Chapter 8 Foot and Ankle

Bones of the Foot and Ankle 28 bones: 28 bones: Tarsals (7) Tarsals (7) Metatarsals (5) Metatarsals (5) Phalanges (14) Phalanges (14) Tibia Tibia Fibula Fibula Calcaneus Talus Navicular Cuboid 3rd Cuneiform 2nd Cuneiform 1st Cuneiform Metatarsals Proximal Phalanx Intermediate Phalanx Distal Phalanx Proximal Phalanx of Great Toe Distal Phalanx of Great Toe

Arches of the Foot 4 arches4 arches LongitudinalLongitudinal MedialMedial LateralLateral MetatarsalMetatarsal TransverseTransverse Plantar FasciaPlantar Fascia Metatarsal Arch Transverse Arch Lateral Longitudinal Arch Medial Longitudinal Arch

Bones of the Ankle and Lateral Ligaments Lateral View (Left Ankle) Lateral View (Left Ankle) 4 Bones Tibia Fibula Talus Calcaneus 3 Main Lateral Ligaments ATF PTF CF

Medial Ligaments of the Ankle Deltoid Ligament (Medial View of Left foot) Deltoid Ligament (Medial View of Left foot) 4 strong ligaments Post. Tibiotalar Lig. Tibiocalcaneal Lig. Ant. Tibiotalar Lig. Tibionavicular Lig.

ROM of Foot and Ankle Dorsiflexion Dorsiflexion Plantar flexion Plantar flexion Inversion Inversion Eversion Eversion Abduction Abduction Adduction Adduction Toe Flexion Toe Flexion Toe Extension Toe Extension

Muscles of the Lower Leg Tibialis Anterior (In front of the Tibia) Tibialis Anterior (In front of the Tibia) Origin: from the lateral condyle and upper portion of the lateral surface of the tibia. Insertion the 1 st cuneiform and base of the 1 st metatarsal Action

Tibialis Posterior (Behind the Tibia) (Behind the Tibia) Origin from the interosseous membrane between the tibia and fibula, lateral portions of the posterior surface of the tibia, proximal 2/3 of the medial surface of the fibula Origin from the interosseous membrane between the tibia and fibula, lateral portions of the posterior surface of the tibia, proximal 2/3 of the medial surface of the fibula Insertion The bottom of the navicular, cuboid, and three cuneiforms Insertion The bottom of the navicular, cuboid, and three cuneiforms Action Action

Extensor Hallicus Longus Hallicus = Big Toe Hallicus = Big Toe Origin Middle 2/4 of the anterior surface of the fibula Origin Middle 2/4 of the anterior surface of the fibula Insertion Base of the distal phalanx of the great toe Insertion Base of the distal phalanx of the great toe Action Action

Extensor Digitorum Longus Origin Lateral condyle of the tibia and proximal ¾ of anterior surface of body of fibula Origin Lateral condyle of the tibia and proximal ¾ of anterior surface of body of fibula Insertion by 4 tendons to the 2nd thru 5 th digits. Each tendon forms and expansion on the dorsal surface of the foot. Ends at the base of each distal phalanx 2-5 Insertion by 4 tendons to the 2nd thru 5 th digits. Each tendon forms and expansion on the dorsal surface of the foot. Ends at the base of each distal phalanx 2-5 Action Action

Gastrocnemius and Soleus Gastrocnemius Gastrocnemius Origin proximal and posterior part of medial condyle and lateral condyle Insertion middle part of the posterior surface of the calcaneus Action Soleus Soleus Origin posterior surface of the head of the fibula and proximal 1/3 of its body, middle 1/3 of the medial border of the tibia Insertion with tendon of gastrocnemius (achilles tendon) to middle part of the posterior of the calcaneus Action “Calf Muscle” “Calf Muscle”

Peroneal Muscles Peroneus Longus Peroneus Longus Origin lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula Origin lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula Insertion lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula Insertion lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula Action Action Peroneus Brevis Peroneus Brevis Origin lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula Origin lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula Insertion Tuberosity at the base of the 5 th metatarsal, lateral side Insertion Tuberosity at the base of the 5 th metatarsal, lateral side Action Action Peroneus Tertius Peroneus Tertius Origin Distal 1/3 of anterior surface of fibula and interosseous membrane Origin Distal 1/3 of anterior surface of fibula and interosseous membrane Insertion Dorsal surface, base of 5 th metatarsal Insertion Dorsal surface, base of 5 th metatarsal Action Action

Flexor Digitorum Longus Origin Middle 3/5 of the posterior surface of the tibia Origin Middle 3/5 of the posterior surface of the tibia Insertion Bases of the distal phalanges of the 2 nd thru 5 th digits Insertion Bases of the distal phalanges of the 2 nd thru 5 th digits Action Action

Flexor Hallicus Longus Hallicus = Big Toe Hallicus = Big Toe Origin Posterior surface of distal 2/3 of the fibula and interosseous membrane Origin Posterior surface of distal 2/3 of the fibula and interosseous membrane Insertion Base of distal phalanx of great toe, plantar surface Insertion Base of distal phalanx of great toe, plantar surface Action Action

Plantaris Origin Distal part of lateral supracondylar line of the femur. Origin Distal part of lateral supracondylar line of the femur. Insertion Posterior part of the calcaneus Insertion Posterior part of the calcaneus Action Action

Great Toe Sprain “Turf Toe” “Turf Toe” Most common injury is foot sliding back on slippery surface and hyperextending toe. Most common injury is foot sliding back on slippery surface and hyperextending toe. Treatment Treatment

Arch Sprain Once the supportive ligaments are stretched they can no longer absorb the shock they were designed to take. Once the supportive ligaments are stretched they can no longer absorb the shock they were designed to take. Most common are metatarsal or inner longitudinal. Most common are metatarsal or inner longitudinal. Causes Treatment

Ankle Sprains Most common ankle injury. Most common ankle injury. Anterior Talofibular Ligament is the most commonly injured ligament. Anterior Talofibular Ligament is the most commonly injured ligament. Usually the first is the worst! Usually the first is the worst! Usually caused by excessive inversion and plantar flexion. More than 80% are inversion sprains.Usually caused by excessive inversion and plantar flexion. More than 80% are inversion sprains.

Ankle Sprains 1st degree 1st degree 2nd degree 2nd degree 3rd degree 3rd degree

Ankle Sprains Treatment P.R.I.C.E., braces, and taping. Treatment P.R.I.C.E., braces, and taping. 3rd degree ankle sprains may require surgical repair. 3rd degree ankle sprains may require surgical repair.

Ankle Dislocation CausesCauses TreatmentTreatment Do not attempt to reduceDo not attempt to reduce

Achilles Tendon Strain Formed by a union between the gastrocnemius and soleus muscles. Formed by a union between the gastrocnemius and soleus muscles. Strongest tendon in the body. Strongest tendon in the body. Causes Causes Treatment Treatment

Achilles Tendon Rupture CauseCause TreatmentTreatment In this case, the Achilles was so tight, it caused an avulsion fracture.In this case, the Achilles was so tight, it caused an avulsion fracture.

Jones Fracture Fracture of the base of the 5 th MetatarsalFracture of the base of the 5 th Metatarsal CausesCauses TreatmentTreatment

Stress Fractures Caused either by too little activity, or too much activity. Caused either by too little activity, or too much activity. Early x-rays may not show stress fracture, but conservative treatment and follow-up x-rays usually confirm the injury. Early x-rays may not show stress fracture, but conservative treatment and follow-up x-rays usually confirm the injury. Treatment Treatment

Fractures The sudden breaking of bone, usually due to an externally applied force. Treatment Splint fracture in position found.

Blisters CausesCauses Treatment Treatment

Shin Splints Catch-all phrase Catch-all phrase Slow healing due to poor blood flow Slow healing due to poor blood flow Causes Causes Treat with ice, orthotics, taping, and/or possible medical referral. Treat with ice, orthotics, taping, and/or possible medical referral.

Anterior Compartment Syndrome Athlete should be referred to a physician right away if suspected. Athlete should be referred to a physician right away if suspected. Can be mistaken for shin splints Can be mistaken for shin splints Causes Causes Direct trauma Excessive exercise---hemorrhage and swelling inside the compartment Pressure on nerves, veins and arteries cause loss of circulation. Pressure on nerves, veins and arteries cause loss of circulation. Treatment Medical emergency that usually results in surgery Have to do a release on the compartment

Heel Bruise Most disabling of contusions in athletics Most disabling of contusions in athletics May involve ligaments, tendons, and/or fat pad of the heel May involve ligaments, tendons, and/or fat pad of the heel Treatment Treatment

Plantar Fasciitis Plantar Fascia = a ligamentous tissue that extends from the calcaneous to metatarsal heads to support the longitudinal arches Plantar Fascia = a ligamentous tissue that extends from the calcaneous to metatarsal heads to support the longitudinal arches

Plantar Fascitis cont. Causes Causes Most common though is chronic irritation. Most common though is chronic irritation. Pain is on bottom of foot near heel and is usually worse in the morning. Pain is on bottom of foot near heel and is usually worse in the morning. Treatment Treatment

Heel Spur Bony growth on the calcaneous that causes inflammation of surrounding soft tissue. Bony growth on the calcaneous that causes inflammation of surrounding soft tissue. Usually results from improper treatment of plantar fasciitis. Usually results from improper treatment of plantar fasciitis. Plantar fascia pulls on the heel causing the bone to spur Plantar fascia pulls on the heel causing the bone to spur Treatment Treatment

Muscle Cramps Sudden, involuntary contraction of the muscle. Sudden, involuntary contraction of the muscle. Factors Factors Treatment **Very common in calf muscles

Special Tests Tinel’s SignTinel’s Sign Tarsal Tunnel Syndrome Morton’s TestMorton’s TestNeuroma/metatarsalgia Percussion TestPercussion Test “Heel Tap”—fracture of tib/fib Compression TestCompression Test Squeeze test—fracture of tib/fib Thompson TestThompson Test Achilles tendon rupture Homan’s SignHoman’s Sign Deep vein thrombophelbitis Anterior Drawer TestAnterior Drawer Test Injury to ATF and other lateral ankle ligaments Talar Tilt TestTalar Tilt Test Extent of damage to ankle ligaments Kleiger’s TestKleiger’s Test Deltoid ligament injury