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Feb 13 - feet and toes.doc

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University of Alberta
Physical Education and Sport
Brad Kern

Feb 13 - Recognition and Management of Specific Injuries First thing we want to do in a foot assessment, we need to get the history of the feet. We should palpate for TIC (tenderness, instability and crepitus) For active ROM, we have the athlete do an extension exercise and observe For passive ROM, someone gives us assistance in an exercise to go past our active ROM Most muscle testing is done at the middle ROM In lab exams, we would do 3 different exercises, 5 times for 5 seconds each Eversion involves the peroneals When assessing ROM, we give it a grade of 0-5 If we all had no injuries, we would get a grade of -5 -5 means no pain, normal strength 5 means normal strength but with pain 3 means that they can do a full range of motion, but they cant resist when someone is pushing against the muscle 2 is poor and means there is some ROM but not full ROM. There is no ability to work against resistance 1 is trace. If you look at the tendons, you will see them fire but there will be no ROM. 0 means there is nothing going on. Not even firing of a tendon. We would see a 0 in a complete rupture When assessing foot, we would assess inversion, eversion, toe flexion, toe extension, planatrflexion, and dorsiflexion. Doing all these movements will hit all the critical foot muscles. Check table 14.1, page 223! Know action, origin and insertion of these muscles • When palpating muscles, look for point tenderness, look for muscles spasming. • Dorsal pedal pulse • Foot problems are associated with improper footwear, poor hygiene, anatomical structural deviations or abnormal stresses • Sports place lots of stress on feet • Athletic trainers must be aware of potential problems and be capable of identifying, ameliorating or preventing conditions Retrocalcaneal Bursitis ( Pump Bump) Cause of Injury: • Caused by inflammation of bursa beneath achilies tendon • Result of pressure and rubbing of shoe heel counter of a shoe • Chronic condition - Develops over time (may take extensive time to resolve) • Sometimes bursitis can be acute, but not this type. • Exotosis (pump bump) may develop. This is a visual cue that something is wrong in the feet • Must differentiate from Sever’s disease. Severs disease is inflammation at the attachment site of the Achilles tendon. S&S of Pump Bump • Signs of inflammation • Tender, palpable bump on calcaneous • Pain with palpation superior and anterior to Achilles insertion, swelling on both sides of the heel cord Care of Pump Bump • Routine stretching of Achilles, use of heel lifts to reduce stress, use of donut pad to reduce pressure • In a donut pad, the injury site would go through the donut hole • Select different footwear that results in increasing or decreasing height of heel counter Heel bruise • Cause of injury (caused by sudden starts, stops or changes of direction, irritation of fat pad • Can be caused by jumping from a height or lots of running • Signs of injury – severe pain in heel and is unable to withstand stress of weight bearing. May progress to chronic inflammation of bone covering. Chronic inflammation is bad because it starts to calcify and will affect ROM. • Care – reduce weight bearing for 24 hours, RICE, and NSAID’s (non steroidal anti inflammatory drugs). Resume activity with heel cup or doughnut pad after pain has subsided (be sure to wear shock absorbent shoes) • Applying tape can also be effective in generating a “heel cup” Plantar Fasciitis Cause of Condition • Increased stress on fascia • Change from rigid supportive footwear to flexible footwear • Poor running technique, change in training surface • Leg length discrepancy, excessive pronation, inflexible longitudinal arch, tight gastroc-soleus complex S&S of Plantar Fasci
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