FOOT, ANKLE AND LOWER LEG Care and Prevention

Bony Anatomy Toes=phalanges Metatarsals-long bones in the foot Have 3 joints, except big toe has only 2 Metatarsals-long bones in the foot Joins with phalanges to make MTP joint Talus & Calcaneus bigger bones in foot & ankle Tibia and fibula Form medial & lateral malleolus

Arches of the Foot Arches are found on plantar aspect Shock absorbers Transverse: front of heel to 5th metatarsal Longitudinal: calcaneus to metatarsals Metatarsal: across distal metatarsals

Muscles and Tendons Peroneal muscles Perform eversion Gastrocnemius and soleus attach via achilles tendon Perform plantarflexion Tibialis anterior, extensor digitorum, and extensor hallucis-TDH muscles Perform dorsiflexion

Ligaments Lateral ankle: Medial ankle: Anterior talofibular (ATF) *Most commonly sprained Posterior talofibular (PTF) Calcaneofibular (CF) Medial ankle: Deltoid ligament Stronger than all the lateral ligs combined

INJURIES Bone injuries: Muscle/Tendon injuries: Ligament Injuries Jones Fx Tibia/Fibula Fx Stress Fx Muscle/Tendon injuries: Medial tibial stress syndrome (Shin splints) Achilles Tendinitis Achilles Tendon Rupture Ligament Injuries Great Toe sprain (Turf toe) (check this) Plantar fasciitis Lateral/Medial ankle sprains Ankle dislocation Tissue Injuries Contusions Toe abnormalities Anterior compartment syndrome

Jones Fracture What is it? MOI: Inversion Signs and Symptoms: Avulsion fx of peroneus brevis tendon MOI: Inversion Perenous brevis muscle contracts quickly and forcefully to stabilize ankle Direct impact Signs and Symptoms: Pain, ttp over 5th metatarsal,swelling HIGH reinjury rate Why? Immobolize in boot and use crutches along with rehab

Tibia/Fibula Fractures MOI: direct or indirect impact Fibular fractures are most common Signs and symptoms: Obvious deformity (sometimes) Loss of function Severe pain Swelling Management: EMS for displaced tibia fracture Casting and in severe cases surgery to reduce fracture

Stress Fractures Hairline fx Common areas: Tibia, fibula, metatarsals MOI: repetitive stress i.e. running S&S: Pain and swelling TTP over stress fx site Pain with walking, running, night pain Management: Xrays Rest If not diagnosed in time can lead to complete fx

Medial Tibial Stress Syndrome A.K.A. Shin Splints What is it? Tiny tears of the muscle from the tibia on the medial aspect of the lower leg. MOI: overuse Tight calves Old shoes Low arches Management: Rest, ice massage Change running shoes, add arch supports if needed Tape lower leg to pull muscle towards the tibia Stretch calves & strengthen tibialis anterior muscle

Achilles Tendonitis Connects Gastroc muscle to calcaneus MOI: overuse from running and jumping Signs & Symptoms: TTP, swelling, crepitus ↓ strength in PF Visible thickened tendon Management: Rest, ice, anti-inflammatories Stretch calves Strengthening calves Complications?

Achilles Tendon Rupture MOI: Forced DF Blow over achilles tendon Sudden, strong contraction of gastroc Signs & symptoms: Ath c/o…. Pain Obvious deformity/depression Unable to complete PF Management: Splint, ice, crutches Refer to MD for surgery

Great Toe Sprain A.K.A. “Turf Toe” MOI: forced hyperextension Sprains lig of MTP joint Happens more on artificial turf than real grass Signs & Symptoms: Pain, swelling, ttp Inability to DF/ “push off” Discoloration Management: Rest, ice Ice in bucket rather than w/bag Rehab Taping

PLANTAR FASCIITIS What is it? MOI: Signs & Symptoms: Management: Inflammation of fasica (thick band/layer) on plantar asepct of foot. MOI: Overuse, tight calves Signs & Symptoms: Pain on calcaneus, moves towards the toes Pain when taking the first steps in the morning Pain with excessive DF Management: Rest, ice Stretch calves Provide orthotics/arch supports if necessary Anti-inflammatory (oral vs injection)

Lateral/Inversion Ankle Sprain 85% of ankle sprains are inversion sprains 2 reasons: Deltoid ligament is stronger than lateral ligs Fibula prevents excessive eversion MOI: Plantarflexion and excessive inversion Some examples? Severity depends on force, strength of muscles, protective devices worn Signs & Symptoms: Pain, swelling, discoloration TTP over ATF ligament typically Loss of ROM and strength (depends on severity) Management: RICE Anti-inflammatories Stretching and strengthening Bracing Balance exercises Refer for XRAYs if rapid swelling occurs or TTP over bone

Medial/Eversion Ankle Sprains Only account for 15% of ankle injuries. More severe than inversion sprains Longer recovery time MOI: Excessive eversion Signs & Symptoms: Pain, swelling, TTP over deltoid ligament Bruising Loss of ROM and strength especially eversion Management: RICE NWB XRays to rule out fracture of fibula Rehab and balance activities

ANKLE DISLOCATION Can occur either anteriorly or posteriorly. MOI: Anterior: Forceful heel strike against the ground. Posterior: Direct blow to the anterior portion of the lower leg when ankle is in PF. Signs & Symptoms: Obvious deformity and severe pain Swelling Management: Activate EMS Emergency because nerves and blood vessels can be damaged Splint lower leg and ankle and transport to ER

TOE ABNORMALITIES

TOE ABNORMALITIES Toe Abnormality MOI and Description Signs & Symptoms Management Hammertoes When PIP is flexed and MTP and DIP are extended. Congenital or from wearing small shoes frequently Callus on PIP joint, blisters, swelling, pain Wearing larger shoes, padding over callus, shaving callus. Surgery to fix toes Hallux valgus a.k.a.bunions Wearing shoes that are too tight which force the big toe towards the smaller toes Tenderness, swelling, and enlarged joint Wearing shoes w/larger toe box, padding the bunion, or surgery to align toe(s). Ingrown toenail Trimming nail too short, trimming nails in a rounded way rather than straight across. Nail grows into skin Swelling, redness, pain, infection Antibiotic ointment, trim nail straight across. If severe dr. takes out side of nail.

Anterior Compartment Syndrome Muscles are covered by fascia. Pressure can accumulate between the fascia and muscle. MOI: Overuse or direct impact Signs & Symptoms: Severe pain that doesn’t go away after activity Heat, redness Hardness of area Loss of ROM/Strength Management: Refer to Dr. immediately Increased pressure places pressure on blood vessels and nerves Surgery to relieve pressure Fasciotomy: Remove piece of fascia

References Cartwright AL, Pitney AW, Fundamentals of Athletic Training. 3rd edition. Human kinetics. Champaign, IL.