The Foot, Ankle, and Lower Leg Chapter 17 The Foot, Ankle, and Lower Leg

Objectives Upon completion of this chapter, you should be able to: Describe the anatomy of the foot and ankle Cite primary extrinsic and intrinsic muscles of the lower leg Explain the common injuries and conditions affecting the foot, ankle, and lower leg Describe medial tibial stress syndrome and its treatment

The Lower Leg Exposed to numerous types of trauma during athletic practices and events Common injuries include: Contusions Strains Tendonitis and tendon ruptures Medial tibial stress syndrome Stress fractures and other fractures Compartment syndrome

The Foot and Ankle 15% of sports injuries involve ankle ligaments, bones, and tendons Basic anatomy: Foot- stabilizes and supports rest of body Individually, parts are weak; as a whole foot is strong 3 arches- transverse, medial, lateral

Joints of the Foot and Ankle Talocrural joint Tarsometatarsal Joint Subtalar Joint Interphalangeal Joint Talonavicular Joint Metatarsophalangeal Joint

Common Injuries of the Foot and Ankle

Common Injuries of the Foot and Ankle Ankle sprains First degree (mild) 1+ ligaments stretched; no abnormal movement Second degree (moderate) Portion 1+ ligaments torn; slight abnormal movement Third degree (severe) 1+ ligaments completely torn; joint instability Treatment: protection, rest, ice, compression, and elevation (PRICE), followed by rehabilitation

Animation – Ankle Sprain Click Here to Play Ankle Sprain Animation

Common Injuries of the Foot and Ankle (cont’d.) Arch sprains Caused by overuse, overweight, fatigue, training on hard surfaces, and nonsupportive shoes Treatment: cold, compression, and elevation Blisters Occur anywhere there is friction Treatment: relieve pain, keep from enlarging, and avoid infection

Common Injuries of the Foot and Ankle (cont’d.) Great toe sprain (Turf Toe) Important for balance, movement, speed Big toe hyperextends Treatment: protection, rest, ice, compression, elevation, and support to limit movement Hematoma Blood pools in toe and puts pressure on nerves

Common Injuries of the Foot and Ankle (cont’d.) Plantar fasciitis Tissue becomes strained from overuse, unsupportive footwear, a tight Achilles tendon, or running on hard surfaces Treatment: correct training errors, icing, and massage, arch supports Can lead to heel spurs, muscle strains, shin splints

Common Injuries of the Foot and Ankle (cont’d.) Heel bruise Heel receives, absorbs, and transfers impact from sports activities Ligaments, tendons, and fat pad are subject to stress and injury Treatment: cold application before activity, cold and elevation afterward, heel cups or pads

Common Injuries of the Foot and Ankle (cont’d.) Heel spur Bony growth on calcaneus that causes painful inflammation of soft tissue Treatment: taping or shoe inserts, ice Fractures Immediately impairs ability to perform S/S: point tenderness, obvious deformity, often presents similar to ankle sprain

Common Injuries to the Lower Leg Contusions Occur most often over the shin; May also involve muscular areas of the leg as result of a direct blow Peroneal nerve- if hit here, causes radiating pain, tingling, numbness, and sometimes foot drop Usually temporary and complete recovery Strains Occur anywhere along the muscles Normally result from a violent contraction, overstretching, or continued overuse

Common Injuries of the Foot and Ankle (cont’d.) Laceration

Common Injuries to the Lower Leg (cont’d.) Muscle cramps Sudden, involuntary contraction of a muscle Contributing factors may include fatigue, fractures, dehydration, lack of nutrients, poor flexibility, improperly fitted equipment Treatment: passive stretching, fluid replacement, massage, rest, and ice

Common Injuries to the Lower Leg (cont’d.) Achilles tendonitis Vital to walking upright Caused by inflammation of the Achilles tendon Tearing of tendon tissues caused by excessive stress S/S: initial discomfort, increased inflammation, pain, crepitus with palpation, redness Treatment: best is prevention (stretching), ice, anti-inflammatory medication, physical therapy, rest

Common Injuries to the Lower Leg (cont’d.) Achilles tendon rupture Caused by poor conditioning and overexertion Treatment: must be surgically repaired; rehab may take up to a year before athlete ready to return

Common Injuries to the Lower Leg (cont’d.) Medial tibial stress syndrome (shin splints) Normally the result of doing too much too soon, repetitive activity on hard surfaces, tight calf muscles, worn or ill-fitting shoes, over-pronation Treatment: ice, reducing activity level, and gentle stretching of posterior leg muscles Long-term treatment: biomechanical assessment of lower extremities, physical therapy, orthotic devices, anti-inflammatory medications, and a strengthening and flexibility program

Common Injuries to the Lower Leg (cont’d.) Stress fractures Incomplete crack in the bone Signs include a “hot spot” of sharp, intense pain Compartment syndrome Develops when there is swelling within one or more lower leg compartments Fracture, contusion, crush injury, infection, excessive exercise, overstretching Treatment: immediate transportation to the nearest medical facility (surgery will usually be needed)

Lateral compartment also called peroneal compartment

Common Injuries to the Lower Leg (cont’d.) Fractures Tibia can be fractured by a direct blow, a twisting force, or occasionally from repetitive overuse Fibula is normally fractured by a direct blow to the outside of the leg Often mistaken for contusion b/c still often able to walk

Additional Tests for the Foot, Ankle, and Lower Leg Standard methods of testing various structures of the lower extremity: Anterior Drawer Test Plantar Fascia Test Talar Tilt Test Tinel’s Sign- to identify entrapment of tibial nerve (tarsal tunnel syndrome)

Conclusion Injuries to the lower extremity are common in athletics Solid understanding of anatomy will help the examiner assess injuries Proper conditioning, equipment, and training are essential to the overall health of the athlete