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Chapter 17 - The Foot, Ankle, & Lower Leg
The Foot, Ankle, and Lower Leg
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Chapter 17 - The Foot, Ankle, & Lower Leg
Common Injuries Ankle sprains Arch sprains Blisters Turf toe Contusions Tendonitis Tendon ruptures Plantar fasciitis Heel bruise Heel spur Fractures Stress Medial Tibial Stress Syndrome 15% of injuries involve the ligaments, bones, and tendons of the ankle Feet act as shock absorbers – cushion up to one million pounds of pressure during one hour of exercise The foot stabilizes & supports the body - standing, running, jumping Individually the bones, muscles & ligaments are weak, but together they are strong enough to withstand most of the demands of athletics Medial Tibial Stress Syndrome = shin splints Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
FOOT ANATOMY Arches Medial Longitudinal arch Lateral Longitudinal arch Transverse ARCHES – key to the foot’s function Muscles & tendons play an important role in the support of the arches Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Medial Arch Most important Highest arch Composed of the – Calcaneus Talus Navicular Cuneiforms Metatarsals 1-3 Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Lateral Arch Lower & flatter than the medial arch Composed of the - Calcaneus Talus Cuboid Metatarsals 4 & 5 Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Transverse Arch Composed of the Cuneiforms Medial Intermediate Lateral Cuboid Navicular Talus Calcaneus Talus & Calcaneus – the two largest bones of the foot The arches are maintained by the shapes of the bones & the ligaments The foot consists of 26 bones & 38 joints 7 tarsals, 5 metatarsals, & 14 phalanges Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Ankle Joints Formed by a combination of two joints Talocrural joint Hinge joint w/most movement in dorsiflexion & plantar flexion Subtalar joint Malleoli Ankle joint is most commonly injured during athletics Talocrural joint = tibia, fibula, & talus Subtalar joint = talus & calcaneus Malleoli = bony prominences on either side of the ankle distal ends of the tibia (medially) and the fibula (laterally) Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Ligaments Connect bone to bone Injuries are called sprains Named for bones they connect Main Ligaments Anterior talofibular Anterior tibiofibular Calcaneofibular Posterior talofibular Deltoid Ligaments = tough bands of tissue Provide strength & support to joints Sprains = a tear, stretch, or complete rupture of one of more ligament Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Lower Leg Anatomy Consists of two bones Tibia Fibula Muscles Intrinsic Extrinsic Tibia – larges of the two leg bones – aka shin bone Fibula – slenderest bone in the body Intrinsic – located within the foot - cause movement of the toes - plantar flexors, dorsiflexors, abductors, adductors of the toes Extrinsic – located outside the foot - have long tendons crossing the ankle & attaching on the bones of the foot TALUS – no tendon attachments Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
MUSCLES Intrinsic Muscles – Cause movement of the toes Help support the arches Extrinsic Muscles – Aid in movement of the ankle & foot Intrinsic muscles – muscle relating to a specific body part or bone Extrinsic muscles – muscle that is outside a body part, organ, or bone Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Muscles – moving the foot
Chapter 17 - The Foot, Ankle, & Lower Leg Muscles – moving the foot Gastrocnemius – plantar flexes foot, flexes leg, supinates foot Soleus – plantar flexes foot Tibialis posterior – plantar flexes foot, inverts foot Tibialis anterior – dorsally flexes foot Plantar flex – movement extending the foot – Toes pointing down Supinate – Dorsally flex – flexing the foot – Bringing toes up toward the tibia Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Muscles – moving the foot
Chapter 17 - The Foot, Ankle, & Lower Leg Muscles – moving the foot Peroneus tertius – dorsally flexes foot Peroneus longus - everts, plantar flexes foot Peroneus brevis – everts foot, plantar flexes foot Plantaris – plantar flexes foot, knee flexion Everts – turns sole of foot outward (laterally) Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Muscles – moving the toes
Chapter 17 - The Foot, Ankle, & Lower Leg Muscles – moving the toes Flexor hallucis brevis – plantar flexes the great toe Flexor hallucis longus – plantar flexes the great toe Extensor hallucis longus – extends great toe, dorsiflexes ankle & great toe Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Muscles – moving the toes
Chapter 17 - The Foot, Ankle, & Lower Leg Muscles – moving the toes Flexor digitorum longus – plantar flexes toes, extends foot Extensor digitorum longus – extends toes, dorsiflexes the foot Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Common Injuries Ankle sprains – most common injury Usually a result of excessive inversion or plantar flexion Ligament most often injured Anterior talofibular ligament – Other ligaments involved Calcaneofibular ligament Posterior talofibular ligaments Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Common Injuries Ankle Sprains – signs & symptoms Three Categories First Degree (mild) Second Degree (moderate) Third Degree (severe) Treatment – PRICE Rehabilitation – ROM exercises Stretching exercises Strengthening exercises First degree – one or more of the supporting ligaments & surrounding tissues are stretched Minor discomfort – point tenderness – little or no swelling Second degree – a portion of one or more ligaments is torn Pain, swelling, point tenderness, disability, loss of function Athlete may not be able to walk normally – favors the leg Third degree – one or more ligaments is completely torn – joint instability Extreme pain or little pain (if nerve damage occurred), loss of function, point tenderness, rapid swelling – possible fracture PRICE – protection, rest, ice, compression, elevation Splinting, taping or bracing – may help protect from further injury All activities causing pain should stop First 24 hours – ice for 15 min – with 1 1/2 hours between applications Compression wrap & Elevate Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Arch Sprains Results from overstretched ligaments in the arch Most arch sprains to the lateral & medial arches Causes Overuse Overweight Fatigue Training on hard surfaces Wearing poor fitting/nonsupportive shoes Treatment Cold, compression & elevation Once ligaments are stretched – they fail to hold the bones of the foot in position. When an arch is weakened, it cannot absorb shock as well Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Blisters Occur anywhere on the body where there is friction Most often found on the feet Fluid forms creating pressure on the nerve endings = Pain – OUCH!! Broken blisters = open wound = may get infection Red/warm skin Pus from the blistered area Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Blisters Treatment Relieve pain, keep from enlarging, and avoid infection Cover w/bandage and change daily Prevention Eliminate friction Appropriate shoes & socks Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Great Toe Sprain (turf toe)
Chapter 17 - The Foot, Ankle, & Lower Leg Great Toe Sprain (turf toe) Caused by foot sliding backward on a slippery surface – hyperextending the toe Treatment PRICE Constant foot/toe support Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Plantar Fasciitis Inflammation of the plantar fascia Plantar fascia – wide, ligamentous tissue extending from the anterior portion of the calcaneus to the heads of the metatarsals Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Plantar Fasciitis Causes: Overuse Unsupportive footwear Tight Achilles tendon Running on hard surfaces Who: Cross-country & Track Athletes Basketball & Volleyball Cross country & Track – continuous straining from running & jumping Basketball & Volleyball – repeated jumping & landing Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Plantar Fasciitis Signs & Symptoms: Pain & tenderness on the bottom of the foot near the heal Treatment: Correcting training errors Icing Massage Treatment: Training errors: check shoes & activity level - more arch support heel cup/cushion Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Heel Bruise One of the most disabling contusions in athletes Treatment: Cold therapy before activity Cold & elevation after Heel cups/cushions/pad Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Heel Spur A bony growth on the calcaneus causing painful inflammation Aggravated by exercise Treatment: Located by pressing on the heel Arch taping Shoe inserts Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Fractures Athletes with a fracture generally cannot bear weight, have more swelling & pain than with a ligament sprain Signs & Symptoms: Point tenderness Obvious deformity Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Contusions Contusions occur most often over the shin The shin is sensitive to direct trauma Possible damage to the peroneal nerve Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Strains Strains – occur anywhere along muscles & normally result from a violent contraction, overstretching, or continued overuse Most common leg strain is to the gastrocnemius muscle Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Muscle Cramps Cramp – sudden, involuntary contraction of a muscle Cause – unknown Contributing factors Fatigue Fractures Dehydration Lack of nutrients Poor flexibility Improperly fitted equipment Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Muscle Cramps Treatment: Passive stretching Fluid replacement Massage Rest & ice Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Achilles Tendonitis A painful condition – inflammation of the Achilles Tendon Achilles tendon connects the gastrocnemius & soleus muscles to the calcaneus Achilles tendonitis can make walking almost impossible Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Achilles Tendonitis Signs & Symptoms: Symptoms gradually develop Pain & Crepitus Redness Treatment: Prevention! Stretching before activity Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Achilles Tendon Rupture
Chapter 17 - The Foot, Ankle, & Lower Leg Achilles Tendon Rupture Cause: Poor conditioning & overexertion Direct trauma Treatment: Must be surgically repaired Rehab may take up to one year Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Medial Tibial Stress Syndrome (Shin Splints)
Chapter 17 - The Foot, Ankle, & Lower Leg Medial Tibial Stress Syndrome (Shin Splints) Catchall term for pain occurring below the knee on either the anterior or the medial side of the leg Associated with repetitive activity on a hard surface or forceable excessive use of the leg muscles Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Medial Tibial Stress Syndrome (Shin Splints)
Chapter 17 - The Foot, Ankle, & Lower Leg Medial Tibial Stress Syndrome (Shin Splints) Treatment: Icing Reducing activity level Stretching of the posterior leg muscles Shin Splints – worse in the morning as the soft tissue tightens over night Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Stress Fractures An incomplete crack in the bone Microscopic fractures that may eventually lead to a full fracture if left untreated Bone scan – definitive diagnosis Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Stress Fractures Signs & Symptoms Palpation of shin & definite hot spot found – sharp, intense pain Stress fractures feels better in the morning – bone was rested Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Compartment Syndrome Develops when there is swelling within one or more of the compartments in the lower leg Anterior Compartment Peroneal Compartment Deep Posterior Compartment Superficial Posterior Compartment Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Compartment Syndrome Anterior Compartment Contains the tibialis anterior; extensor digitorum longus, peroneus tertius, & extensor hallucis muscles Peroneal Compartment Contains the peroneus longus and peroneus brevis muscles Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Compartment Syndrome Deep Posterior Compartment Contains the popliteus, flexor digitorum longus, flexor hallucis longus, and tibialis posterior muscles Superficial Posterior Compartment Contains the gastrocnemius, soleus, and the plantaris muslces Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Compartment Syndrome Signs & Symptoms Sudden or gradual onset of symptoms involving the leg Swelling Point tenderness & pain in the affected muscle group Numbness, weakness & inability to use the affected muscle (later stages) Treatment Surgery Compartment Syndrome – must be diagnosed immediately or irreversible neurological, muscular, and vascular damage will occur Treatment delay may result in permanent disability Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Foot/Ankle Rehabilitation
Chapter 17 - The Foot, Ankle, & Lower Leg Foot/Ankle Rehabilitation Exercises can be used both for rehabilitation and for prevention of injury Complete Healing Absence of pain – Best determination of complete healing Full range of motion Strength Power Endurance Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Foot Muscle Strengthening
Chapter 17 - The Foot, Ankle, & Lower Leg Foot Muscle Strengthening Curl toes on top of a towel spread on the floor, causing the towel to bunch up Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Tibialis Anterior Muscle
Chapter 17 - The Foot, Ankle, & Lower Leg Tibialis Anterior Muscle With one foot, step on an elastic band. Lift up the other foot with the elastic band wrapped around it. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Peroneus Brevis Muscle
Chapter 17 - The Foot, Ankle, & Lower Leg Peroneus Brevis Muscle With one foot, step on an elastic band; evert the other foot. The closer the two feet are, the greater the resistance The further away, the less resistance Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Tibialis Posterior Use a foot loop. Cross the leg muscle to be worked over the front of the other foot, which is placed above the band. Move the two feet in opposite directions. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Achilles Tendon Stretch
Chapter 17 - The Foot, Ankle, & Lower Leg Achilles Tendon Stretch Place the foot not to be stretched forward. Both feet point straight ahead. Slowly squat. Repeat with the back foot turned out about 35 to 45 degrees. Repeat with the back foot turned in about 30 to 45 degrees. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Special Tests Certain tests can be performed that aid in the evaluation of injury. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Thompson Test With the subject prone and legs bent at 90 degrees, the certified athletic trainer places hand and fingers around the lower leg. Lower leg muscles are squeezed. If the Achilles tendon is intact, the foot will plantar flex. If the foot does not move, the Achilles tendon is ruptured. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Anterior Drawer Test The top of the ankle is stabilized with one hand, and the heel pulled up with the other. Forward movement indicates a torn anterior talofibular ligament. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Plantar Fascia Test Pressing in the area of the injury near the medial calcaneus helps determine how much of the plantar fascia is affected. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Talar Tilt Test With the subject sitting and the ankle in a neutral position, grasp the calcaneus while holding the lower leg and apply direct inversion stress. The test is positive if the talus tilts out (injured calcaneofibular ligament). Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Chapter 17 - The Foot, Ankle, & Lower Leg
Tinel’s Sign Tap the tibial nerve just below the lateral malleolus. Radiating pain indicates an inflamed tibial nerve. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
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