Eval of Musculoskeletal Injuries Test 2

Retrocalcaneal Bursitis

Inflammation of the bursa between the bursa and the Achilles, generally chronic in nature due to pressure and rubbing from the shoe. May see swelling and pain with palpation superior and anterior of the insertion of the tendon

Cuboid Subluxation

Often caused by pronation and trauma and can sometimes be confused with plantar fasciitis. May find pain along the 4th and 5th metatarsals as well as over the cuboid. The cuboid will generally move downward and can even have referred pain to the heel. Manipulation to reduce will significantly reduce pain.

Tarsometatarsal Fracture/Dislocation (Lisfranc Injury)

Traumatic injury caused by the ankle being plantar flexed with the rearfoot locked then as a sudden, forceful, hyper plantarflexion resulting in the dorsal displacement of the proximal end of the metatarsals. Characterized by pain and inability to bear weight, swelling and tenderness over the dorsum of the foot. Often missed as a sprain of the 4th and 5th proximal metatarsals

Jones Fracture

A fracture in the base of the 5th metatarsal. Most common of foot injuries, caused by direct force; by inversion and plantar flexion of the foot; or repetitive stress. Characterized by immediate pain and swelling over the 5th metatarsal.

Morton’s Neuroma

Neuroma located between the 3rd and 4th metatarsal heads. Irritation increases with the collapsing of the transverse arch. Can be predisposed by excessive foot pronation.

Great Toe Hyperextension (Turf Toe)

Hyperextension causes a sprain of the metatarsophalangeal joint of the great toe, can be traumatic or chronic. Usually characterized by significant pain and swelling in and around the metatarsophalangeal joint and pain is exacerbated when trying to push off.

Pes Planus Foot (Flat Foot)

Refers to a type of foot in which the medial longitudinal arch appears flat. Generally associated with excessive foot pronation and can be caused by structural forefoot deformity; tight shoes; trauma to supportive ligaments; overweight; excessive exercise.

Pes Cavus Foot (High Arch Foot)

Sometimes called clawfoot, or hollow foot. Is generally associated with excessive supination. Signs and symptoms include general foot pain; clawed or hammer toes; abnormal shortening of the Achilles; heavy calluses on the ball and heel of the foot.

Plantar Fasciitis

Often a catchall term for pain described in the proximal arch and heel with multiple etiologies associated with. Signs and symptoms include pain in the anterior medial heel, usually at attachment of plantar fascia on calcaneus; most common to have pain early in the morning or when becoming weight bearing after a period of time of not being weight bearing with pain lessening after a few steps

Sesamoiditis

Reports pain on the bottom of the foot, specifically under the base of the first metatarsophalangeal joint. May have difficulty flexion or extending the great toe. Method of injury usually includes increased activity or repetitive irritation, especially those requiring activities on the ball of the foot.

Bunions (Hallux Valgus Deformity)/Bunionette (Tailor’s Bunions)

Occurs at the head of the 1st and 5th metatarsal. Often caused by shoes that are pointed, too narrow, or too short. Occasionally the bursa over the joint will become inflamed and eventually thickens. The joint often becomes enlarged causing a malalignment of the great toe. Signs and symptoms are tenderness, swelling, and enlargement of the joint with pain with ambulation.

Inversion/Lateral Ankle Sprains

Most common injury to the lower let, the anterior talofibular ligament is the weakest and most often sprained. Etiology is inversion with some plantar flexion. Signs and symptoms include pain and swelling in the general area and possible problems weight bearing. Should use the Ottawa Ankle rules to determine fracture.

Eversion/medial Ankle Sprains

Approximately 5-10% of ankle sprains because the bony structure and deltoid is strong. Is usually preceded by an avulsion fracture of the malleolus before the ligament tears. Etiology is eversion force and signs and symptoms would be pain and swelling in the general area and possible problems weight bearing.

Syndesmotic Sprain (High Ankle Sprain)

Tears to the anterior and posterior tibiofibular ligaments which are difficult to treat and often take months to heal. Etiology is generally increased external rotation and/or forced dorsiflexion. Signs and symptoms include pain and swelling in the syndesmosis and loss of ankle function.

Ankle Fracture/Dislocation

Due to a number of different mechanisms; Avulsion fractures occur when a chip of bone pulled off by the resistance of ligament, bimalleolar fracture occurs when both malleoli are fractured. Signs and symptoms are severe pain and swelling with possible deformity

Osteochondritis Dissecans

One or several fragments of bone or cartilage partially or fully detached and moving within the joint space. Etiology includes single trauma or repeated injury. Signs and symptoms are pain and swelling, and possible locking or clicking with movement. Management may include surgery.

Achilles Tendon Abnormalities

Includes stains, tendinitis, tendinosis though usually starts as tendinitis and evolves. Signs and symptoms include inflammation, may feel crepitus in some cases which is a grinding, crackling, or popping sound that occurs when moving a joint. Leads to rupture.

Medial Tibial Stress Syndrome (Shinsplints)

A “catch all” term for pain in the anterior shin, generally due to pain associated with the posterior tibialis. Etiology is repetitive microtrauma with signs and symptoms of diffuse pain over the anterior medial shin. There are 4 grades, pain after activity; pain before and after activity; pain before, during and after that affects performance; and pain severe enough to make activity impossible.

Compartment Syndromes

Increased pressure in one of four compartments of the shank, generally anterior compartment and deep posterior compartments is involved, excessive pressure in muscular and neurovascular structures which can be a medical emergency if there are motor and neural deficits. has 3 categories acute, acute exertional, and chronic. Signs and symptoms are deep achy pain, swelling with taut skin, numbness and loss of function. Treatment includes rest, ice, and elevation with NO compression

Stress Fracture of the Tibia or Fibula

Common overuse injury commonly with structural or biomechanical abnormalities with pain and specific point tenderness along the bone.