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Foot, Ankle and Lower Leg Sports Medicine Chapters 14 & 15.

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Presentation on theme: "Foot, Ankle and Lower Leg Sports Medicine Chapters 14 & 15."— Presentation transcript:


2 Foot, Ankle and Lower Leg Sports Medicine Chapters 14 & 15

3 Lower Leg l Anatomy of the foot, ankle and lower leg l Common Injuries l Treatment l Prevention l Rehabilitation

4 Vocabulary apophysis, exostoses, metatarsalgia, Mortons neuroma, pes planus, pronation, pes cavus supination, eversion, dorsiflexion, inversion, plantar flexion,proprioception, Thompson test

5 Anatomy l Bones of the foot and ankle Foot: 1. Lateral/Medial Mallelous 2. Talus 3. Calcaneus 4.Navicular 5.Cuboid 6. 1 st, 2 nd, 3 rd or medial, middle, lateral Cuneiforms 7.Metatarsals/phalanges

6 Ligaments l 1.Anterior Talo Fibular Most common lig. Injured. Injured by plantar flexion/inversion l 2.Posterior Talo Fibular Injured by dorsiflexion and inversion l 3.Calcaneofibular Injured by dorsiflexion and inversion 4.Deltoid/post. talotibial Largest lig. In the ankle. Eversion sprain l 5.Ant/Post tibiofibular attaches tibia/fibula

7 MUSCLES l Gastrocnemius/soleus –plantar flexion –forms the achilles tendon and attaches to the calcaneus l Tibialis Anterior –in front of your tibia –attaches to the 1st metatarsal –produces dorsi flexion and inversion l Flexor Hallucis longus/brevis –flexes big toe –is part of your arch

8 Muscles cont. l Peroneal Longus/brevis –attaches to base of 5th metatarsal –produces eversion l Peroneal tertius –same as above l Extensor digitorum longus –extends your phalanges l Flexor digitorum longus –flexes toes –goes by the deltoid lig.

9 Injuries l Blisters. l Caused by friction. Rx: donut and cover. l Ingrown toenails. l Toenail is growing down into the toe. Rx: soaking the toe, cleaning it out, lifting the nail up. Or dr. l Heel bruise. l Direct blow to the heel. Very painful, rest ice and heel cup or tape. l Arch strain: metatarsal, transverse, inner/outer longitudinal arches. l Very painful while running/walking. l Rx. RICE, arch tape job, ultrasound, whirlpool and stiff sole shoe. l Mortons neuroma: 2nd or 3rd metatarsal. l - RX pad.

10 Injuries Cont. l Fractures of your toes: l Dr. Referral if great toe involved. If not tape together and wear wide fitting shoes. l Fracture of the metatarsals. l Direct blow or twisting type of an injury. l Jones fracture. l fx. Base of 5th metatarsal, caused by same mechanism of sprain ankle. High incidence of nonunion. l Bunion: hallux valgus. l 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.

11 Injuries Cont. l Hammer toes: 2nd or 3rd toe l May be congenital, or wears shoes too small l Overly contracted flexor tendons/overly stretched extensor tendons l Surgery or taping of the toes l Bony outgrowths (exostoses ) l Heel spurs l Located at the head of the 1st metatarsal or heel l Apophysitis l Where the achilles tendon attaches. Rx= 1/4 heel lift

12 l Plantar fasciitis l Heel spur syndrome. Most frequent hind foot problem. S/S burning, sharp pain around the heel. Rx.= NSAIDs ultrasound, ice and stretch l Stress fractures: 18% occur here l In the metatarsals Rx.= Cast, rest for 3-4 weeks

13 Ankle Injuries l Sprains. l Grade1=3-7 days out. l Grade 2=7-14 days out. l Grade 3= 2-6 weeks out. l Rx.= RICE, horseshoe. l Achilles tendonitis. l Rx.= Ice/stretch, NSAIDs, heel lift, ultrasound. l May take weeks/months to heal. l If untreated may result in rupture. l Shin contusion. l Very painful and takes very long to heal especially the distal 1/3 of the tibia because of the low blood supply. l Rx.= Ice compression and elevation.

14 l Tennis leg: gastrocnemius strain. l Calf strain cause by quick starts and stops with foot planted and extends the knee. Rx.= Same care for a muscle strain. l Shin splints. l Medial Tibial stress syndrome. Pain in the distal anterior 1/3 of the tibia. l Causes: poor fitting shoes, bad arches in shoes, poor conditioning, running on hard surfaces, muscle fatigue, ankle pronation. l Rx.= Ice massage, ice whirlpool after workouts, tape arches, run on soft surfaces, proper shoes.

15 Injuries Continued l Anterior compartment syndrome. l Four compartments in the lower leg. l Muscle, nerves, arteries become compressed by swelling. l S/S= weakness in foot dorsiflexion and extension of big toe = foot drop. l Numbness or tingling over the dorsal surface of the foot. l Foot is cold. Lack of circulation. l Rx.= Ice, elevation and to dr. ASAP don not compress.

16 Ankle Injuries Cont. l Stress fracture: l Common overuse injuries. l Athletes who have hypermobile, pronated, or flat feet (pes planus) are susceptible to fibular stress fx. l Athletes who have rigid pes cavus are susceptible to tibial stress fx. l Intense pain while running but subsides while resting. Very point tender. l Rx.= X-ray with bone scan. l Depending on where the fx. Is will determine if non weight bearing or walking cast. l Rest is the key. l Swimming and biking is ok.

17 Ankle Injuries Cont. l Achilles tendon rupture. l S/S= felt like I got kicked in the calf. Possible deformity, poor plantarflexion strength. l Treatment: perform Thompson test, splint in relaxed position and send to dr. Also ice. l Could be caused by chronic tendonitis and is common to people in their mid 30s.

18 Rehabilitation l Evaluation: l see handout l Anterior drawer test= ATF lig. l Talor tilt test= CF/Deltoid lig. l Rehab for Ankle sprain

19 Rehabilitation of an ankle injury l Stage 1: –RICE with horseshoe and elevation as much as possible –Non weight bearing if athlete can not bear weight without a lot of pain –After swelling has subsided use contrast baths –CV by bike or pool w/out legs l Progression to stage 2: –Swelling has subsided and pain is at a minimum, Full weight bearing l Stage 2 –Contrast baths –PNF- balance board, tubing and pool workouts with balance –Manual resistance: plantar/dorsiflexion first than eversion/inversion –Flexibility –CV- bike and pool workouts using legs a little bit more l Progression to stage 3: –Pain free, full ROM, Almost full strength

20 Rehab continued l Stage 3: –PNF –SAID principle- sports specific –Protective taping –Jogging straight then slowly introduce jogging with big curves –Jog sprint jog –Jogging with cuts –Jog fig. 8s –Back pedal –Sprints straight –Sprint with cuts –Sprint with change of direction –Side steps –Activity specific to their sport –Ice after activity

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