Toes (Phalanges) Designed to give wider base for balance and propelling the body forward. Designed to give wider base for balance and propelling the body forward. 1st toe (Hallux) 1st toe (Hallux) Two sesamoid bones located under the 1 st MP joint. Two sesamoid bones located under the 1 st MP joint.
Metatarsals 5 Bones 5 Bones 1 st metatarsal is the largest and strongest and functions as the main body support during walking and running. 1 st metatarsal is the largest and strongest and functions as the main body support during walking and running. Palpable at the ball of the foot. Palpable at the ball of the foot. 5 th metatarsal most common fractured. 5 th metatarsal most common fractured.
Tarsals 7 bones Aids in the support of the body. Calcaneous = largest tarsal bone, supports talus and shapes heel, and provides attachment for achilles tendon.
Bones of the Ankle Tibia Main weight bearing bone of LOWER LEG Forms medial malleolus Fibula Non-weight bearing Mainly muscle and ligament attachment Forms lateral malleolus Talus Main weight bearing bone of the ANKLE
Lateral Ligaments of the Ankle Resist ankle inversion Anterior talofibular (ATF) Most commonly sprained Calcaneofibular (CF) Posterior talofibular (PTF)
Quiz 1. Which bone in the lower leg is the most weight bearing? 2. What does ATF stand for? 3. Which ligaments resist inversion? 4. Which ligaments resist eversion? 5. What does MP stand for? 6. How many tarsal bones are there? 7. How many bones are in the foot?
Muscles of the Foot and Ankle Anterior Muscles (3) Extensor Hallucis Longus/Brevis extension of great toe extension of great toe Extensor Digitorum Longus/Brevis extension of 2 – 5 phalanges extension of 2 – 5 phalanges
Muscles of the Foot and Ankle Anterior Muscles cont. (3) Tibialis anterior inversion and dorsiflexion of foot / ankle
Muscles of the Foot and Ankle Medial Muscles (3) Tibialis Posterior Inversion and plantarflexion Flexor Hallucis Longus Flexor of great toe and plantarflexion of ankle Flexor Digitorum Longus Flexors of 2 – 5 toes and plantarflexion of ankle
Muscles of the Foot and Ankle
Posterior Muscles (2) Gastrocnemius plantarflexion of ankle plantarflexion of ankle Soleus plantarflexion of ankle plantarflexion of ankle
Quiz 1. What is the primary function of the Extensor Hallucus Longus and Brevis? 2. What is the primary function of the tibialis anterior? 3. What two motions does the peroneus longus and brevis perform? 4. What motion does the Gastrocnemius/ Soleus perform? 5. What are the two main motions of the tibialis posterior muscle?
Answers 1. Extension of great toe 2. Inversion and dorsiflexion of foot 3. Eversion and plantar flexion of the ankle 4. Plantarflexion of ankle 5. Inversion and plantarflexion
Arches of the Foot
Supinated Arches (High Arches)
Pronated Arches (Flat Feet)
Foot and Ankle Injuries
Ankle Sprain Cause: Excessive inversion or eversion of the ankle S/S: Point tenderness, swelling, discoloration, laxity, inability to walk or run properly (extent based on degree). TX: RICE, rehabilitation immediately (Grade III requires immobilization) Prevention: Strengthening exercises, proper shoes/ equipment
1 st Degree Ankle Sprain Mechanism (MX) Inversion and/or plantarflexion ATF most common sprained Occurs during contact or non – contact.
S/S 1 st degree Mild pain Pt – ATF Possible swelling Fast recovery to FWB and ROM No joint laxity
2 nd Degree Ankle Sprain MX Same as 1 st degree, more severe. Involves the ATF, CF Possible growth plate involvement Most cases x-ray needed
S/S 2 nd degree Felt a pop Felt a pop Localized severe pain Localized severe pain Pt – more then one ligament Pt – more then one ligament Rapid swelling Rapid swelling Decrease ROM Decrease ROM Laxity in joint Laxity in joint Unable to FWB Unable to FWB
3 rd Degree Ankle Sprain Rupture of ligaments (ATF, CF, PTF) Consider a FX X-ray is mandatory
S/S 3 rd Degree Felt or heard pop Extreme pain Extreme/rapid swelling No ROM Unable to FWB
1 st Degree Ankle Sprain 2 nd Degree Ankle Sprain 3 rd Degree Ankle Sprain RICE Return to Play (Toe raise, heel walk, Full go w/ full ROM Tape to Play Reevaluate 24hrs RICE (Horseshoe w/ compression wrap) Crutches 24 hours Reevaluate 24hrs Refer to Dr. X-rays RICE (Horseshoe w/ compression wrap) Crutches Posterior Splint Refer to Dr. X-rays
Anterior Drawer Test Tests for ligament instability Mainly tests ATF integrity but can also test the CF and PTF depending on severity Ankle must be relaxed Ankle in slight plantar flexion
Talar Tilt Test for lateral ankle instability Test for lateral ankle instability Positive test indicates tear in ATF, and CF Positive test indicates tear in ATF, and CF
Thompson Test Test for achilles tendon rupture
Ankle Dislocation Mx: Anterior – Heel strikes ground forcefully Posterior – blow to anterior lower leg S/S: PN deformity, inability to move foot, rapid swelling, refusal to allow moving or touching foot TX: Splint, ICE, 911 or transport to hospital
Sprain of the 1 st MP joint Mx: Hyperextension/ hyperflexion of great toe Hyperextension/ hyperflexion of great toe Common on artificial surface Common on artificial surface Flexible types of footwear can contribute Flexible types of footwear can contribute S/S Pain over the first MP joint Pain over the first MP joint Turf Toe
Achilles Tendonitis MX: Repetitive motions such as running and jumping that cause tendon breakdown S/S: Swelling, crepitus, pn with palpation, pn with dorsiflexion, weak with plantarflexion TX: RICE Limiting or restricting the activity that caused the irritation Aggressive stretching of heel cord Crepitus (crackling and grinding) may mean it is too late Prevention: Achilles and gastroc/solues stretching, proper acclimization to activity.
Achilles Tendon Rupture MX: Sudden, forceful plantar flexion of the ankle with a chronically tight tendon. S/S: Feel or hear a pop. Feel as if they’ve been kicked in the leg. Inability to plantar flex foot. TX: Surgery or a cast Prevention: Stretching and proper care of any tendonitis
Mx – Downward force to the foot causing depression of the arch Downward force to the foot causing depression of the arch Most common with overuse (running) Most common with overuse (running) S/S Sharp pain with weight bearing Sharp pain with weight bearing Painful during dorsiflexion Painful during dorsiflexion Longitudinal Arch Strain
“Shin Splints”: catch all term related to lower leg pain. catch all term related to lower leg pain. MX: constant pounding associated with running constant pounding associated with running S/S: sharp pain in lower leg around medial/lateral aspect of lower leg and connective tissue between tibia and fibula sharp pain in lower leg around medial/lateral aspect of lower leg and connective tissue between tibia and fibula TX: RICE (cold whirlpool), heal lift, arch support, shoes, change running surface RICE (cold whirlpool), heal lift, arch support, shoes, change running surface Lower Leg Problems
Compartment Syndrome MX: Increased pressure within one of four compartments of lower leg causes compression of the structures in the leg. S/S: Deep aching pain, tightness, and swelling. Pain with stretching. TX: Acute~ immediate surgery Chronic~ activity modification & ice and some times surgery Prevention: Stretching (Hard to prevent)
Toe Abnormalities Hammer Toes MX: Poor shoe choices Middle joint (PIP) flexed, other joints (MP, DIP) hyperextended TX: Refer, orthotics or surgery
Bunion / Hallux Valgus MX: Bony enlargement of the head of the 1st metatarsal caused from wearing improperly fitting shoes S/S: Obvious deformity, tenderness, and swelling TX: Proper shoe selection, protection devices, surgery may be necessary Prevention: Properly fitting shoes
Ingrown Toenail MX: Improper shoe fitting and nail cutting S/S: Increased pain, swelling, redness around the nail bed TX: Hot, soapy water, antibiotics, raise nail up Prevention: Proper shoes, proper nail trimming