1. Unit 3: Lower leg, foot, ankle

2. Lower leg/ankle

3. Anatomy Tibia Fibula Talus Calcaneus Weight bearing bone of lower leg
Heel bone

4. Articulations Inferior tibiofibular joint
Talocrural joint (ankle joint)
Subtalar joint

5. Ligaments Lateral ligaments Medial Anterior talofibular
Posterior talofibular
Calcaneofibular
Medial
Deltoid

8. Muscles (4 compartments)
Anterior
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneal (fibularis) tertius
Lateral
Peroneal (fibularis) longus
Peroneal (fibularis) brevis
Superficial posterior
Gastroc
Soleus
Plantaris
Deep posterior
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

10. Anterior Muscle Action Tibialis anterior Dorisflex and inverts foot
Extensor hallicus longus
Dorsiflex and inverts foot; extends great toe
Extensor digitorum longus
Dorsiflex and everts foot; extends the toes
Peroneus (fibularis) teritus
Dorsiflex and everts foot

11. Lateral Muscles Actions Peroneus (fibularis) longus
Plantar flexes and everts foot
Peroneus (fibularis) brevis
Plantar flexes and everts the foot

12. Superficial posterior
Muscles
Actions
Gastrocnemius
Flexes the leg and plantarflexes the foot
Soleus
Plantarflexes the foot
Plantaris
Flexes the leg; plantarflexes the foot

13. Deep posterior Muscles Actions Popliteus
Flexes and rotates the leg medially
Flexor hallicus longus
Plantar flexes and inverts the foot; flexes great toe
Flexor digitorum longus
Plantarflexes and inverts the foot; flexes the toes
Tibialis posterior
Plantarflexes and inverts the foot

14. Evaluation-History Distinguish between overuse vs. acute
Acute- sudden onset
Overuse- develops over time
What irritates it more?
Intensity, activity, sport, terrain
What kind of surface do they play on?
How long has it been bothering them and how did it happen?

15. Evaluation- Observation
Gait analysis – how they walk
Foot type
Arches, forefoot position, rearfoot position
Weight bearing vs. non-weight bearing alignment

16. Evaluation- Palpation
Bony landmarks
Tibia, fibula, malleolus’, calcaneus, talus, navicular, cuboid, cuneiforms, metatarsals, styloid process of the 5th, metatarsal heads
Plantar fascia
Ligaments- ATF, CF, PTF, deltoid
Muscles – anterior tibialis, gastroc, soleus, peroneals, extensor tendons, Achilles tendon

17. Evaluation- Special Tests
Muscle testing
Extensor digitorm longus
Extensor hallicus longus
Flexor digitorum longus
Flexor hallicus longus
Tibialis anterior
Tibialis posterior
Peroneals
Gastrocnemius
Soleus

18. Evaluation- Special tests
What it tests for…
Video
Anterior drawer
ATF
Posterior drawer
PTF
Compression test
Fracture
Bump test
Thompson test
Achilles
Talar tilt
(inversion) CF
(eversion) deltoid

19. Ankle injuries Lateral ankle sprain Medial ankle sprain
Syndesmotic (high) ankle sprain
Achilles tendinitis
Medial tibial stress syndrome
Compartment syndrome

20. Ankle injuries Lateral ankle sprain Ligaments involved: CF, ATF, PTF
MOI: Inversion
Signs and symptoms:
Painful pop on lateral side of ankle
Bruising
Instability
Swelling
Weakness
Treatment:
RICE/crutches if unable to walk
Rehab

21. Ankle injuries Medial ankle sprain Ligaments involved: deltoid
MOI: eversion
Signs and symptoms:
Painful pop on medial side of ankle
Bruising
Instability
Swelling
Weakness
Treatment:
RICE/crutches if unable to walk
Rehab

22. Ankle injuries Sydesmotic Sprain (high) MOI: forced dorsiflexion
Typically happen in conjunction with lateral or medial ankle sprain
Signs and symptoms:
Severe pain
Loss of function
Pain with passive ER and dorsiflexion
Treatment:
Take longer to heal
Immobilization
RICE
rehab

23. Ankle injuries Achilles tendinitis Inflammation of the Achilles tendon
MOI: repetitive weight-bearing activities; duration and intensity of activity is increased too quickly with insufficient recovery time; overuse injury
Signs and symptoms:
Generalized pain and stiffness in Achilles
Uphill running and hill workouts
Crepitus in tendon
Treatment:
Proper shoe ware
Decrease activity and proper training
Modalities
Massage

24. Ankle injuries Medial tibial stress syndrome (MTSS) Shin splints
MOI: repetitive microtrauma due to running and jumping activities
Weakness of leg muscles
Shoes
Training errors (on hard surfaces)
Signs and symptoms: pain in medial leg
Treatment: stretching, strengthening program, change in shoes and training, ice, modalities

25. Ankle injuries Compartment syndrome
MOI: increased pressure within one of the compartments of the lower leg and causes compression in the muscles and neurovascular structures
Signs and symptoms:
Deep aching pain
Tightness and swelling
Pain with passive stretching
Reduced circulation and sensory changes
Treatment:
Ice and elevation, stretching
Refer to doctor

26. Rehab

27. Foot

28. Anatomy Toes (phalanges)
First toe- hallux
Metatarsals – 5 bones between the phalanges and tarsal bones
Tarsal bones
Calcaneus (heel bone)
Talus
Cuboid
Navicular
Cuneiforms – first, second, and third

30. Arches of the foot Metatarsal arch Transverse arch
Medial longitudinal arch
Lateral longitudinal arch
Plantar fascia- band of fibrous tissue along the bottom of the foot

31. Articulations Interphalangeal (IP) joint
Metatarsophalangeal (MTP) joint
Intermetatarsal joint
Tarsometatarsal Joint (Lizfranc)
Subtalar joint
Midtarsal joint

33. Muscles and movements Dorsiflexion Plantarflexion Tibialis anterior
Extensor digitorum longus
Extensor hallicus longus
Peroneus teritus
Plantarflexion
Gastrocnemius
Soleus
Plantaris
Peroneus longus and brevis
Tibialis posterior
FHL
FDL

34. Muscles and movements Inversion, adduction, and supination
“Tom, Dick, and Harry”
Tibialis posterior
Flexor digitorum longus
Flexor hallicus longus
Eversion, abduction, and pronation
Peroneus longus
Peroneus brevis
Peroneus tertius
EDL

36. Evaluation- History

37. Evaluation- Observation

38. Evaluation- Palpation

39. Evaluation- Special Tests

40. Foot injuries Jone’s Fracture March fracture Calcaneus fracture
Metatarsalgia
Turf toe
Lizfranc injury

41. Foot deformities/injuries
Pes planus – flat foot
Pes cavus – high arch
Plantar fascitis
Jones fracture – fx at base of 5th metatarsal
Turf toe (great toe hyperextension)

42. Rehab
In small groups come up with a 3 day ankle/lower leg rehab program
Show progression through the program
Pick one of these injuries:
Shin splints
Ankle sprain
Turf toe
Achilles tendinitis

43. Rehab Examples of beneficial exercises for lower leg/ankle/foot…
Balance on dynadisc/foam pads
SL hops
Calf raises
4 way ankle exercises
Towel scrunches
Heel walks
Toe walks

44. So how does walking work?

45. Gait cycle

46. Let’s walk it out…
Looking for…
Pronation
Supination
Toe out/in