ATR 5110 Orthopedic Assessment I: Foot and Ankle Pathologies

Lateral Ankle Sprain

Structures: ATFL and CFL ligaments,

MOI: INV/SUP, sudden forceful movement

Signs/Sx: Tearing or popping sensation, pain along lat ligament complex and sinus tarsi, pain w/ INV/PF

ST: Ant Drawer, Talar Tilt (IN)

Management/Tx: POLICE, early ROM, rehab,

Medial Ankle Sprain

Structures: Deltoid, Lat Mal

MOI: ER of Talus

Signs/Sx: Tearing or popping sensation, pain along med/ant Jt line, pain over lat mal, swelling

ST: Kleiger’s Test (ER), Talar Tilt (EV)

Management/Tx: POLICE, early ROM, rehab, imaging, surgery

Syndesmosis Sprain

“High Ankle Sprain”

Structures: Tibiofibular Syndesmosis, Interosseous Membrane, Ant & Post tib-fib lig, Fibula

MOI: Excess IR of Talus or forced DF, Collisions, Excess Cutting

Signs/Sx: Pain over ant ankle and prox along interosseous membrane, increased pain w/ DF, pain w/ palp over ant & post tib-fib lig, decreased pain with WB and in DF

ST: Kleiger’s Test, Squeeze Test, Cotton Test, Fibular Translation Test, DF-Compression Test

Management/Tx: POLICE, early ROM, rehab, imaging, surgery

Achilles Tendon Rupture

Structures: Achilles Tendon

MOI: Forceful sudden contraction (can be due to degeneration or sudden acute movement)

Signs/Sx: Popping sensation followed by immediate severe pain, inability to push off, inability to do a heel raise, may see or palpate torn tendon in calf

ST: Thomson Test

Management/Tx: POLICE, early ROM, rehab, imaging, surgery

Plantar Fasciitis

Structures: Plantar Fascia

MOI: age, changes in activity, prolonged standing, weight gain, limited ankle DF ROM

Signs/Sx: pain near fascia origin, morning pain, pain in heel after activity, pain w/ push off or heel raise, increased pain w/ DF walking climbing stairs on toes

ST: Windlass Test, Navicular Drop Test

Management/Tx: POLICE, early ROM, stretching, rehab, imaging, surgery

Tarsal Tunnel Syndrome

Structures: Post Tibial Nerve

MOI: Acute Trauma, Overuse

Signs/Sx: Diffuse pain, burning, paresthesia, numbness, cold intolerance, radiating pain into calf, pain with certain footwear

ST: Tinel’s Sign, DF-EV Test

Management/Tx: Orthotic footwear, surgery

Jones Fracture

Structures: Base of 5th MT

MOI: Direct trauma, compressive tensile rotation crushing forces

Signs/Sx: Pain, crepitus, swelling, inability to WB

ST: Long bone compression test

Management/Tx: POLICE, boot 6-8 weeks, imaging, surgery

Turf Toe

Structures: 1st MTP Jt

MOI: Hyperext of 1st MTP Jt

Signs/Sx: Pain at Jt during push off, pain w/ active Jt motion, Pain w/ MMT, pain w/ quick stopping motions

ST: None

Management/Tx: POLICE, crutches and other immobilization tactics, anti-inflammatory meds

Morton’s Neuroma

Structures: Digital Plantar nerve, Lat Plantar Nerve

MOI: Prolonged pressure on nerve

Signs/Sx: Pain in ant transverse arch, numbness and parasthesia on plntar surface of foot, relief after removing shoes

ST: Intermetatarsal Neuroma Test, Mulder’s Click Test

Management/Tx: Footwear modification, anti-inflammatory meds, surgery

Hallux Valgus

Structures: 1st MTP Jt

MOI: Limitation of passive MTP ext, flexible forefoot valgus, PF 1st ray, EV calcaneus

Signs/Sx: Jt angle >20 degrees, bunion, pain at 1st MTP Jt

ST: None

Management/Tx: Modified footwear, padding, anti-inflammatory meds, surgery

Metatarsalgia

Structures: MT

MOI: Unknown

Signs/Sx: Pain w/ palp over MT, pain w/ activity

ST: Tarsal MT Glide Test, Midtarsal Jt Glide Test

Management/Tx: POLICE, reduce activity, rehab

Sever’s Disease

Structures: Apophysis in Calcaneus

MOI: Abnormal foot postures, tight triceps surae, repetitive tensile forces on achilles tendon attachment

Signs/Sx: Activity pain pain in post heel, touch toe gait, pain w/ palp and compression of calcaneus

ST: None

Management/Tx: POLICE, manage activity level, heel cups, stretching and strengthening

Compartment Syndrome

Structures: Involved compartment of lower leg —> Muscles, nerves soft tissue

MOI: Acute Trauma —> blow to anterolateral or lat portion of lower leg, Acute Exertional and Chronic —> increased thickness of fascia and overtraining and excess pronation

Signs/Sx: T”Five P’s —> pain, pallor, pulselessness, paresthesia, paralysis

ST: Doctor diagnosis

Management/Tx: Surgery