Foot, Ankle and Lower LegFoot, Ankle and Lower Leg

Sports Medicine Chapters 14 & 15

Lower LegLower Leg Anatomy of the foot, ankle and lower leg Common Injuries Treatment Prevention Rehabilitation

VocabularyVocabulary

apophysis, exostoses, metatarsalgia, Morton’s neuroma, pes planus, pronation, pes cavussupination, eversion,dorsiflexion, inversion,plantar flexion,proprioception, Thompson test

AnatomyAnatomy Bones of the foot and ankle

Foot:1.Lateral/Medial Mallelous

2.Talus

3. Calcaneus4.Navicular5.Cuboid6. 1st, 2nd, 3rd or medial, middle, lateral Cuneiforms7.Metatarsals/phalanges

Ligaments Ligaments 1.Anterior Talo FibularMost common lig. Injured. Injured by plantar

flexion/inversion

2.Posterior Talo FibularInjured by dorsiflexion and inversion

3.CalcaneofibularInjured by dorsiflexion and inversion 4.Deltoid/post. talotibialLargest lig. In the ankle. Eversion sprain

5.Ant/Post tibiofibularattaches tibia/fibula

MUSCLESMUSCLES Gastrocnemius/soleus

– plantar flexion

– forms the achilles tendon and attaches to the calcaneus

Tibialis Anterior– in front of your tibia

– attaches to the 1st metatarsal

– produces dorsi flexion and inversion

Flexor Hallucis longus/brevis– flexes big toe

– is part of your arch

Muscles cont.Muscles cont. Peroneal Longus/brevis

– attaches to base of 5th metatarsal

– produces eversion

Peroneal tertius– same as above

Extensor digitorum longus– extends your phalanges

Flexor digitorum longus– flexes toes

– goes by the deltoid lig.

InjuriesInjuries Blisters. Caused by friction. Rx: donut and cover. Ingrown toenails. Toenail is growing down into the toe. Rx: soaking the toe,

cleaning it out, lifting the nail up. Or dr. Heel bruise. Direct blow to the heel. Very painful, rest ice and heel cup or

tape. Arch strain: metatarsal, transverse, inner/outer

longitudinal arches. Very painful while running/walking. Rx. RICE, arch tape job, ultrasound, whirlpool and stiff sole

shoe. Morton’s neuroma: 2nd or 3rd metatarsal. - RX pad.

Injuries Cont.Injuries Cont. Fractures of your toes: Dr. Referral if great toe involved. If not tape together and wear wide

fitting shoes. Fracture of the metatarsals. Direct blow or twisting type of an injury. Jones fracture. fx. Base of 5th metatarsal, caused by same mechanism of sprain

ankle. High incidence of nonunion. Bunion: hallux valgus. Most common injury to the great toe. Bursa becomes inflamed due

to poor fitting shoes or a congenital deformity. Tape like turf toe but off to the side.

Injuries Cont.Injuries Cont. Hammer toes: 2nd or 3rd toe May be congenital, or wears shoes too small Overly contracted flexor tendons/overly stretched

extensor tendons Surgery or taping of the toes

Bony outgrowths (exostoses) Heel spurs Located at the head of the 1st metatarsal or heel Apophysitis Where the achilles tendon attaches. Rx= 1/4” heel

lift

Plantar fasciitis Heel spur syndrome. Most frequent hind foot

problem. S/S burning, sharp pain around the heel. Rx.= NSAID’s ultrasound, ice and stretch

Stress fractures: 18% occur here In the metatarsals Rx.= Cast, rest for 3-4 weeks

Ankle InjuriesAnkle Injuries Sprains. Grade1=3-7 days out. Grade 2=7-14 days out. Grade 3= 2-6 weeks out. Rx.= RICE, horseshoe.

Achilles tendonitis. Rx.= Ice/stretch, NSAID’s, heel lift, ultrasound. May take weeks/months to heal. If untreated may result in rupture.

Shin contusion. Very painful and takes very long to heal especially the

distal 1/3 of the tibia because of the low blood supply. Rx.= Ice compression and elevation.

Tennis leg: gastrocnemius strain. Calf strain cause by quick starts and stops with

foot planted and extends the knee. Rx.= Same care for a muscle strain.

Shin splints. Medial Tibial stress syndrome. Pain in the distal anterior

1/3 of the tibia. Causes: poor fitting shoes, bad arches in shoes, poor

conditioning, running on hard surfaces, muscle fatigue, ankle pronation.

Rx.= Ice massage, ice whirlpool after workouts, tape arches, run on soft surfaces, proper shoes.

Injuries ContinuedInjuries Continued

Anterior compartment syndrome. Four compartments in the lower leg. Muscle, nerves, arteries become compressed by swelling. S/S= weakness in foot dorsiflexion and extension of big

toe = foot drop. Numbness or tingling over the dorsal surface of the foot. Foot is cold. Lack of circulation. Rx.= Ice, elevation and to dr. ASAP don not compress.

Ankle Injuries Cont.Ankle Injuries Cont. Stress fracture: Common overuse injuries. Athletes who have hypermobile, pronated, or flat feet (pes

planus) are susceptible to fibular stress fx. Athletes who have rigid pes cavus are susceptible to tibial

stress fx. Intense pain while running but subsides while resting. Very

point tender. Rx.= X-ray with bone scan. Depending on where the fx. Is will determine if non weight

bearing or walking cast. Rest is the key. Swimming and biking is ok.

Ankle Injuries Cont.Ankle Injuries Cont. Achilles tendon rupture. S/S= felt like I got kicked in the calf. Possible

deformity, poor plantarflexion strength. Treatment: perform Thompson test, splint in relaxed

position and send to dr. Also ice. Could be caused by chronic tendonitis and is common to

people in their mid 30’s.

RehabilitationRehabilitation Evaluation: see handout Anterior drawer test= ATF lig. Talor tilt test= CF/Deltoid lig.

Rehab for Ankle sprain

Rehabilitation of an ankle injuryRehabilitation of an ankle injury Stage 1:

– RICE with horseshoe and elevation as much as possible

– Non weight bearing if athlete can not bear weight without a lot of pain

– After swelling has subsided use contrast baths

– CV by bike or pool w/out legs

Progression to stage 2:– Swelling has subsided and

pain is at a minimum, Full weight bearing

Stage 2– Contrast baths

– PNF- balance board, tubing and pool workouts with balance

– Manual resistance: plantar/dorsiflexion first than eversion/inversion

– Flexibility

– CV- bike and pool workouts using legs a little bit more

Progression to stage 3:– Pain free, full ROM, Almost

full strength

Rehab continuedRehab continued Stage 3:

– PNF

– SAID principle- sports specific

– Protective taping

– Jogging straight then slowly introduce jogging with big curves

– Jog sprint jog

– Jogging with cuts

– Jog fig. 8’s

– Back pedal

– Sprints straight

– Sprint with cuts

– Sprint with change of direction

– Side steps

– Activity specific to their sport

– Ice after activity