The Foot, Ankle and Lower Leg
 Acting:
 Break a Leg = Good Luck
 Athletics:
 Break a Leg = Better than a Sprain???
Anatomy & Physiology
 Limbs are part of the appendicular skeleton
 Skeleton:




Aid movement
Support and protect organs
Produce red and white blood cells
Store minerals
Anatomy & Physiology
 Osteo = Bone
 Osteocyte: _____________________
 Osteoblast: cells that produce more bone
 Osteoclasts: cells that absorb/digest bone
 The movement of a joint is determined by the shape
of the bones in the joint
Osteoblast activity
Osteoclast activity
Injury to bone
 Injury to skeleton/bone = fracture
 Most common in ankle and lower leg:
 Stress fracture
 Simple fracture
Treatment of bone injury:
 Bone remodeling (cells)
 Reduction
 External fixation:
 Cast
 Rods
 Internal fixation:
 Surgery
 Wires
 Plates
 Screws
Walking Boot/Brace vs Cast
 1980 – fractured fibula - cast for 6-8 weeks
 2014 – fractured fibula - walking boot or brace
time dependent upon individual rate of healing
 Why?
 Muscle Atrophy
 Blood Pressure
Muscle (Myo) Physiology
 Skeletal muscle
 Under voluntary control
 Aids in movement
* Tendon
* Attaches muscle to bone
 Characteristics of muscles
 Contractibility – ability to shorten (flexion)
 Excitability or irritability – ability to respond to electrical signals
called action potentials
 Extensibility – ability to be stretched
 Elasticity – ability to return to original length after being stretched
Muscle Physiology
Muscle Anatomy
 Muscles attach to a bone that does not move (origin)
 And to a bone that does move (insertion)
 Most muscles are arranged in pairs
 Example: Bicep Curl
 Prime mover
 causes the main motion – bicep
 Antagonist
 opposes the main movement – tricep
 Synergist
 stabilizes movement
Bicep
Origin
Bicep
Insertion
Muscle Biomechanics
 As a result of the structure of muscles and bones,
MUSCLES ONLY PULL
 Therefore one muscle must pull in one
direction – flexion (Bicep)
 While another muscle pulls in the opposite
direction – extension (Tricep)
Injury to Muscle
 sTrain
 Grade 1
 stretching or slight tearing
 Grade 2
 significant stretching and/or
 moderate tear
 Grade 3
 muscle/tendon is torn
 Partial tear
 Rupture
Ruptured Achilles Tendon
GRAPHIC
IMAGE
Signs of Muscle Strain
 Pain
 Spasm
 Weakness
 Swelling
 Inflammation
 Cramping
 Loss of function
Other Muscle Issues
 Atrophy
 write down an example of how a person
could experience muscle atrophy
 Hypertrophy
 write down an example of how a person
could experience muscle hypertrophy
Muscle Tone
Anatomy of Ligaments
 Made up of collagen fibers (75%)
 Fibroblasts – cells that form ligaments
 Considered inflexible – they don’t like to be stretched
 Ligaments are avascular – they do not have their own
blood supply
 Little blood flow to middle region of ligament
 Blood flow is better at the origin and insertion – where
the ligament is attached to bone
Function of Ligaments
 Ligaments attach bone to bone
 Unlike tendons they resist being stretched, thus they
are considered joint stabilizers
 Stretching can cause injury
 Hypermobility – genetics mostly
Ligament Injuries
 sPrian
 Grade 1
 overstretching or slight tearing of ligament
 Joint is still stable
 Grade 2
 Partial ligament tear
 Grade 3
 ligament is torn
 Partial tear
 Rupture
Other Common Chronic Injuries
 Tendonitis – inflammation that occurs when tendon
becomes irritated; overuse; chronic
 Bursitis – inflammation of the bursa (fluid-filled sac)
resulting from repetitive movement or prolonged or
excessive pressure
Other Common Lower Leg Injuries
 Contusion – bruise
 Myositis ossificans can develop if a bruise/contusion is
not managed properly
 Calcification forms within the muscle, restricting
movement, increasing pain
 Surgery
Nerves - Neuro
 Neurons send impulses down the length of the fiber, to the
Neuromuscular synapse
 Neuromuscular synapse – the point at which the neuron signal
crosses to the muscle, causing excitability (contract, relax)
Injury to Nerves
 Injury to nerves can stop the flow of electrical activity
to muscles, causing a loss of sensation and/or function
 Nerve injury can result from
 Cutting a nerve
 A nerve being compressed
 A nerve being overstretched
 Some nerve injuries can be corrected surgically or
with time but severe injuries may result in permanent
loss of function (paralysis)
Neuroma
 A somewhat common nerve injury in the foot
is called Morton’s Neuroma
 The nerves that run through the foot to the
third and fourth metatarsals become
compressed, irritated and damaged
 This compression creates enlargement of the
nerve, eventually leading to permanent nerve
damage.
 One of the most common causes is wearing
shoes that have a tapered toe box, or highheeled shoes that cause the toes to be
forced into the toe box.
Ankle anatomy
Directions: Label each part of the ankle using the following word key. Some words will not be used depending on
the view of the ankle you are looking at. Color-code using the suggestions on the next page.
Label each bone either weight-bearing or non-weight-bearing.
Tibia
Fibula
Talus
Calcaneus
Lateral Malleolus
Medial Malleolus
Achilles tendon
Deltoid ligament
Anterior talofibular ligament
Anterior tibiofibular ligament
Posterior talofibular ligament
Posterior tibiofibular ligament
Calcaneofibular ligament
LATERAL VIEW OF ANKLE
Subtalar joint
Talocrural joint
Ankle anatomy
Directions: Label each part of the ankle using the following word key. Some words will not be used depending on
the view of the ankle you are looking at. Color-code using the suggestions on the next page.
Label each bone either weight-bearing or non-weight-bearing.
Tibia
Fibula
Talus
Calcaneus
Lateral Malleolus
Medial Malleolus
Achilles tendon
Deltoid ligament
Anterior talofibular ligament
Anterior tibiofibular ligament
Posterior talofibular ligament
Posterior tibiofibular ligament
Calcaneofibular ligament
ANTERIOR VIEW OF ANKLE
Subtalar joint
Talocrural joint
Common Foot & Ankle Injuries
Plantar Fasciitis
Common Foot & Ankle Injuries
Shin Splints
Medial Tibial Stress Syndrome
NEXT SLIDE IS GRAPHIC!
 Achilles Tendonitis
“Shredded” tendon
Compartment Syndrome
Compartment Syndrome
NEXT SLIDE IS GRAPHIC!
Compartment Syndrome
Taping and Bracing:
Which is the Better Option?
Taping
The purpose of a tape job is usually one of two things.
 One possible reason to tape an ankle is to prevent an
ankle injury.
Since most injuries occur
due to an inversion
(turning in of the ankle)
and plantarflexion, most
ankle tape jobs are applied
so that they limit the
inversion motion.
Preventative Taping
 Preventative tape jobs are useful in situations of
ankle weakness or when the likelihood of
suffering an ankle injury is high due to the
practice or game conditions.
Gas pedal = Gastroc (jy)
 If the ankle is weak the athlete must also
_____________________ the injured area
 Examples:




Gas pedal
ABC’s
Toe raises
Stretches
Windshield wipers
Toe taps
Band exercises
Protective Taping
 After an ankle sprain, the ligaments, muscles and tendons
are weak and injured.
 In order to resume practice and play safely and swiftly,
ankle tape jobs are often applied to protect the injury.
Protective Taping
 Again, since most injuries are due to an inversion and
plantarflexion mechanism, these tape jobs often
center around preventing ____________ & ________.
 Mechanism of injury must be
determined by an athletic
trainer or doctor prior to
return to play so that the
tape job can be modified to
protect against the exact
mechanism of injury
Disadvantages of taping
 Taping may
weaken the body’s
natural protective
mechanisms




Ligaments
Muscles
Tendons
Joint capsule
Taping tries to
mimic what the
ligaments are
supposed to do.
 proprioception
But what else
should the athlete
be doing?
Many believe
that regular
use of a tape
job will cause
the secondary
supports to
become
weaker and
less effective,
so that if the
tape job fails
or the athlete
plays without
it, injury is
more likely.
Disadvantages of taping
 One of the main problems with ankle tape jobs is that learning
to tape is difficult. In other words, one must complete many
tape jobs to become efficient.
Another potential problem is that
there is a great deal of variability
between tape jobs applied by
different people.
 A veteran trainer once commented that there are as many
different ways to tape the ankle as there are people taping.
Bracing
 An alternative to
ankle taping is ankle
bracing. Most sports
medicine
professionals prefer
one over the other
with some
advocating taping
and others bracing.
In reality, there are
probably uses for
both.
Advantages of Bracing
 Consistency – same feel every time
 Adjustable – unlike tape, if it’s too tight or too loose the user can
easily make adjustments
 Self-reliance – unlike taping, you do not need anyone to put a brace
on for you. You can use a brace even when a trainer is not available
 Custom-made option – you can buy a brace that has been made just
for you. This option usually requires a doctors visit and a prescription
for the type of brace you need
Disadvantages
 Smelly-factor




bacteria
skin irritation
discomfort
gross!
 Over-the-counter option
 everyone can walk into a drug store and buy a brace, but that doesn’t
mean that they know which brace is right for them and their injury.
 Easy access to a brace is good if you know how to shop for one, but can
be a very bad thing if you get the wrong brace and end up doing more
harm than good
Con’s of Bracing, cont.
 Weakens the support structures in the
ankle, just like tape does. The injured
area gets dependent on the brace;
patient MUST be doing rehab to ensure
the injured area gets stronger!
Injury Management
Inflammation is a good
thing for a short period
of time. RICE helps flush
out waste products
(dead cells) and bring in
healthy oxygenated cells
to help repair the
Damage.
Wrapping an ankle
Distal to proximal
Snug but not too tight
Do NOT sleep with a wrap on
Felt or Foam horseshoe cut-out
Can also ice while wrapped
Rehabilitation Exercise
Progression is critical!
 Non-weight bearing ROM
 Weight-bearing ROM & strengthening
 Proprioception
 Functional
 Don’t skip steps in the process
Progressive Rehabilitation
 Non Weight-bearing




ABC’s
Gas pedal
Seated toe taps
Windshield wipers
Weight-bearing
Heel raises
Heel to Toe walking
Band exercises
Rehabilitation Exercise
 Proprioception
 Balance exercises
 Eyes closed exercises
 Rocker board
Functional
Agility
Sport-specific movements
Which of these are…
Non-weight-bearing?
Weight-bearing?
Proprioception
These exercises
would be
classified as…
These exercises are
shown using a
Bosu Board but you
could also use a
rocker or wobble
board
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" The 20 benefits of ankle taping > ManageYourLifeNow.com." Manage Your Life Better with
ManageYourLifeNow.com. N.p., 13 Jan. 2009. Web. 11 Apr. 2010. <http://www.manageyourlifenow.com/>.
"People who exercise on work days are happier, suffer less stress and are more productive." Mail Online.
N.p., 16 Dec. 2008. Web. 11 Apr. 2010. <http://www.dailymail.co.uk/news/>.
"The FITT Principle of Training." Phil Davies' Sports Fitness Advisor - Get Fit for Sport & Life. Sports Fitness
Advisor, n.d. Web. 11 Apr. 2010. <http://www.sport-fitness-advisor.com/fitt-principle.html>.
Bolton, Raphael. "Exercising Properly With Aerobic And Anaerobic Exercises." Article Alley. N.p., 1 Apr.
2010. Web. 11 Apr. 2010. <http://www.articlealley.com/>.
Bronson, Mary. Glencoe Health. Woodland Hills; TIME,2009.335.print