4Toes (Phalanges)Designed to give wider base for balance and propelling the body forward.1st toe (Hallux)Two sesamoid bones located under the 1st MP joint.
5Metatarsals5 Bones1st metatarsal is the largest and strongest and functions as the main body support during walking and running.Palpable at the ball of the foot.5th metatarsal most common fractured.
6Tarsals 7 bones Aids in the support of the body. Calcaneous = largest tarsal bone, supports talus and shapes heel, and provides attachment for achilles tendon.
7Joints of the Foot Interphalangeal joint (IP) Flexion / ExtensionMetarsalphalangeal joint (MP)Abduction / Adduction
8Bones of the Ankle Tibia Fibula Talus Main weight bearing bone of LOWER LEGForms medial malleolusFibulaNon-weight bearingMainly muscle and ligament attachmentForms lateral malleolusTalusMain weight bearing bone of the ANKLE
9Lateral Ligaments of the Ankle Resist ankle inversionAnterior talofibular (ATF)Most commonly sprainedCalcaneofibular (CF)Posterior talofibular (PTF)
10Medial Ankle Ligaments DeltoidResists ankle eversionLow rate of injury
12Quiz Which bone in the lower leg is the most weight bearing? What does ATF stand for?Which ligaments resist inversion?Which ligaments resist eversion?What does MP stand for?How many tarsal bones are there?How many bones are in the foot?
21Muscles of the Foot and Ankle Medial Muscles (3)Tibialis PosteriorInversion and plantarflexionFlexor Hallucis LongusFlexor of great toe and plantarflexion of ankleFlexor Digitorum LongusFlexors of 2 – 5 toes and plantarflexion of ankle
30QuizWhat is the primary function of the Extensor Hallucus Longus and Brevis?What is the primary function of the tibialis anterior?What two motions does the peroneus longus and brevis perform?What motion does the Gastrocnemius/ Soleus perform?What are the two main motions of the tibialis posterior muscle?
31Answers Extension of great toe Inversion and dorsiflexion of foot Eversion and plantar flexion of the anklePlantarflexion of ankleInversion and plantarflexion
43Ankle Sprain Cause: Excessive inversion or eversion of the ankle S/S: Point tenderness, swelling, discoloration,laxity, inability to walk or run properly (extentbased on degree).TX: RICE, rehabilitation immediately (GradeIII requires immobilization)Prevention: Strengthening exercises, propershoes/ equipment
44Lateral Ankle Sprain Mechanism (MX) ATF most common sprained 1st Degree Ankle SprainMechanism (MX)Inversion and/or plantarflexionATF most common sprainedOccurs during contact or non – contact.
45Lateral Ankle Sprain S/S 1st degree Mild pain Pt – ATF Possible swellingFast recovery to FWB and ROMNo joint laxity
46Lateral Ankle Sprain 2nd Degree Ankle Sprain MX Involves the ATF, CF Same as 1st degree, more severe.Involves the ATF, CFPossible growth plate involvementMost cases x-ray needed
53Ankle Special Tests Anterior Drawer Test Tests for ligament instabilityMainly tests ATF integrity but can also test the CF and PTF depending on severityAnkle must be relaxedAnkle in slight plantar flexion
54Ankle Special Tests Talar Tilt Test for lateral ankle instability Positive test indicates tear in ATF, and CF
55Ankle Special TestsThompson TestTest for achilles tendon rupture
56Ankle Dislocation Mx: S/S: Anterior – Heel strikes ground forcefullyPosterior – blow to anterior lower legS/S:PN deformity, inability to move foot, rapidswelling, refusal to allow moving or touching footTX:Splint, ICE, 911 or transport to hospital
60Achilles Tendonitis MX: S/S: TX: Prevention: Repetitive motions such as running and jumping that cause tendon breakdownS/S:Swelling, crepitus, pn with palpation, pn with dorsiflexion, weak with plantarflexionTX:RICELimiting or restricting the activity that caused the irritationAggressive stretching of heel cordCrepitus (crackling and grinding) may mean it is too latePrevention:Achilles and gastroc/solues stretching, proper acclimization to activity.
62Achilles 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 castPrevention:Stretching and proper care of any tendonitis
64Longitudinal Arch Strain Mx –Downward force to the foot causing depression of the archMost common with overuse (running)S/SSharp pain with weight bearingPainful during dorsiflexion
65Lower Leg Problems “Shin Splints”: MX: S/S: TX: catch all term related to lower leg pain.MX:constant pounding associated with runningS/S:sharp pain in lower leg around medial/lateral aspect of lower leg and connective tissue between tibia and fibulaTX:RICE (cold whirlpool), heal lift, arch support, shoes, change running surface
67Compartment Syndrome MX: S/S: TX: Prevention: 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 surgeryChronic~ activity modification & ice and some times surgeryPrevention:Stretching (Hard to prevent)
72Toe Abnormalities Hammer Toes MX: TX: Poor shoe choices Middle joint (PIP) flexed, other joints (MP, DIP) hyperextendedTX:Refer, orthotics or surgery
73Bunion / Hallux Valgus MX: S/S: TX: Prevention: Bony enlargement of the head of the 1st metatarsal caused from wearing improperly fitting shoesS/S:Obvious deformity, tenderness, and swellingTX:Proper shoe selection, protection devices, surgery may be necessaryPrevention:Properly fitting shoes
76Ingrown Toenail MX: S/S: TX: Prevention: Improper shoe fitting and nail cuttingS/S:Increased pain, swelling, redness around the nail bedTX:Hot, soapy water, antibiotics, raise nail upPrevention:Proper shoes, proper nail trimming