Injuries to the Foot, Ankle and
Lower Leg
Mr. Brewer
Ankle Injuries
The ankle is one of the most common injured
parts of the body.
Why do you think?
Ankle Injuries
• The ankle has 6 major movements that can be
produced, based on the anatomy and how the
bones are structured.
• All of the 6 movements can result in injury if they
are “extreme” movements.
• Extreme movements = Movements that are
either too quick/fast for the muscles to respond
to in time, OR they produce enough force to
extend the ankle beyond it’s normal range of
motion.
Terminology
• Elasticity- A product of matter being deformed,
but preserving enough of the original structure to
return to it’s original form.
• Plasticity- A product of matter being deformed
beyond the point of being able to return to it’s
original form, yet not breaking it’s basic structure.
• Fracture/Rupture- In our terms, once a bone,
ligament, muscle or tendon is stressed beyond its
maximum plasticity, the result is a permanent
break (Fracture/Rupture).
Visual Representation of the Physics
behind the theory.
Muscle Strains
• Any muscle in the body can be strained.
• Some are more difficult to strain because of
the anatomy of the body.
• A strain can occur when a muscle is stretched
beyond it’s plasticity.
• Or when extreme force is created to make a
quick movement or move a heavy load.
Manual Muscle Tests (MMTs)
• When testing for muscle strains, you can start
by allowing the athlete to move the ankle in
all 4 major directions.
• Be sure to utilize proper hand placement to
isolate the muscle you are testing to get
accurate results.
– You are looking for:
• ROM of the joint (in comparison with the other ankle)
• Where the pain is located.
• What type of pain is there?
Make or Break
• There are two main ways to test a muscle(and it’s
tendons)
– A “make” test: A test that starts with the athlete in a
position where the muscle you are testing is on a
stretch to start.
• You will then apply resistance and ask the athlete to contract
the muscle against your applied resistance.
– A “Break” test: A test where the muscle you are
testing is in the state of contraction.
• You will then ask the athlete to hold the contraction while
you attempt to move the body part (ankle in this case) from
it’s current position.
Activity
With a partner:
- One of you will be the “athlete”, and one of you will be
performing the test.
- Practice performing both a make and break MMT for
the following movements:
-
Plantar Flexion
Dorsi-Flexion
Eversion
Inversion
- Switch Roles
Broken Bones
• Just as any muscle in the foot/lower leg can be
strained, any bone in the foot/lower leg can
be broken.
• Bones can break due to a blunt force,
compression, torsion or avulsion.
• An avulsion fracture involves the tendon of a
muscle (or a ligament) detaching from either
it’s insertion or origin while pulling a piece of
bone with it.
Ottawa Ankle Rules
• When dealing with the foot, an Athletic Trainer
should always rule out a fracture first.
• Some things to check first:
– The Lateral Malleolus at the growth plate and around
the anterior and posterior edges.
– The Medial Malleolus at the growth plate and around
the anterior and posterior edges.
– The 5th Metatarsal, specifically at the styloid process.
– The navicular bone (from the medial, plantar and
dorsal surfaces)
– Test and athletes ability to bare weight.
Ottawa Ankle Rules
Fractures
- Jone’s Fracture:
- A Jone’s Fracture is a
fracture of the proximal
portion of the 5th
metatarsal.
- Limited blood supply to
the base of the 5th
metatarsal, and sometimes
needs to have a screw
placed not only for bone
structure and healing, but
also to innovate the area
with some blood flow.
Jone’s Fracture
Navicular Stress Fracture
• The Navicular is a bone that is difficult to
fracture, but is not that uncommon with
athletes who are jumping repeatedly.
• Basketball players are a common victim of this
injury due to the fact that they are jumping
and landing with great force AND because
they are typically larger and heavier players
who are putting a lot of force on the bones.
Fracture Mechanisms
• Mechanism of injury = what happened to
cause the injury.
• Fractures are usually a result of a direct blow
causing the bone to “crack”
• Fractures can also occur if a tendon pulls off a
piece of bone due to weak bone at the
insertion point, an intense burst of the muscle
attached OR a combination of both.
Shin Splints
• Shin Splints often times come as a result of
starting up an intense running program without
the properly allowing your body to adjust
gradually.
• Shins splints are intense inflammation of the
lower leg muscles at their originations.
• They can also be a result of flat feet, or over
pronating, and general overuse of the muscles.
• This “overuse” can be a result of just too much
training, or other supporting muscles are weak
and forcing these muscles to be over worked.
Shin Splints
• Running on hard surfaces such as pavement or
concrete sidewalks can also contribute to shin
splints.
• A better alternative would be running on a
rubber track and/or grass instead.
• If not taken seriously, shin splints can eventually
lead to “stress fractures” or “micro-fractures” of
the tibia.
• Rest is really the best, and only true way to allow
shin splints to heal most efficiently.
Lateral Ankle Sprain
• The most common
form of an ankle
sprain.
• Mechanism of
injury is usually
plantar flexion and
inversion of the
ankle.
Lateral Ankle Sprain
• The ligament that is most
often the primary victim
is the Anterior TaloFibular Ligament(ATF).
• The deeper into inversion
your ankle goes, the
more damage that can be
done to the other lateral
ligaments (CF and PTF).
• NOTE: it is common to
have the peroneal
tendons affected as well
based on the mechanism.
Medial Ankle Sprain
• This is a sprain of the DELTOID
ligament.
• The Deltoid ligament is
extremely tough, and due to
the restricted range of motion
involved with EVERSION, the
Deltoid ligament is difficult to
sprain in isolation; however,
painful when it does occur.
• Mechanism of injury:
– Usually involves eversion, with
the ankle in a neutral position.
(difficult to occur)
High Ankle Sprain
• A “High Ankle Sprain”
is an injury to the
syndesmotic joint.
• The Syndesmotic Joint
at the ankle is made
up of the Anterior
Inferior Tib-Fib
Ligament, and the
Posterior Inferior TibFib Ligament.
High Ankle Sprain
• Common Mechanism of
Injury for a high ankle
sprain involves an ankle
that is fixed on the
ground, and torsion of
the leg bones take place
with the foot stuck into
place.
• This cause the Tibia and
Fibula to want to
“separate” distally,
stressing the Anterior
and Posterior Tib-Fib
Ligaments.
Plantar Faciitis
• The Plantar Fascia is a
thick fibrous band
located on the plantar
surface of the foot,
stretching from the
calcaneus up to the
heads of the
metatarsal bones.
• Plantar FASCIITIS is
simply “inflammation”
of the plantar fascia.
Plantar Fasciitis
•
•
•
Although “tears” can take place if you
were to step in a ditch or divot which
puts the plantar fascia on an extreme
stretch, Plantar Fasciitis often results
from long periods of walking
incorrectly, or without proper
support from footwear.
Over years and years of mild
deformation due to the fibrous
elastic band pulling at the calcaneus
or “heel bone”, you can develop what
is known as a Heel Spur, which more
than likely will exacerbate OR create
the symptoms.
The most telling sign/symptom
indicating that you might have
plantar fascia injury would be on your
first step out of bed in the morning.
If you have the condition, this step
will be he most painful.
Achilles Tendonitis and Ruptures
• An Achilles Tendon rupture is
rare in all people, but especially
younger people.
• Much more common in the
over 40 population.
• As you age, the area 1-3 cm
above the insertion point into
the calcaneus (heel bone)
tends to dry out, and this is the
most common location of tears
of the achilles.
• A result from a very explosive
movement, usually going from
a dorsi-flexed or neutral state
towards a plantar flexed state.
Turf Toe
• Turf Toe occurs when
an athlete forces their
great toe into extreme
extension at the 1st
Metatarsal-Phalangeal
joint.
• Usually the result of an
athlete going up onto
their toe(s), and the
axial load(force) is
pressing down, forcing
the toe into hyper
extension.
Hammer Toe
• Hammer Toe is a
condition in which the
toe is bent into
awkward positions at
each individual joint
between the
phalanges.
• Wearing high heels has
been linked to hammer
toe, but there are
other causes for
hammer toe that build
up over time and
repeated use.
Acute Compartment Syndrome
• Acute Compartment
syndrome of the lower leg
can occur as a result of a
direct blow, or some other
condition that effects your
body’s reaction deep inside
of the leg.
• Because your leg is broken
down into internal
compartments, at times a
certain compartment can
become filled with pressure,
but no where for that
pressure to escape.
• Swelling, internal bleeding
and/or where extremely tight
clothing around the calf area
can contribute to this
pressure build up.
Acute Compartment Syndrome
• If one or more of these compartments becomes trapped, and pressure
builds up, this can be an EMERGENCY situation that could require surgery to
release the pressure in the leg before it cuts of circulation to the lower
extremity.
• This could result in loss of limb if not taken seriously.
• Signs and Symptoms include and extremely tight feeling calf, a shiny-red
appearance on the surface of the skin, and extremely intense pain and/or
loss of sensation below the calf.
Athlete’s Foot
• Athlete's foot AKA tinea
pedis.
• A fungal infection that
usually begins between
the toes.
• It occurs most commonly
in people whose feet
have become very
sweaty while confined
within tight-fitting shoes.
• Very itchy, and can
present itself as a rash.