© 2010 Delmar, Cengage Learning 1 © 2011 Delmar, Cengage Learning BELLWORK Name as many injuries to the foot, ankle, or lower leg that you have heard of or experienced. 1

+ Chapter 17 The Foot, Ankle, and Lower Leg

© 2010 Delmar, Cengage Learning 3 © 2011 Delmar, Cengage Learning Objectives Upon completion of this chapter, you should be able to: Describe the anatomy of the foot and ankle Cite primary extrinsic and intrinsic muscles of the lower leg Explain the common injuries and conditions affecting the foot, ankle, and lower leg Describe medial tibial stress syndrome and its treatment 3

© 2010 Delmar, Cengage Learning 4 © 2011 Delmar, Cengage Learning The Lower Leg Exposed to numerous types of trauma during athletic practices and events Common injuries include: Contusions Strains & sprains Tendonitis and tendon ruptures Medial tibial stress syndrome (“shin splints”) Stress fractures and other fractures Compartment syndrome 4

© 2010 Delmar, Cengage Learning 5 © 2011 Delmar, Cengage Learning The Foot and Ankle 15% of sports injuries involve ankle ligaments, bones, and tendons Ankle absorbs 3x the force of the body during running & jumping ~20,000 ankle sprains in the US every day! Feet log ~1,000 miles per year Minor, yet debilitating conditions: Athlete’s foot Turf toe Calluses Ingrown toenails blisters 5

© 2010 Delmar, Cengage Learning 6 © 2011 Delmar, Cengage Learning Basic Anatomy of Foot & Ankle 3 arches Key to foot’s function Absorb impact of walking, running, & jumping Medial longitudinal arch Highest & most important Lateral longitudinal arch Transverse arch 6

© 2010 Delmar, Cengage Learning 7 © 2011 Delmar, Cengage Learning Basic Anatomy of Foot & Ankle (con’t) 26 bones in the foot Tarsals (7): 1,2,3 cuneiform Navicular Cuboid Talus Calcaneus Metatarsals (5) Phalanges (14) 7

© 2010 Delmar, Cengage Learning 8 © 2011 Delmar, Cengage Learning Basic Anatomy of Foot & Ankle (con’t) 2 main ankle joints Talocrural (talus, tibia, fibula) Subtalar (talus, calcaneus) Medial malleolus Distal end of tibia Lateral malleolus Distal end of fibula 8

© 2010 Delmar, Cengage Learning 9 © 2011 Delmar, Cengage Learning Ligaments of the Foot & Ankle Ligaments: named for bones they connect Lateral ankle ligaments Anterior tibiofibular Anterior talofibular Calcaneofibular Posterior talofibular Medial ankle ligament Deltoid ligament 9

© 2010 Delmar, Cengage Learning 10 © 2011 Delmar, Cengage Learning Basic Anatomy of the Lower Leg 2 bones Tibia: largest of the 2; “shin” Fibula: smaller of the 2 10

© 2010 Delmar, Cengage Learning 11 © 2011 Delmar, Cengage Learning Basic Anatomy of the Lower Leg (con’t) Intrinsic muscles Muscles specific to a body part or bone Flexor hallucis longus Flexor digitorum longus Tibialis posterior From anterior to posterior: “Tom, Dick, and Harry” FHL

© 2010 Delmar, Cengage Learning 12 © 2011 Delmar, Cengage Learning BELLWORK Name the most important arch in the foot. How many tarsal bones are there? Name them. What’s the most often injured ligament in the ankle? 12

© 2010 Delmar, Cengage Learning 13 © 2011 Delmar, Cengage Learning Basic Anatomy of the Lower Leg (con’t) Extrinsic muscles Outside a body part, organ, or bone

© 2010 Delmar, Cengage Learning 14 © 2011 Delmar, Cengage Learning Basic Anatomy of the Lower Leg (con’t)

© 2010 Delmar, Cengage Learning 15 © 2011 Delmar, Cengage Learning Muscles Moving the Foot and Toes MUSCLEFUNCTION GastrocnemiusPlantar flexes foot SoleusPlantar flexes foot Tibialis posteriorPlantar flexes foot Tibialis anteriorDorsally flexes foot Peroneus longusEverts foot Flexor hallucis longusFlexes great toe Flexor digitorum longusFlexes toes (2-5) Extensor hallucis longusExtends great toe Extensor digitorum longusExtends toes (2-5)

© 2010 Delmar, Cengage Learning 16 © 2011 Delmar, Cengage Learning Common Injuries of the Foot and Ankle Ankle sprains Most common mechanism: inversion & plantar flexion (over 80%) Most common ligament injured: anterior talofibular lig. First degree (mild) Second degree (moderate) Third degree (severe) Treatment: protection, rest, ice, compression, and elevation (PRICE), followed by rehabilitation 16

© 2010 Delmar, Cengage Learning 17 © 2011 Delmar, Cengage Learning Animation – Ankle Sprain Click Here to Play Ankle Sprain Animation

© 2010 Delmar, Cengage Learning 18 © 2011 Delmar, Cengage Learning BELLWORK Name the 3 muscles represented by “Tom, Dick, and Harry”. Name the 3 muscles responsible for plantarflexing the foot. 18

© 2010 Delmar, Cengage Learning 19 © 2011 Delmar, Cengage Learning Common Injuries of the Foot and Ankle (cont’d.) Arch sprains Caused by overuse, overweight, fatigue, training on hard surfaces, and non-supportive shoes Treatment: cold, compression, and elevation Blisters Occur anywhere there is friction Treatment: relieve pain, keep from enlarging, and avoid infection Proper shoes & socks 19

© 2010 Delmar, Cengage Learning 20 © 2011 Delmar, Cengage Learning Common Injuries of the Foot and Ankle (cont’d.) Great toe sprain (“turf toe”) Big toe hyperextends Treatment: PRICE and support 20

© 2010 Delmar, Cengage Learning 21 © 2011 Delmar, Cengage Learning Common Injuries of the Foot and Ankle (cont’d.) Plantar fasciitis Plantar fascia: non-elastic ligamentous tissue that extends from calcaneus to heads of metatarsals Tissue becomes strained from overuse, unsupportive footwear, a tight Achilles tendon, or running on hard surfaces Treatment: correct training errors, icing, and massage Arch support and/or heel cups 21

© 2010 Delmar, Cengage Learning 22 © 2011 Delmar, Cengage Learning Common Injuries of the Foot and Ankle (cont’d.) Heel bruise Heel receives, absorbs, and transfers impact from sports activities Ligaments, tendons, and fat pad are subject to stress and injury Treatment: cold application before activity, cold and elevation afterward, heel cups or pads 22

© 2010 Delmar, Cengage Learning 23 © 2011 Delmar, Cengage Learning Common Injuries of the Foot and Ankle (cont’d.) Heel spur Bony growth on calcaneus that causes painful inflammation of soft tissue Treatment: taping or shoe inserts Fractures Immediately impairs ability to perform Often a site of point tenderness is present, and an obvious deformity may be seen 23

© 2010 Delmar, Cengage Learning 24 © 2011 Delmar, Cengage Learning Common Injuries to the Lower Leg Contusions Occur most often over the shin May also involve muscular areas of the leg Result of a direct blow Strains Occur anywhere along the muscles Normally result from a violent contraction, overstretching, or continued overuse 24

© 2010 Delmar, Cengage Learning 25 © 2011 Delmar, Cengage Learning Common Injuries to the Lower Leg (cont’d.) Muscle cramps Sudden, involuntary contraction of a muscle Contributing factors may include fatigue, fractures, dehydration, lack of nutrients, poor flexibility, improperly fitted equipment Treatment: passive stretching, fluid replacement, massage, rest, and ice 25

© 2010 Delmar, Cengage Learning 26 © 2011 Delmar, Cengage Learning Common Injuries to the Lower Leg (cont’d.) Achilles tendonitis Caused by inflammation of the Achilles tendon tendon in back of ankle that attaches gastroc & soleus to calcaneus Tearing of tendon tissues caused by excessive stress Treatment: best is prevention (stretching), ice, anti- inflammatory medication, physical therapy, rest Achilles tendon rupture Caused by poor conditioning and overexertion Treatment: must be surgically repaired 26

© 2010 Delmar, Cengage Learning 27 © 2011 Delmar, Cengage Learning Common Injuries to the Lower Leg (cont’d.) Medial tibial stress syndrome (shin splints) Pain on either inside or outside portion of lower leg Normally the result of doing too much too soon Treatment: ice, reducing activity level, and gentle stretching of posterior leg muscles Long-term treatment: biomechanical assessment of lower extremities, physical therapy, orthotic devices, anti-inflammatory medications, and a strengthening and flexibility program 27

© 2010 Delmar, Cengage Learning 28 © 2011 Delmar, Cengage Learning Common Injuries to the Lower Leg (cont’d.) Stress fractures Incomplete crack in the bone Signs include a “hot spot” of sharp, intense pain Compartment syndrome Develops when there is swelling within one or more lower leg compartments Treatment: immediate transportation to the nearest medical facility (surgery will usually be needed) 28

© 2010 Delmar, Cengage Learning 29 © 2011 Delmar, Cengage Learning Common Injuries to the Lower Leg (cont’d.) Fractures Tibia can be fractured by a direct blow, a twisting force, or occasionally from repetitive overuse Fibula is normally fractured by a direct blow to the outside of the leg 29

© 2010 Delmar, Cengage Learning 30 © 2011 Delmar, Cengage Learning Additional Tests for the Foot, Ankle, and Lower Leg Standard methods of testing various structures of the lower extremity: Anterior Drawer Test (anterior talofibular lig.) Plantar Fascia Test (plantar fasciitis) Talar Tilt Test (calcaneofibular lig.) Tinel’s Sign (nerve entrapment) Thompson Test (Achilles tendon rupture) 30

© 2010 Delmar, Cengage Learning 31 © 2011 Delmar, Cengage Learning Conclusion Injuries to the lower extremity are common in athletics Solid understanding of anatomy will help the examiner assess injuries Proper conditioning, equipment, and training are essential to the overall health of the athlete 31