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Athletic injuries (Ankle/Foot/Lower Leg)
Terms in this set (37)
Anterior Compartment Syndrome
This injury can be acute or chronic. It has a sudden onset and causes considerable pain. It is often due to an injury or impact to the big tibialis anterior muscles at the front of the leg which swells up. The chronic stage of this condition comes on gradually and may be due to the muscle growing too big for the sheath surrounding it.
Signs and Symptoms: The acute and chronic stage of this injury include pain in the tibialis anterior muscle on the outside of the lower leg. There will be weakness in the muscle so trying to pull the foot upwards against resistance may be difficult and pain may also be reproduced by pulling the foot downwards to stretch the muscle. In severe cases foot drop or a slapping gait may be seen as the athlete cannot properly lift the foot up when walking.
In the acute stage this injury is likely to have followed a direct impact, tear or contusion to the muscle. It may also happen as a result of a chronic stage flaring up painfully through over use.
The chronic stage of this injury will be similar but will have come on over a period of time. It may be possible for the athlete to run for a few miles pain free before the injury comes on, gradually getting worse until they must stop. A period of rest will relieve symptoms only for the compartment syndrome to return again later a few miles into a run.
MOI:Also, known as Sever's disease, it occurs in young, physically active patients. Sever's disease is a traction injury at the apophysis of the calcaneus where the Achilles tendon attaches.
Signs and Symptoms: Pain occurs at the posterior heel below the attachment of the Achilles tendon insertion of the child or adolescent athlete. Pain occurs during vigorous activity and does not continue at rest.
Arch Sprain (longitudinal)
MOI: This injury is usually caused by subjecting the musculature of the foot to increased stress produced by repetitive contact with hard surfaces. In this condition, there is a flattening or depression of the longitudinal arch while the foot is in the midsupport phase; resulting in a strain to the arch. Such a strain may appear suddenly, or it may develop slowly over a considerable length of time.
Signs and Symptoms: As a rule, pain is experienced only during running or jumping. The pain usually appears just below the posterior tibialis tendon and is accompanied by swelling and tenderness along the medial aspects of the foot. This injury may also be associated with a sprain of the calcaneonavicular ligament as well as a strain of the flexor hallucis longus tendon.
Arch Sprain (transverse)
MOI: Any twisting injury to the lower extremity where the athlete's body turns and their foot remains planted in the ground or playing surface can lead to a midfoot sprain. When the athlete twists all the force that occurs when they plant and pivot is transmitted through their foot as opposed to through the ground. This can also occur in sports where the foot is purposely kept in place like a stirrup for jockeys and for windsurfers. Different playing surfaces and shoe wear can have an affect on an injury depending on the amount of friction that occurs between the two. An injury can also occur when another athlete lands or steps on the back of the patient's heel causing a large force to occur directly through the foot.
Signs and Symptoms: An athlete with a midfoot sprain will have sustained a twisting or pivoting injury to his or her foot. They will develop immediate pain and later swelling in the central region of their foot. The swelling often can lead to bruising on either the top or bottom or the foot. How much swelling and subsequent bruising occurs is related to how severe the injury is. The athlete will also complain of pain with bearing weight. In milder injuries they will be able to walk without too much pain, but the higher demands on the foot in athletics will be painful. On the other end of the spectrum, in more severe injuries, the injured athlete may not be able to bear any weight even to walk. On physical examination, the injured foot will look swollen and be tender over the injured joints. It's important that the examining physician localize the injury to the specific joints involved. The tendons of the foot should remain intact in a midfoot sprain, however their motion may produce pain in the foot if they place stress on the injured joints with motion.
MOI: This injury is one the most frequent painful deformities at the head of the first metatarsal. This term is often used to refer to an exostosis. Commonly, this injury is associated with a structural forefoot varus in which the first ray tends to splay outward, putting pressure on the first metatar-short. It is generally believed that women's shoes play a predominant role in the development of a hallux valgus deformity. The bursa over the first metatarsophalangeal joint becomes inflamed and eventually thickens. Tendinitis may develop in the flexor tendons of the great toe. The joint becomes enlarged and the great toe becomes malaligned, moving laterally toward the second toe, sometimes to such an extent that it eventually overlaps the second toe. This type of injury is also associated with a depressed or flattened transverse arch and a pronated foot. The bunionette, is much less common than hallux valgus and affects the fifth meatarsophalangeal joint. In this case, the little toe angulates toward the fourth toe, causing an enlarged metatarsal head. In all of these injuries both the flexor and extensor tendons are malaligned, creating more angular stress on the joint.
Signs and Symptoms:
Achilles Tendon Rupture
A rupture of this ligament is possible in stop and go action. Most common in athletes of 30 years or older but happens at any age. Usually happens in individuals with a history of chronic inflammation and gradual degeneration caused by microtears.
MOI: Initial insult normally is the result of sudden pushing-off action of the forefoot with the knee being forced into complete extension.
Signs and Symptoms: when the rupture occurs, the patient complains of a sudden snap that felt like something kicked him or her in the lower leg. Pain immediate but rapidly subsides. Point tender, swelling and discoloration are usually associated with the trauma. Toe raising is impossible. Problem with this injury is proper diagnosis, especially with partial tears. A positive Thompson test will indicate this.
MOI: There are a number of ways this can happen. A foot that is forcibly abducted can produce a transverse fracture of the distal tibia and fibula. In contrast, a foot that is planted in combination with forced internal rotation of the leg can produce a fracture to the distal and posterior tibia.
Signs and Symptoms: In most cases of fracture, swelling and pain may be extreme. There may be some or no deformity; however, if a fracture is suspected, splinting is essential.
Ankle Sprain/Sprain-Fracture Eversion
MOI: This out ward movement of the ankle represents only about 5-10% of all these injuries. This injury is less common than the inversion injury largely because of the bony and ligamentous anatomy. More often this injurie involves a fracture of the tibia before the deltoid ligament tears. Despite that this injury is less common than inversion it will take longer to heal and are more severe. A foot that excessively pronates, is hypermobile, or has a depressed medial longitudinal arch is more predisposed to this injury.
Signs and Symptoms: The patient complains of severe pain and loss of function in the ankle region. When the ankle is passively externally rotated or dorsiflexed, there is a major pain in the lower leg indicating a syndesmotic sprain or possibly a lateral malleolar fracture. Pain normally occurs along the anterior leg.
Ankle Sprain/Sprain-Fracture Inversion
Inner rotation of the ankle is the most common injury and can result in injury to the lateral ligaments. The anterior talofibular ligament is the weakest of the three lateral ligaments. It's major function is to stop forward subluxation of the talus. It is injured in an inverted, plantar flexed, and internally rotated position. The calcaneofibular and posterior talofibular ligaments may also be injured in inner rotation. Increased inner rotation force is needed to tear the calcaneofibular ligament. It is possible that an inner rotation could be so bad that an avulsion fracture could happen. An avulsion of the lateral malleolus and a fracture of the medial
malleolus can happen known as a Bimalleolar fracture.
MOI: foot is forcefully inverted such as when a basketball player jumps and comes down on another players foot. Can happen when suddenly stepping wrong or into a hole.
Signs and symptoms: pain anywhere from mild-severe and lessened ROM. Weightbearing is difficult to unbearable. Swelling all around. Could feel a pop or a snap, on the lateral side. Sometimes if it's bad enough the ankle can sublux.
Syndesmosis (High) ankle sprain
MOI: Isolated injuries to the distal tibiofemoral joint are referred to as this injury. The anterior and posterior tibiofibular ligaments are found between the distal tibia and fibula and extend up the lower leg as the interosseous ligament. These ligaments are torn with increased external rotational or forced dorsiflexion and are often injured in conjunction with a severe pain of the medial and lateral ligament occurs distally at the tibiofibular ligament above the ankle mortise.
Signs and Symptoms: The patient complains of severe pain and loss of function in the ankle. When the ankle passively externally rotated or dorsiflexed, there is a major pain in the lower leg indicating a injury or possibly a lateral malleolar fracture. Pain normally occurs along the anterolateral leg.
MOI: Caused by inflammation of the bursa that lies between the Achilles tendon and the calcaneus. This injury often occurs from the pressure and rubbing of the heel counter of a shoe. This condition is chronic, developing gradually over a long period of time, and may take many days and sometimes weeks or months to resolve. An exostosis is a benign bony outgrowth or callus that protrudes from the surface of a bone and is usually capped by cartilage. An exostosis that develops on the posterior aspect of the calcaneus because of ongoing inflammation of the retrocalcaneal bursa is sometimes referred to as a pump bump.
Signs and Symptoms: Pain may be elicited by palpating the bursa just above and anterior to the insertion of the Achilles tendon. There will likely be some swelling on both sides of the heel cord. If the source of irritation persists, a bony callus may also begin to form.
Tarsal Tunnel Syndrome
MOI: This area in the body is a loosely defined area behind the medial malleolus that forms a tunnel with an osseous floor and the roof composed of the flexor retinaculum. Through this tunnel pass the tibialis posteior, flexor hallucis longus, and flexor digitorum muscles with their surrounding synovial sheaths and the tibial nerve artery and vein. Any condition that compromises the structures within this tunnel can cause this injury, including tenosynovitis, previous fractures, excessive pronation, or any acute trauma.
Signs and Symptoms: Complaints of pain and paresthesia are typical, particularly along the medial and plantar aspects of the foot. Complaints of increased pain at night are also common. Tinel's sign will be positive in cases of this injury. If the condition persists, motor weakness and atrophy may gradually appear, following the course of the tibial nerve.
MOI:This fracture is frequently found on the weightbearing surfaces of the femur at the knee joint. They also can occur under the patella. These fractures commonly involve both the articular cartilage and the bone underneath. Usually, only one fracture occurs at a time, but sometimes more than one occurs at the time of injury. These fractures also can occur in the ankle along the talus. This fracture that occurs on the outer side of the talus usually only tears a piece from the surface of articular cartilage. An injury to the inner side more often results in a crater-like lesion that involves bone underneath the cartilage. In the knee, this fracture typically result when you twist your knee badly. Direct trauma to the inner or outer part of the femur at the knee can lead to these lesions. In the ankle, these fractures occur by a force directed from the joint surface of the tibia , across the joint, and into the talus. Most of these fractures to the outer side of the talus result from trauma. Injuries to the inner side of the talus may result from a recurring ankle injury, such as a sprain.
Signs and Symptoms: Immediate pain and swelling of the joint and pain with weightbearing when you stand up or start to walk.
Soft and hard corns
MOI: This condition are examples of hyperkeratosis caused by abnormal skin pressure and friction. A clavus durus is the most serious type. It is caused by the pressure of improperly fitting shoes and other anatomical abnormalities the same mechanisms that cause calluses. Hammertoes are usually associated with the this condition that form on the tops of deformed toes. Clavus mollis is the result of the combination of wearing narrow shoes and having exessive foot perspiration. It is associated iwth an exostosis. Because forms between the fourth and fifth toes. A circular area of thickened, white, macerated skin appears between the toes at the base of the proximal head of the phalanges. Both pain and inflammation are likely to be present.
Sings and Symptoms: Local pain and disability, with inflammation and thickening of soft tissue. Because of the chronic nature of this condition, it requires a physician's care. With the clavus mollis version, the patient complains of pain laterally on the fifth toe. During inspection, this injury appears as a circular piece of thickened, white, macerated skin on the lateral side of the fifth toe at the base of the proximal head of the phalanges.
Dislocation of Peroneal Tendons
MOI: An uncommon injury to a group of two tendons whose muscles originate on the outside of the calves. These two muscles are named the Peroneus Brevis and Peroneus Longus. These two muscles are responsible for eversion of the foot. These tendons are also called "stirrup" tendons because as they pass into the foot they act as a stirrup to help hold up the arch of the foot. As these tendons pass behind the outside ankle bone, called the fibula, they are held in place by a band of tissue called the peroneal retinaculum. Injury to the retinaculum can cause it to stretch or even tear. When this occurs the peroneal tendons can dislocate from their groove on the back of the fibula. The tendons can be seen to roll over the outside of the fibula. This will cause the tendons to function abnormally and can cause damage to the tendons. Most commonly occur as a result of injury during participation in athletic activities. The most common sport causing injury is snow skiing. It can also occur while playing football, basketball, and soccer.
Signs and Symptoms: Physical examination will reveal swelling behind the outside of the ankle if it is an acute injury. If the injury is chronic there may be little to no swelling. There is usually tenderness particularly when pressure is applied behind the outside of the ankle. Having the patient forcefully turn the foot outward against the physician's hand can demonstrate injury to this area. This will cause the injury over the outer edge of the lateral malleolus.
Epiphyseal Plate Injury
see page 286 for pics
There are 5 types of injuries that can be sustained to the growth plate. Usually happening during sporting events.
1. complete separation of the physis in relation to the metaphysis without fracture to the bone.
2. separation of the growth plate and a small portion of the metaphysis.
3. fracture of the physis.
4. fracture of a portion of the physis and metaphysis.
5. no displacement of the physis, but crushing force can cause a growth deformity.
MOI: This area's fractures has the fibula fracturing the most. It occurs principally in the middle third, while fractures of the tibia occur predominantly in the lower third. Fractures of the shaft of both the tibia and fibula result from either direct or indirect trauma. There may be bony displacement with deformity that results in overriding of the bone ends, particularly if the athlete attempts to move or to stand on the limb after the injury. Crepitus and a temporary loss of limb function are usually present.
Signs and Symptoms: This injury causes soft-tissue insult and hemorrhaging. The patient complains of severe pain and disability. The leg appears hard and swollen, which may indicate the beginning of Volkmann's contracture. Volkmann's contracture is the result of interanl tension caused by hemorrhage and swelling within closed fascial compartments, which inhibits the blood supply and results in necrosis of muscle and contractures.
MOI: A hyperextension of the great toe results in a sprain of the metatarsophalangeal joint, either from a single trauma or from repetitive overuse. Typically, this injury occurs on unyielding synthetic turf although it can occur on a grass also. Many of these injuries occur because sports shoes made for use on artificial turf often are more flexible and allow dorsiflexion of the great toe.
Signs and Symptoms: Significant pain and swelling in and around the metatarsophalangeal joint of the great toe. Pain is exacerbated when the patient tries to push off the foot in walking and certainly in running and jumping.
Fractures and Dislocation of the Phalanges
MOI: Breaks in this area usually occur either by kicking an object, stubbing a toe, or being stepped on. A area getting out of it's alignment of the phalanges are less common than breaks. If one occurs, it is most likely to be dorsal dislocation of the middle phalanx proximal joint. The mechanism of injury is the same as for fractures. Frequently, breaks and displacements accompany one another.
Signs and Symptoms: There is immediate intense pain, which is increased when the toes are moved. In the case of a displacement, deformity will be obvious. Swelling of the joint occurs rapidly, and there is subsequent discoloration in the area of injury.
MOI: This injury is a flexible deformity that becomes fixed. It is caused by flexion contracture at the proximal interphylangeal (PIP) joint. Usually caused by shoes that are too tight causing a deformity over time.
Sings and Symptoms: In this condition the MP, PIP, and/or DIP joints can become fixed. There may be blistering, swelling, pain, callus formation, and occasionally infection.
MOI: Blood can accumulate under a toenail as a result of the toe being stepped on, dropping an object on the toe, or kicking another object. Repetitive shearing forces on toenails, as may occur in the shoe of a long-distance runner, may also cause bleeding into the nail bed. In any case, blood that accumulates in a confined space underneath the nail is likely to produce extreme pain and can ultimately cause loss of the nail.
Signs and Symptoms: Bleeding into the nail bed may be either immediate or slow, producing considerable pain. The area under the toenail assumes a bluish-purple color and gentle pressure on the nail greatly exacerbates pain.
MOI:This injury is a calcium deposit on the underside of the heel bone. On an X-ray, the injury protrusion can extend forward by as much as a half-inch. This injury often is caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping.
Signs and Symptoms: This injury often cause no symptoms. But this injury can be associated with intermittent or chronic pain especially while walking, jogging, or running. If inflammation develops at the point of the injury formation. In general, the cause of the pain is not the injury itself but the soft-tissue injury associated with it. Many people describe the pain of the injury and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning. A pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.
MOI: This condition is common in the toes. The large to is the most often affected. The nail grows into the lateral nail fold and enters the skin. In general, the ingrown nail results from the lateral pressure of poorly fitting shoes, improper toenail trimming, or trauma such as repeated pressure from sliding to the front of the shoe.
Signs and Symptoms: The first indications of an ingrown toenail are pain and swelling. If not treated early, the penetrated skin becomes severely inflamed and purulent. The lateral nail fold becomes swollen and irritated.
MOI: While less common than in the knee, this injury can occur in the superior medial articualr surface of the talar dome. One or several fragments of articular cartilage and its underlyning subchondral bone are either partially detached or completely detached and moving within the joint space. The mechanism of injury may be a single trauma, in which case it may be diagnosed as an osteochdral fracture, or it may be due to repeated episodes of ankle sprain.
Signs and Symptoms: Initially the patient may complain of pain and effusion with signs of progressing atrophy. There may also be complaints of catching, locking, or giving way, particularly if the fragment is detached.
MOI: This condition refers to a type of foot that has an arch that is higher than normal. Sometimes called clawfoot or hollow foot, this injury is not as common as pes planus. This injury is generally associated with excessive supination. The accentuated high medial longitudinal arch may be congenital or may indicate a neurological disorder.
Signs and Symptoms: In this injury, shock absorption is poor, and thus problems such as general foot pain, metatarsalgia, and clawed or hammer toes are seen. Commonly associated with this condition are a structural forefoot valgus deformity and an abnormal shortening of the Achilles tendon. The Achilles tendon is directly linked with the plantar fascia. Also, because of the abnormal distribution of body weight, heavy calluses develop on the ball and heel of the foot.
MOI: This injury refers to a type of foot in which the medial longitudinal arch appears to be flat and is sometimes said to be fallen. In general, this condition is associated with excessive foot pronation and maybe be caused by a number of factors, including a structrual forefoot varus deformity, wearing shoes that are too tight, trauma that weakens supportive structures such as muscles and ligaments, overweight, or excessive exercise that repeatedly subjects the arch to severe pounding on an unyielding surface.
Signs and Symptoms: The patient may complain of pain and a feeling of weakness or fatigue in the medial longitudinal arch. There may be calcaneal eversion, a bulging of the navicular bone, a flattening of the medial longitudinal arch, and dorsiflexing with lateral splaying of the first metatarsal.
MOI: Tension develops in the under area of the foot both during extension of the toes and during depression of the longitudinal arch as the result of weight bearing. When the weight is principally on the heel, as in ordinary standing, the tension exerted on the fascia is negligible. However, when the weight is shifted to the ball of the foot fascial tension is increased. In running, because the toe-off phase involves both a forceful extension of the toes and a powerful thrust by the ball of the foot,
MOI: Morton's neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Morton's neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock. Morton's neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb. High-heeled shoes have been linked to the development of Morton's neuroma. Many people experience relief by switching to lower heeled shoes with wider toe boxes. Sometimes corticosteroid injections or surgery may be necessary.
Signs and Symptoms: Typically, there's no outward sign of this condition, such as a lump. Instead, you may experience a feeling as if you're standing on a pebble in your shoe. A burning pain in the ball of your foot that may radiate into your toes and tingling or numbness in your toes.
MOI: This condition is found on the sole of the foot, on or adjacent to areas of abnormal weight bearing. The papillomavirus can be spread on to the hands and other body parts.
Signs and Symptoms: This condition is seen in areas with excessive epidermal thickening and cornification. They produce general discomfort and point tenderness in the areas of excessive callus formation. Commonly the athlete complains that the condition feels as though he or she has stepped on broken glass. A major characteristic of the plantar wart is hemorrhagic puncta, which look like a cluster of small black seeds.
Plantaris Muscle Rupture
MOI: The patient will come in limping, having suffered a whip-like sting in his calf while stepping off hard on his foot or charging the net during a game of tennis, or similar activity.
Signs and Symptoms: He may have actually heard or felt a "snap" at the time of injury. The deep calf pain persists and may be accompanied by mild swelling and ecchymosis. Neurovascular function will be intact.
MOI: Known as medial tibial stress syndrome, this condition means pain in the anterior part of the shin. Conditions such as stress fractures, muscle strains, and chronic anterior compartment syndromes have been termed this condition. Commonly seen in running and jumping activities. This can be caused by weakness of the leg muscles, shoes with running on hard surfaces or over-training. Malalignment problems such as varus lao leads to.
Signs and Symptoms: Four grades of pain can be seen with this. 1. pain occurring after 2. Pain occurring before and after affecing performance; 4. so severe that activity is impossible.
Stress fractures of the leg
MOI: This type of fracture is a common overuse stress condition, especially among distance runners. Stress fractures of the lower leg, like many other overuse syndromes, are most likely to occur in individuals who have structural deformities of the foot. Individuals who have hypermobile pronated cavus are more prone to tibial this type of fracture. Runners frequently develop this injury in the lower third of the leg; ballet dancers more commonly acquire one in the middle third. Stress fractures often occur to inexperienced and nonconditioned individuals. Training errors are often cause. Other causes may include amenorrhea and nutritional deficiencies.
Signs and Symptoms: The patient complains of pain in the leg that is more intense after than during the activity. There is usually point tenderness, but it may be difficult to discern the difference between bone pain and soft-tissue pain. Once technique for distinguishing bone pain from soft-tissue pain is bone percussion. The fibula or tibia is tapped firmly above the level of tenderness. Vibration travels along the bone to the injury, which may respond with pain. Another percussive technique is to hit the heel upward from below, which causes pain to occur at the fractures site. Diagnosis of this injury may be difficult. X-ray exam may or may not detect the problem. A bone scan will more accurately assess the presence of this injury but does not clearly distinguish between this injury and periostitis.
MOI: Exostosis means filing up of bone at the site of irritative lesion in response to direct trama. Causes can be large erosion in the neck of talus, repetitive stress, poorly fitting footwear, direct trama, and push off phase of running.
Signs and Symptoms: Irritative lesion in response to overuse ,Increase in bone mass at talotibial joint, Pain while walking Swelling over dorsal aspect of foot
MOI: An inflammatory condition that involves the end point of the calf or its tendon sheath (the paratenon) in which case the condition is referred to as end point of the calf tenosynovitis. This condition causes fibrosis and scarring that can restrict the tendon's motion within the tendon sheath. This can lead to the tendon tendinosis. Most people when they have pain in this area have tendinosis instead of tendinitis or tenosynovitis. With this area's tendinosis, also known as this area's tendinopathy, there is no evidence of inflammation, the injured areas of the tendon have lost their normal appearance, and the collegen fibers that make up the tendon show that the cells are disorganized, scarred, and degenerated. This condition is a soreness and stiffness that comes on gradually and continues to worsen until treated. It worsens with running or jumping motions.
Signs and Symptoms: Often complaints of generalized pain and stiffness about the tendon that, when localized, is usually just proximal to the calcaneal insertion. Uphill running or hill workouts will usually aggravate the condition. There may be reduced gastrocnemius and soleus muscle flexibility in general that may worsen as the condition progresses. May see the tendon thicken with use as compared to the other side.
Anterior Tibialis Tendinitis
MOI: This condition is a common condition in individuals who run downhill for an extended period of time.
Signs and Symptoms: There is point tenderness over the tendon. The patient complains of pain when the tendon is stretched or when the muscle is contracted.
Posterior Tibialis Tendinitis
MOI: This condition is a common overuse condition among runners with hypermobility or pronated feet. It is a repetitive microtrauma occurring during pronation in movements such as jumping, running, or cutting.
Signs and Symptoms: The patient complains of pain and swelling in the area of the medial malleolus. Inspection reveals edema and point tenderness directly behind the medial malleolus. In serious cases, the pain becomes more intense during resistive inversion and plantar flexion.
MOI: Although not particualarly common, this area can be a problem in individuals with pes cavus. In pes cavus, the foot tendons to excessively supinate, which causes weight bearing on the outside of the foot and thus places stress on the peroneal tendon.
Signs and Symptoms: The patient complains of pain behind the lateral mallelous when rising on the ball of the foot during jogging, running, cutting, or turning activities. Tenderness is noted over the tendon located at the lateral aspect of the calcaneus distally to beneath the cuboid bone.
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