Posterior and Anterior
Anatomy of the Leg and
Ankle
Plantarflexors of the Lower Leg
• Gastrocnemius
• Soleus
• Plantaris
Gastrocnemius
O: Medial and Lateral
Femoral Condyles
I: Calcaneus (heel bone)
via Achilles or
Calcaneal Tendon
(strongest and thickest
tendon in the body
A:
• Plantarflexion of
Ankle
• Flexion of Knee
Integrated Function of
Gastrocnemius
• Assists in eccentric deceleration of ankle
dorsiflexion
• Assists in eccentric deceleration of knee
extension
• Assists in dynamic stabilization of the
subtalar and tibio-femoral joint during
functional movement
Soleus
• The soleus is
deep to the
gastrocnemius,
but medial and
laterally
superficial
Soleus
O: Posterior Tibia and
Fibula
I: Calcaneus via
Achilles Tendon
A:
• Plantarflexion of
ankle
• Inversion of ankle
Integrated Function of Soleus
• Assists in eccentric deceleration of ankle
dorsiflexion
• Assists in eccentric deceleration of ankle
eversion
• Assists in dynamic stabilization of the
subtalar joint during functional movement
Triceps Surae
• Gastrocnemius and
Soleus make up triceps
surae and they are the
primary movers of
plantarflexion
Plantaris
O: Lateral Epicondyle of
Femur
I: Calcaneus via Achilles
Tendon
A: Plantarflexion of
Ankle
Integrated Function of Plantaris
• Assists in eccentric deceleration of ankle
dorsiflexion
• Assists in dynamic stabilization of the
tibio-femoral joint during functional
movement
Popliteus
•
•
•
•
Located in the posterior
knee
The popliteus is deep to the
gastrocnemius and plantaris
Most important stabilizer of
the posterior knee
Unlocks the knee by
laterally rotating the femur
on the tibia during a closed
chain movement (foot in
contact with the ground)
Popliteus
O: Lateral Condyle of
Femur
I: Proximal Posterior
Tibia
A:
• Medial rotation of the
tibiofemoral joint
• Knee Flexion
Integrated Function of Popliteus
• Assists in dynamic stabilization of the
tibiofemoral joint
• Assists in eccentric deceleration of lateral
rotation of the tibiofemoral joint
• Assists in eccentric deceleration of knee
extension
Calf Raise
• When the knees are extended,
the gastrocnemius is the prime
mover, because it is fully
stretched and is more effective
at producing force in an
extended knee position, when
compared to a flexed knee
position.
• The seated calf raise causes the
gastrocnemius to shorten and
the soleus, which does not
cross the knee, takes most of
the load
Exercises for Gastrocnemius
• Standing Calf Raise (Floor, BOSU,
Disk)
• Standing Single Leg Calf Raise
• Standing Calf Raise with Tubing
• Calf Raise on horizontal leg press
• Prone or Seated Leg Curl
• SB Leg Curl
Exercises for Soleus
• Seated Calf Raise
(Machine, SB)
• Single Leg Seated Calf
Raise
Stretches
Slant Board
ProStretch
Stretches
Gastrocnemius Stretch
Soleus Stretch
PNF Flexed Knee Hold-Relax
• With the knee flexed it focuses the stretch
on the Soleus.
• This stretch is appropriate for all clients
who are free of ankle and knee pathology,
i.e., sprained ankle, torn meniscus, postop ACL.
• Have client lie prone
• With client lying prone, flex knee to 90
degrees
• Passive prestretch (10 seconds),
isometric hold (6 seconds), passive
stretch (30 seconds)
• Autogenic Inhibition
Injuries
• Achilles Tendon Rupture
– Sudden forced plantar flexion of the foot, direct
trauma, result of chronic tendonitis
• Achilles Tendonitis
– Common in runners and
walkers
• Calf Strain
– Gastrocnemius or soleus
• Calf Tear
– Gastrocnemius or soleus
is pulled from the achilles
Primary Dorsiflexor of the Lower Leg
• Tibialis Anterior
• Superficial anterior
muscle of the leg
• Lies just lateral to the tibia
Tibialis Anterior
O: Lateral Condyle of Tibia and
Lateral Surface of Tibia
I: Medial Foot: 1st cuneiform
and 1st metatarsal
A:
• Dorsiflexion of ankle
• Inversion of ankle
Integrated Function of Tibialis
Anterior
• Assists in eccentric deceleration of
ankle plantarflexion
• Assists in eccentric deceleration of
ankle eversion
Plantar Fasciitis
• Pronounced “plantar fash-eee-eye-tiss”
• Most common condition of heel pain
• The pain is usually located close to where
the achilles tendon inserts into the calcaneus
• It is commonly thought of as being caused
by a heel spur, but research has found that
this is not the case. On x-ray, heel spurs are
seen in people with and without plantar
fasciitis (Mayo Clinic)
Plantar Fascia Ligament
• The plantar fascia ligament is located on
the bottom of the foot and extends out
towards the toes
• It is a continuation of the Achilles tendon
• It supports the medial arch of the foot
• During walking, the plantar fascia ligament
will stretch and contract as the weight is
put through the foot
Plantar Fasciitis
• The condition occurs when the plantar fascia ligament
is under constant stress and stretch. The ligament
becomes inflamed and begins to tear off from the
calcaneus bone
Symptoms of Plantar Fasciitis
• Heel pain
• Pain is usually felt in the morning because the
fascia ligament tightens up during the night
during sleep
• It is difficulty to get out of bed and place
pressure on the ligament
• Pain usually decreases as the tissue warms up,
but may easily return again after long periods of
standing or weight bearing, physical activity, or
after getting up after long periods of sitting
Plantar Fasciitis
• Risk factors include:
– Foot arch problems (both flat foot and high arches)
– Obesity or sudden weight gain
– Pregnancy
– Excessive Running or Jumping
– Tight Achilles tendon
– People with Arthritis in their foot
– People with Diabetes due to peripheral neuropathy
– Wearing high-heeled shoes or improperly fitted
shoes
– Occupation-people who are on their feet throughout
the day
Treatment of Plantar Fasciitis
• PRICE
–Protection, Rest, Ice, Compression,
Elevation
•
•
•
•
Calf Stretches
Calf Strengthening
Arch Supports
Medication prescribed by physician
Exercises for Plantar Fasciitis
• Gastrocnemius Towel Stretch
– Loop a towel around the ball of the foot and pull the
towel toward the body, hold this position for 30
seconds. Repeat 3 times
• Frozen Can Roll
– Roll the affected foot back and forth from the heel to
your mid-arch over a frozen juice can. This exercise
may be helpful if done first thing in the morning
• Towel Pick-Up
– Pick up a towel with the toes
• Seated Toe Tapping
Exercises for Plantar Fasciitis
•
•
•
•
•
Resisted Dorsiflexion and Plantarflexion
Resisted Inversion and Eversion
Standing Gastrocnemius Stretch
Standing Soleus Stretch
Single-leg Balance
Shin Pain Conditions
• Shin Splints
• Anterior
Compartment
Syndrome
• Stress
Fracture
Shin Splints
• The shins have to bear as much as
six times our body weight during
sports and exercise
• Shin splints, also called Periostitis is
the name given to pain at the front of
the lower leg.
• There are two types of shin splints:
–Anterior and Posterior
Shin Splints
• Anterior shin splints occur in the front portion of
the shin bone (tibia).
• Posterior shin splints occur on the inside
(medial) part of the leg along the tibia.
• Excessive pronation contributes to both anterior
and posterior shin splints
Shin Splints
• Inflammation of the periosteum (sheath
surrounding the bone) of the tibia
• Causes:
–OVERUSE!!!
–Runners who increase their mileage
–Poor running shoes/insufficient shock
absorption
–Runners who change the surface on
which they are running
–Excessive pronation (eversion) of foot
Causes of Shin Splints
• Muscle imbalances
–tibialis anterior is tight
• Walking uphill
• Overtraining
• Walking faster than normal
• Jumping
• Running stairs
Symptoms of Shin Splints
•
•
•
•
•
Tenderness over the inside of the shin
Lower leg pain
Sometimes some swelling
Lumps and bumps over the bone
Pain when the toes or foot are bent
downwards
• A redness over the inside of the shin
Treatment of Shin Splints
• PRICE: Protection, Rest, Ice, Compression,
Elevation
• Ice: Apply ice packs to your shin for 20 to 30
minutes every 3 to 4 hours for 2 or 3 days or
until the pain goes away.
• Ice massage: Freeze water in a Styrofoam cup.
Peel the top of the cup away to expose the ice
and hold onto the bottom of the cup while you
rub ice over your leg for 5 to 10 minutes.
• Medicine: Take anti-inflammatory medicine as
prescribed by your health care provider.
Treatment of Shin Splints
• Shoe supports: Arch supports (orthotics)
help correct over-pronation. They can be
prescribed and custom-made or you can
buy pre-made arch supports at your local
pharmacy, shoe store, or sporting goods
store.
• Strengthening and Stretching the
posterior and anterior calf muscles
• Running in water
• Surgery
Prevention of Shin Splints
• Prevent shin splints by strengthening the
tibialis anterior muscle
• Exercises for strengthening the tibialis
anterior include:
–Sit down and write the letters of the
alphabet in the air with your toes
–Walk on your heels. Do several
repetitions of 10 seconds and gradually
work your way up to 30-second intervals
Prevention of Shin Splints
• Walk with feet turned inward and
outward.
• With socks off, gather up a towel that
is flat on the floor, using only the toes
• Pick up marbles using the toes
Anterior Compartment Syndrome
• A condition of the lower leg in which there is excessive
muscle swelling or increased pressure in the muscles
due to limited flexibility of the fascia surrounding the
muscles in the lower leg
• This swelling puts pressure on the blood vessels and
the nerve supply of the lower leg and foot
• If swelling continues, the blood vessels are
compressed so much that blood flow to and from the
muscle is shut off, and the nerves are pinched to the
extent that the feet and lower legs go numb
• Tibialis Anterior, Extensor Hallucis Longus,
Extensor Digitorum Longus, and Peroneus Tertius
may be affected
Causes of Compartment Syndrome
•
•
•
•
•
•
Overuse through exercise
Pain which increases during exercise
Bleeding/swelling in the compartment
Weakness
Motor loss
The sheath becomes inelastic and
unable to expand
Treatment
• Rest
• Diagnosis and Treatment by a health care provider
• Surgery- a small cut or two is made in the muscle
sheath to allow the muscle to expand out
Stress Fracture
• An overuse injury
that occurs when
muscles become
fatigued and are
unable to absorb
added shock
• Eventually, the
fatigued muscle
transfers the
overload of stress to
the bone causing a
tiny crack called a
stress fracture
Stress Fractures
• Usually a result of increasing the amount or
intensity of an activity too rapidly
• Other causes:
– Unfamiliar surface (tennis player switching
surfaces, i.e. soft clay to a hard court)
– Improper equipment (worn out shoes)
– Increased physical stress (an athlete with a
substantial increase in playing time)
– Smoking makes it worse because it interferes
with bone healing
Treatment of Stress Fractures
• PRICE:
–Protection, Rest, Ice, Compression,
Elevation
• New Shoes
• Non-weight bearing exercises
–Swimming or cycling
• Cane or crutches