Crush Injury Rt foot presentation .pdf.pdf

Crush injury of the right foot
MSK clinical assignment
EDPT451

1. OF THE RIGH FOOT
Crush Injury
Presented by: Mafaz Mohamad Alotaiq
Supervisor: Dr. Sahar Hassan
MSK (EDPT451)

2. “Movement is a medicine for
creating change in a person’s
physical, emotional, and
mental states.”
– Carol Welch
Carol Welch’s quote emphasizes the transformative power of movement. Physiotherapy often includes exercises
that can improve physical function, reduce pain, and enhance overall emotional and mental well-being.

3. Introduction
Definitions
Anatomy of the Foot
Causes and Mechanisms
Classification
Pathophysiology
Effects on the Tissues
Symptoms
Complications
Case Study
Treatment and Management
OBJCTIVES

4. A foot crush injury is a severe type of broken foot condition. In this injury, the foot is compressed between two hard
surfaces, resulting in a “crushing” of bones, soft tissue, and nerves.
This often occurs in transportation or occupational accidents, such as if a heavy object falls on the foot, if the foot
is run over by heavy machinery, or if the individual is in a car accident.
Foot crush injuries are often more extensive than typical foot breaks. These injuries are typically very severe,
including several broken bones and soft tissue damage.
As a result, treating a foot crush injury can be exceptionally difficult, often involving podiatrists, orthopedic
surgeons, and physical therapists. While minor crush injuries, such as those that do not involve bone fractures, can
heal on their own. This condition responds well to quick treatment.
INTRODUCTION

5. INTRODUCTION
A crush injury of the right foot occurs when a significant force is applied to the foot, leading to damage of the soft tissues, bones, and nerves.
Such injuries can result from various incidents, including accidents involving heavy objects, falls, or industrial mishaps. The severity of a crush
injury can vary widely, ranging from minor contusions to complex fractures and compartment syndrome, potentially requiring surgical
intervention.
The foot is a complex structure composed of 26 bones, 33 joints, and numerous muscles, tendons, and ligaments. It serves several critical
functions, including:
1. Weight Bearing: The foot supports the body's weight during standing, walking, and running, providing stability and balance.
2. Shock Absorption: The arches of the foot help absorb impact forces during movement, protecting the skeletal system and reducing stress on
the joints.
3. Mobility and Locomotion: The foot facilitates various movements, including walking, jumping, and running, allowing for efficient locomotion.
4. Proprioception: The foot contains numerous sensory receptors that provide feedback about body position and movement, contributing to
balance and coordination.
5. Adaptation to Surfaces: The foot's flexible structure enables it to adapt to different terrains, enhancing stability and reducing the risk of
injury.
Understanding the functions of the foot is crucial for assessing the impact of a crush injury and determining appropriate treatment and
rehabilitation strategies.

6. DEFINITIONS
A serious condition resulting
from the breakdown of
muscle tissue that releases
harmful substances into the
bloodstream, which can lead
to kidney damage.
Rhabdomyolysis
A type of injury that occurs
when a body part is
subjected to extreme
pressure or force, often
resulting in damage to
muscles, nerves, and blood
vessels.
Crush Injury
A condition that arises when
pressure within a muscle
compartment increases to
dangerous levels, leading to
reduced blood flow and
potential tissue damage.
Compartment
Syndrome
Damage to muscles,
ligaments, tendons, and
other connective tissues,
which may occur in
conjunction with crush
injuries.
Soft Tissue Injury
A break in the bone that may
occur as a result of a crush
injury, often categorized as
either open (compound) or
closed (simple).
Fracture

7. ANATOMY OF THE FOOT
Bones
The human foot is a highly developed, biomechanically
complex structure that serves to bear the weight of the body
as well as forces many times the weight of the human body
during propulsion.
About 26 bones in the human foot provide structural support.
They can be grouped into 3 parts, as follows:
The tarsal bones (7)
The metatarsal bones (5)
The phalanges (14)
Apart from these main bones, the sesamoid bones help
improve function and are often found as variants of the
accessory bones.
The foot itself can be divided into 3 parts: the hindfoot, the
midfoot, and the forefoot. The hindfoot is composed of 2 of
the 7 tarsal bones, the talus, and the calcaneus; the midfoot
contains the rest of the tarsal bones; and the forefoot
contains the metatarsals and the phalanges.

8. ANATOMY OF THE FOOT
Muscles
All intrinsic muscles of the foot originate and insert within it.
They have two main actions. The first is to stabilise the foot and support
the arches to maintain foot structure. The second is to aid the actions of
the muscles of the lower leg to produce fine movements of the toes.
The intrinsic foot muscles include:
Abductor hallucis (ABH)
Flexor digitorum brevis (FDB)
Quadratus plantae (QP)
Abductor digiti minimi (ABDM)
Flexor hallucis brevis (FHB)
Adductor hallucis (ADDH)
Lumbricals (LUMB)
Dorsal interossei (D-INT)
Plantar interossei (P-INT)
Flexor digiti minimi (FDM)
Extensor digitorum brevis (EDB)
Extensor hallucis brevis (EHB)

9. ANATOMY OF THE FOOT
Tendons
1. Tibialis Anterior Tendon
- Location: Front of the ankle, inserts into the medial foot.
- Function: Dorsiflexes and inverts the foot.
2. Extensor Hallucis Longus Tendon
- Location: Front of the ankle to the big toe.
- Function: Extends the big toe, assists in dorsiflexion.
3. Extensor Digitorum Longus Tendon
- Location: Front of the ankle, splits to lesser toes.
- Function: Extends the toes, assists in dorsiflexion.
4. Peroneus Longus Tendon
- Location: Lateral side of the leg, wraps around the lateral
malleolus.
- Function: Everts and plantarflexes the foot.
5. Peroneus Brevis Tendon
- Location: Beneath peroneus longus on the lateral side.
- Function: Everts the foot, assists in plantarflexion.
6. Tibialis Posterior Tendon
- Location: Back of the leg, behind the medial malleolus.
- Function: Inverts the foot, supports the arch.
7. Flexor Hallucis Longus Tendon
- Location: Back of the leg into the big toe.
- Function: Flexes the big toe, assists in plantarflexion.
8. Flexor Digitorum Longus Tendon
- Location: Back of the leg, divides into four for lesser toes.
- Function: Flexes the lesser toes.
9. Achilles Tendon
- Location: Connects calf muscles to the heel bone.
- Function: Enables plantarflexion, vital for walking and running.

10. CAUSES
Events such as
earthquakes or landslides
can cause buildings or
debris to collapse,
leading to crush injuries.
Natural
Disasters
In workplaces like
construction sites,
workers may be injured
by falling objects, heavy
machinery, or equipment
malfunctions.
Industrial
Accidents
Motor vehicle collisions
can lead to crush injuries,
especially when a person
is pinned between
vehicles or against a
structure.
Traffic
Accidents
In contact sports, players
may sustain crush injuries
from tackles or being hit
by heavy equipment.
Sport Injuries
Blast injuries can result in
crush injuries when
structures collapse or
debris falls on individuals.
Explosions

11. MECHANISMS
As pressure builds,
tissues can be stretched
beyond their limits,
resulting in tears in
muscles, ligaments, and
tendons.
Tension and
Stretching
The primary mechanism,
where an object exerts
pressure directly on the
body part, causing tissue
deformation and damage.
Direct
Compression
These occur when
different layers of tissue
move against each other,
often leading to
lacerations and internal
injuries.
Shearing
Forces
Increased pressure can
lead to vascular
obstruction, reducing
blood flow to the affected
area and potentially
causing ischemia.
Vascular
Compromise
Compression can lead to
neuropraxia or more
severe nerve injuries due
to the high pressure on
nerve pathways.
Nerve damage

12. CLASSIFICATIONS
Closed Injuries
Fractures
Tendon Injuries
Sprain
Open Injuries
Crush Injuries
Tendon Injuries
Traumatic Amputations

13. PATHOPHYSIOLOGY
Depending on the severity of the crush injury, symptoms will differ. For a minor injury,
there can be bruising, lacerations and moderate pain, while for a major crush, there is
often serious damage below the skin, including tissues, organs, muscles and bones.
When a major crush injury occurs, energy is transferred from an offending object into
the tissues and the tissues are stretched.
When tissues are stretched beyond their normal tolerance, damage occurs.
If compression continues over an extended time (typically longer than 4 hrs), the
muscle tissue will actually begin to break down and may cause systemic problems by
releasing toxins into the blood stream. These toxins can cause cardiac problem, a drop
in blood pressure and renal failure.

14. PATHOPHYSIOLOGY
As the tissue is compressed, it is deprived of blood flow and becomes ischemic,
eventually leading to cellular death.
The time to injury and cell death varies with the crushing force involved; however,
skeletal muscle can often tolerate ischemia for up to 2 hr without permanent injury.
This results in hypovolemia by hemorrhagic volume loss and the rapid shift of
extracellular volume into the damaged tissues. Acute renal failure (ARF) is caused by
hypoperfusion of the kidneys.
Return of circulation to the injured and schemic area after rescue also results in injury,
as reperfusion leads to increased neutrophil activity and the release of free radicals.
A second effect from pressure and reperfusion is the release of debris from the
damaged cells into the circulation.
Another complication of reperfusion is the development of compartment syndrome.

15. EFFECTS ON TISSUE
Overstretching and tearing of the muscle
bleeding and swelling within the muscle
itself.
A disruption of muscle-tendon
connections may result in loss of function.
Muscles
Lacerations and contusions.
Foreign material -> embedded in the
wounds.
Alternatively, the skin may look largely
intact.
Skin and Subcutaneous Tissue
The stretching forces may create small,
partial tears.
During the healing process, scar tissue
forms to heal such tears and may cause
the tendons to adhere to surrounding
tissues, resulting in loss of joint motion
and hand function.
Tendons
Usually, nerves are not torn by a crush
injury.
Conduction disrupted.
It may take weeks to even months to
determine whether the loss of nerve
activity is permanent.
Nerves
Direct compression or shearing forces,
which may injure the inner layer.
If the injured vessel is an artery ->
Ischemia.
If the injured vessels are veins ->
restriction of venous outflow
Blood Vessels
Joint capsules and surrounding ligaments
may rupture.
In children, the growth plates of the bones
may be disrupted.
Disruption of growth plates interferes with
subsequent bone growth, and the bone
may not grow to its proper length.
Bones and Joints

16. While a foot crush injury may sound like an easy condition to diagnose, doctor will need to identify several
symptoms before providing a definitive diagnosis. Each accident and injury cause is different, which means
there is wide variety of symptom experiences.
The most common foot crush injury symptoms are:
Fractures
Lacerations
Pain
Bruising
Swelling
Numbness
SYMPTOMS

17. Compartment Syndrome: When swelling within a confined muscle
compartment (like the foot) exceeds its capacity, blood flow is
compromised, leading to tissue damage and even amputation. Early
detection and surgical intervention are crucial.
Crush Syndrome (Rhabdomyolysis): The breakdown of muscle tissue
releases harmful toxins that can damage the kidneys, heart, and lungs.
Infection: Crush injuries create an ideal environment for bacteria to
thrive. Antibiotics and thorough wound cleaning are essential to
prevent infection.
Nerve Damage: Crushed nerves can cause numbness, tingling, and
weakness while exacerbating other nerve conditions. Physical therapy
and nerve stimulation therapies can help regain function.
COMPLICATIONS
OTHER EFFECTS
Toxemia
Septicemia
Disability with extensive tissue loss
Gas gangrene

18. CASE STUDY
Patient Profile
Name: IBRAHIM MOHAMED ELHALAWANI
Age: 38 years
Gender: Male
Dominant side: Right side
Date of Accident: September 25, 2024
Date of Surgery: September 26, 2024
Mechanism of Injury:
Excavator Bucket Falling on Rt Foot
Excavators are heavy construction
equipment primarily consisting of a boom,
dipper (or stick), bucket, and cab on a
rotating platform known as the "house"

19. ASSESSMENT & DIAGNOSIS
Surgical Interventions:
- Debridement and K-wire fixation for the right foot.
- Repair of extensor tendons and skin approximation
with sutures.
Current Issues:
- Crush injury to the right foot with open fractures,
second metatarsal and soft tissue loss.
- Impaired peripheral circulation in toes.
- Degloving injury on the right foot.
- Undisplaced midshaft fracture of the right tibia.
- Bilateral non-displaced inferior pubic rami fractures.
- Left big toe chip fracture.

20. GOALS OF THERAPY
1. Short-term Goals
(1-2 weeks):
- Promote wound healing and skin integrity.
- Maintain joint mobility in the unaffected areas.
- Prevent stiffness and maintain circulation.
- Educate the patient on post-operative care and
precautions.
2. Long-term Goals
(3-6 months):
- Restore function and strength in the right foot.
- Improve ambulation and weight-bearing capacity.
- Regain full range of motion (ROM) in affected joints.
- Manage pain effectively and reduce swelling.

21. - Vital Signs: Stable
- Skin Condition: Bluish discoloration; dressing dry.
- Edema: Notable swelling in the left thigh and mild swelling in the left big toe.
- Circulation: Impaired in toes; monitor for improvement.
- Functional Assessment: Limited weight-bearing on the right foot.
INITIAL ASSESSMENT

22. Wound Care:
- Ensure proper dressing changes as per physician's orders.
- Monitor for signs of infection or complications.
PHYSICAL THERAPY INTERVENTIONS
Gentle ROM Exercises:
- Ankle pumps (while maintaining the back slab).
- Toe movements (if tolerated) to promote circulation.
Edema Management:
- Elevate the left thigh and right foot when resting.
- Utilize compression bandages as appropriate
(after clearance).
Education:
- Importance of keeping the surgical area dry and clean.
- Techniques for effective pain management.
Phase 1: Acute Care (Days 3-10 Post-Op)
Frequency: 1-2 times/day
Activities:

23. Progressive Weight Bearing:
- Begin partial weight-bearing
with crutches or a walker as
tolerated.
- Gradually increase weight-
bearing as per physician approval.
PHYSICAL THERAPY INTERVENTIONS
Strengthening:
- Isometric exercises for unaffected lower extremities.
- Gradual resistance exercises for upper body to maintain
overall strength.
Continued ROM Exercises:
- Focus on gentle stretching of
the ankle and toes.
- Begin ROM exercises for the left
big toe and ankle.
Phase 2: Early Mobilization (Weeks 2-4 Post-Op)
Frequency: 2-3 times/week
Activities:

24. Advanced Strengthening:
- Introduce resistance bands
for foot and ankle exercises.
- Weight-bearing exercises
for the right foot as tolerated.
PHYSICAL THERAPY INTERVENTIONS
Functional Training:
- Gait training to improve
ambulation patterns.
- Balance activities (e.g.,
standing on one leg with
support).
Continued Wound Care:
- Monitor healing process and adapt exercises as necessary.
- Prepare for potential skin grafts or flap surgeries.
Education:
- Discuss long-term management and potential need for
orthotics.
- Encourage gradual return to daily activities as healing
permits.
Phase 3: Rehabilitation Phase (Weeks 4-12 Post-Op)
Frequency: 2-3 times/week
Activities:

25. Advanced Strengthening:
- Introduce resistance bands for foot and ankle exercises.
PHYSICAL THERAPY INTERVENTIONS
1. Theraband Pull Ups 2. Theraband Push Downs
3. Theraband Turn Outs 4. Theraband Turn Ins
1. Arch Lifts 2. Towel Scrunches 3. Marble Pick-Ups 4. Toe Squeezes
Dynamic Foot Strengthening
1. Static Pull Ups
Action: Gently draw the foot
upwards into the hand,
resisting the movement with
the hand so you feel the
muscles clench. Remember, the
foot shouldn’t move but you
should feel the muscles along
the front of the foot and ankle
clench
Repetition: Hold for 3-5
seconds and relax. Repeat 10-
20 times
2. Static Push Downs
Action: Gently push the foot
downwards into the hand,
resisting the movement with
the hand so you feel the
muscles clench. The foot stays
still
Repetition: Hold for 3-5
seconds and relax. Repeat 10-
20 times
Alternative: Rather than using
your hand to provide the
resistance, sit on the floor with
your foot against the wall. Push
through your toes into the wall
3. Static Turn Outs
Action: Gently push the foot
outwards into the hand,
resisting the movement with
the hand so you feel the
muscles clench. Keep the foot
still throughout
Repetition: Hold for 3-5
seconds and relax. Repeat 10-
20 times
Static Ankle Strengthening Exercises
Resistance Band Ankle Exercises

26. PHYSICAL THERAPY INTERVENTIONS
Parameters for Progression
Pain Level: Should remain manageable
(rated ≤ 4/10).
Wound Condition: No signs of infection; healing
progressing.
Mobility: Improvement in weight-bearing
capacity and ambulation.
Edema: Decreasing swelling in both the right
foot and left thigh.
Follow-Up
—Weekly Assessment: Adjust therapy plan
based on progress.
—Collaboration: Ongoing communication with
orthopedic and plastic surgery teams for
coordinated care.
Notes
Ensure patient understands the importance of
adhering to the rehabilitation plan.
Regularly assess for psychological well-being,
as trauma may affect mental health.

27. REFERENCES
How Do Injuries Occur? - Buffalo Rehab Group1.
Muscles of the Foot: A Comprehensive Guide - JOI Jacksonville Orthopaedic Institute2.
How Strong is Your Foot’s Core?3.
Broken Foot (Fractured Foot): Symptoms, Treatment & Recovery4.
Medscape Registration5.
CRUSH INJURIES OF THE HAND.ppt | Free Download6.
Crush injuries of hand | PPT | Free Download7.
Severe crush injury in adults - UpToDate8.
Intrinsic muscles of the foot – small but mighty! | Find out more9.
 Tissue Stresses ◦ Tension* ◦ Stretching ◦ Compression* ◦ Shearing* ◦ Bending COMPRESSION TENSIONTENSION SHEAR. - ppt download10.
Normal Anatomy of Foot And Ankle New York11.
Crush Injury - Olwen Hospital - Orthopaedic Superspeciality Hospital & Imaging Center12.
Tissue stress - Wikipedia13.
crush injury-rohit.pptx14.
Surgical treatment and results in 17 cases of open lacerations of the extensor hallucis longus tendon - ScienceDirect15.
Open Extensor Tendon Repair in the ED — BROWN EMERGENCY MEDICINE BLOG16.
Stress Fractures of the Foot and Ankle - OrthoInfo - AAOS17.
Compartment Syndrome18.
Top tips on Crutches Everyone Should Know | Access Rehabilitation Equipment19.
Crush Injury20.
Ankle Strengthening Exercises: Improve Strength & Prevent Injuries21.
AJ HEALTH & FITNESS | Lower Body Isometric Workout ?????? What are Isometric Exercises? ???????????? ???????????? Isometric exercises are exercises that involve the static contraction... | Instagram22.
Foot & Ankle Stretches: Flexibility & Control - Foot Pain Explored23.
Ankle Sprain Rehab Exercise Program24.
Exercise for Healthy Bones — Bone Talk25.

28. Thank you!
FOR YOUR ATTENTION