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This 4 page Class Notes was uploaded by McKenzie Jordan on Sunday September 18, 2016. The Class Notes belongs to 1600 at Appalachian State University taught by Mark Boatright in Fall 2016. Since its upload, it has received 5 views. For similar materials see Intro to Athletic Training in Athletic Training at Appalachian State University.
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Date Created: 09/18/16
Introduction to Athletic Training 1600 104 Mark Boatright 9/15/16 (McKenzie Jordan) Page 1 RICE R rest I ice C compression E elevation ORIF O open R reduction I internal F flexion Plantar Fasciitis (Plantar Fascia, Plantar Ponderosa) Do NOT stretch, does NOT adapt well to change, do NOT let someone numb it ● History: acute/ chronic ○ Pn worse in the morning, pain eases as day progresses, moves up fascia ○ Sx ○ Mx direct blow/ overuse ● Inspection: slightly swollen or bruised (ecchymosis) ● Palpation: point tender at calcaneal tubular ● Function: plantar flexion makes it worse ● Special Test: (windlass tests (wb/nwb)), feiss line ● Treatment: make custom orthotic **Windlass test: weight bearing/ nonweight bearing Hyperextend great toe (standing = weight bearing, sitting = non weight bearing) Tarsal Coalition two bones fuse together as one, commonly navicular, cuboid, calcaneus ● Coalition: genetic condition ● Bony union between two or more tarsal bones ● Pes plantas ● Talar breaking ● Limited subtalar motion Tarsal Tunnel Syndrome soft tissue, retinaculum inflammation, compression (PTN) PTN = posterior tibial nerve ● History: acute/ chronic ○ Pn sharp, numbness, paresthesia (tingling sensation), medial aspect of foot ○ Sx - pn increases with activity, cold intolerance → DO NOT ICE Introduction to Athletic Training 1600 104 Mark Boatright 9/15/16 (McKenzie Jordan) Page 2 ○ Mx compression of posterior tibial nerve, plantar flexion and eversion of ankle fracture dislocation, pronated feet susceptible ● Inspection: not significant, limited swelling/bleeding ● Palpation: tinel sign ● Function ● Special Test: Tinel Sign, posterior tibial nerve, dorsiflexion eversion test ● Neurological Test: positive tinel ● Imaging: C.T., MRI ** take advil/ aleve ** can sometimes inject ** walking boot 23 wks ** Catch 22: Tarsal Tunnel can mimic Plantar Fasciitis → Tinel Sign: dorsiflexion, eversion, flick PTN, radiate pain down great toe Metatarsal Fracture long bones of foot, forefoot **ORIF **happens from torsion ● History: acute (trauma)/ chronic (stress fx) ○ Pn localized to fx site ○ Mx direct trauma, rotational forces, repetitive stress ○ Predispose morton's toe, pes plantas or cavus ● Inspection: deformity, swelling over shaft of bone ● Palpation: tender and crepitus over fx site ● Function: ROM that compresses the bone, inability to bear weight or walk, PAINFUL ● Special Test: long bone compression test ● Imaging: x rays 1. Jones Fracture fx of 5th metatarsal, torsion direct trauma a. 1 cm distal to proximal disphases, point tender with crepitus, right below proximal head, non weight bearing, four weeks in boot 2. Avulsion Fracture base of 5th metatarsal a. Mx inversion of foot with contracting peroneal i. Peroneal Brevis Tendon b. Pn swelling, pain, crepitus over incision site 3. MARCH FRACTURE mid shaft, 2nd, 3rd, and 4th MT a. Stress fx of metatarsals b. Dull pain at fracture c. Pn Increase with activity, decrease with rest d. Bone density issues low vitamin D, low calcium deposits Introduction to Athletic Training 1600 104 Mark Boatright 9/15/16 (McKenzie Jordan) Page 3 Neuroma nerve issues, “scar tissue on nerve” ● History ○ Between 2nd and 3rd, as well as 3rd and 4th MT heads ○ Increase pain with time ○ Weight bearing will cause demyelination of nerve ○ Pn forefoot, radiating, numbness, paresthesia ○ Mx inflammation of plantar nerve ■ Narrow shoes, high heels, hyperpronated feet ● Inspection: swelling around forefoot ● Palpation: point tender between met heads, palpate nodule ● Special Test: Morton's test grab MT and squeeze together Pencil test 2nd and 3rd MT, press up with pencil eraser Muddlers Test both combined, squeeze together and pinch ● Neurological Test: LQE ● Imaging: MRI with contrast **inflammation of plantar nerve on bottom side of foot **creates module scar tissue around demyelinated nerve Hallux Rigidus Stiff Great Toe Usually Secondary Condition ● History ○ Onset chronic, degeneration of MTP joint as well as articular surfaces ○ Pn point tender over area of 1st MTP joint ○ Mx degeneration from repetitive stress ○ Predispose Morton’s toe, hypermobility of 1st ray, flat metatarsal heads ● Inspection: swelling of joint ● Palpation: exostosis (calcium deposit, dorsal medial side of joint) toe inside ● Function: ROM, painful and very limited, increase pain with inactivity ● Treatment: PROM, orthotics stiff forefoot, injection surgical removal of exostosis **calcification around great toe **cavalier, spring steel toe box of shoe Turf Toe 1st MTP sprain ● History: onset/acute ○ Mx foot planted, ankle dorsiflexed, weight bearing and forward movement, forcing MTP joint into hyper extension ○ Pn MTP joint during push off phase of gait pain with MRE’s ● Inspection: swelling and discoloration Introduction to Athletic Training 1600 104 Mark Boatright 9/15/16 (McKenzie Jordan) Page 4 ● Palpation: point tender over 1st MTP joint ● Function: limited ROM with PROM, AROM ● Special Test: valgus and varus stress test to check ligaments ● Predisposing: barefoot athletes ● Treatment: firm side shoe (spring steel cavalier), orthotics, NSAIDS, injection Lis Franc Fx/ dislocation, overload issue ● History: acute, fx of 2nd metatarsal and dislocation of 1st and/or 2nd cuneiform ○ Pn extreme, feel snapping, popping, tearing ○ Mx rotational loading of TMT joint or axial loading that forces toes into extension and foot and ankle into dorsiflexion, rotational loading on fixed foot, crushing force ● Inspection: swelling over dorsum of foot, deformity (widening of foot) ● Palpation: point tenderness over TMT joint, fx site ● Function: pain with all end ROM, decrease pronation/supination ● Neurological: check foot sensation ● Vascular: check diastole pulses and dermatomes ● Treatment: patient should be nonweight bearing ● Surgical Intervention (arthrodesis): relocate cuneiform, rewire pins **extremely painful **splint and go Sesamoiditis ● History ○ Pn diffuse pain of great toe, snapping, cracking ○ Mx repetitive MTP extension of great toe, weight bearing ● Inspection: swelling of first ray ● Palpation: point tender over sesamoids ● Function: pain with all ROM ● Special Test: N/A ● Neurological: positive tinel (plantar nerve) ● Imaging: xrays, CT scan, MRI ● Treatment: NWB, metatarsal pad, sesamoidectomy
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