Presentation on theme: "Foot, Ankle and Lower Leg"— Presentation transcript:
1 Foot, Ankle and Lower Leg Sports Medicine Chapters 14 & 15
2 Lower Leg Anatomy of the foot, ankle and lower leg Common Injuries TreatmentPreventionRehabilitation
3 Vocabulary apophysis, exostoses, metatarsalgia, Morton’s neuroma, pes planus, pronation, pes cavussupination, eversion,dorsiflexion, inversion,plantar flexion,proprioception,Thompson test
4 Anatomy Foot: 1.Lateral/Medial Mallelous 2.Talus 3. Calcaneus Bones of the foot and ankleFoot:1.Lateral/Medial Mallelous2.Talus3. Calcaneus4.Navicular5.Cuboid6. 1st, 2nd, 3rd or medial, middle, lateral Cuneiforms7.Metatarsals/phalanges
5 Ligaments 1.Anterior Talo Fibular 2.Posterior Talo Fibular Most common lig. Injured. Injured by plantar flexion/inversion2.Posterior Talo FibularInjured by dorsiflexion and inversion3.Calcaneofibular4.Deltoid/post. talotibialLargest lig. In the ankle. Eversion sprain5.Ant/Post tibiofibularattaches tibia/fibula
6 MUSCLES Gastrocnemius/soleus Tibialis Anterior plantar flexionforms the achilles tendon and attaches to the calcaneusTibialis Anteriorin front of your tibiaattaches to the 1st metatarsalproduces dorsi flexion and inversionFlexor Hallucis longus/brevisflexes big toeis part of your arch
7 Muscles cont. Peroneal Longus/brevis Peroneal tertius attaches to base of 5th metatarsalproduces eversionPeroneal tertiussame as aboveExtensor digitorum longusextends your phalangesFlexor digitorum longusflexes toesgoes by the deltoid lig.
8 Injuries Blisters. Ingrown toenails. Heel bruise. Caused by friction. Rx: donut and cover.Ingrown toenails.Toenail is growing down into the toe. Rx: soaking the toe, cleaning it out, lifting the nail up. Or dr.Heel bruise.Direct blow to the heel. Very painful, rest ice and heel cup or tape.Arch strain: metatarsal, transverse, inner/outer longitudinal arches.Very painful while running/walking.Rx. RICE, arch tape job, ultrasound, whirlpool and stiff sole shoe.Morton’s neuroma: 2nd or 3rd metatarsal.- RX pad.
9 Injuries Cont. Fractures of your toes: Fracture of the metatarsals. Dr. Referral if great toe involved. If not tape together and wear wide fitting shoes.Fracture of the metatarsals.Direct blow or twisting type of an injury.Jones fracture.fx. Base of 5th metatarsal, caused by same mechanism of sprain ankle. High incidence of nonunion.Bunion: hallux valgus.Most common injury to the great toe. Bursa becomes inflamed due to poor fitting shoes or a congenital deformity.Tape like turf toe but off to the side.
10 Injuries Cont. Hammer toes: 2nd or 3rd toe Bony outgrowths (exostoses) May be congenital, or wears shoes too smallOverly contracted flexor tendons/overly stretched extensor tendonsSurgery or taping of the toesBony outgrowths (exostoses)Heel spursLocated at the head of the 1st metatarsal or heelApophysitisWhere the achilles tendon attaches. Rx= 1/4” heel lift
11 Stress fractures: 18% occur here Plantar fasciitisHeel spur syndrome. Most frequent hind foot problem. S/S burning, sharp pain around the heel. Rx.= NSAID’s ultrasound, ice and stretchStress fractures: 18% occur hereIn the metatarsals Rx.= Cast, rest for 3-4 weeks
12 Ankle Injuries Sprains. Achilles tendonitis. Shin contusion. Grade1=3-7 days out.Grade 2=7-14 days out.Grade 3= 2-6 weeks out.Rx.= RICE, horseshoe.Achilles tendonitis.Rx.= Ice/stretch, NSAID’s, heel lift, ultrasound.May take weeks/months to heal.If untreated may result in rupture.Shin contusion.Very painful and takes very long to heal especially the distal 1/3 of the tibia because of the low blood supply.Rx.= Ice compression and elevation.
13 Shin splints. Tennis leg: gastrocnemius strain. Calf strain cause by quick starts and stops with foot planted and extends the knee. Rx.= Same care for a muscle strain.Shin splints.Medial Tibial stress syndrome. Pain in the distal anterior 1/3 of the tibia.Causes: poor fitting shoes, bad arches in shoes, poor conditioning, running on hard surfaces, muscle fatigue, ankle pronation.Rx.= Ice massage, ice whirlpool after workouts, tape arches, run on soft surfaces, proper shoes.
14 Injuries Continued Anterior compartment syndrome. Four compartments in the lower leg.Muscle, nerves, arteries become compressed by swelling.S/S= weakness in foot dorsiflexion and extension of big toe = foot drop.Numbness or tingling over the dorsal surface of the foot.Foot is cold. Lack of circulation.Rx.= Ice, elevation and to dr. ASAP don not compress.
15 Ankle Injuries Cont. Stress fracture: Common overuse injuries. Athletes who have hypermobile, pronated, or flat feet (pes planus) are susceptible to fibular stress fx.Athletes who have rigid pes cavus are susceptible to tibial stress fx.Intense pain while running but subsides while resting. Very point tender.Rx.= X-ray with bone scan.Depending on where the fx. Is will determine if non weight bearing or walking cast.Rest is the key.Swimming and biking is ok.Ankle Injuries Cont.
16 Ankle Injuries Cont. Achilles tendon rupture. S/S= felt like I got kicked in the calf. Possible deformity, poor plantarflexion strength.Treatment: perform Thompson test, splint in relaxed position and send to dr. Also ice.Could be caused by chronic tendonitis and is common to people in their mid 30’s.
17 Rehabilitation Rehab for Ankle sprain Evaluation: see handout Anterior drawer test= ATF lig.Talor tilt test= CF/Deltoid lig.Rehab for Ankle sprain
18 Rehabilitation of an ankle injury Stage 1:RICE with horseshoe and elevation as much as possibleNon weight bearing if athlete can not bear weight without a lot of painAfter swelling has subsided use contrast bathsCV by bike or pool w/out legsProgression to stage 2:Swelling has subsided and pain is at a minimum, Full weight bearingStage 2Contrast bathsPNF- balance board, tubing and pool workouts with balanceManual resistance: plantar/dorsiflexion first than eversion/inversionFlexibilityCV- bike and pool workouts using legs a little bit moreProgression to stage 3:Pain free, full ROM, Almost full strength
19 Rehab continued Stage 3: Ice after activity PNF SAID principle- sports specificProtective tapingJogging straight then slowly introduce jogging with big curvesJog sprint jogJogging with cutsJog fig. 8’sBack pedalSprints straightSprint with cutsSprint with change of directionSide stepsActivity specific to their sportIce after activity
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