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SUBUNGUAL HEMATOMA MORTON’S, INTERDIGITAL OR PLANTAR NEUROMA 1

SUBUNGUAL HEMATOMA

SUBUNGUAL HEMATOMA
SUBUNGUAL HEMATOMA
SUBUNGUAL HEMATOMA

MORTON’S, INTERDIGITAL OR PLANTAR NEUROMA

ARCHES
ARCHES

Longitudinal

Transverse

NORMAL NERVES

NORMAL

NERVES

ARCHES Longitudinal Transverse NORMAL NERVES 2

Signs and Symptoms

Severe intermittent pain radiating from the distal metatarsal heads to the tips of the toes.

Pain relieved when not bearing weight.

Burning numbness made worse with running, squatting and stairs.

numbness made worse with running, squatting and stairs. CAUSES Tight Shoes Dropped Transverse Arch of the

CAUSES

Tight Shoes

CAUSES Tight Shoes Dropped Transverse Arch of the Foot.

Dropped Transverse Arch of the Foot.

TREATMENT Mobilization of foot. Test strength of Peroneus Longus and Tib. Posterior. Metatarsal Pad.

TREATMENT

Mobilization of foot.

Test strength of Peroneus Longus and Tib. Posterior.

Metatarsal Pad.

INGROWN TOE NAIL

INGROWN TOE NAIL
Mobilization of foot. Test strength of Peroneus Longus and Tib. Posterior. Metatarsal Pad. INGROWN TOE NAIL
Mobilization of foot. Test strength of Peroneus Longus and Tib. Posterior. Metatarsal Pad. INGROWN TOE NAIL

CONSERVATIVE

TREATMENT

CONSERVATIVE TREATMENT
CONSERVATIVE TREATMENT
CONSERVATIVE TREATMENT 5
CONSERVATIVE TREATMENT 5

NORMAL

NORMAL ANATOMY
NORMAL ANATOMY

ANATOMY

NORMAL ANATOMY 6
NORMAL ANATOMY 6
NORMAL ANATOMY 6
FOOT MOTION and PLANTAR FASICIA 7
FOOT MOTION and PLANTAR FASICIA 7
FOOT MOTION and PLANTAR FASICIA 7
FOOT MOTION and PLANTAR FASICIA
FOOT MOTION
and
PLANTAR
FASICIA

HEEL SPURS

HEEL SPURS

TREATMENT PLANS

Foot taping.

Orthotics?

Strengthen weak muscles.

Stretch tight muscles.

MOST COMMON INJURY

MOST COMMON INJURY

BONY ANKLE JOINT

BONY ANKLE JOINT F T Ta
F T Ta
F T
Ta
Flex. Hallucis Achilles Longus Tendon Flex. Digitorum Longus P. Longus Tib. Posterior P. Brevis P.
Flex. Hallucis
Achilles
Longus
Tendon
Flex. Digitorum
Longus
P. Longus
Tib. Posterior
P.
Brevis
P.
Tertius
Tib. Anterior
Ext. Digitorum
Ext. Hallucis
Longus
Longus
Longus P. Longus Tib. Posterior P. Brevis P. Tertius Tib. Anterior Ext. Digitorum Ext. Hallucis Longus

LATERAL LIGAMENTS

LATERAL LIGAMENTS
LATERAL LIGAMENTS ANKLE MOVEMENT AND THE EFFECTS ON LIGAMENTS Plantar Neutral Dorsi 10

ANKLE MOVEMENT AND THE EFFECTS ON LIGAMENTS

ANKLE MOVEMENT AND THE EFFECTS ON LIGAMENTS Plantar Neutral Dorsi

Plantar

Neutral

Dorsi

INVERSION

SPRAIN

INVERSION SPRAIN

BOTH INVERSIONS?

BOTH INVERSIONS? A B

A

B

INVERSION SPRAIN

85% of all sprains

Happens during loading and unloading of the ankle.

What ligament is the first line of defence?

What ligament is the first line of defence? Depends on ankle position

Depends on ankle position

Peroneus Brevis Base 5th

Peroneus Brevis Base 5th

Lateral Structures Ankle

Ant. Talofibular.
Ant. Talofibular.

Post.

Talofib.

Anterior Inf. Tib-fib.

Calcaneofibular

P. Brevis

Base 5

MANDATE ON PLAYING SURFACE

HOW SEVERE IS THE INJURY.

HOW DO WE REMOVE THEM FROM THE FIELD

HOW SEVERE IS THE INJURY. HOW DO WE REMOVE THEM FROM THE FIELD WEIGHT BEARING OR

WEIGHT BEARING

WEIGHT BEARING OR NON-WEIGHT BEARING

OR

NON-WEIGHT

BEARING

FIELD ASSESSMENT Ankle Sprains - General

Mechanism of Injury

Pain …… where?

Hear/feel anything?

Injured before?

Continue with activity?

PALPATION Anterior Inferior Tibiofibular Ligament 1 2 Anterior Talofibular 3 Calcaneofibular Lig. 4 Base of
PALPATION
Anterior Inferior
Tibiofibular Ligament
1
2 Anterior Talofibular
3
Calcaneofibular Lig.
4
Base of 5 th
Metatarsal

EVERSION SPRAIN

Least common sprain.

Most fractures happen in eversion.

Stability of the medial ankle depends upon the Deltoid Ligament and the lateral malleolus.

EVERSION

Slight medial tenderness.

Pain and slight limitation on active eversion.

Stand to determine if there is leg pain.

Walk off playing surface if not antalgic.

ANKLE SPRAIN SEVERE

Rigid, high footwear.ANKLE SPRAIN SEVERE Unable to continue on with the activity. Leg pain on standing.

Unable to continue on with the activity.ANKLE SPRAIN SEVERE Rigid, high footwear. Leg pain on standing.

Leg pain on standing.ANKLE SPRAIN SEVERE Rigid, high footwear. Unable to continue on with the activity.

ANKLE SPRAIN SEVERE Rigid, high footwear. Unable to continue on with the activity. Leg pain on
3. Fracture 1. Deltoid 2. Ant. Inf. Tib-fib.
3. Fracture
1. Deltoid
2. Ant. Inf.
Tib-fib.
Eversion and External Rotation of the ankle without Deltoid Ligament tear.

Eversion and External Rotation of the ankle without Deltoid Ligament tear.

1. Deltoid 2. Ant. Inf. Tib-fib. Eversion and External Rotation of the ankle without Deltoid Ligament
1. Deltoid 2. Ant. Inf. Tib-fib. Eversion and External Rotation of the ankle without Deltoid Ligament
Hockey Player Inversion Minimal Pain Mild swelling Mild bruising Return in five days 17
Hockey Player Inversion Minimal Pain Mild swelling Mild bruising Return in five days 17
Hockey Player Inversion Minimal Pain Mild swelling Mild bruising Return in five days

Hockey Player

Inversion

Minimal Pain

Mild swelling

Mild bruising

Return in five days

Day 6

Day 6

Day 6 THE MINOR SPRAIN Can this athlete return to play during this contest? Definition… Discomfort

THE MINOR SPRAIN

Can this athlete return to play during this contest?

Definition… Discomfort versus pain?

Pain changes the way you do things!

Dissect the sport into its’ components starting from the most simple on the ankle and progress to the most difficult. If they can perform the test without pain… then return. (Following taping?)

NON-RETURNING

ATHLETE

C.I.C.E.R.

Crutches for proper gait.

Referral for physio.

Prepare for return.

taping?) NON-RETURNING ATHLETE C.I.C.E.R. Crutches for proper gait. Referral for physio. Prepare for return. 19

PREPARE FOR RETURN

Aside from the ‘formal’ rehabilitation, the athlete must work on maintaining conditioning and doing whatever sport skills they can.

on maintaining conditioning and doing whatever sport skills they can. WHEN DO I KNOW THAT I

WHEN DO I KNOW THAT I AM READY TO RETURN?????

WALK Pain JOG FIGURE 8
WALK
Pain
JOG
FIGURE 8

SHUTTLE RUN

Figure 8 and Shuttle Run FIGURE 8 ½ Speed SHUTTLE ¾ Speed R L 25
Figure 8 and Shuttle Run
FIGURE 8
½ Speed
SHUTTLE
¾ Speed
R
L
25 m
???
???