Unit 5:Understanding AthleticRelated Injuries to the Lower
Extremity
Foot and Ankle, Anatomy and Injuries
Sports Medicine
The Foot (Bones)
 Bones



= 26
14 phalanges
5 metatarsals
7 tarsals
Toes (Phalanges)

Designed to give
wider base for
balance and
propelling the body
forward.
 1st toe (Hallux)
 Two sesamoid
bones located under
the 1st MP joint.
Metatarsals




5 Bones
1st metatarsal is the
largest and strongest
and functions as the
main body support
during walking and
running.
Palpable at the ball of
the foot.
5th metatarsal most
common fractured.
Tarsals

7 bones
 Aids in the support of
the body.
 Calcaneous = largest
tarsal bone, supports
talus and shapes
heel, and provides
attachment for
achilles tendon.
Joints of the Foot

Interphalangeal joint
(IP)


Flexion / Extension
Metarsalphalangeal
joint (MP)


Flexion / Extension
Abduction / Adduction
Bones of the Ankle

Tibia



Fibula




Main weight bearing bone
of LOWER LEG
Forms medial malleolus
Non-weight bearing
Mainly muscle and
ligament attachment
Forms lateral malleolus
Talus

Main weight bearing bone
of the ANKLE
Lateral Ligaments of the
Ankle

Resist ankle inversion

Anterior talofibular (ATF)



Most commonly sprained
Calcaneofibular (CF)
Posterior talofibular (PTF)
Medial Ankle Ligaments


Deltoid
Resists ankle
eversion
 Low rate of injury
Quiz
1.
2.
3.
4.
5.
6.
7.
Which bone in the lower leg is the most weight
bearing?
What does ATF stand for?
Which ligaments resist inversion?
Which ligaments resist eversion?
What does MP stand for?
How many tarsal bones are there?
How many bones are in the foot?
Answers:
1.
2.
3.
4.
5.
6.
7.
Tibia
Anterior Talofibular
Anterior Talofibular, tibiofibular, calcaneofibular
(lateral)
Deltoid ligaments (medial)
Metatarsalphalangeal
7
26
Muscles of the Foot and
Ankle

Anterior Muscles (3)

Extensor Hallucis
Longus/Brevis


extension of great toe
Extensor Digitorum
Longus/Brevis

extension of 2 – 5
phalanges
Muscles of the Foot and
Ankle

Anterior Muscles
cont. (3)

Tibialis anterior

inversion and
dorsiflexion of foot /
ankle
Muscles of the Foot and
Ankle

Medial Muscles (3)

Tibialis Posterior


Flexor Hallucis Longus


Inversion and plantarflexion
Flexor of great toe and
plantarflexion of ankle
Flexor Digitorum Longus

Flexors of 2 – 5 toes and
plantarflexion of ankle
Muscles of the Foot and
Ankle
Muscles of the Foot and Ankle

Posterior Muscles (2)

Gastrocnemius


plantarflexion of ankle
Soleus

plantarflexion of ankle
Muscles of the Foot and
Ankle
Muscles of the Foot and
Ankle

Lateral Muscles (2)

Peroneus Longus /
Brevis

eversion, plantar
flexion of ankle
Quiz
1.
2.
3.
4.
5.
What is the primary function of the Extensor
Hallucus Longus and Brevis?
What is the primary function of the tibialis
anterior?
What two motions does the peroneus longus
and brevis perform?
What motion does the Gastrocnemius/ Soleus
perform?
What are the two main motions of the tibialis
posterior muscle?
Answers
1.
2.
3.
4.
5.
Extension of great toe
Inversion and dorsiflexion of foot
Eversion and plantar flexion of the ankle
Plantarflexion of ankle
Inversion and plantarflexion
Arches of the Foot
Supinated Arches (High
Arches)
Supinated Arches
Pronated Arches (Flat Feet)
Pronated Arches
Pronated Arches
Pronated Arches
Orthotics
Orthotics
Orthotics
Foot and Ankle Injuries
Ankle Sprain

Cause: Excessive inversion or
eversion of the
ankle

S/S: Point tenderness,
swelling, discoloration,
laxity, inability to walk or run
properly (extent
based on degree).
TX: RICE, rehabilitation
immediately (Grade
III requires immobilization)
Prevention: Strengthening
exercises, proper
shoes/ equipment



1st Degree Ankle Sprain

Mechanism (MX)


Inversion and/or
plantarflexion
ATF most common
sprained
 Occurs during contact
or non – contact.

S/S

1st degree





Mild pain
Pt – ATF
Possible swelling
Fast recovery to FWB
and ROM
No joint laxity

2nd Degree Ankle Sprain

MX




Same as 1st degree, more
severe.
Involves the ATF, CF
Possible growth plate
involvement
Most cases x-ray needed

S/S

2nd degree







Felt a pop
Localized severe pain
Pt – more then one
ligament
Rapid swelling
Decrease ROM
Laxity in joint
Unable to FWB


3rd Degree Ankle
Sprain
Rupture of
ligaments (ATF,
CF, PTF)
 Consider a FX
 X-ray is
mandatory

S/S

3rd Degree





Felt or heard pop
Extreme pain
Extreme/rapid swelling
No ROM
Unable to FWB
1st Degree
Ankle Sprain
2nd Degree Ankle
Sprain
3rd Degree
Ankle Sprain
RICE
RICE
RICE
Return
(Horseshoe w/
compression wrap)
Crutches 24 hours
Reevaluate 24hrs
Refer to Dr.
X-rays
(Horseshoe w/
compression
wrap)
Crutches
Posterior
Splint
Refer to Dr.
X-rays
to Play
(Toe raise, heel
walk, Full go w/
full ROM
Tape to Play
Reevaluate
24hrs

Anterior Drawer
Test




Tests for ligament
instability
Mainly tests ATF
integrity but can also
test the CF and PTF
depending on severity
Ankle must be relaxed
Ankle in slight plantar
flexion
 Talar


Tilt
Test for lateral ankle
instability
Positive test indicates
tear in ATF, and CF
 Thompson

Test
Test for achilles
tendon rupture
Ankle 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
Turf Toe


Sprain of the 1st MP joint
Mx:




Hyperextension/
hyperflexion of great toe
Common on artificial
surface
Flexible types of footwear
can contribute
S/S

Pain over the first MP joint
Achilles Tendonitis

MX:


S/S:


Repetitive motions such as running and jumping that cause
tendon breakdown
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:


S/S:


Feel or hear a pop. Feel as if they’ve been kicked in
the leg. Inability to plantar flex foot.
TX:


Sudden, forceful plantar flexion of the ankle with a
chronically tight tendon.
Surgery or a cast
Prevention:

Stretching and proper care of any tendonitis
Longitudinal Arch Strain

Mx –



Downward force to the
foot causing
depression of the arch
Most common with
overuse (running)
S/S


Sharp pain with weight
bearing
Painful during
dorsiflexion
Lower Leg Problems

“Shin Splints”:


MX:


constant pounding
associated with running
S/S:


catch all term related to
lower leg pain.
sharp pain in lower leg
around medial/lateral
aspect of lower leg and
connective tissue
between tibia and fibula
TX:

RICE (cold whirlpool),
heal lift, arch support,
shoes, change running
surface
Compartment Syndrome

MX:


S/S:


Deep aching pain, tightness, and swelling. Pain with
stretching.
TX:



Increased pressure within one of four compartments
of lower leg causes compression of the structures in
the leg.
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:


S/S:


Obvious deformity, tenderness, and swelling
TX:


Bony enlargement of the head of the 1st metatarsal
caused from wearing improperly fitting shoes
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