Injuries to the Lower Leg, Ankle, and Foot

Anatomy  Provide stable base of support and a dynamic system for movement  Bones of the lower leg consist of tibia and fibula  Normal foot contains 26 bones  Talus  Calcaneus  Navicular  Cuboid  Cuneiforms (3)  Metatarsals  Phalanges

Anatomy  Ankle joint- talocrural joint  Lateral side  Anterior talofibular ligament  Posterior talofibular ligament  Anterior tibiofibular ligament  Posterior tibiofibular ligament  Calcaneofibular ligament  Medial side  Deltoid ligaments

Medial Ankle Ligaments

Anatomy  Movements of the ankle  Dorsiflexion  Plantarflexion  Inversion  Eversion  Supination  Pronation  Extension/Flexion of toes

Anatomy  Two different arches in the foot  Longitudinal arch  Transverse arch  Act as shock absorbers and provide propulsion off surfaces during movement  Muscles of the lower leg are divided into compartments  Anterior  Posterior  Lateral

Fractures  Direct trauma through contact will cause most fractures  Magnitude of force will vary for different bones  Stress fractures can occur from overuse trauma  MOI  Direct trauma  Microtrauma  Signs and symptoms  Swelling, deformity, discoloration, NWB, pop/snap  Treatment  Splint and transport for x-rays  RICE

Ankle Sprains  One of the most common injury to the lower leg and foot  Happens to the lateral and medial aspects  MOI  Abnormal stress is placed on the ligaments when the foot rolls to one side  First, second and third degree sprains  Signs and Symptoms  Depends on degree  Pain, swelling, disability, point tenderness, loss of function, laxity  Treatment  RICE  Crutches if necessary  Strengthening program

High Ankle Sprain  Injury to the syndesmosis between tibia and fibula  MOI  Ankle is forced into dorsiflexion and eversion  Signs and Symptoms  Pain and point tender over the anterior aspect of the ankle  Treatment  RICE  Crutches  Rehab program

Achilles Tendon Injuries  Commonly injured by long distance runners, basketball players and tennis players  The onset of tendonitis will be slow in runners and will have a faster onset in basketball players and tennis players  MOI  Tendonitis- Overuse, tendon becomes inflamed  Rupture- explosive jumping or direct trauma causes tearing or rupturing of tendon  Signs and symptoms of rupture  Swelling and deformity  Loud pop or snap  Severe pain and loss of function (mainly plantarflexion)  Treatment for rupture  Splint and transport to ER  RICE  Surgery is usually necessary

Compartment Syndrome  Results from acute or chronic stresses and will affect the lower leg  Results from too much swelling within the compartment  Compromises the vascular and neurological structures  MOI  Chronic- overuse of the muscles creates extra fluid  Traumatic- creates blood loss and swelling into the compartment  Signs and symptoms  Pain, swelling, and loss of function  Loss of sensation, motor control, or pulse in the foot  Treatment  Ice and elevation  Important to get medical advice early on

Compartments  Anterior compartment  muscular  tibialis anterior  extensor hallucis longus  extensor digitorum longus  peroneus tertius  neurovascular  deep peroneal nerve  anterior tibial vessels  Lateral compartment  muscular  peroneus longus  peroneus brevis  neurovascular  superficial peroneal nerve

 Superficial posterior compartment  muscular  gastrocnemius  plantaris  soleus  neurovascular  sural nerve  Deep posterior compartment  muscular  tibialis posterior  flexor hallucis longus  flexor digitorum longus  popliteus  neurovascular  tibial nerve  posterior tibial vessels

Shin Splints  Very common  Defined as a wide variety of exercise induced lower leg problems  Develop when the muscle and bone tissue (periosteum) become overworked by repetitive activity  MOI  Multiple causes  Sudden change in activity  Commonly from running activities on different services  Improper footwear  Signs and symptoms  Lower leg pain  Can be bilateral or unilateral  Treatment  Ice and rest  NSAIDs  Strengthening program  Determine cause and fix the problem- Most effective

Plantar Fasciitis  Dense collection of tissue including muscles and tendons that can be become injured and inflamed  MOI  Caused by a change in shoes, training techniques, training surfaces, etc.  Signs and symptoms  Unbearable pain on the bottom of foot  Pain is at its worst in the morning- first steps out of bed  Treatment  Usually conservative with different rehabilitative techniques  Ice  NSAIDs  Stretching and massage

Arch Problems  Arch problems will be classified into two categories  Pes Planus- Flat foot  Too much stress placed on navicular bone and joints  General discomfort  Pes Cavus- High arches  Can lead to plantar fasciitis and clawing of the toes  Discomfort due to the inability of foot to absorb forces  Treatments  Proper footwear- shoes, orthotics  Taping techniques

Foot Disorders Bunions Blisters  A result of an inflamed bursa or a deformity of the bony structure of the toes and feet  In athletics- usually a result of poorly fitting shoes  Effect the biomechanics of the entire foot  Excessive amounts of motion produce a great deal of friction between the layers of the of the foot and the shoe  Cause pain and discomfort  Blister should be drained and padded  Leave the top layer of skin  Keep area clean to prevent infection

Toe Injuries  Toe injuries will occur due to trauma to the area  Hematoma’s  Occur underneath the nail as a result of direct trauma  Subungal hematoma  Need to be drained  Ingrown toe nails  Can result from improperly fitting shoes or not cutting toe nails properly  If not treated properly can result in an infection

Preventative Ankle Taping  Lots of research about ankle taping  Pros and cons?  Ankle taping is both an art and a science  Careful attention needs to be taken so that every piece of tape has a purpose  Only certified athletic trainers should tape ankles, not c oaches…