Unit 5:Understanding Unit 5:Understanding Athletic-Related Injuries Athletic-Related Injuries to the Lower Extremity to the Lower Extremity Foot and Ankle, Anatomy and Foot and Ankle, Anatomy and Injuries Injuries Sports Medicine Sports Medicine
Dec 16, 2015
Unit 5:Understanding Athletic-Unit 5:Understanding Athletic-Related Injuries to the Lower Related Injuries to the Lower
ExtremityExtremity
Foot and Ankle, Anatomy and InjuriesFoot and Ankle, Anatomy and Injuries
Sports Medicine Sports Medicine
The Foot (Bones)The Foot (Bones)
Bones = 26Bones = 26 14 phalanges 14 phalanges 5 metatarsals5 metatarsals 7 tarsals7 tarsals
Toes (Phalanges)Toes (Phalanges) Designed to give Designed to give
wider base for wider base for balance and balance and propelling the body propelling the body forward.forward.
1st toe (Hallux)1st toe (Hallux) Two sesamoid Two sesamoid
bones located under bones located under the 1the 1stst MP joint. MP joint.
MetatarsalsMetatarsals 5 Bones5 Bones 11stst metatarsal is the metatarsal is the
largest and strongest largest and strongest and functions as the and functions as the main body support main body support during walking and during walking and running. running.
Palpable at the ball of Palpable at the ball of the foot.the foot.
55thth metatarsal most metatarsal most common fractured.common fractured.
TarsalsTarsals 7 bones7 bones Aids in the support of Aids in the support of
the body.the body. Calcaneous = largest Calcaneous = largest
tarsal bone, supports tarsal bone, supports talus and shapes talus and shapes heel, and provides heel, and provides attachment for attachment for achilles tendon.achilles tendon.
Joints of the FootJoints of the Foot Interphalangeal joint Interphalangeal joint
(IP)(IP) Flexion / ExtensionFlexion / Extension
Metarsalphalangeal Metarsalphalangeal joint (MP)joint (MP) Flexion / Extension Flexion / Extension Abduction / AdductionAbduction / Adduction
Bones of the AnkleBones of the Ankle TibiaTibia
Main weight bearing bone Main weight bearing bone of LOWER LEGof LOWER LEG
Forms medial malleolusForms medial malleolus
FibulaFibula Non-weight bearingNon-weight bearing Mainly muscle and Mainly muscle and
ligament attachmentligament attachment Forms lateral malleolusForms lateral malleolus
TalusTalus Main weight bearing bone Main weight bearing bone
of the ANKLEof the ANKLE
Lateral Ligaments of the Lateral Ligaments of the AnkleAnkle
Resist ankle inversionResist ankle inversion
Anterior talofibular (ATF)Anterior talofibular (ATF) Most commonly sprainedMost commonly sprained
Calcaneofibular (CF)Calcaneofibular (CF) Posterior talofibular (PTF)Posterior talofibular (PTF)
Medial Ankle LigamentsMedial Ankle Ligaments
DeltoidDeltoid
Resists ankle Resists ankle eversioneversion
Low rate of injuryLow rate of injury
QuizQuiz
1.1. Which bone in the lower leg is the most weight Which bone in the lower leg is the most weight bearing?bearing?
2.2. What does ATF stand for?What does ATF stand for?
3.3. Which ligaments resist inversion?Which ligaments resist inversion?
4.4. Which ligaments resist eversion?Which ligaments resist eversion?
5.5. What does MP stand for?What does MP stand for?
6.6. How many tarsal bones are there?How many tarsal bones are there?
7.7. How many bones are in the foot?How many bones are in the foot?
Answers:Answers:
1.1. TibiaTibia
2.2. Anterior TalofibularAnterior Talofibular
3.3. Anterior Talofibular, tibiofibular, calcaneofibular Anterior Talofibular, tibiofibular, calcaneofibular (lateral)(lateral)
4.4. Deltoid ligaments (medial)Deltoid ligaments (medial)
5.5. Metatarsalphalangeal Metatarsalphalangeal
6.6. 77
7.7. 2626
Muscles of the Foot and Muscles of the Foot and AnkleAnkle
Anterior Muscles (3)Anterior Muscles (3)
Extensor Hallucis Extensor Hallucis Longus/BrevisLongus/Brevis extension of great toeextension of great toe
Extensor Digitorum Extensor Digitorum Longus/BrevisLongus/Brevis extension of 2 – 5 extension of 2 – 5
phalangesphalanges
Muscles of the Foot and Muscles of the Foot and AnkleAnkle
Anterior Muscles Anterior Muscles cont. (3)cont. (3)
Tibialis anteriorTibialis anterior inversion and inversion and
dorsiflexion of foot / dorsiflexion of foot / ankleankle
Muscles of the Foot and Muscles of the Foot and AnkleAnkle
Medial Muscles (3)Medial Muscles (3)
Tibialis PosteriorTibialis Posterior Inversion and Inversion and
plantarflexionplantarflexion
Flexor Hallucis LongusFlexor Hallucis Longus Flexor of great toe and Flexor of great toe and
plantarflexion of ankleplantarflexion of ankle
Flexor Digitorum LongusFlexor Digitorum Longus Flexors of 2 – 5 toes and Flexors of 2 – 5 toes and
plantarflexion of ankleplantarflexion of ankle
Muscles of the Foot and Muscles of the Foot and AnkleAnkle
Muscles of the Foot and AnkleMuscles of the Foot and Ankle
Posterior Muscles (2)Posterior Muscles (2)
GastrocnemiusGastrocnemius plantarflexion of ankleplantarflexion of ankle
SoleusSoleus plantarflexion of ankleplantarflexion of ankle
Muscles of the Foot and Muscles of the Foot and AnkleAnkle
Muscles of the Foot and Muscles of the Foot and AnkleAnkle
Lateral Muscles (2)Lateral Muscles (2)
Peroneus Longus / Peroneus Longus / BrevisBrevis eversion, plantar eversion, plantar
flexion of ankleflexion of ankle
Quiz Quiz
1.1. What is the primary function of the Extensor What is the primary function of the Extensor Hallucus Longus and Brevis?Hallucus Longus and Brevis?
2.2. What is the primary function of the tibialis What is the primary function of the tibialis anterior?anterior?
3.3. What two motions does the peroneus longus What two motions does the peroneus longus and brevis perform?and brevis perform?
4.4. What motion does the Gastrocnemius/ Soleus What motion does the Gastrocnemius/ Soleus perform?perform?
5.5. What are the two main motions of the tibialis What are the two main motions of the tibialis posterior muscle?posterior muscle?
AnswersAnswers
1.1. Extension of great toeExtension of great toe
2.2. Inversion and dorsiflexion of footInversion and dorsiflexion of foot
3.3. Eversion and plantar flexion of the ankleEversion and plantar flexion of the ankle
4.4. Plantarflexion of anklePlantarflexion of ankle
5.5. Inversion and plantarflexionInversion and plantarflexion
Arches of the FootArches of the Foot
Supinated Arches (High Supinated Arches (High Arches)Arches)
Supinated ArchesSupinated Arches
Pronated Arches (Flat Feet)Pronated Arches (Flat Feet)
Pronated ArchesPronated Arches
Pronated ArchesPronated Arches
Pronated ArchesPronated Arches
OrthoticsOrthotics
OrthoticsOrthotics
OrthoticsOrthotics
Foot and Ankle InjuriesFoot and Ankle Injuries
Ankle SprainAnkle Sprain Cause: Excessive inversion or
eversion of theankle
S/S: Point tenderness, swelling, discoloration,laxity, inability to walk or run properly (extentbased on degree).
TX: RICE, rehabilitation immediately (GradeIII requires immobilization)
Prevention: Strengthening exercises, propershoes/ equipment
11stst Degree Ankle Sprain Degree Ankle Sprain
Mechanism (MX)Mechanism (MX) Inversion and/or Inversion and/or
plantarflexionplantarflexion
ATF most common ATF most common sprainedsprained
Occurs during contact Occurs during contact or non – contact. or non – contact.
S/SS/S
11stst degree degree Mild painMild pain Pt – ATFPt – ATF Possible swellingPossible swelling Fast recovery to FWB Fast recovery to FWB
and ROMand ROM No joint laxityNo joint laxity
22ndnd Degree Ankle Sprain Degree Ankle Sprain
MXMX Same as 1Same as 1stst degree, more degree, more
severe.severe.
Involves the ATF, CFInvolves the ATF, CF Possible growth plate Possible growth plate
involvementinvolvement Most cases x-ray neededMost cases x-ray needed
S/SS/S
22ndnd degree degree Felt a popFelt a pop Localized severe painLocalized severe pain Pt – more then one Pt – more then one
ligamentligament Rapid swellingRapid swelling Decrease ROMDecrease ROM Laxity in jointLaxity in joint Unable to FWBUnable to FWB
33rdrd Degree Ankle Degree Ankle SprainSprain
Rupture of Rupture of ligaments (ATF, ligaments (ATF, CF, PTF)CF, PTF)
Consider a FXConsider a FX X-ray is X-ray is
mandatorymandatory
S/SS/S
33rdrd Degree Degree Felt or heard popFelt or heard pop Extreme painExtreme pain Extreme/rapid swellingExtreme/rapid swelling No ROMNo ROM Unable to FWBUnable to FWB
11stst Degree Degree Ankle SprainAnkle Sprain
22ndnd Degree Ankle Degree Ankle SprainSprain
33rdrd Degree Degree Ankle SprainAnkle Sprain
RICERICEReturn to Play Return to Play
(Toe raise, heel (Toe raise, heel walk, Full go w/ walk, Full go w/ full ROMfull ROMTape to PlayTape to PlayReevaluate Reevaluate 24hrs24hrs
RICE RICE
(Horseshoe w/ (Horseshoe w/ compression wrap)compression wrap)Crutches 24 hoursCrutches 24 hoursReevaluate 24hrsReevaluate 24hrsRefer to Dr.Refer to Dr.X-raysX-rays
RICE RICE (Horseshoe w/ (Horseshoe w/ compression compression wrap)wrap)CrutchesCrutchesPosterior Posterior SplintSplintRefer to Dr.Refer to Dr.X-raysX-rays
Anterior Drawer Anterior Drawer TestTest Tests for ligament Tests for ligament
instabilityinstability Mainly tests ATF Mainly tests ATF
integrity but can also integrity but can also test the CF and PTF test the CF and PTF depending on severitydepending on severity
Ankle must be relaxedAnkle must be relaxed Ankle in slight plantar Ankle in slight plantar
flexionflexion
Talar TiltTalar Tilt Test for lateral ankle Test for lateral ankle
instabilityinstability Positive test indicates Positive test indicates
tear in ATF, and CFtear in ATF, and CF
Thompson TestThompson Test Test for achilles Test for achilles
tendon rupturetendon rupture
Ankle DislocationAnkle Dislocation
Mx: Anterior – Heel strikes ground forcefully Posterior – blow to anterior lower leg
S/S: PN deformity, inability to move foot, rapid
swelling, refusal to allow moving or touching foot
TX: Splint, ICE, 911 or transport to hospital
Sprain of the 1Sprain of the 1stst MP joint MP joint Mx:Mx:
Hyperextension/ Hyperextension/ hyperflexion of great toehyperflexion of great toe
Common on artificial Common on artificial surfacesurface
Flexible types of footwear Flexible types of footwear can contributecan contribute
S/SS/S Pain over the first MP jointPain over the first MP joint
Turf ToeTurf Toe
Achilles Tendonitis MX:
Repetitive motions such as running and jumping that cause tendon breakdown
S/S: Swelling, crepitus, pn with palpation, pn with dorsiflexion, weak
with plantarflexion TX:
RICE Limiting or restricting the activity that caused the irritation Aggressive stretching of heel cord
• Crepitus (crackling and grinding) may mean it is too late Prevention:
Achilles and gastroc/solues stretching, proper acclimization to activity.
Achilles Tendon Rupture
MX: Sudden, forceful plantar flexion of the ankle with a
chronically tight tendon. S/S:
Feel or hear a pop. Feel as if they’ve been kicked in the leg. Inability to plantar flex foot.
TX: Surgery or a cast
Prevention: Stretching and proper care of any tendonitis
Mx – Mx – Downward force to the Downward force to the
foot causing foot causing depression of the archdepression of the arch
Most common with Most common with overuse (running)overuse (running)
S/SS/S Sharp pain with weight Sharp pain with weight
bearingbearing Painful during Painful during
dorsiflexiondorsiflexion
Longitudinal Arch StrainLongitudinal Arch Strain
““Shin Splints”:Shin Splints”: catch all term related to lower catch all term related to lower
leg pain.leg pain. MX:MX:
constant pounding associated constant pounding associated with runningwith running
S/S:S/S: sharp pain in lower leg sharp pain in lower leg
around medial/lateral aspect around medial/lateral aspect of lower leg and connective of lower leg and connective tissue between tibia and tissue between tibia and fibulafibula
TX: TX: RICE (cold whirlpool), heal RICE (cold whirlpool), heal
lift, arch support, shoes, lift, arch support, shoes, change running surfacechange running surface
Lower Leg Problems
Compartment Syndrome MX:
Increased pressure within one of four compartments of lower leg causes compression of the structures in the leg.
S/S: Deep aching pain, tightness, and swelling. Pain with
stretching. TX:
Acute~ immediate surgery Chronic~ activity modification & ice and some times
surgery Prevention:
Stretching (Hard to prevent)
Toe Abnormalities
Hammer Toes MX:
Poor shoe choices Middle joint (PIP)
flexed, other joints (MP, DIP) hyperextended
TX: Refer, orthotics or
surgery
Bunion / Hallux Valgus
MX: Bony enlargement of the head of the 1st metatarsal
caused from wearing improperly fitting shoes S/S:
Obvious deformity, tenderness, and swelling TX:
Proper shoe selection, protection devices, surgery may be necessary
Prevention: Properly fitting shoes
Ingrown Toenail
MX: Improper shoe fitting and nail cutting
S/S: Increased pain, swelling, redness around the
nail bed TX:
Hot, soapy water, antibiotics, raise nail up Prevention:
Proper shoes, proper nail trimming