEUROPATHIES IN THE FOOT .Mechanism: fibrous enlargement of a plantar interdigital nerve with entrapment between metatarsal heads (usually 3rd and 4th ) . MORTON·S NEURALGIA ( NEUROMA ) .
local injection.metatarsal neck pads. other orthotic correction. loss of sensation . .Pain in the web. surgery ENTRAPMENT NEUROPATHIES IN THE FOOT .
sural nerve behind the lateral malleolus or over the styloid process of the fifth metatarsal ENTRAPMENT NEUROPATHIES IN THE FOOT .dorsal cutaneous branch of the deep peroneal nerve on the dorsum of the foot . Other neuropathies: .
discomfort in front of lat.differential diagnosis from chronic lat.treatment: control of over pronation. running .ligament sprain .Sinus tarsi: concavity at the lateral tarsal canal of the subtalar joint .SINUS TARSI SYNDROME .tibialis muscle. strengthening of post. local injection .malleolus.
physio. footwear attention . local inj.BURSITIS ABOUT THE HEEL .NSAIDS..Below achilles tendon: retrocalcaneal bursa .treatment: rest.running with ill-fitting shoes Haglund·s syndrome: (bony bossing) on the posterior aspect of calcaneum . low friction taping.Over achilles tendon: posterior calcaneal bursa .
orthotics: use of a semi rigid moulded heel cup.veteran runners: age and repeated trauma . weight loss.Disruption of the fibrofatty protective tissue over the sensitive periosteum of calcaneum ..treatment: decreased weight bearing activity. shoes with a snug firm heel counter DON·T USE: local inj.HEEL FAT PAD SYNDROME (BRUISED HEEL ) . flat or convex pads .
tennis.mechanism: MTP extension produces a ´windlassµ stress over plantar fascia lifting the longitudinal arch of the foot . netball.Running on hard surfaces.Periosteal reaction may produce a heel spur ( x-rays ) .PLANTAR FASCIITIS . jumping .
early in the morning. stairs . physiotherapy. orthotics to modify over pronation . worse on tip toeing. 4-8mm heel raise.treatment: NSAIDS.PLANTAR FASCIITIS .Pain under medial aspect of the heel.
NSAIDS.pain and tenderness over medial arch of the foot . jumping .Ice.CALCANEONAVICULAR LIGAMENT SPRAIN ( Spring Ligament ) . electrotherapy. orthotics .Acute twisting injuries of the foot in football.
orthotics to support in flexion the cubometatarsal joint and control pronation.Cuboid bone: pulley for peroneus longus tendon. Tenderness with pressure proximal of the 5th metatarsal . stabilizer of the transverse arch of the foot .lateral mid foot pain.CUBOID SYNDROME . Physio for strength of the toes long flexors and anterior tibialis .
painful. atrophic muscles. sprains.REFLEX SYMPATHETIC DYSTROPHY OF THE FOOT . swollen. anxious patient . hypersensitive to touch. laceration or foot surgery . moist foot. Stiff joints.x-rays: osteopenia and soft tissue swelling .Associated with minor strains. hot or cold.
Treatment: aggressive physiotherapy. tubigrip. sympathectomy by epidural injection .REFLEX SYMPATHETIC DYSTROPHY OF THE FOOT .recovery from 8 weeks to 2 years .
Physio ( tight triceps surae ) Attention to shoes .treatment: callus care. correct pronation.ANTERIOR METATARSALGIA .over pronated feet.callus formation under 2nd and 3rd metatarsal heads . orthotics incorporating metatarsal bars. weight loss.Tenderness at plantar aspect of metatarsal heads . excessive mobility of 1st metatarsal .
shoes with elevated heels avoided. gymnasts.SESAMOIDITIS .Sesamoid bones in the tendon of flexor hallucis brevis . basketball . orthotics. bipartite sesamoid. ice skaters. gymnasts: adhesive padding and rest. surgical excision .x-rays and bone scan imaging . Dancers.crush fractures. osteonecrosis . avulsion.dancers.
tendon twists laterally from 15cm above insertion becoming more pronounced at 2-5cm above insertion.ACHILLES TENDON INJURIES . Blood supply reduced at this level .Common tendon of gastrocnemius and soleus muscles .
ACHILLES TENDON INJURIES . rear foot varus or valgus.Aetiology factors: lack of rear foot support in shoes. tight calf muscles . biomechanical factors of foot: over pronation. terrain. excessive training loads. pes cavus.
heel raise. swelling. Acute phase: rest. NSAIDS.Assessment: ultrasound scan: ruptures. ice.surgery: ( ruptures.ACHILLES TENDON INJURIES . electrotherapy. calcifications .treatment: correct biomechanics with orthotics. gentle stretching. . no inj. degenerative cysts. adhesive peritendinitis ) .
calcaneum fractures: most conservative.Ankle fractures: intarticular. early ROM .FRACTURES . if displaced ORIF -talus fracture: surgical treatment to avoid osteonecrosis .
FRACTURES . most common fracture 5th metatarsal base ( Jones ) .Metatarsal fractures: reduce dislocations.toe fractures: most treated conservative. strapping with next toe for 3 weeks .
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