Objectives Understand: Identify: Recognize: the anatomy of the foot, ankle, & lower leg. Principles of rehabilitation for the foot, ankle, & lower leg Preventive/supportive techniques for lower extremity Identify: Components of an evaluation format Recognize: Common injuries Foot Supports 3 times the body weight. Foot contains ¼ of the total number (24 bones and 38 joints)

Bones Lower Leg & Foot Tibia- lower leg Fibula- lower leg Tarsals- (7) Talus, Calcaneus, navicular, cuboid, cuneiforms (medial, intermediate, & lateral) Talus-one of the largest foot bones Calcaneus-one of the largest foot bones Metatarsals- (5)mid-foot Phalanges- (14) The bony prominences (malleoli) on the sides of your ankle are the distal ends of the tibia (medially) & fibula (laterally)

Ligaments -anterior talofibular Ligaments- named for the bones they connect. Lateral aspect of the ankle is most commonly injured. -anterior talofibular -anterior tibiofibular -calcaneofibular -posterior talofibular Medial aspect of the ankle most commonly injured deltoid ligament

Muscles & Tendons Tendon: Most important for ankle support Achilles Tendon -attach the gastrocnemius and soleus muscles (calf muscles) to the calcaneus. Muscles: Peroneus Brevis & Peroneus Longus - run along the lateral side of the leg and foot. -everts and abducts -plantar flexes - helps to prevent sprains.

Muscles & Tendons Continued Anterior Lower Leg (shin): associated with shin pain: interosseous membrane: connects the tibia & fibula -Tibialis anterior-dorsiflexes foot, inverts & adducts -extensor halluscis longus-extends great toe, dorsiflexes -extensor digitorum longus-extends toes, dorsiflexes foot, everts foot Posterior Lower Leg: -gastrocnemius-plantar flexes, flexes lower leg -soleus-plantar flexes -tibialis posterior-plantar flexes foot, inverts and adducts foot, supports arch -flexor digitorm longus-flexes toes, plantar flexes foot, inverts and adducts foot -flexor hallucis longus

Joints of the Foot Talocrural joint (ankle joint)-most commonly injured joint in athletics. -bones: Tibia, Fibula, & Talus -hinge joint-flexion (dorsiflexion) and extension (plantarflexion.) Subtalar joint (ankle joint) -bones: Talus & Calcaneus -triplanar-movement around the oblique axis. -most stable when in dorsiflexion

Range of Motion Dorsiflexion- draw toes towards body Plantar Flexion- draw toes away from lower leg Inversion- turning sole inward Eversion- turning sole outward Flexion- toes forward Extension- toes backward Pronation- foot abduction, eversion Supination- foot adduction, inversion Abduction- away from the midline of the body Adduction- toward midline of the body

Arches Metatarsal Transverse Medial longitudinal (inner) Lateral longitudinal (outer) balance, movement, support, and shock absorption

Evaluation Format H.O.P.S. (H)-History: how did it happen, where does it hurt, did you hear a pop or snap, have you hurt it before. (O)-Observation: compare the uninjured to the injured lower extremity. Bleeding, deformity, swelling, discoloration, scars, etc. (P)-Palpation: above and below injured site, then affected site. -neurological (motor and sensory) -circulation (pulse & capillary refill) -anatomical structures (palpate) -fracture test (palpation, compression, and distraction) (S)-Special Tests-joint stability, disability, and pain.

Assessment Tests -Test for bony integrity: 1. Heel Tap test: integrity of tibia, fibula and talus 2. Squeeze Test: bony integrity of tibia and fibula -Tests for ligamentous stability: 1. anterior drawer test: anterior talofibular and calcaneofibular ligaments 2. Inversion or lateral stress test (talar tilt): calcaneofibular and anterior talofibular ligaments 3. Eversion or medial stress test (talar tilt): deltoid ligament 4. external rotation test (kleiger test): anterior and posterior tibiofibular ligaments and interosseous membrane -Tests for Muscle Function & Flexibility: 1. Thompson test: achilles tendon 2. Gastrocnemius Tightness test: degree of tightness in the ankle due to inflexibility 3. Soleus Tightness test: degree of tightness in the ankle due to inflexibility.

Common Injuries Blisters Ankle Sprains: (PRICES) -80% of ankle sprains are inversion and plantar flexion. -Ligament most injured is anterior talofibular -Eversion sprain less common-deltoid ligament (thick) 1. First degree sprain -one or more ligaments are STRETCHED. 2. Second degree sprain -portion of one or more ligaments is torn. 3. Third degree sprain -one or more ligaments have been completely torn.

Common Injuries Arch Sprains: (transeverse, metatarsal, inner or outer longitudinal (most common) fail to hold bones of foot in position. Might get shine splints. Achilles tendon strain, foot fatigue, strained muscles, blisters. Causes: overuse, overweight, fatigue, training on hard surfaces, non-supportive shoes. Great Toe Sprain (turf toe): (balance, movement, and speed)(PRICES) ligament supporting the toe will become sprained 1st metatarsal phalangeal joint (Sprain)

Common Injuries -poor blood supply, slow to heal. Shin Splints: (Medial Tibia Stress Syndrome): Inflammation of the interosseous membrane and strain to the soleus. -poor blood supply, slow to heal. -muscle inbalance or weakness -poor flexibility or lack of stretching -lack of proper conditioning -running on hard surfaces -improper running form -improper running shoes

Common Injuries Anterior Compartment Syndrome: muscles that dorsiflex the foot and ankle. (tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius) Direct trauma or excessive exercise results in hemorrhage and swelling in compartment. Pressure on peroneal nerve, the veins, and arteries. Muscle cells will die. Signs: pain (even after cold treatment), firmness of the muscle, numbness of foot, pain with passive motion of ankle, lack of strength. MEDICAL EMERGENCY!!!

Common Injuries Stress Fractures: bones are living tissue. Achilles Tendon Strain: (strongest in body) (PRICES, but move more conservatively than most muscle injuries) -causes: overuse, muscle imbalance, inflexibility, or sudden movement. Stress Fractures: bones are living tissue. -causes: lack of exercise, severe exercise or too long, change in bone structure. -signs: specific point tenderness, increased pain during exercise, hurt when athlete presses fingers just above and below site of most pain. -Later stages: pain is constant, especially at night. Muscle Cramps: a sudden, involuntary contraction of a muscle. -cause: unknown, several factors seem to contribute: Fatigue, fractures, dehydration, lack of electrolytes, poor flexibility, previous injury, improper fitted equipment.