Foot and Ankle Sports Orthopaedics (eBook)

Professor Valderrabano performed his medical studies in Zurich, Switzerland. He received his MD degree for the experimental work “Structural Adaptations of the Pars Convoluta of the Distal Tubulus of the Mouse Nephron under Thiazide Treatment” at the Institute of Anatomy in Zurich. He then completed his residency in Orthopaedics & Traumatology with achievement of the “Swiss Medical Degree for Orthopaedics and Traumatology”. Subsequently, he performed his curriculum in Sports Medicine with achievement of the “Swiss Federal Sports Medicine Medical Degree” in 2005. Professor Valderrabano obtained his Ph.D. (Dr. phil.) in Biomechanics at the Human Performance Laboratory at the University of Calgary in Canada in 2009.  From 2009 to 2014 he was elected as Chairman and Director of the Orthopaedic Department at the University Hospital of Basel, Basel, Switzerland. He is currently Chairman of the SWISS ORTHO CENTER in Basel and Professor for Orthopaedics and Trauma Surgery at the University of Basel in Switzerland. Professor Valderrabano is author of numerous scientific papers and was honoured by several international scientific and clinical awards.  

Contents 5
Contributors 9
Part I: General Aspects 15
1: Clinical Anatomy 16
Surface Anatomy 16
Anteroposterior View 16
Posteroanterior View 16
Lateral View 17
Medial View 17
Surgical Approaches 17
Anterolateral Suprafibular Approach 17
Included 17
Indications 18
Position 18
Hazards 18
Superficial Dissection 18
Deep Dissection 19
Medial Approach 19
Included 19
Indications 20
Position 21
Hazards 21
Superficial Dissection 21
Deep Dissection 21
Anterior Ankle Approach 23
Indications 23
Position 23
Hazards 23
Incision 23
Superficial Dissection 23
Deep Dissection 23
Posterolateral Approach 23
Indications 23
Position 24
Hazards 24
Superficial Dissection 24
Deep Dissection 24
Posteromedial Approach 25
Indications 25
Position 25
Hazards 25
Incision 25
Superficial Dissection 25
Deep Dissection 26
Midfoot Approaches 26
Dorsomedial Approach 26
Indications 26
Position 26
Hazards 27
Incision 27
Superficial Dissection 28
Deep Dissection 28
Indications 29
Position 30
Hazards 30
Incision 30
Superficial Dissection 30
Deep Dissection 30
Dorsolateral Approach 30
Indications 30
Position 31
Hazard 31
Incision 31
Superficial Dissection 31
Deep Dissection 31
First Metatarsophalangeal Joint Approach 31
Indications 31
Position 32
Harzards 32
Incision 32
Superficial Dissection 32
Deep Dissection 32
Dorsal Intermetatarsal Space 33
Indications 33
Position 33
Harzards 33
Incision 34
Superficial Dissection 34
Deep Dissection 34
References 37
2: Biomechanical Principles of Foot and Ankle 38
Introduction 38
Kinematics 39
Kinetics 39
Gait 39
Component Biomechanics 41
Ankle Joint 41
The Subtalar Joint 41
Transverse Tarsal Articulation 43
Metatarsophalangeal Break 43
Plantar Aponeurosis – Windlass Mechanism 43
Biomechanics of Running 44
Surgical Biomechanics 44
Biomechanics of Ankle Osteoarthritis 44
Biomechanics of Total Ankle Replacement 44
Biomechanics of Ankle Fusion 45
Biomechanics of Subtalar Joint Fusion 45
Biomechanics of Fusion of the Chopart Joint 45
Biomechanics of Forefoot Corrections 45
Tendon Transfers 46
Ankle Ligaments 46
Summary 46
References 46
3: Overview and Epidemiology of Foot and Ankle Problems in Sports 48
Introduction 48
Epidemiology 48
Etiologic Factors 49
Biomechanical Abnormalities 49
Footwear 50
Sports-Related Injuries to the Foot and Ankle 50
Acute Injuries 50
Overuse Injuries 50
Initial Evaluation of the Injured Athlete 51
References 51
4: Clinical Examination 52
Introduction 52
Inspection 52
Gait Observation 54
Range of Motion 54
Ankle ROM 54
Subtalar ROM 54
First Metatarsal-Phalangeal Joint ROM 54
Palpation 54
Neurovascular Exam 54
Specialized Tests of the Ankle 55
Ankle Instability 55
Ankle Impingement 55
Achilles Tendon Rupture 55
Achilles Tendinopathy 56
Achilles Tendon Contracture Verses Gastrocnemius Contracture 56
Peroneal Tendonitis and Subluxation 56
Specialized Tests of the Foot 58
Stress Fractures 58
Morton’s Neuroma 60
Posterior Tibialis Tendon Dysfunction 60
Tarsal Tunnel Syndrome 60
Turf Toe/Plantar Plate Injury 60
Evidence 60
Summary 61
References 61
5: Sports Medicine of the Foot & Ankle, the Role of Imaging
Introduction & Techniques
Osseous Abnormalities 63
Stress Fractures 63
Sesamoid Pathology 64
Osteochondral Injuries 65
Fracture Healing 65
Painful Bone Marrow Edema 67
Soft Tissue Abnormalities 68
Tendon Tears 68
Ankle Ligament Injuries 68
Lisfranc Injuries 68
Plantar Plate & Turf Toe Injuries
Plantar Fascia 71
References 72
6: Biomechanical Functional Imaging 75
Introduction 75
Problem-Oriented Analysis of Movement 76
Gait-, Run- and Treadmill Analysis 76
Kinematic Motion Analysis 77
Important Analysis Parameters 78
Kinetic Motion Analysis 79
Dynamometry 79
Pedography 79
Important Analysis Parameters 80
Electromyography 83
Important Analysis Parameters 83
Summary and Take Home Massage 84
References 84
7: Arthroscopic Supplementation of Imaging Findings: Using Arthroscopy to Detect Abnormalities Missed on Imaging 86
Ankle Fractures and Arthroscopy 87
Ankle Instability and Arthroscopy 88
Osteochondral Lesion Evaluation 88
Subtalar Evaluation by Arthroscopy 89
Peroneal Pathology 89
Summary 90
References 90
8: Management of Injured Athletes at the Field 91
Challenges and Requirements of On-Field Management 91
Epidemiology 92
Preparation of Medical Coverage 92
Initial Assessment 93
Inspection 93
Palpation 93
Functional Examination 93
Initial Treatment 94
Judical Situation 96
Evidence 96
Summary 96
References 97
9: Sports and Osteoarthritis 98
Introduction 98
Epidemiology and the Influence of Sports on Osteoarthritis 99
Pathomechanism of Osteoarthritis 99
Muscles and Osteoarthritis 100
Sports as a Risk Factor of Osteoarthritis 101
Sports as Prevention and Treatment for Osteoarthritis 102
Level of Evidence 102
Summary 102
References 102
10: Sports in Children and Young Age 105
Introduction/Epidemiology 105
Injury Patterns in the Young Athlete 105
Acute Injuries 106
Ankle Sprains 106
Fractures 106
Distal Tibial Transitional Fractures 107
Two/Triplane Fracture 107
Tillaux Fracture 107
Osteochondritis Dissecans of the Talus 107
Metatarsal Fractures 109
Phalangeal Fractures 109
Overuse Injuries/Growth-Related Problems 109
Apophysitis of the Calcaneus (Sever’s Disease) 109
Stress Fractures 109
Tarsal Coalition 110
Prevention 110
Evidence 110
Summary 110
References 111
11: Sports in Seniors 112
Introduction 112
Musculoskeletal Changes in Geriatrics 112
Skeletal Muscle 112
Tendon and Ligaments 113
Bone Structure and Osteoporosis 113
Articular Cartilage 113
Physical Performance in the Elderly 113
Sports Related Musculoskeletal Injury in the Elderly 113
Acute Traumatic Injuries 113
Chronic Overuse Injuries 114
Osteoarthritis 114
Stress Fracture 114
Foot and Ankle Problems in Sport Active People 114
Achilles Tendon Problems 114
Posterior Tibial Tendon Dysfunction (PTTD) 114
Mortons Neuroma 114
Stress Fracture 114
Diagnosis and Treatment 115
Prevention 115
Evidence 115
Summary 115
References 115
12: Sports for Disabled and Handicapped People 117
Definition 117
Introduction 117
Sports for the Disabled: Its Role in Prevention 118
Paralympics 118
Types of Sports 118
Classification 118
Wheelchairs 118
Prosthetics 119
Sports Related Injuries in Disabled and Handicapped People 120
Overview 120
Lower Leg and Ankle Injuries 121
Sports for Disabled and Handicapped People Using the Example of Children with CP 121
Introduction 121
Types of Therapy 121
Sports 122
Evidence 122
Summary 122
References 123
13: Orthobiologics in Foot & Ankle
Introduction 124
Bone Orthobiologics 124
Bone Graft Properties 124
Allografts 125
Recombinant Growth Factors and Proteins 125
Cartilage Orthobiologics 125
Injections 125
Autograft & Allograft Techniques
Tendon & Ligament Orthobiologics
Platelet-Rich Plasma 127
Autograft & Allograft Techniques
Membranes 128
Summary 129
References 129
14: Rehabilitation, Back to Sports and Competition 131
Introduction 131
Eitiology and Pathomechanics 132
Management 132
Acute Stage 132
Sub-acute Stage 133
Rehabilitation Stage 136
Criteria to Progress to Rehabilitation Stage 136
Functional Stage 139
Criteria to Progress to Functional Stage (Phase 4) 139
Criteria to Return to Play 139
Rehabilitation Following Ankle Fracture 139
Prevention 147
Summary 147
References 148
Part II: Clinics, Lesions, and Diseases 149
15: Acute Fractures (Lower Leg, Ankle, Hindfoot, Midfoot, Forefoot) 150
Acute Fractures (Lower Leg, Ankle, Hindfoot, Midfoot, Forefoot) 150
Etiology and Pathomechanism 150
Symptoms 150
History 150
Clinical Investigation 150
Imaging 151
Lower Leg and Ankle Fractures 151
Classification 151
Therapy 151
Conservative Treatment 151
Surgery 151
Rehabilitation and Back-to-Sports 152
Evidence (Description of Highest Evidence with Mentioning the Level and Grade of Evidence) 153
Hindfoot Fractures 153
Calcaneal Fracture 153
Classification 153
Sanders Classification [15] 153
Essex Lopresti Classification 153
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, Aftertreatment) 153
Conservative Treatment 153
Surgery 154
Talar Fractures 154
Talar Neck Fractures 154
Classification 154
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, Aftertreatment) 154
Chopart Joint Dislocation Fractures 154
Classification 154
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, Aftertreatment) 154
Conservative Treatment 154
Surgery 154
Rehabilitation and Back-to-Sports After Hindfoot Fractures 155
Prevention 155
Evidence (Description of Highest Evidence with Mentioning the Level and Grade of Evidence) 155
Lisfranc Joint Dislocation 155
Classification 155
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, Aftertreatment) 155
Conservative Treatment 155
Surgery 155
Fifth Metatarsal Base Fractures 155
Avulsions Fracture 155
Jones Fracture 155
Classification 155
Dameron-Quill Classification 155
Torg Classification for Fractures Distal to the Tuberosity 156
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, Aftertreatment) 156
Avulsions Fracture 156
Jones Fracture 156
Rehabilitation and Back-to-Sports 156
Forefoot Fractures 156
Classification 156
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, Aftertreatment) 156
Conservative Treatment 156
Surgery 156
Evidence 156
Summary 157
References 157
16: Acute Ankle Osteochondral and Chondral Lesions 159
Introduction 159
Etiology and Pathomechanism 159
Symptoms 160
Diagnostics, Classification 160
Therapy: Conservative Treatment and Surgery 160
General Considerations 160
Debridement Followed by Bone Marrow Stimulation, Fixation 161
Augmented Bone Marrow Stimulation 161
Rehabilitation and Back-to-Sports 161
Prevention 161
Evidence 161
Summary 161
References 162
17: Stress Fractures of the Foot and Ankle 163
Etiology and Pathomechanism 163
Symptoms 164
Diagnostics, Classification 164
Treatment 165
Prevention 165
Calcaneal Stress Fracture 166
Metatarsal Stress Fractures 166
Ballet 167
Navicular Stress Fractures 167
Sesamoid Stress Fractures 168
Fibular Stress Fracture 169
Summary 170
References 170
18: Compartment Syndromes (Acute & Chronic)
Introduction 172
Etiology and Pathomechanism 173
Anatomy 173
Pathomechanism 173
Symptoms 174
Diagnostics, Classification 174
Imaging and Other Diagnostic Studies 174
Differential Diagnosis 175
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, After Treatment) 175
Non-operative Management 175
Surgical Management 176
Preoperative Planning 176
Positioning 176
Approach 176
Techniques 176
Single-Incision Lateral Approach for Anterior and Lateral Compartment Fasciotomy 176
Dual-Incision Lateral Approach for Anterior and Lateral Compartment Fasciotomy 176
Perifibular Approach for Four-Compartment Fasciotomy 176
Posteromedial Incision for Fasciotomy of the Posterior Compartments 177
Endoscopically-Assisted Compartment Release 177
Three Incision Approach of the Foot 177
The Single Incision Medial Approach 178
Risks 178
Post-operative Care 178
Complications 178
Rehabilitation and Back-to-Sports 178
Prevention 179
Evidence 179
Summary 179
References 179
19: Shin Splints 182
Introduction 182
Etiology and Pathomechanism 182
Symptoms 183
Diagnostics, Classification 183
Classification 183
Therapy 185
Conservative Treatment 185
Rest 185
Ice Fomentation 186
Physiotherapy 186
Exercises 186
Orthotics 186
Fascial Distortion 186
Others 186
Surgical Treatment 186
Rehabilitation and Back-to-Sports 186
Prevention 186
Evidence 187
Summary 187
References 187
20: Achilles Tendon 188
Etiology and Pathomechanism 189
Achilles Tendinopathy 189
Achilles Tendon Rupture 190
Symptoms 190
Achilles Tendinopathy and Paratenonitis 190
Partial and Complete Achilles Tendon Rupture 190
Diagnostics 190
Achilles Tendinopathy and Paratenonitis 191
Achilles Tendon Rupture 191
Therapy 192
Mid-portion Achilles Tendinopathy 192
Insertional Achilles Tendinopathy 193
Paratenonitis 193
Achilles Tendon Rupture 194
Surgical Treatment 194
Conservative Treatment 195
Rehabilitation and Back-to-Sports 195
Achilles Tendonitopathy 195
Achilles Tendon Ruptures 196
Prevention 196
Evidence 196
Summary 197
References 197
21: Plantar Fasciitis in Sport 201
Introduction 201
Incidence 201
Etiology and Pathomechanism 202
Symptoms 202
Classification 202
Diagnostics 202
Therapy 203
Surgical Treatment 205
Rehabilitation and Back-to-Sports 205
Prevention 205
Evidence 206
Summary 206
References 206
22: Exostosis (Osteochondrosis, Apophysites, and Haglund’s Deformity) 208
Osteochondroses 208
Freiberg’s Infraction 209
Kohler’s Disease 210
Osteochondrosis of the Sesamoids 210
Apophysites 211
Sever’s Disease 211
Iselin’s Disease 211
Haglund’s Deformity 211
References 216
23: Posterior Tibial Tendon Lesions and Insufficiency 218
Acute PTT Injuries 218
Introduction 218
Incidence 218
Aetiology and Pathomechanism 218
Symptoms 219
Diagnostics 219
Therapy 219
Chronic PTT Insufficiency 220
Introduction 220
Incidence 220
Aetiology and Pathomechanism 220
Symptoms 221
Classification 221
Diagnostics 221
Therapy 222
Surgical Treatment 223
Rehabilitation and Back-to-Sports 226
Prevention 227
Evidence 227
Summary 227
References 227
24: Peroneal Tendons 229
Anatomy and Functional Aspects 229
Peroneal Tendinitis and Tendinopathy 230
Etiology and Pathomechanism 230
Therapy of the Tendinopathy 231
Treatment of Painful Os Peroneum Syndrome (POPS) 231
Peroneal Tendon Tears 231
Peroneus Brevis Tears 232
Peroneus Longus Tears 232
Therapy 233
Subluxation/Dislocations 234
Etiology and Pathomechanism 234
Symptoms 234
Provocation Tests 234
Imaging 234
Classification 235
Therapy 235
Postop, Rehab. and Back to Sports 235
Evidence 236
Summary 236
References 236
25: Anterior Tibial Tendon Lesion 237
Anatomy 237
Etiology and Pathomechanism 237
Symptoms 238
Diagnostics 238
Therapy 238
Conservative Treatment 238
Surgery 238
Authors’ Preferred Surgical Technique 239
Rehabilitation and Back to Sports 240
Evidence 240
Summary 240
References 240
26: Flexor Hallucis Longus Tendon 241
Introduction 241
Anatomy 241
Biomechanics and Function 242
Types of Pathology 242
History and Physical Examination 242
Imaging 242
Management 243
Nonoperative 243
Operative 243
Rehabilitation 243
Prevention 244
Summary 244
References 244
27: Acute Ankle Instability/Ankle Sprains in Athletes 246
Introduction 246
Etiology and Pathomechanism 246
Symptoms and Diagnosis 247
Classification 248
Therapy 249
Non-operative Management 249
Surgical Management 249
Preoperative Planning 249
Positioning 249
Approach 249
Techniques 249
Modified Brostrom Lateral Ligament Repair 249
Modified Brostrom Lateral Ligament Repair with Suture Anchors 250
Modified Brostrom-Evans Procedure 250
The Role of Ankle Arthroscopy in Acute Ankle Instability 250
Post-operative Care 251
Risks/Complications 251
Rehabilitation and Back-to-Sports 251
Rehabilitation 251
Return to Sport 251
Prevention 251
Outcomes (Evidence) 251
Summary 252
References 252
28: Chronic Ankle Instability 254
Introduction 254
Etiology and Pathomechanism 255
Diagnostics, Classification and Graduation 255
Therapy: Conservative Treatment and Surgery 256
Operative Treatment 257
Rehabilitation and Back-to-Sports 258
Evidence 259
Summary 259
References 259
29: Acute Syndesmotic Injuries 261
Introduction 261
Etiology and Pathomechanism 262
History and Physical Examination 262
Imaging 263
Classification 264
Conservative Treatment 264
Operative Treatment 265
Reduction Technique 265
Radiographic Assessment of Syndesmotic Reduction 265
Diagnostic Arthroscopy 265
Treatment of Acute Injuries 266
Screw Fixation 267
Dynamic Suture-Button Fixation 268
Screw Removal 270
Rehabilitation and Back-to-Sports 270
Evidence 270
Summary 270
References 270
30: Acute and Chronic Subtalar, Chopart- and Lisfranc Instability 274
Subtalar Instabiliy 274
Etiology and Pathomechanism 274
Symptoms 275
Diagnosis 275
Conservative Treatment 276
Surgery 277
Rehabilitation and Back-to-Sports 277
Prevention 277
Evidence 277
Summary 277
Chopart Instabiliy 278
Etiology and Pathomechanism 278
Symptoms 278
Diagnosis 279
Classification 279
Conservative Treatment 279
Surgery 279
Rehabilitation and Back-to-Sports 279
Prevention 279
Evidence 280
Summary 280
Lisfranc Instability 280
Etiology and Pathomechanism 280
Symptoms 280
Diagnosis 280
Classification 281
Conservative Treatment 281
Surgery 281
Rehabilitation and Back-to-Sports 281
Prevention 283
Evidence 283
Summary 283
References 283
31: Chronic Ankle Osteochondral and Chondral Lesions 285
Introduction 285
Etiology and Pathomechanism 285
Symptoms 286
Diagnostics, Classification 286
Therapy: Conservative Treatment and Surgery 286
Conservative Treatment 286
Surgery 286
General Considerations 286
Debridement Followed by Bone Marrow Stimulation 287
Autologous Bone Grafting 287
Autologous Matrix-Induced Chondrogenesis (AMIC) 287
ACI/MACI 288
Autologous Osteochondral Transplantation (AOT) 288
Allograft Transplantation 288
Novel Techniques 288
Supplemental Procedures 288
Rehabilitation and Back-to-Sports 289
Prevention 289
Evidence 289
Summary 289
References 290
32: Anterior and Posterior Ankle Impingement 293
Introduction 293
Etiology and Pathophysiology 293
Anterior Ankle Impingement 293
Posterior Ankle Impingement 295
Specific Aspects of Posterior Ankle Impingement 295
Epidemiology 297
Rehabilitation and Back to Sports 297
Nonoperative Treatment 297
Operative Treatment 297
Anterior Impingement 297
Posterior Impingement 297
Evidence 298
Summary 299
References 299
33: Ankle Osteoarthritis 301
Etiology of Ankle Osteoarthritis 301
Sport as Risk Factor for the Development of Ankle Osteoarthritis 302
Ankle Instability as Risk Factor for the Development of Ankle Osteoarthritis 303
Treatment Options for Ankle Osteoarthritis 304
Corrective Osteotomies 304
Conclusion 307
Total Ankle Replacement 307
Conclusion 310
Ankle Arthrodesis 310
Conclusion 312
Sports Activities in Patients Treated for Ankle Osteoarthritis 312
Evidence 316
Summary 316
References 317
34: Subtalar, Chopart, and Lisfranc Joint Degeneration 323
Section I: Subtalar Joint DJD 323
Etiology and Pathomechanism 323
Symptoms 324
Diagnostics 325
Classification 325
Therapy 325
Nonoperative Treatment 325
Operative Treatment 325
Approach 325
Preparation of the Arthrodesis Site 326
Supplemental Adjuncts 326
Position of Arthrodesis 326
Fixation 326
Postoperative Care 326
Rehabilitation and Back-to-Sports 326
Prevention 326
Summary 326
Section II: Chopart Joint DJD 327
Anatomy 327
Etiology and Pathomechanism 327
Symptoms 327
Diagnostics 327
Classification 327
Therapy 327
Nonoperative Treatment 327
Operative Treatment 328
Approach 328
Position of Arthrodesis 329
Fixation 329
Rehabilitation and Back-to-Sports 329
Prevention 329
Summary 329
Section III: Lisfranc DJD 329
Anatomy 329
Etiology and Pathomechanism 329
Symptoms 331
Diagnostics 331
Classification 331
Therapy 332
Nonoperative Treatment 332
Operative Treatment 332
Approach 332
Position of Arthrodesis 332
Medial and Middle Column Arthrodesis 332
Lateral Column Arthrodesis 333
Rehabilitation and Back-to-Sports 333
Prevention 333
Summary 333
References 333
35: Coalition and Sports 335
Etiology and Pathomechanism 335
Symptoms 335
Diagnostics, Classification 336
Therapy 337
Rehabilitation and Back-to-Sports 339
Prevention 339
Evidence 339
Summary 339
References 339
36: Hallux Valgus and Hallux Rigidus in Sports 341
Etiology and Pathomechanism 341
Hallux Valgus 342
Etiology 342
Sports 342
Pathomechanism 342
Hallux Rigidus 342
Etiology 342
Sports 342
Pathomechanism 342
Symptoms 343
Hallux Valgus 343
Hallux Rigidus 343
Diagnostics, Classification 343
Hallux Valgus 343
Hallux Rigidus 343
Therapy: Conservative Treatment and Surgery 344
Hallux Valgus 344
Conservative Treatment 344
Surgical Treatment 344
Hallux Rigidus 345
Conservative Treatment 345
Surgical Treatment 345
Minimally Invasive Surgery 347
Rehabilitation and Back-to-Sports 347
Prevention 347
Evidence 348
Summary: 5 Take-Home Lessons 348
References 348
37: Sesamoid and Capsule Lesions of the First Metatarsophalangeal Joint 349
Introduction 349
Anatomy 350
Etiology 350
Work-Up 351
Classification 352
Non-operative Treatment 352
Surgical Treatment 353
Rehabilitation 357
Evidence 357
Summary 357
References 358
38: Metatarsophalangeal Problems II-V 359
Introduction 359
Etiology and Pathomechanism 359
Symptoms 360
Diagnostics, Classification 360
Therapy 361
Rehabilitation and Back-to-Sport 363
Prevention 363
Evidence 363
Summary 364
References 364
39: Forefoot Sports Injuries 365
Traumatic Hallux Valgus 365
Etiology and Pathomechanism 365
Symptoms 365
Diagnostics and Classification 365
Therapy 366
Rehabilitation and Back to Sports 366
Prevention 366
Evidence 366
Turf toe 366
Etiology and Pathomechanism 366
Symptoms 366
Diagnostics, Classification 366
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, After Treatment) 366
Rehabilitation and Back-to-Sports 367
Prevention 367
Evidence 367
Metatarsal Stress Fracture 367
Etiology and Pathomechanism 367
Symptoms 367
Diagnostics 367
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, Aftertreatment) 367
Rehabilitation and Back-to-Sports 367
Prevention 367
Sesamoid Disorders 368
Etiology and Pathomechanism 368
Symptoms 368
Diagnostics 368
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, Aftertreatment) 368
Rehabilitation and Back-to-Sports 368
References 368
40: Tarsal Tunnel Syndrome in Sport 370
Introduction 370
Anatomy 370
Aetiology 371
Symptoms and Presentation 372
Diagnosis 373
Treatment 374
Rehabilitation and Back-to-Sports 374
Summary 375
References 375
41: Nerve Entrapments 376
Morton’s Neuroma 377
Etiology and Pathomechanism 377
Diagnostics, Classification 377
Symptoms 377
Therapy: Conservative Treatment and Surgery 377
Rehabilitation and Back-to-Sports 378
Prevention 378
Tarsal Tunnel Syndrome 378
Etiology and Pathomechanism 378
Symptoms 378
Diagnostics, Classification 378
Therapy: Conservative Treatment and Surgery 379
Rehabilitation and Back-to-Sports 379
Prevention 379
Deep Peroneal Nerve (Anterior Tarsal Tunnel) 379
Etiology and Pathomechanism 379
Symptoms 379
Diagnostics, Classification 379
Therapy: Conservative Treatment and Surgery 379
Rehabilitation and Back-to-Sports 380
Prevention 380
Medial Plantar Nerve 380
Etiology and Pathomechanism 380
Symptoms 380
Diagnostics, Classification 380
Therapy: Conservative Treatment and Surgery 380
Rehabilitation and Back-to-Sports 380
Prevention 380
First Branch of the Lateral Plantar Nerve (Baxter’s Nerve) 380
Etiology and Pathomechanism 380
Symptoms 380
Diagnostics, Classification 381
Therapy: Conservative Treatment and Surgery (Approach, Technique, Risks, Aftertreatment) 381
Rehabilitation and Back-to-Sports 381
Prevention 381
Superficial Peroneal Nerve 381
Etiology and Pathomechanism 381
Symptoms 381
Diagnostics, Classification 381
Therapy: Conservative Treatment and Surgery 381
Rehabilitation and Back-to-Sports 382
Prevention 382
Summary 382
References 382
42: Morton’s Neuroma in Sports 384
Introduction 384
Incidence 385
Aetiology and Pathomechanism 385
Symptoms and Signs 385
Classification 385
Diagnostics 385
Therapy 386
Rehabilitation and Back-to-Sports 387
Prevention 387
Evidence 387
Summary 387
References 388
43: Soft Tissue Management in the Foot and Ankle 389
Introduction 389
Etiology and Pathomechanism 389
Diagnostics, Classification 389
Principles of Reconstruction 390
General Principles 390
Timing of Reconstruction 390
Surgical Debridement 390
Fracture and Vessel Management 390
Wound Conditioning 390
Subunit Reconstruction 390
Single Subunit Reconstruction 390
Multiple Subunit Reconstruction 390
Principles of Subunit Reconstruction 391
Pressure Zones of the Foot 391
Reconstructive Options and Evaluation 391
Treatment Algorithm 392
Regional Propeller Flaps 392
Special Considerations Regarding the Reconstruction of Specific Subunits 392
Ankle Reconstruction 392
Achilles Tendon Reconstruction 392
Ankle Reconstruction – Composite Defects 392
Osteo-cutaneous Composite Flaps 394
Composite Ankle Reconstruction 394
Reconstruction of the Dorsum of the Foot 394
Sole Reconstruction 394
Rehabilitation and Back-to-Sports 395
Evidence­ 395
Summary 395
References 395
Part III: Sports Specific Injuries 396
44: Aerobic and Fitness Sports 397
Injuries 397
Achilles Tendinitis 397
Shin Splints and Stress Fracture 397
Ankle Sprain 397
Plantar Fasciitis and Heel Spurs 398
Forefoot Injuries (Metatarsalgia, Sesamoiditis and Lesser Toe Deformities) 398
Etiology and Pathomechanism 398
Achilles Tendinitis 398
Stress Fractures and Shin Splints 398
Ankle Sprain 398
Plantar Fasciitis and Heel Spurs 398
Forefoot Injuries (Metatarsalgia, Sesamoiditis and Lesser Toe Deformities) 398
Epidemiology 399
Therapy (On the Field, Conservative and Surgical) 400
Achilles Tendinitis 400
Stress Fractures and Shin Splints 400
Ankle Sprain 400
Plantar Fasciitis and Heel Spurs 400
Forefoot Injuries (Metatarsalgia, Sesamoiditis and Lesser Toe Deformities) 400
Rehabilitation and Back-to-Sports 400
Achilles Tendinitis 400
Stress Fractures and Shin Splints 401
Ankle Sprain 401
Plantar Fasciitis and Heel Spurs 401
Forefoot Injuries (Metatarsalgia, Sesamoiditis and Lesser Toe Injuries) 401
Prevention 401
Achilles Tendinitis 401
Stress Fractures and Shin Splints 401
Ankle Sprain 401
Plantar Fasciitis and Heel Spurs 401
Forefoot Injuries (Metatarsalgia, Sesamoiditis and Lesser Toe Injuries) 401
Evidence 402
Summary 402
References 402
45: American Football 403
Turf Toe 403
Etiology and Pathomechanism 403
Epidemiology 403
Therapy (On the Field, Conservative, Surgical) 404
Rehabilitation and Back-to-Sports 404
Prevention 404
Jones Fracture 404
Etiology and Pathomechanism 404
Epidemiology 404
Therapy (On the Field, Conservative, Surgical) 404
Rehabilitation and Back-to-Sports 404
Prevention 404
Lisfranc 404
Etiology and Pathomechanism 404
Epidemiology 406
Therapy (On the Field, Conservative, Surgical) 406
Rehabilitation and Back-to-Sports 406
Prevention 406
Achilles Tendon Rupture 406
Etiology and Pathomechanism 406
Epidemiology 406
Therapy (On the Field, Conservative, Surgical) 407
Rehabilitation and Back-to-Sports 407
Prevention 407
Syndesmotic Ankle Sprains 407
Etiology and Pathomechanism 407
Epidemiology 408
Therapy (On the Field, Conservative, Surgical) 408
Rehabilitation and Back-to-Sports 408
Prevention 409
References 409
46: Athletic Injuries 411
Athletic Injuries 411
Etiology and Pathomechanism 411
Epidemiology 412
Therapy (On the Field, Conservative, Surgical) 413
Rehabilitation and Back-to-Sports 413
Prevention 414
Evidence 414
Summary 414
References 414
47: Basketball 416
Introduction 416
Injuries 416
Lateral Ankle Sprain and Instability 417
Etiology and Pathomechanism 417
Epidemiology 417
Therapy (On the Field, Conservative, Surgical) 417
Rehabilitation and Back-to-Sports 418
Prevention 418
Jones Fractures 419
Etiology and Pathomechanism 419
Epidemiology 419
Therapy (On the Field, Conservative, Surgical) 419
Rehabilitation and Back-to-Sports 420
Prevention 420
Achilles Tendon Ruptures 420
Etiology and Pathomechanism 420
Epidemiology 420
Therapy (On the Field, Conservative, Surgical) 420
Rehabilitation and Back-to-Sports 421
Prevention 421
Osteochondral Lesions of the Talus (OLTs) 421
Etiology and Pathomechanism 421
Epidemiology 421
Therapy (On the Field, Conservative, Surgical) 422
Rehabilitation and Back-to-Sports 422
Prevention 422
Anterior Ankle Impingement 422
Etiology and Pathomechanism 422
Epidemiology 422
Therapy (On the Field, Conservative, Surgical) 423
Rehabilitation and Back-to-Sports 423
Prevention 423
Evidence 423
Summary 423
References 423
48: Rock Climbing 426
Injuries 426
Etiology and Pathomechanism 426
Epidemiology 426
Therapy 427
Acute Injuries 427
Chronic Injuries 427
Prevention 427
Evidence 428
Summary 428
References 428
49: Cycling 429
Introduction 429
Traumatic Injuries 430
Skin Lesions 430
Ankle Injuries 430
Overuse Injuries 431
Metatarsalgia and Plantar Neuropathy 431
Achilles Tendon Injuries 431
Ingrowing Nail 432
Rehabilitation and Back-to-Sports 432
Prevention 432
Evidence 432
Summary 432
References 433
50: Dance Injuries/Ballet 434
Introduction 434
Injuries 434
Ankle Sprain/Ankle Joint Instability 434
Anterior Ankle Impingement Syndrome 435
Posterior Impingement Syndrome 435
Achilles Tendinitis 435
Metatarsal Stress Fractures 436
Hallux Valgus 436
Osteoarthritis 436
Etiology and Pathomechanism 437
Epidemiology 437
Therapy (On the Field, Conservative, Surgical) 437
Prevention 437
Evidence (Description of Highest Evidence with Mentioning the Level and Grade of Evidence) 437
Summary 437
References 438
51: Equestrian Sports 439
Injuries 439
Etiology and Pathomechanism 440
Epidemiology 441
Therapy 442
Rehabilitation and Back-to-Sports 442
Prevention 442
Evidence 442
Summary 443
References 443
52: Football/Soccer 445
Introduction 445
Injuries 445
Ankle Sprains 445
Bruises and Contusions 446
Fractures 446
Chondral/Osteochondral Lesions 446
Tendon Lesions 447
Anterior Ankle Impingement 448
Etiology and Pathomechanism 448
Epidemiology 448
Therapy (On the Field, Conservative, Surgical) 449
Prevention 449
Evidence (Description of Highest Evidence with Mentioning the Level and Grade of Evidence) 449
Summary 449
References 449
53: Floorball 451
Introduction 451
Injuries 452
Etiology and Pathomechanism 452
Epidemiology 452
Therapy (on the Field, Conservative, Surgical) 452
Rehabilitation and Return-to-Sports 453
Prevention 453
Evidence 453
Summary 453
References 453
54: Golf 455
Introduction 455
Injuries 455
Etiology and Pathomechanism 455
Epidemiology 456
Therapy 456
Rehabilitation and Back-to-Sports 456
Prevention 456
Evidence 457
Summary 457
References 457
55: Gymnastics 458
Introduction 458
Injuries 458
Etiology and Pathomechanism 459
Epidemiology 459
Therapy 459
Rehabilitation and Back to Sports 459
Sample Skill Progression 461
Prevention 462
Summary 462
References 462
56: Handball 463
Injuries 463
Etiology and Pathomechanism 463
Epidemiology 464
Therapy 464
Rehabilitation and Back-to-Sports 465
Prevention 465
Case Report: Handball Player with Chronic Lateral Ankle Instability 465
Summary 466
References 466
57: Hiking, Mountaineering, Canyoning 468
Etiology, Risk Factors and Pathomechanisms 468
Epidemiology 468
Acute Pathologies 468
Blisters 468
Sprains 469
Frostbites 469
Chronic Pathologies 470
Stress Fractures 470
Achillodynia and Plantar Fasciitis 470
Paraesthesia 471
Prevention 471
Rehabilitation and Return to Sports 471
Level of Evidence 471
Summary 471
References 471
58: Ice Hockey 473
Injuries 473
Ankle Sprains/Syndesmosis 473
Bruises/Fractures 474
Injury to the Tendons, Vessels and Nerves 475
Skin 475
Etiology and Pathomechanism 475
Epidemiology 475
Therapy (on the Field, Conservative, Surgical) 475
Rehabilitation and Back-to-Sports 476
Prevention 476
Evidence 476
Summary 476
References 476
59: In-Line and Roller Skating 478
Injuries 478
Etiology and Pathomechanism 478
Roller Skating 478
In-Line Skating 479
Heelys and Street Gliders 479
Therapy 479
Rehabilitation and Back to Sports 479
Prevention 480
Evidence 480
Summary 480
References 480
60: Martial Arts 481
Introduction 481
Injury Patterns, Etiology and Pathomechanism 481
Epidemiology 482
Prevention 482
Therapy 483
Rehabilitation and Back-to-Sports 483
Evidence 483
Summary 483
References 483
61: Motorsports 484
Injuries in Motorsports 484
Etiology and Pathomechanism 484
Epidemiology 485
Therapy 485
Rehabilitation and Back-to-Sports 485
Prevention 485
Clinical Case 487
Evidence 487
Summary 487
References 487
62: Orienteering 488
Introduction 488
Injuries: Etiology and Pathomechanism 488
Acute and Chronic Ankle Instability 489
Epidemiology 489
Therapy 489
Prevention 489
Evidence 490
Summary 490
References 490
63: Rugby 491
Ankle Injuries 491
Lateral Ligamentous Injuries 492
Ankle Syndesmotic Injuries 493
Achilles Tendon Injuries 494
Chronic Achilles Tendinopathy 495
Medial Ankle Ligament Injuries 495
Lisfranc Injuries 496
Foot and Ankle Fractures 496
References 496
64: Running 498
Bony Injuries: Stress Fractures 498
Epidemiology 498
Etiology and Pathomechanism 498
Therapy (On the Field, Conservative, Surgical) 499
Rehabilitation and Back-to-Sports 499
Prevention 499
Bony Injuries: Sesamoid Injury 499
Epidemiology 499
Etiology and Pathomechanism 499
Therapy (On the Field, Conservative, Surgical) 499
Rehabilitation and Back-to-Sports 500
Prevention 500
Bony Injuries: Accessory Navicular 500
Epidemiology 500
Etiology and Pathomechanism 500
Therapy (On the Field, Conservative, Surgical) 500
Rehabilitation and Back-to-Sports 500
Prevention 500
Bony Injuries: Os Trigonum Syndrome 500
Epidemiology 500
Etiology and Pathomechanism 500
Therapy (On the Field, Conservative, Surgical) 501
Rehabilitation and Back-to-Sports 501
Prevention 501
Soft Tissue Injury: Ankle Sprains 501
Epidemiology 501
Etiology and Pathomechanism 501
Therapy (On the Field, Conservative, Surgical) 501
Rehabilitation and Back-to-Sports 501
Prevention 502
Soft Tissue Injury: Achilles Tendinopathy 502
Epidemiology 502
Etiology and Pathomechanism 502
Therapy (On the Field, Conservative, Surgical) 502
Rehabilitation and Back-to-Sports 502
Soft tissue Injury: Plantar Fasciitis 502
Epidemiology 502
Etiology and Pathomechanism 502
Therapy (On the Field, Conservative, Surgical) 502
Rehabilitation and Back-to-Sports 503
Prevention 503
Summary 503
References 503
65: Alpine Sports 504
Alpine Skiing 504
Etiology and Pathomechanism 504
Injuries 504
Head and Spine 504
Upper Extremity 504
Shoulder 505
Elbow, Wrist and Hand 505
Lower Extremity 505
Injuries of the knee 505
Lower Leg and Ankle 505
Small Breaches 505
Heel Injuries 505
Distal Fibula Fractures 505
Tibial Pilon Fractures 505
Others 506
Epidemiology 506
Competitive Alpine Skiing 506
Recreational Alpine Skiing 506
Therapy (On the Field, Conservative, Surgical) 506
Rehabilitation and Back-to-Sports 506
Prevention 507
Summary 507
Snowboarding 507
Etiology, Pathomechanism and Therapy 507
Fracture of the Processus Lateralis Tali 507
Peroneal Tendon Injuries 507
Fractures of the Foot 507
Epidemiology 507
Therapy and Rehabilitation 508
Cross-Country Skiing 508
Injuries 508
Etiology and Pathomechanism 508
Epidemiology 508
Focus: Lower Leg and Ankle 508
Therapy 509
Rehabilitation and Back-to-Sports 509
Prevention 509
Summary 509
References 509
66: Surfing: Board, Wind, Kite 511
Introduction 511
Injuries 511
Etiology and Pathomechanism 511
Epidemiology 512
Kitesurf 512
Windsurf 512
Surf 512
Therapy 513
Rehabilitation and Back-to-Sports 514
Prevention 514
Evidence 514
Summary 514
References 514
67: Swimming/Aquatics 515
Injuries 515
Etiology and Pathomechanism 515
Epidemiology 516
Therapy 516
Rehabilitation and Back-to-Sports 516
Prevention 516
Evidence 516
Summary 516
References 516
68: Snowboarding 517
Introduction 518
Snowboardbindings: Softbinding, Slip-in, Step-in and Plate Bindings 518
Epidemiology of Ankle Injuries 519
“Snowboarder’s Ankle”/Fracture of the Lateral Process of the Talus 520
Generally Classification + Epidemiology and Location of Talus Fractures 521
Clinical Signs 521
Diagnosis, Imaging Procedures 521
Important 521
Evidence 523
Summary 523
References 523
69: Tennis and Racquet Sports 524
Introduction 524
Injuries 525
Etiology and Pathomechanisms 525
Epidemiology 525
Therapy 526
Rehabilitation and Prevention 526
Summary 527
References 527
70: Volleyball 528
Injuries 528
Acute Injuries 528
Stress-Injuries 528
Etiology and Pathomechanism 528
Epidemiology 529
Therapy (On Field, Conservative, Surgical) 529
Acute Injuries 529
Overuse Injuries 529
Rehabilitation and Return to Sports 530
Prevention 530
Evidence 530
Summary 530
References 531
71: Water Sports 532
Water Skiing 532
Ankle Sprains 532
Lateral Process of the Talus Fractures (Snowboarder’s Fracture) 532
Calcaneal Tendon Ruptures 533
Ankle Fractures 533
Rafting 533
Canoeing and Kayaking 533
Sailing 533
Rowing, Snorkeling and Diving 534
Evidence 534
Summary 534
References 534
Index 535