Klein Oak Sports Medicine II

1
Foot Injuries

• Klein Oak Sports Medicine II

2
Objectives

• Explain how to recognize the most common injuries
  sustained by the foot
• Evaluate common foot injuries
• Explain how to apply appropriate immediate and
  superficial follow-up care to the foot

3
The Foot

• The foot region has a high incidence of sports
  injuries.
• The human foot is a marvel of strength,
  flexibility, and coordinated movement.
• It transmits stresses throughout the body when
  walking, running, and jumping.
• It contains 26 bones that are held together by an
  intricate network of ligaments and fascia and
  moved by a complicated group of muscles.

4
Foot Injuries

• We will discuss the following injuries in class
• Skin trauma and Infection of the Foot
• Foot calluses
• Blisters
• Corns
• Ingrown toenails
• Acute Foot Injuries
• Heel bruise
• Longitudinal Arch strain
• Great toe sprain (Turf toe)
• Fractures and dislocations of the toes
• Fractures of the metatarsals
• Chronic and Overuse Foot Injuries
• Fallen Arch
• Flatfoot
• High Arch
• Bunion (hallux valgus)
• Metatarsalgia
• Hammer Claw Toes

5
Foot Anatomy
6
Foot Anatomy - Arches
7
Prevention of Skin Trauma

• The majority of skin conditions are preventable.
• In those sports where skin problems are common,
  the athlete should be instructed on proper foot
  hygiene.
• Which includes proper washing and drying of the
  feet following activity and changing to clean
  socks daily.
• Also it must be emphasized that the athlete wear
  proper fitting shoes and socks.

8
Foot Calluses

• Foot calluses may be caused by shoes that are to
  narrow or too short.
• Athletes whose shoes are properly fitted but who
  still develop heavy calluses commonly have foot
  mechanics problems that may require shoe inserts
  (orthotics)

9
Foot Calluses

• Excessive callus accumulation can be prevented
  by
• Wearing two pair of socks, a thin cotton or nylon
  pair next to the skin and a heavy athletic pair
  over the cotton pair.
• Wearing shoes that are the correct size and in
  good condition
• Routinely, applying materials such as petroleum
  jelly to reduce friction

10
Foot Calluses

• Athletes who are prone to excess calluses should
  be encouraged to use an emery callus file after
  each shower.
• Also massaging in small amounts of lanolin once
  or twice a week may help to soften the callus and
  add some tissue elasticity.
• Great care should be taken not to remove the
  callus totally and the protection it affords at a
  given pressure point.

11
Blisters

• Like calluses, blisters are often a major problem
  of sports participation, especially early in the
  season. Why?
• A blister is a result of shearing forces acting
  on the skin, fluid accumulates below the outer
  skin layer. The fluid may be clear, bloody, or
  infected (pus).

12
Stages of a Blister

• Normal skin
• Pressure Friction
• Early Stage of Blister
• Causes redness on skin, Hot Spot
• Fluid Filled Blister
• Result of uncontrolled pressure friction

13
Blisters Prevention

• It has been found that a dusting of cornstarch
  the application of petroleum jelly can protect
  the skin against abnormal friction.
• Wearing tube socks or 2 pair of socks can help
  prevent blisters. When wearing 2 pair of socks
  the first pair should be worn normal and the
  second pair should be worn inside out.
• Shoes should be broken in before being used for
  long periods of time
• If an area of friction (Hot Spot) develops the
  athlete has several options
• Cover the area with friction-proofing material,
  i.e. petroleum jelly
• Place a blanked-out piece of tape tightly over
  the area
• Cover the area with a piece of moleskin
• Apply ice massage (ice cup) to skin areas that
  have developed abnormal friction.

14
Caring for a Blister

• Cleanse the blister and the surrounding tissue
  with soap and water rinse with antiseptic
• Using sterile scissors, cut the torn blister
  halfway around the perimeter
• Apply antiseptic and antibiotic ointment
  (Neosporin, etc.)
• Lay the flap of skin back over the treated
  tissue cover the area with a sterile dressing.
• Check daily for signs of infection.
• Within 2-3 days, or when the underlying tissue
  has hardened sufficiently, remove dead skin.
  This should be done by trimming the skin on a
  bevel and as close as possible to the perimeter
  of the blister.

15
Corns

• The hard corn (clavis durum) is the most serious
  type of corn.
• It is caused by the pressure of improperly
  fitting shoes, the same mechanisms that causes
  calluses.
• Signs Symptoms include
• Local pain and disability
• Inflammation and thickening of soft tissue (skin)
• Treatment
• Coach can issue shoes that fit properly
• Athlete can soak the foot in warm water to soften
  the corn
• Protect corn by making a doughnut pad

16
Ingrown Toenail

• An ingrown toe nail is a condition in which the
  leading side edge of the toenail has grown into
  the soft tissue nearby, usually resulting in a
  severe inflammation and infection.

17
Ingrown Toenail Prevention

• Check that the athletes shoes are of the proper
  size and width.
• Make sure that the athletes nail is trimmed so
  that its margins do not penetrate the tissues on
  the sides
• The nail should be left sufficiently long that it
  is clear of the underlying tissue and still
  should be cut short enough that it is not
  irritated by the shoe or socks

18
Ingrown Toenail Treatment

• Soak the toe in hot water for approximately 20
  minutes, two or three times a day
• When the nail is soft and pliable (bendable), use
  forceps to insert a wisp of cotton under the edge
  of the nail.
• Continue with this procedure until the nail has
  grown out sufficiently that it can be trimmed
  straight across.

19
Ingrown Toenail Treatment

• If the toe becomes infected, a minor surgical
  procedure may be used to remove the piece of nail
  growing into the tissue.

20
Ingrown Toenail Before
Cutting out nail
Cauterizing
Ingrown Toenail After
21
Acute Foot Injuries - Contusions

• A common contusion sustained in sports is to the
  heel (Heel Bruise).
• Usually a result of an impact with a hard
  surface.
• Of the many contusions and bruises that an
  athlete may receive, there is none more disabling
  than the heel bruise
• May also be referred to as a Stone Bruise

22
Acute Foot Injuries - Contusions

• Signs Symptoms
• Severe pain in the heel
• Unable to withstand the stress of weight bearing
• Limping
• May have some swelling

• Treatment
• Initially, cold is applied to the bruise.
• If possible have the athlete use crutches
• Beginning on the third day use heat, warm
  whirlpool and ultrasound
• A heel cup or protective doughnut may be used
  when the athlete returns to walking.

23
Heel Bruise Protection
24
Acute Foot Injuries - Strains

• Insufficient conditioning of musculature,
  structural imbalance, and incorrect mechanics can
  cause the foot to become prone to strain.
• Common strains that we will discuss are the
  longitudinal arch and the plantar fascia

25
Foot Anatomy - Arches
26
Foot Anatomy Plantar Fascia
27
Acute Foot Injuries Longitudinal Arch Strain

• Longitudinal arch strains are usually
  early-season injuries caused by subjecting the
  musculature of the foot to unaccustomed severe
  exercise and forceful contact with a hard playing
  surface.
• Ex. Football, field is dry and hard due to lack
  of rain. Can you list other examples?

28
Acute Foot Injuries Longitudinal Arch Strain

• Signs Symptoms
• Pain is experienced only when running is
  attempted
• Pain is usually just below the medial malleolus
  (inner ankle bone)
• Swelling and tenderness along the inner aspect of
  the foot

• Treatment
• RICE
• Reduce weight bearing
• Stretching and strengthening exercises
• Tape the arch for return to play

29
Arch Tape Job
30
The Sprained Great Toe Turf Toe

• Sprains of the great toe often result from a
  considerable force applied in such a manner as to
  extend the joint beyond its normal range of
  motion (jamming it) or to twist the toe.

31
Turf Toe

• Signs Symptoms
• Pain
• Swelling (usually minor)
• May limp

• Treatment
• Treat as an acute sprain
• RICE
• Wear a stiff-soled shoe
• Tape or brace to play

32
Fractures of the Toes

• Fractures of the the toes are usually the
  bone-crushing type such as may be incurred by
  kicking an object or stubbing a toe.

33
Fractures of the Toes

• Any suspected fracture of the great toe should
  be referred for an X-ray
• As a rule, 3 or 4 weeks of inactivity permits
  healing, although tenderness may persist for some
  time

34
Fractures of the Metatarsals

• Fractures of the metatarsals can be caused by
  direct force, such as being stepped on by another
  player, a severe torque of the midfoot, or by
  abnormal repetitive stress.
• Characterized by pain and swelling
• The most common acute fracture of the foot is to
  the base of the fifth metatarsal, called a Jones
  fracture.

35
Jones Fracture

• Normally caused by a sharp twisting inward of the
  foot (much like an ankle sprain)
• Jones fractures have a high rate of nonunion
  (meaning that they dont heal well without
  surgery)

36
Chronic and Overuse Foot Conditions Arch
Problems

• Painful arches are usually the result of
  improperly fitting shoes, overweight, excessive
  activity on hard surfaces, overuse, faulty
  posture, or fatigue.
• Arch problems are divide into three degrees
• First degree slight soreness in the arch
• Second degree soreness, redness, swelling, and
  a slight visible drop in the arch
• Third degree completely fallen arch, extreme
  pain, immobility, and deformity

37
Three Common Arch Problems

• 1. Fallen Metatarsal Arch Usually caused by
  prolonged activity on hard surfaces with stress
  on the balls of the feet
• 2. Fallen Medial Longitudinal Arch (Flatfoot) -
  (Pes Planus)Various stresses weaken ligaments and
  muscles that support the arch.
• 3. High Arch (Pes Cavus) Commonly called claw
  foot, hollow foot, or an abnormally high arch.
  Usually congenital or may indicate a neurological
  disorder.

38
Arch Problems
1.

• (Pes Planus) Flatfoot
• (Pes Cavus) High Arch

2.
39
Care for Arch Problems

• Shoes should fit properly
• Hydrotherapy, especially whirlpool, should be
  given three or four times daily
• Deep therapy, such as ultrasound, can be used
  when prescribed by a physician
• Arch orthoses (supports)
• Weakened arches, if caught early, can be aided by
  an exercise program.

40
Forefoot Problems Bunion (Hallux Valgus)

• Bunions are one of the most frequent painful
  deformities of the great toe.
• There are many reasons an athlete may get
  bunions, but the most common is a combination of
  congenital deformity and wearing shoes that are
  pointed, too narrow, too short, or high heeled

41
Care for a Bunion

• Athletes should wear proper fitting shoes with a
  wide toe box
• Tape the toe and use a wedge between the great
  toe and the second toe.

42
Metatarsalgia

• Metatarsalgia is a general term to describe
  pain or cramping in the ball of the foot.
• Often associated with pain under the second or
  third metatarsal heads

43
Hammer Toes?????
44
Hammer/Claw Toes

• Hammer, or clawed, toes may be congenital, but
  more often the condition is caused by long-term
  wearing of shoes that are too short and that
  cramp the toes.
• Usually involves the second or third toe, whereas
  clawed toes involve more than one toe

45
Plantar Fasciitis (Heel Spur Syndrome)

• Plantar fasciitis, or heel spur syndrome is one
  of the most common hind foot problems among
  athletes who run and/or jump
• The plantar fascia runs forward from the heel
  bone tuberosity on the sole of the foot and to
  insert on the heads of the metatarsal bones.

46
Plantar Fasciitis (Heel Spur Syndrome)

• Because of stress placed on the heel bone during
  repeated running and jumping, a chronic
  irritation and/or bone spur can occur

47
Plantar Fasciitis (Heel Spur Syndrome)

• Stretching the heel cord is important in treating
  this injury.
• Ice massage
• Arch supports or tape to play
• Use of a night splint, usually helps the
  stretching process

48
(No Transcript)
49
(No Transcript)
50
The EndQuestions?