1. In Your Notebooks:
List at least 9 bones of the foot and lower leg that we learned last class.

2. #1 Anterior Talofibular Ligament Calcaneofibular ligament
Deltoid Ligament
Posterior Talofibular Ligament

3. Answer
C. Deltoid Ligament

4. #2 Deltoid, Calcaneofibular, Tibularfibulia
Anterior Talfibular, Posterior Talofibular, Calcaneofibular
Tibularfibulia, Anterior Cruciate Ligament, Posterior Cruciate ligament
None of these

5. Answer
B. Anterior Talfobular, Posterior Talofibular, Calcaneofibular

6. #3 A. Eversion B. High Ankle Sprain C. Forced Dorsiflexion
D. Inversion

7. Answer
D. Inversion

8. #4
A. The ligaments on the laterasl side of the ankle are amaller and weaker
B. The length of the fibula stops the ankle from being forced outward
C. Neither of these
D. Both A and B

9. Answer
D. Both A and B

10. #5 A. Tibialis Anterior and Gastrocnemius B. Soleus and Gastrocnemius
C. Tibialis Anterior and Tibialis Posterior
D. Peroneus Longus and Perones Brevis

11. Answer
B. Soleus and Gastrocnemius

12. #6 A. Tibialis Anterior and Gastrocnemius B. Soleus and Gastrocnemius
C. Tibialis Anterior and Tibialis Posterior
D. Peroneus Longus and Perones Brevis

13. Answer
A. Tibialis Anterior

14. #7 A. Tibialis Anterior and Gastrocnemius B. Soleus and Gastrocnemius
C. Tibialis Anterior and Tibialis Posterior
D. Peroneus Longus and Perones Brevis

15. Answer
A. Tibialis Anterior

16. #8 A. Tibialis Anterior and Gastrocnemius B. Soleus and Gastrocnemius
C. Tibialis Anterior and Tibialis Posterior
D. Peroneus Longus and Perones Brevis

17. Answer
D. Peroneus Longus and Peroneus Brevis

18. #9
A. The back view
B. The side view
C. The front view
D. Inside of

19. Answer
C. The front view

20. #10
A. The back view
B. The side view
C. The front view
D. Inside of

21. Answer
A. The back View

22. #11
A. microtrauma
B. direct contact
C. avulsion
D. none of these

23. answer
B. direct contact

24. #12 A. The broken bone comes through the skin
B. A piece of bone is pulled off by the tendon
C. Repeated microtrauma
D. None of these

25. Answer
B. A piece of bone is pulled off by the tendon

26. #13 A. Swelling, deformity & inability to bear weight
B. Redness, swelling & signs of infection
C. Mild pain, discoloration, & loss of function
D. None of these

27. answer
A. Swelling, deformity & inability to bear weight

28. #14 A. Send immediatley to the ER
B. Treat for shock, care for open wounds, immobilize & transport
C. Immobilize & transport
D. have parent come pick up the athlete

29. answer
B. Treat for shock, care for open wounds, immobilize & transport

30. #15
A. Inversion
B. High ankle sprain
C. Eversion
D. Bad Ones

31. answer
C. Eversion

32. #16 A. The amount of pain only
B. The amount of swelling, disability & pain
C. The amount of disability only
D. There is no difference

33. answer
B. The amount of swelling, disability & pain

34. #17 A. RICE and a horseshoe pad to direct the swelling B. RICE only
C. Crutches always
D. Send to the hospital

35. answer
A. RICE and a horseshoe pad to direct the swelling

36. #18
A. All degrees
B. only 3rd degree
C. 2nd and 3rd degree
D. Never

37. answer
C. 2nd and 3rd degree

38. #19 A. Inversion B. Forced Dorsiflexion C. Forced Plantarflexion
D. Eversion

39. answer
B. Forced Dorsiflexion

40. #20 A. RICE only B. RICE & crutches for the first 72 hours C. Cast
D. Send to ER

41. answer
B. RICE & crutches for the first 72 hours

42. #21 A. The tape is not as strong as a brace
B. The tape is too expensive
C. The tape loses effectiveness after approximately 20 minutes
D. There is no disadvantage of taping

43. answer
C. The tape loses effectiveness after approximately 20 minutes

44. #22 A. Not stretching B. Explosive motions
C. Rapid change of exercise intensity or training surfaces
D. Ankle Sprains

45. answer
C. Rapid change of exercise intensity or training surfaces

46. #23 A. Swelling & deformity B. Pain & disability
C. loss of function & motion
D. pain & redness

47. answer
A. Swelling & deformity

48. #24
A. Posterior
B. medial
C. Lateral
D. Anterior

49. answer
D. Anterior

50. #25 A. Sharp pain, throbbing and infection
B. Swelling, loss of sensation, inability to dorsiflex & loss of pedal pulse
C. Infection, fluid build-up and loss of plantarflexion
D. Cramping and Achilles tightness

51. answer
B. Swelling, loss of sensation, inability to dorsiflex & loss of pedal pulse

52. #26
A. Rest
B. Ice
C. Compression
D. Elevation

53. answer
C. Compression

54. #27
A. Direct Trauma
B. microtrauma
C. Repetitive Stress
D. Unknown

55. answer
D. Unknown

56. #28 A. The absence of plantar fascia
B. Inflammation of the plantar fascia
C. A tear in the plantar fascia
D. Has nothing to do with plantar fascia

57. answer
B. Inflammation of the plantar fascia

58. #29 A. Extreme pain all throughout the day
B. Extreme pain only when jumping
C. Extreme pain first thing in the morning that eases throughout the day
D. Tight Achilles

59. answer
C. Extreme pain first thing in the morning that eases throughout the day

60. #30 A. Rest, ice, anti-inflammatories & stretching of achilles
B. Ice only
C. Rest only
D. Stretching only

61. answer
A. Rest, ice, anti-inflammatories & stretching of achilles

62. #31 A. Callus formations on the heel
B. A possible result of untreated plantar faciitis in which ossification occurs forming a painful piece of bone on the heel
C. Medial leg pain brought about by walking, running or related activity
D. Brought about by repeated friction from tightly fitting shoes

63. answer
B. A possible result of untreated plantar faciitis in which ossification occurs forming a painful piece of bone on the heel

64. #32 A. 3rd metatarsal is longer than the 1st metatarsal
B. 2nd metatarsal is longer than the 3rd metatarsal
C. 2nd metatarsal is longer than the 1st metatarsal
D. A neuroma is present

65. answer
C. 2nd metatarsal is longer than the 1st metatarsal

66. #33
A. Morton’s Toe
B. Bunion
C. Morton’s Neuroma
D. Blisters

67. answer
C. Morton’s Neuroma

68. #34 A. Having an abnormally high arch
B. Having an abnormally flat arch
C. Not being able to plantarflex
D. Not being able to dorsiflex

69. answer
B. Having an abnormally flat arch

70. #35 A. Having an abnormally high arch
B. Having an abnormally flat arch
C. Not being able to plantarflex
D. Not being able to dorsiflex

71. answer
A. Having an abnormally high arch

72. #36 A. Improperly fitting shoes B. Getting kicked in the foot
C. getting stepped on
D. You are born with bunions

73. answer
A. Improperly fitting shoes

74. #37 A. The size B. the palcement
C. A blister is filled with fluid while a callus is not
D. A callus is filled with fluid while a blister is not

75. answer
C. A blister is filled with fluid while a callus is not

76. #38
A. A bruise
B. An ingrown toenail
C. A bunion
D. A hematoma

77. answer
D. A hematoma

78. #39 A. A cleat stepping on the toe B. Improperly fitting shoes
C. bad Hygiene
D. You are born with ingrown toenails

79. answer
B. Improperly fitting shoes

80. #40 A. Navicular and Cuboid B. Talus and Tibia C. Tibia and Fibula
D. Navicular and Cuneiforms

81. answer
C. Tibia and Fibula

82. Injuries to the: Lower Leg, Ankle and Foot

83. Anatomy Review Bones and Ligaments of the Ankle and Foot Tibia Fibula
Tarsals
Metatarsals
Phalanges
Note the subtalar joint that is responsible for
inversion and eversion of the foot

84. Anatomy Review (cont.)
Foot Bones (medial view)

85. Bones 1. 2. 3. 4. 5. 6. 8. 7. 9.

87. Joints 5. 4. 1. 2. 3.

88. Tarsal-metatarsal joints 2.Metatarsal-phalangeal joints
5.Talocrural joint
4.Subtalar joint
Tarsal-metatarsal joints
2.Metatarsal-phalangeal joints
3.Inter-phalangeal joints

89. Ligaments 1. 2. 6. 3. 4. 5.

90. 1. 2. 6. 3. 4. 5.

91. Muscles 3. 1. 2. 4.

93. Foot Anatomy Quiz Word Bank
-Calcaneus
-Talus
-Posterior Talofibular
-Navicular
-Gastrocnemius
-Cuneiforms
-Inter-phalangeal
-Phalanges
-Talocrural
-Cuboid
-Metatarsal-phalangeal
-Tibia
-Tarsal-metatarsal
-Subtalar
-Tibialis Anterior
-Deltoid
-Anterior Talofibular
-Posterior Tibiofibular
-Metatarsals
-Calcaneofibular
-Anterior Tibiofibular
-Fibula
-Peroneus Longus/Brevis
-Soleus

94. In your Notebooks:
List 4 joints of the foot and ankle discussed last class

95. Ligaments
The deltoid ligament is the primary stabilizer of the medial side of the talocrural (ankle) joint.

96. Ligaments (cont.) Ligaments of the Ankle (lateral view)
The three primary ligaments are:
Anterior talofibular
Posterior talofibular
Calcaneofibular

97. In Your Notebooks:
What ligament(s) are located on the medial side of the ankle?
What ligament(s) are located on the lateral side of the ankle?

98. Directional Term Review:
Anterior:
Posterior:
Medial:
Lateral:
Proximal:
Distal:
Superior:
Inferior:
Superficial:
Deep:
Dorsal:
Plantar:
Intermediate:

99. In Your Notebooks: Define the following directional terms: Anterior:
Posterior:
Medial:
Lateral:
Proximal:
Distal:

100. The Lateral Ankle
These ligaments are NOT as large or strong as the deltoid.
Additional lateral stability is provided by the length of the fibula on the lateral side of the ankle.
The talocrural joint is strongest in dorsiflexion and weakest in plantar flexion.

101. Motions of the Foot & Ankle:
Plantarflexion:
Dorsiflexion:
Inversion:
Eversion:

102. Anatomy Review: Muscles
Plantarflexion:
Gastrocnemius
Soleus
Eversion:
Peroneus Brevis
Peroneus Longus
Dorsiflexion:
Tibialis Anterior
Inversion:

103. You have 2 minutes to:
List all 11 bones of the foot, ankle and lower leg we have learned.

104. You have 2 minutes to:
List all 7 ligaments of the foot, ankle and lower leg we have learned about.

105. You have 1 minute to:
List the 4 joints of the foot, ankle and lower leg we have learned.

106. In your notebooks:
List 5 major muscles of the foot, ankle and lower leg along with their actions.

107. Review Question Answers
Tibia and Fibula
The Fibula is on the lateral side of the lower leg and supports approximately 2% of the body weight.
Talocrural Joint
Deltoid Ligament
Anterior Compartment- Tibialis Anterior- Dorsiflexion
Medial Compartment- Tibialis Anterior- Inversion
Lateral Compartment- Peroneal longus and Peroneal Brevis- Eversion
Posterior Compartment- Gastrocnemius and Soleus- Plantarflexion

108. 6. Anterior Compartment
7. Swelling, deformity, discoloration, inability to bear weight, possible bone projecting through skin, athlete reports hearing/feeling a snap or pop.
8. True
9. An Eversion ankle sprain is more severe.
10. The Achilles Tendon attaches to the gastrocnemius and the soleus muscles down to the calcaneus. Signs and Symptoms of injury are swelling and deformity,athlete reports and snap or a pop, pain, loss of function. Treatment includes ice and compression, immobilization and transport to a medical facility.
11. Compromising the blood vessels and nerves.

109. 12. Suggest a change in workout routine and have their gate analyzed
13. 1.) Almost unbearable pain in the plantar aspect of the foot with the first steps taken on getting out of bed in the morning and pain that eases with each following step. 2.) Point tenderness on the plantar aspect of the calcaneal tuberosity. Heel spurs are ossifications at the site of the attachment on the plantar aspect of the calcaneus.
14. The first and second metatarsal bone.
15. Pes planus is an abnormally flat foot and pes cavus is an abnormally high arch in the foot

110. 16. A blister is the separation of the layers of skin and a callus is a build up of tissue.
17. Wash area, use sterile needle to puncture and drain blister without removing the top layer of the blister, check area daily for redness or signs of infection, apply antibiotic ointment and cover with sterile dressing.
18. It is definitely best to help prevent blisters by having properly fitted footwear and giving new shoes a short break-in period before using them in practice or competition
19. False. When there is friction between the callus and layers of skin, a blister can form between the callus and the next lower layer of skin

111. 20. True. A callus should be shaved regularly to allow for only a small amount of buildup.

112. Common Sports Injuries
Fractures
Most often caused by direct trauma through contact. Contact causes most fractures to the lower leg and foot.
Repeated micro trauma can result in a stress fracture.
Avulsion fracture of 5th metatarsal can occur with a lateral ankle sprain.

113. Fractures Signs and symptoms include:
Swelling and/or deformity at the site of fracture.
Discoloration at the site.
Possible broken bone end projecting through skin.
Athlete reports a snap or pop was heard or felt.
Inability to bear weight on the affected leg.
For a stress fracture or growth plate fracture that did not result from traumatic event, the athlete complains of extreme point tenderness and pain at the site of injury.

114. Fractures (cont.) First Aid Watch and treat for shock, if necessary.
Apply sterile dressing to any open wounds.
Carefully immobilize the foot and leg using a splint.
Arrange for transport to a medical facility.

115. Soft Tissue Injuries Ankle Injuries
Ankle sprains are one of the most common injuries to this region.
Lateral sprains are more common; 80% to 85% of all ankle sprains are to the lateral ligaments (inversion sprains).
Eversion sprains, while less frequent, are often severe.

116. Ankle Injuries: Sprains
Signs and symptoms depend on degree of sprain.
1st degree: Pain, mild disability, point tenderness, little laxity, little or no swelling
2nd degree: Pain, mild to moderate disability, point tenderness, loss of function, some laxity, swelling (mild to moderate)
3rd degree: Pain and severe disability, point tenderness, loss of function, laxity, moderate to severe swelling

117. Ankle Injuries: Sprains (cont.)
First Aid
Apply ice and compression.
Elevate.
Apply a horseshoe- or doughnut-shaped pad.
Courtesy of Brent Mangus

118. Ankle Injuries: Sprains (cont.)
First Aid (cont.)
Have athlete use crutches if a second- or third- degree sprain has occurred.
If there is any question regarding the severity of the sprain, refer athlete to a medical facility for physician’s evaluation.

119. Ankle Injuries: Sprains (cont.)
Tibiofibular (tib-fib) Sprains
These injuries are often treated inappropriately as lateral ankle sprains, hindering recovery.
The difference is the mechanism of injury. Tib-fib sprains involve dorsiflexion followed by axial loading with external rotation of the foot.
Symptoms include a positive sprain test, but athlete is also in great pain. “Squeeze test” elicits pain in area.

120. Ankle Injuries: Sprains (cont.)
First Aid
Immediately apply ice and compression, and elevate the leg.
Apply a doughnut-shaped pad kept in place with an elastic bandage to provide compression.
Have athlete rest and use crutches for first 72 hours, followed by wearing a walking boot for 3 to 7 days.

121. Preventing Ankle Injuries
Taping or bracing will reduce the number of ankle injuries.
Prophylactic adhesive taping supports the ankle only for a short time.
Bracing may be better than taping.
Bracing combined with some high-top shoes may be helpful.
Courtesy of McDavid

122. Tendon-Related Injuries
Achilles tendon is commonly injured by long-distance runners, basketball players, and tennis players.
Onset of tendonitis may be slow among runners, but more rapid among basketball and tennis players.
Athletes who dramatically increase workout times or running distances, or who run on hard, uneven, or uphill surfaces are prone to Achilles tendonitis.
The injury can be either acute or chronic.
Acute injuries are often associated with explosive jumping or blunt trauma.

123. Achilles Tendon Injuries
Signs and symptoms include:
Swelling and deformity at site of injury.
Athlete reports a pop or snap associated with the injury.
Pain in lower leg that ranges from mild to extreme.
Loss of function, mainly in plantar flexion.
First Aid
Immediately apply ice and compression.
Immobilize with air cast or splint.
Arrange for transport to nearest medical facility.

124. Compartment Syndrome
Compartment syndrome usually involves the anterior compartment of the lower leg.
Chronic form is related to overuse of the compartment’s muscles that causes swelling of tissues.
Acute trauma, such as being kicked in the leg, can result in swelling within the compartment as well.
In either case, swelling puts pressure on vessels and nerves.
Properly sized shin guards can protect lower leg in soccer.

125. Compartment Syndrome (cont.)
Signs and symptoms include:
Pain and swelling in the lower leg.
Athlete may complain of chronic or acute injury to the area.
There may be loss of sensation or motor control to the lower leg and/or foot.
There can be loss of pulse in the foot.
Inability to extend the big toe or dorsiflex the foot.
First Aid
Apply ice and elevate. Do NOT apply compression.
If there is numbness, loss of movement, or loss of pulse to the foot, seek medical advice immediately; this is a true medical emergency.

126. Shin Splints
“Shin splints” is a very common disorder of lower leg. Term describes exercise-induced leg pain.
The types of activities that produce this problem and the manifestations of the injury vary depending on the athlete.
The etiology,(cause) and pathology (injury) of this disorder are unclear.

127. Shin Splints (cont.) Signs and symptoms include:
Lower leg pain either medially or posteromedially.
Typically, the athlete reports a chronic problem that progressively worsens.
Pain can be unilateral (one-side) or bilateral (both sides) .
First Aid
Apply ice and have the athlete rest.
Use of NSAIDs may be helpful.
Athlete may need to have his or her gait analyzed for biomechanical deficiencies.
If problem worsens, athlete should seek medical advice.

128. Plantar Fasciitis
The plantar fascia is a dense collection of tissues that traverses from the plantar aspect of the metatarsal heads to the calcaneal tuberosity.
If this tissue becomes tight or inflamed by overuse or trauma, it can produce pain and disability.
Typical symptom is extreme pain in the plantar aspect of the foot with the first steps taken after getting out of bed in the morning. Pain eases with subsequent steps.
Athlete also has point tenderness in the region of the calcaneal tuberosity.

129. Plantar Fasciitis (cont.)
Treatment is typically conservative and includes:
Rest.
Anti-inflammatories.
Applying cold and heat alternatively to enhance healing.
A heel pad and stretching the Achilles tendon complex can assist in recovery.
Re-aggravating the injury increases the healing time.

130. Heel Spurs Heel spurs can be related to chronic plantar fasciitis.
Chronic inflammation can result in ossification at the site of attachment on the plantar aspect of the calcaneus.
Heel spurs result in long-term disability for many athletes.
Treatment of Heel Spurs
Athlete should consult a physician if spurs become unbearable.
Applying a doughnut-shaped pad beneath the heel spur may help but rarely do they improve the problem.
Heel Spurs

131. Morton’s Foot
Morton’s foot typically involves either a shortened 1st metatarsal or an elongated 2nd metatarsal bone.
The result shifts weight bearing to the 2nd metatarsal instead of along the 1st metatarsal.
Results in pain throughout the foot during weightbearing.

132. Morton’s Foot Morton’s foot may result in Morton’s neuroma.
The problem is usually with the nerve between the 3rd and 4th metatarsal heads.
Pain radiates to 3rd and 4th toes.
A neuroma is an abnormal growth on a nerve.
Tight-fitting shoes may be the cause. Going barefoot may help.
This condition is best cared for by a physician.

133. Arch Problems
There are two groups of arch problems: pes planus and pes cavus.
Pes planus (flat feet) related to pronation.
Excessive pronation can cause difficulties in the navicular bone and some of the joints around the ankle.
Arch taping has limited effectiveness.
Corrective arch orthotics may be beneficial.
Pes cavas (high arches) associated with plantar fasciitis and clawing of the toes.
Athlete may benefit from orthotic device.

134. Bunions Bunions are uncommon in high school and college athletes.
Can be inflamed bursae or bone or joint deformities.
Can be caused by improperly fitting shoes.
Chronic bunion should be evaluated by physician.

135. Blisters & Calluses
Blisters and calluses are very common formations, resulting from friction between layers of skin.
When a blister forms, fluid collects between skin layers, occasionally the fluid will contain blood.
If the blister is large, it should be drained and the area padded to prevent further friction.
When draining a blister, it is best to leave top layer of skin in place.
Use sterile instruments and wear latex gloves or some other barrier to avoid contact with athlete’s body fluid.

136. Blisters & Calluses (cont.)
NSC First Aid Procedures
Wash area with soap and warm water; sterilize area with rubbing alcohol.
Use sterile needle to puncture the base of the blister and drain by applying light pressure. Process may need to be repeated during the first 24 hours.
Do not remove the top of the blister.
Apply antibiotic ointment to the top and cover with sterile dressing.
Check daily for signs of infection (redness or pus).
After 3–7 days, remove the top of blister and apply antibiotic ointment and sterile dressing.
Watch for signs of infection. Pad area with gauze
pads or moleskin.

137. Toe Injuries
Common injuries are torn-off nails or hematoma formation under the nail.
Collection of blood under nail needs to be released.
Use commercially available nail bore to drill small hole in nail to release blood.
Ingrown toenails may result from improperly fitting shoes.
Soak affected toe in warm antibacterial solution.
Elevate toenail by placing a small cotton roll under it and leave in place as nail grows.
Have athlete obtain shoes that fit more comfortably.

138. In your Notebooks:
List the signs and symptoms of a lower leg/foot fracture:
( yes, the information is in your notes!)

139. You have 5 minutes to:
Retrieve and look over your posters you constructed before we left for break

140. Get in your Poster Groups
You will have 6 minutes at each poster to gather information on the following “common sports injuries to the lower leg, foot and ankle:
Shin Splints
Arch Problems
Sprains
Fractures
Toe Injuries
Heel Spurs
Plantar Fasciitis
Blisters
Tendonitis
Morton’s Toe
Compartment Syndrome
Bunions

141. In Your Notebooks:
List and define the two foot arch abnormalities we have talked about in class.

143. Basic Taping 1. 2. 3.

144. Basic Taping (cont.) 4. 5. 6.

145. Basic Taping (cont.) 7. 8. 9.

146. Basic Taping (cont.)
10.
11.
12.

147. Basic Taping (concluded)
13.
14.
15.