Unit 5:Understanding Athletic-Related Injuries to the Lower Extremity Foot and Ankle, Anatomy and Injuries Sports Medicine

The Foot and Ankle

The Foot (Bones) Bones = 26 14 phalanges 5 metatarsals 7 tarsals

Toes (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.

Metatarsals 5 Bones 1st 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.

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.

Joints of the Foot Interphalangeal joint (IP) Flexion / Extension Metarsalphalangeal joint (MP) Abduction / Adduction

Bones of the Ankle Tibia Fibula Talus 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)

Medial Ankle Ligaments Deltoid Resists ankle eversion Low rate of injury

Muscles of the Foot and Ankle Posterior Muscles (2) Gastrocnemius plantarflexion of ankle Soleus

Arches of the Foot

Arch Chart

Arches of the Foot

Supinated Arches (High Arches)

Supinated Arches

Supinated Arches

Pronated Arches (Flat Feet)

Pronated Arches

Orthotics

Orthotics

Orthotics

Foot and Ankle Injuries

Ankle Sprain Cause: Excessive inversion or eversion of the ankle Signs and Symptoms (S/S): Point tenderness, swelling, discoloration, laxity, inability to walk or run properly (extent based on degree). Treatment (TX): PRICE, rehabilitation immediately (Grade III requires immobilization) Prevention: Strengthening exercises, proper shoes/ equipment

Lateral Ankle Sprain Treatment 1st Degree Ankle Sprain 2nd Degree Ankle Sprain 3rd Degree Ankle Sprain PRICE Return to Play (Toe raise, heel walk, Full go w/ full ROM (range of motion) Tape to Play Reevaluate 24hrs (Horseshoe w/ compression wrap) Crutches 24 hours Reevaluate 24hrs Refer to Dr. X-rays PRICE (Horseshoe w/ compression wrap) Crutches Posterior Splint

Horseshoe Brace

Ankle Special Tests 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

Ankle Dislocation Injury cause: S/S: 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

Turf Toe Sprain of the 1st MP joint Mx: S/S Hyperextension/ hyperflexion of great toe Common on artificial surface Flexible types of footwear can contribute S/S Pain over the first MP joint

Compartment Syndrome (Miss. Katelyn’s favorite injury type) Cause: 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: TX: Poor shoe choices Middle joint (PIP) flexed, other joints (MP, DIP) hyperextended TX: Refer, orthotics or surgery

Bunion / Hallux Valgus MX: S/S: TX: Prevention: 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: S/S: TX: Prevention: 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

Ankle Taping – Heel Locks

Ankle Taping – Full Ankle