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Kin 3K03: Sports Injuries (Foot Conditions Summary)

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McMaster University
Krista M Baker

Sports Injuries: Kin 3K03 FOOT CONDITIONS Turf Toe  MTP Joint 1  Mostly damage to passive tissue (ligament or capsule)  Can involve damage to muscle, tendon AND joint  Tears capsule mostly, sometimes plantar plate (bottom of foot)  Thickening of joint capsule  Cause: Hyper-extension o 2 sesamoid bones rest under head of MT; embedded in tendon o Flexors of big toe affected (halluces longus + brevis) o During hyper-extension, can disrupt plantar plate/joint capsule, tendons of FHL/FHB, fracture sesamoids Mechanism of Injury - Talocrural joint (ankle) is dorsiflexed whole toe is hyperextended - Axial load pushed through heel while foot is dorsiflexed - Ex. When a football player gets into 3 point stance and needs to explode forward, their toes are fixed on the ground and force their foot into extension. Contraction of flexor halluces muscles is enough to cause damage. (Less common turf toe MOI) - Antagonist injury – sand toe. Reverse turf toe; hyperflexion. - Disrupt structures on dorsal aspect of MTP as opposed to plantar fascia. Contributing Factors a) Footwear -flexible (particularly through forefoot) -footwear allows hyperextension of toes b) Synthetic playing surfaces -with synthetic turf, foot stays fixed on ground, more friction therefore more injuries c) Body mass -larger athlete puts more load on top of toe extension, increases severity d) Ankle ROM -person without much dorsiflexion will bend more around big toe -turf toe = reduced ROM at talocrural joint = limited dorsiflexion st e) 1 MTP ROM -stiffer joint, rigid foot. Can fail at any specific ROM. Degree of Injury 1. - Local tenderness; able to pinpoint pain (bottom of MTP joint) - Zero to minimal swelling; 10% injured fibers - Normal colour; no bruising/redness - Normal laxity; ROM isn’t diff than normal joint 2. - Mild to moderate swelling; 80% injured fibers - Bruising (ecchymosis); more capacity for bleeds - Diffuse pain; less specific more widespread, can’t pinpoint. - Joint effusion (part of swelling) can look dramatic - ↑ joint laxity; disrupted fibers = little restraint 3. - Severe pain - Moderate + swelling; all through forefoot - Major ecchymosis - Loss of joint integrity Sports Injuries: Kin 3K03 Recognition Pain Location: - Pain on MTP joint 1 and bottom of foot (turf toe) ROMS Affected: - Active Flexion: Pain and weakness with active flexing of toe (damaged FHL/FHB) - Active Extension: Pain due to stressed tendons/capsule - Passive Flexion: No pain - Passive Extension: Tells us laxity in turf toe, pain - Resisted Flexion: Pain if FHL/FHB are injured - Resisted Extension: No pain Aggravated By: - Walking, jumping Short Term Care st  Taping the toe holds it down and prevents hyperextension (for 1 degree)  Surgery and a splint boot prevents movement at MTP joint (2 ndand 3 degree) Intermediate to Long Term Care  Stiffer shoes reduce movement in joint, assist recovery  Training surface: use natural grass instead of synthetic turf  Ankle ROM: open plantar flexors to improve ankle ROM (especially work dorsiflexion) Time Lost o Severity: - 1 degree injury with 5% tissue injury, can return to play in 1 week - 2 degree, can return to play in ~6 weeks rd - 3 degree, can return in up to 10 weeks (full season) o Body Mass: - The heavier the athlete the longer the recovery time. o Sport and Position - Swimmer will go back to play faster than football or basketball player because their toes aren’t usually in an extended position. Plantar Fascia • Calcaneus to metatarsal heads • Acts as an elastic on arch of foot. The tighter the elastic, the higher the arch. • Defines and give shape to medial longitudinal arch • Dynamic structure that stretch passively when force is applied to talus • Aponeurosis: fibrous membrane that anchors a muscle or connects it with the part that the muscle moves Chronic Fasciitis o Jump and run sports - Stresses the plantar fascia the most as you stress the arch of the foot excessively o Barefoot running - Running shoes that don’t support medial arch stress the plantar fascia more o Recent training changes - Changes in training patterns may be excessive and stress plantar fascia Sports Injuries: Kin 3K03 o Foot type - Excessive pronators (lower arch) stress plantar fascia excessively - Rigid foot (high arch) has minimal shock absorption, short and tight plantar fascia will fail if pronation takes place - Plantar fasciiti
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