EXSC 1650 Second half of semester

Arches of the foot

assist the foot in supporting the body weight and in absorbing the shock of weight bearing

there are 4: medial longitudinal, the lateral longitudinal, the metatarsal and the transverse

Plantar Fascia

thick white band of fibrous tissue originating from the medial aspect of the calcaneus and ending at the distal heads of the metatarsals

Orthotic

a custom-designed insert that can be placed in the shoe and worn to correct a variety of biomechanical abnormalities that can potentially lead to injury

Nearly all what are preventable

blisters, calluses, corns, and ingrown toenails

point tenderness

pain that is produced when the site of injury is palpated

exostosis

bony outgrowth

Sever’s disease

chronic inflammation of Achilles tendon attachment

An athlete who is prone to heel bruises

should routinely wear a padded heel cup

Metatarsalgia

pain in the bottom of the foot

pes planus

flat feet, decreased efficiency, the medial arch of the foot, less stretch so less absorption of energy, associated with excessive pronation

As long as an existing condition in the foot is not causing pain

don’t try to fix it

Neuroma

enlargement of a nerve

The ankle joint (talocrural) is composed of the

tibia, fibula, talus

The talocrural joint allows two motions

plantarflexion and dorsiflexion

The subtalar joint allows two motions

inversion and eversion

Medial ligament includes the what

the deltoid

Lateral ligaments include the

anterior talofibular, posterior talofibular, calcaneofibular

Prevention of lower leg and ankle injuries

stretching of the gastrocnemius and soleus muscles and the Achilles tendon, strength training, neuromuscular control, appropriate footwear, ankle taping and bracing

Ankle sprain classification

Inversion sprain, eversion sprain, high ankle sprain

Common sites for tendinitis

anterior tibialis, posterior tibialis, fibularis

What is more commonly fractured than the fibula

the tibia

shin splints

medial tibial stress syndrome, anterior lower-leg pain

Compartment syndrome classifications

Acute compartment syndrome, acute exertional compartment syndrome, chronic compartment syndrome

Electrical stimulating currents

decrease pain, M reeducation and strengthening, retard M atrophy, lontophoresis

Ultrasound therapy

stimulates repair of soft tissue, phonophoresis

LASER light therapy

stimulates repair, soft tissue mostly

Traction (soft tissue mobilization)

separation of vertebrae, shoulder, and other joints

Intermittent compression

Norma techs, like compression boots, causes air to fill in the machine and it puts pressure in different ways to get some fluid and things moving

Message

clinician can observe and feel what is wrong and can directly help getting hands on

Joint mobilization

clinician moving the joint or injured area along the lines of what it is supposed to do so scar tissue can lay correctly

IASTM

using Graston, message ball, using external instrument to get mobilization

Improper biomechanics

predispose athlete to injury, congenital or acquired defects, habitual incorrect application of skill, postural deviation

STG (short term goals)

first aid and control swelling, decrease pain, restore ROM, core stability, increase muscular strength endurance and power, neuromuscular control, balance, cardiovascular fitness, functional progression

LTG (long term goals)

get back to play

Tarsals

7 bones

foot

has 26 bones

Metatarsals

1-5, long bones of the foot

Phalanges

14 the digits

Medial longitudinal arch

the inside arch of the foot

Lateral longitudinal arch

outside of the foot arch

Pes cavus

high arch, tight heel cord, higher risk of stress fracture, higher risk of over supination and decreased shock absorption

Kinetic chain

direct effect on distal and proximal segments

Normal gait

heel strike to toe-off cycle

supination, pronation, supination

rotary motion of tibia

knee absorbs transverse rotation

translates to hip joint, low back

Pes planus and overpronation possible injuries

stress fracture, plantar fasciitis, Achilles tendinitis

Plantar fascia

broad band of dense connective tissue

assist in maintaining stability

bracing long arch

shock absorption

Starts as sharp pulling feeling, then ebbs and flows depending on if you were sitting or moving more, continues to nag and usually gets irritated near its insertion

Etiology: increased tension with weight bearing, pes planus, pes clavus, tight heel cord, footwear

Pain at medial heel, pain with dorsiflexion toe-off

Common to last 8-12 weeks, extended period of treatment: identify cause

night splint, message, dorsiflexion stretch, dry needling, shockwave therapy, cortisone injection

Stress fractures in the foot

March fractures

Running, jumping, marching

Other abnormalities; pes planus/pes clavus, training errors, Morton’s toe: short 1st metatarsal

Usually at 2nd or 3rd metatarsal it occurs

Point tender, throbbing, aching

relieves with rest

Adress underlying cause

2-4 weeks complete rest

gradual introduction to activity

boot to absorb impact

Bunions

exostosis (bone spur)

genetic

extra soft tissue growth that can turn into boney

adaptation to tight shoes like cleats or ballet shoes

Hallux Valgus

big toe

when the distal extremity is deviating away from the midline

can cause bunions

Hallux valgus and bunions

shoe selection

donut pad at bunion

Surgical correction?

Toe spacer to possibly avoid surgery

Subungual Hematoma

under the nail bed blood growth

contusion, shearing

tight shoes or really lose shoes

running downhill a lot

pressure and pain

Ice immediately

Relief of pressure

May lose toenail(hygiene)

Tibia

medial malleolus

Absorbs most of the impact

Fibula

lateral malleolus

Absorbs about 10% of the weight

Talus

sits in the concave part of the tibia and fibula where medial and lateral malleolus attach

talus pointing and flexing on the malleolus

Calcaneus

performs inversion and eversion on the malleolus

Distal tibiofibular

between tibia and fibula

Talocrural

“ankle joint”

Lateral ligaments

Anterior talofibular ligament (ATFL)- most common ankle sprain

Calcaneofibular ligament (CFL)

posterior talofibular ligament (PTF)

Limit inversion movement

Inversion/lateral ankle sprain

forced inversion and plantar flexion

ATFL, CFL, PTFL
Cardinal signs and symptoms laterally

POLICE/RICE crutches

Refer to MD if Fx suspected

make compression tighter distally then loser as you go up

Avulsion fracture

most common with sprains

more boney pain and above the insertion

Deltoid ligament

thick, combo of multiple ligaments, limit’s eversion movement

Eversion/medial ankle sprain

when talus rocks into eversion the fibula goes further than the tibia so it prevents that much movement usually however it can happen and cause sprains

cardinal signs medially

POLICE/RICE crutches

refer to MD if Fx suspected

Deltoids lig. complex

5-10%

eversion mechanism

High ankle sprains

interosseous membrane

Tibiofibular Ligaments

Also called “syndesmotic” ligaments or “distal TibFib”

sprain distal where the tib fib are connected

external rotation and forced dorsiflexion

syndesmotic ligaments: tibtib lig

tearing a piece of paper

pain often superior to malleoli

long healing process

extended immobilization

compression wrap w/ horseshoe pad

POLICE Crutches?

X-ray referral

Tape or wrap

Splint- air cast, brace, soft cast

PRE

Progressive Resistive Exercise

Ankle Rx: Functional Tests

Heel/toe walking

lateral/medial border walking

DL to SL hopping

straight-line jogging

sport-specific Fen

Agility: cutting, pivoting, jumpstop

Ankle dislocation

rare

vacuum splint

splint in position found

you don’t know if there is a fracture so it can be dangerous to compress it

Where is the most amount of the stability in the knee from

muscles and ligaments

What has a poor blood supply in the knee

The meniscus, can impair healing in a torn meniscus

Major movements of the knee

Flexion, extension, rotation

Prevention of Knee injuries

Physical conditioning and rehabilitation, shoe type, shoe and cleat design, functional and prophylactic knee braces

When observing knee injuries, we should look at the athlete performing

walking, half-squatting, going up and down stairs

Valgus

medially directed force

Varus

Laterally directed force

A lateral knee sprain can be caused by a

varus force when the tibia is internally rotated

Knee and its bursae

The knee has many, the prepatellar and deep infrapatellar bursae are most often irritated

A knee that locks and unlocks during activity

may indicate a torn meniscus

Iliotibial band friction syndrome

runners knee

Knees that give way or catch have a number of possible pathological conditions

sub luxating patella, meniscal tear, anterior cruciate ligamentous tear

Patellar tendinopathy

jumper’s knee

Innominate bones

ilium,, ischium, pubis

In the hip region flexibility and strengthening

of the muscles in this region are the keys to preventing injury

In order of incidence of sports injury to the thigh

quadriceps contusions rank first and hamstring strains rank second

Myositis ossifications can occur following

a single severe, contusion, repeated contusion to a muscle, improper care of a contusion

Avascular necrosis

tissue death caused by lack of circulation

Coxa plana or a slipped capital femoral epiphysis

a young athlete who complains of pain in the groin, abdomen or knee who walks with a limp may display signs

Dorsiflexors

Tibialis anterior m (front of shin lateral)

Extensor digitorum longus m (toes)

Extensor hallucis longus m (toes)

Plantarflexors

gastrocnemius m

soleus m (deep)

Inversion of lower leg

tibialis posterior m

Flexor digitorum longus

flexor hallicus longus

Eversion of the lower leg

Peroneals/figularis M

Anterior compartment of lower leg

Dorsiflexors

Lateral compartment (lower leg)

everters

Superficial posterior compartment (lower leg)

plantar flexors (calf muscles)

Deep posterior compartment (lower leg)

inverters

Lower leg compartments- compartment syndrome

Increased swelling, compression of muscular and neurovascular structures, lots of pressure, acute or chronic: limited area for swelling

Acute Anterior compartment symdrome

Direct blow to the shin, vascular and neurological changes, emergency, rest ice elevation no compression, emergency fasciotomy, can also occur after lower leg fractures and surgeries, 5 P’s= Pain, pulselessness, pallor, paresthis (tingly, numbness), paralysis

there is pressure to the nerve and blood flow because there is no or minimal elasticity in the fascia

Chronic (exertional) compartment syndrome

Extensive running, increased pressure, repetitive microtrauma, flat feet or high arches, confused with “shin splints”, too much force or shock over time, often in runners and people who wear cleats, neurovascular changes, rest relieves sx, modify activity, possibly surgery

Medial tibial stress syndrome (MTSS) “shin splints”

Repetitive microtrauma, irritated periosteum, generalized anterior pain, often along medial tibial, tightness, more likely to get with flat feet, usually all along the tibia, if pain is localized to one spot could be stress fracture as well as delayed throbbing pain, identify and correct biomechanical factors, may be train and error processes, ice massage, activity modification, orthotics, footwear, stretching, strengthening, arch tape, shin tape, heel lifts

Stress fractures of the lower leg

repetitive microtrauma, biomechanical factors, amenorrhea/dysmenorrhea, nutritional deficiencies, point tender, ache, night throb, cease activity for 2-6 weeks, address biomechanics, progression back to activity

Injury prevention strategies for lower leg and foot

Stretching: Achilles- ankle DF

Strengthening: Weak muscles- long tendons

Neuromuscular control

footwear

Orthotics/footbeds/inserts

Knee anatomy

tibia- tibial tuberosity

Femur- medial/lateral condyles and epicondyles

Fibula

Patella

Quadriceps

group of four

knee extension