August 30th foot ankle and lower leg notes

Foot, ankle and lower leg make up 15% of injuries seen.

Feet absorb 3x body weight

3 different arches
o medial longitudinal arch

Arch you think of (even etched into shoes

o Lateral longitudinal arch

Not as large as medial

o Transverse arch

Across the base of each metatarsal

Basic anatomy
o 26 bones in foot (7 tarsals, 5 metatarsals, 14 phalanges)

tibia

fibula

medial malleolus

lateral malleolus

tarsals

talus
o talorcruel

plantar/dorsi flexion joint

top

o subtalor

inversion/eversion joint

bottom

calcaneous

metatarsals

phalanges

o Ligaments

Anterior talofibular ligament (ATF)

Connects talus and fibula

Plantar flexion+ inversion = damage

Calcaneofibular ligament (CF)

Calcaneus and fibula

Inversion damages

Deltoid ligament

Triangle shaped

Medial

Eversion damages

o Articulations of the ankle

Talocrural joint

o Muscles

Intrinsic Muscles

Muscles that originate and insert within ft.

Extrinsic

originate outside ft, insert inside ft.

Gatroc/soleus (calf)

o Ankle sprains

Very common

Mechanism= inversion/ inversion + plantar flexion

Inversion alone=CF

Inversion +plantar flex= CF+ATF

Less common mechanism =eversion

Fibula helps stop eversion

o Special Tests

Anterior drawer test

Testing the integrity of the anterior Talofibular

ligament

Heel in hand, footrests on forearm, pull anteriorly

Talar tilt test

Testing integrity of the Calcaneofibular ligament

(Inversion) and the deltoid (Eversion)

Passively moving athletes foot into inversion or

eversion

o 3 different categories of sprain

1st

swelling, ecchymosis, (least severe)

loss of function tenderness

unable to walk, extreme pain

2nd

3rd

o treatment

R.I.C.E.

ROM/stretching exercises

Strengthening exercises

Functional movement

Proprioception

Skill specific

Return to play

o Arch sprains

Any ligaments can suffer from ligament sprain

When weakened, cannot absorb shock as well

Once ligament is stretched, fail to keep the foot in proper

pos

Mechanism = pronation and supination of the foot

o Blisters

Mechanism

friction

As layers of skin rub, friction causes separation of top layer

Fluid fills the separation area

Treatment

prevent further friction, relieve pain, avoid infection

o Great toe sprain

AKA turf toe

Mechanism

Sliding backwards while plantar flexed

(hyperextension of toe)

Treatment

Provide support c tape, ROM exercises

o Plantar fasciitis

Plantar fascia is a wide, nonelastic ligament tissue that

extends from the calcaneus to the distal metatarsals

Mechanism

Chronic
o Overuse, unsupportive footwear, running on
hard surfaces, or tight Achilles

Seen freq. in cross country and track

Treatment

Correct insoles

Arch tape

o Heel bruise

Contusion to calcaneus

Fat pad receives repetitive stress or acute hard blow

o Heel spur

Boney growth on calcaneus that causes painful

inflammation of surrounding soft tissue

Plantar fascia is stretched and pulled overtime at the

attachment site.

o Muscle cramps

Sudden involuntary contraction of a muscle

Fatigue

Fracture

Dehydration

Lack of nutrients

Poor flexibility

Improper equipment

Treatment

Stretching and fluid replacement

o Achilles tendonitis

Inflammation of the Achilles tendon

Where the gastroc and soleous meet at keel

Swelling caused by the gradual onset or single

incident of overtstressing the Achilles

Treatment

Stretching, correcting gait, and taking ibuprofen

o Achilles tendon rupture

Tendon completely tears

Muscle will ball up towards knee

Overextension or sudden force while dorsiflexed

Treatment

Surgery + 1 year rehab

o Medial Tibial Stress Syndrome (MTSS)

Shin splint

Doing too much too soon

Causes

Strain

Microfx

Tight calf

Improper ft. wear/gait

Uneven or hard surfaces

Treatment

Ice

Reduce activity

Stretching

o Stress fx

Incomplete crack in bone

Sharp localized pain

o Compartmental syndrome

Serious condition that may develop when swelling exists in

1+ of the compartments in the lower leg

Swelling caused from contusion, fx, or infection

Causes increased pressure cutting off blood flow/

nerve signals

Can lead to loss off appendages/ phalanges or

serious damage

Must be treated within 72 hours