Chapter Six
Foot, Ankle & Lower Leg
Anatomy
The foot is the site of
some of the most
debilitating conditions
suffered by athletes.
Include:
 Blisters
 Calluses
 Athletes foot
 Turf toe
 Ligament Sprains
 Ingrown toe nails
 Heel bruises
 Arch strains
 Fractures
Anatomy
The foot has stresses that exceed the
demands placed on any other area of the
body.
 Stabilizes & Supports During:
Standing
 Walking
 Running
 Jumping
The foot absorbs up to 3 times the body weight!

Anatomy
Individually, the parts of the
foot (bones, muscles,
ligaments) are weak.
Collectively, they can
withstand most of the
demands placed on them
in athletics.
Anatomy
The key to proper function of the foot is a set of
four arches.
 Help absorb the impact of walking, running,
& jumping.
The arches are:
1. Metatarsal
2. Transverse
3. Medial Longitudinal (inner)
4. Lateral Longitudinal (outer)
Anatomy
The foot contains ¼ of the total number of
bones in the body.
 26 Bones
7 Tarsal bones
 5 Metatarsal bones
 14 Phalanges

There are also 38 joints!
Anatomy
Tarsal Bones:
 Talus
 Calcaneus
 Navicular
 Cuboid
 Medial, Intermediate, & Lateral Cuniform
Bones (that’s 3 of them)
Mid-foot region has 5 Metatarsal Bones
The toes (AKA Phalanges) have 14 Bones
Anatomy
Anatomy
The ankle joint (Talocrural Joint)
 The most commonly injured joint in athletics.

Most injuries are either ligament sprains or
muscle strains.
Anatomy
The ankle joint has 2 joints:
1. Talocrural Joint

2.
Bones: Tibia, Fibula, & Talus
Subtalar

Bones: Talus & Calcaneus (2 largest Bones of
the foot)
Note:
Large boney Prominences on either side of the
foot are the Medial Malleoli (tibia) & Lateral
Malleoli (fibula)
Anatomy
Tibia
 Transmits the weight or force placed on the
lower leg to the talus.

Mounted directly on top of the talus & extends
over the medial side forming the medial malleolis
Fibula
 On the lateral side forming the lateral
malleolis helps to stabilize the ankle joint
Range of Motion
Talocrural Joint
 a hinge joint.
Dorsiflexion “toes to the nose”
Plantar Flexion extension “Point the Toes”
Range of Motion
Subtalar Joint
triplanar movement with around the oblique
axis.
 Most stable when placed in dorsiflexion
Range of Motion
Talus
Moves Anteriorly (forward) & Posteriorly
(Backward)
 Talus sit on top of the calcaneous
The ankle joint despite # of injuries in the area
is still very strong.
Stresses in athletics is the cause of ankle
injuries
Anatomy
After bony structure strong ligaments make
up the first line of defense against ankle
sprains.
Most ligaments involved in supporting the
ankle are attached to the rough edges of the
malleoli.
Anatomy / Ligaments
Ligaments are named for the bones they
connect.

Most commonly injured are on the Lateral side
(outside) of the ankle.
 Anterior
talofibular (ATF)
 Anterior tibiofibular
 Calcaneofibular
 Posterior talofibular

Ligaments on the Medial side (inside) of the
ankle (fyi, sprain to medial ligaments often associated
with a fx)
 Deltiod
Anatomy / Muscles
13 Major Muscle that support the ankle joint
 2 of the most important:
Achilles Tendon
 Peroneus Muscle Group

Anatomy / Muscles
Achilles Tendon
 The attachment of the Gastronemius and
Soleus Muscles (Calf Muscles)
Attach to the Calcaneus
 Tightness of Achilles Tendon is often the cause
of recurrent ankle sprains.

Anatomy / Muscles
Peroneal Muscle
 Group of muscles along the Lateral side of
the leg & foot
The Peroneal Brevis attach to several areas of
the foot
 The Peroneal Longus runs across the plantar
surface of the foot
 When the Peroneal group contracts it everts the
foot
 This helps to prevent Lateral ankle sprains.

Anatomy / Shin
2 Bones of the Leg:
 Tibia
 Fibula
Shin – is the area in the front of the leg
Interosseous Membrane – associated with anterior
(front) shin pain (Shin Splints)
Dermatome – A sensory distribution of a nerve root.

Produces sensation in the corresponding area
Myotome – a single nerve root

Produces movement of anatomical structures
Bones
Tibia
 Fibula
 Talus
 Calcaneus
 Navicular
 Cuniforms (1-3)
 Cuboid
 Metatarsals (1 – 5)
 Phalanges (1 – 5)

Ligaments / Muscles








Anterior Talofibular Ligament
Posterior Talofibular Ligament
Deltoid Ligament
Gastrocnemius – Plantar Flexes the foot &
Flexes the lower leg.
Soleus - Plantar Flexes the foot
Peroneus Longus – everts & abducts foot,
Plantar Flexes foot
Peroneus Brevis – everts & abducts foot, Plantar
Flexes foot
Popliteus – Knee Flexon, medial rotation of tibia
Metatarsal
 Transverse
 Medial Longitudinal (inner)
 Lateral Longitudinal (outer)

Range of Motion
Dorsiflexion – the act of drawing the toe or
foot toward the dorsal aspect
of the proximally conjoined
body segment.
 Toes to the nose
Plantar Flexion – the act drawing the toe or
foot toward the dorsal aspect
of the proximally conjoined body
segment.
 Point the toe
Range of Motion
Inversion – turning the sole of the foot inward
Eversion – turning the sole of the foot outward
Flexion (toes) – decreasing the angle between
the toes and the sole of the
foot
Extension (toes) – Increasing the angle
between the toes and the sole of
the foot
Range of Motion
Pronation – combined motions of calcaneal
eversion, foot abduction and
dorsiflexion.
Supination - combined motions of calcaneal
inversion, foot adduction and
plantar flexion.
Abduction – movement of body segments
away from the midline
Adduction - movement of body segments
towards from the midline
Evaluation
The first purpose of an evaluation is to
determine if a serious injury has occurred.
 Always suspect a fx till proven otherwise
Signs of Fracture
 Direct or indirect pain
 Deformity
 Grating sound
 Loss of function
Evaluation
Note: some fractures are not accompanied by
swelling or pain.
If a Fracture is suspected the extremity should
be splinted & the athlete transported for
medical evaluation.
HISTORY
1.
Mechanism of Injury

2.
Location of Pain

3.
Where does it hurt?
Sensation experienced

4.
How did it happen?
Did you hear a “pop” or a “snap”?
Previous History

Have you injured this area before?
Observation
Look for signs of trauma: Compare involves vs.
Uninvolved
 Bleeding
 Deformity
 Swelling
 Discoloration
 Scars
Palpation
Palpate above & below injury site.

Work your way down to injury.



Gain confidence of athlete
Involve the athlete as much as possible
Compare
Areas to check:
1. Neurological (motor/sensory)
2. Circulation
3. Anatomical Structures
4. Fracture Test (palpation, compression,
distraction)
Special Test
Testing instability, disability, & pain.
Before you start, can you make it worse?
Only a NATABOC certified athletic trainer is
considered competent to perform these test and
give a proper evaluation (other medical professional as well)
Test performed to assess the following:
1. Joint Stability
2. Muscles / Tendons
3. Accessory Anatomical Structures
4. Inflammation
5. ROM (active, assistive, passive, resistive)
6. Pain / weakness
Special Test
Assessment Test:
Bony Integrity
Heel Tap Test: Check the Tibia, Fibula, & Talus
Squeeze Test: Check the Tibia & Fibula
Ligament Stability
Anterior Drawer Test: Test anterior talofibular and
calcaneofibular ligaments
Talar Tilt: Calcaneofibular, anterior talofibular, but
also the (medial) deltoid ligaments
Special Test
Muscle Function
Thompson Test: Test the Achilles tendon
Refer When
There is:
 Gross Deformity
 Significant Pain
 Increase swelling
 Circulation or Neurological Issues
 Joint Instability
 Suspected Fracture
 Abnormal Sensations (clicking, popping, grating, or
weakness)

Any doubts!
Injuries
Ankle Sprains
 Most common injury to the ankle


Usually caused by excessive plantar flexion
with inversion
“stepping in a hole”
Injuries (Ankle Sprain)
3 Categories
1. First Degree – (mild) 1 or more supporting ligaments
are stretched


Minor discomfort, point tenderness, swelling.
No instability
2. Second Degree – (moderate) a portion 1 or more
ligaments are torn


There is pain, point tenderness, swelling, disability, & loss of
function
There is some abnormal movement in the joint
3. Third Degree – (Severe) 1 or more ligaments are
completely torn



Joint is unstable
Pain can be extreme to very little (torn nerve endings), loss of
function, point tenderness, rapid swelling
Usually associated with a fracture
Injuries (Arch Sprain)




Arches are designed to act as “shock absorbers”
Most common injuries occur to the metatarsal or
the inner longitudinal arches
Any of the 4 arches can sprain a ligament
Causes:






Flat feet
Overuse
Overweight
Fatigue
Training on hard surfaces
Wearing non supportive, worn, or shoes that do not FIT!
Injuries (Great Toe Sprain)
“Turf Toe”
A sprain given to the First Metatarsophalangeal
Joint.
 Mechanism of injury – hyperextension of the
great toe.
Injuries (Medial Tibia Stress Syndrome)
Shin Splints
Thought to be an inflammation of the
interosseous membrane, strain to the soleus
muscle, or other chronic lower leg condition.
Cause: muscle weakness or imbalance, lack of
proper conditioning, improper or incomplete
warm-up, poor flexibility, lack of stretching,
running on hard surfaces, improper running
form or habits, improper running shoe, or
poor anatomical structures.
Injuries (Plantar Fasciitis)
The plantar fascia is a wide, non – elastic
ligamentous tissue that extends from the
anterior portion of the calcaneus to the heads
of the metatarsals.
 Supply support to the longitudinal arch of the
foot.
 Can strain tissue from overuse, unsupportive
footwear, a tight Achilles tendon, or running o
hard surfaces.
Injuries (Heel Spur)
A bony growth on the calcaneus that causes
painful inflammation of the accompanying
soft tissue and is aggravated by exercise.
Injuries
(Anterior Compartment Syndrome)
4 Compartments
Once suspected, anterior compartment syndrome
should be treated as a medical emergency
Injuries
(Anterior Compartment Syndrome)
Cause:
Direct trauma or excessive exercise can result
in hemorrhage & swelling inside the
compartment.
 Swelling will increase the pressure on the
peroneal nerve, the veins, and finally, the
arteries inside the compartment.
 Without arterial circulation, muscle cells will
become necrotic and die.
Injuries
(Anterior Compartment Syndrome)

Signs:
Pain even after icing down
 Firmness of the muscle
 Numbness of the foot
 Pain with passive ROM
 Lack of strength

Injuries (Achilles Tendon Strain)
Achilles Tendon is the strongest in the body
 Injuries range from a minor strain to a
complete tear.
 Minor strains should be treated
conservatively because many strains will
lead to complete tear
 Remember Thomson Test for eval.
Injuries (Stress Fracture)
If exercise is too severe, or too long in a
duration, a negative change in bone
structures will occur and cause stress
fracture.
Injuries (muscle cramps)
A cramp is a sudden, involuntary contraction of a
muscle.
Cause: unknown
Can be because of several factors:
 Fatigue
 Fractures
 Dehaydration
 Poor Flexibility
 Previous injury, rehab not completed
 Improper fitted equipment.