Anatomy- Bones  28 bones (called phalanges)  Each toe has three bones (proximal, middle, distal) except the big toe which only has the proximal and distal  Toe joints are interphalangeal joints  Bones under big toe are called sesamoids which ease muscular movement over a bony surface (assist flexion)  Metatarsals are long bones of the foot (numbered 1 to 5)  Metatarsophalangeal joints are joints between the metatarsals and phalanges  Midfoot contains small several bones that joint together at the joint and produce small movements  Calcaneus is the heel bone  Medial malleolus is the end of the tibia on the medial side and the end of the fibula  Lateral malleolus is the end of the fibula at the lateral aspect

Anatomy  Arches of the Foot 3 arches on planter (bottom) of foot 3 arches on planter (bottom) of foot Purpose of arches  shock absorbant Purpose of arches  shock absorbant Transverse arch  in front of the heel and goes to the fifth metacarpal to the navicular bone Transverse arch  in front of the heel and goes to the fifth metacarpal to the navicular bone Longitudinal arch  runs from the calcaneus to the metatarsal heads Longitudinal arch  runs from the calcaneus to the metatarsal heads Metatarsal arch  runs along the metatarsal heads Metatarsal arch  runs along the metatarsal heads

Anatomy- Muscles  Peroneal muslces ( proneus brevis and proneus longus) attatch to the lateral aspect and under side of the foot to stabilize the lateral aspect of the foot  Gastrocnemius  attaches by the Achilles tendon and allows the athletes to propel themselves when running

Anatomy- Ligaments  Lateral ligaments  include anterior talofibular, posterial talofibular, calcaniofibular ligaments  hold bony structures together on lateral side (weaker than medial side)  Medial ligaments  includes deltoid  covers the entire medial side, maintains stability (especially during eversion)

Prevention  Wear shoes!!!  they provide ankle and foot support  Supportive ankle tapping to prevent ankle inversion  Wear shin guards  to prevent contusions of the lower leg  Strengthing and conditioning programs  If physicians find a weakness in the leg they should be replaced in rehabilitation

Ligament Injuries  Great Toe Sprains Excessive force is applied to the great (big) toe during flexion or extension Excessive force is applied to the great (big) toe during flexion or extension Cause: stubbing your toe, suddenly stopping when running, and landing awkwardly. Cause: stubbing your toe, suddenly stopping when running, and landing awkwardly. Symptoms: pain, tenderness, unable to move toe, swelling, and bruising Symptoms: pain, tenderness, unable to move toe, swelling, and bruising Treatment: PRICE Treatment: PRICE

Ligament injuries Cont…  Arch Sprain Causes: prolonged stress on the feet, overstretching Causes: prolonged stress on the feet, overstretching Symptoms: pain, tenderness, and sometimes bruising on bottom of foot Symptoms: pain, tenderness, and sometimes bruising on bottom of foot Treatment: PRICE Treatment: PRICE

Ligament Injuries Cont…  Lateral and Medial Ankle sprains When the ankle is inverted the lateral ligaments are injured, when everted the deltoid ligaments are injured When the ankle is inverted the lateral ligaments are injured, when everted the deltoid ligaments are injured 85% of ankle sprains are caused by excessive inversion 85% of ankle sprains are caused by excessive inversion The ankle is the most often sprained part of the body The ankle is the most often sprained part of the body Causes: awkwardly planting the foot, stepping on an irregular surface, during athletic events when one player steps on another Causes: awkwardly planting the foot, stepping on an irregular surface, during athletic events when one player steps on another Symptoms: swelling, pain, and joint may throb, difficulty walking, discoloration, redness, and warmth Symptoms: swelling, pain, and joint may throb, difficulty walking, discoloration, redness, and warmth Treatment: PRICE! Treatment: PRICE!

Ligament Injuries Cont…  Ankle dislocation Causes: foot is forcefully flexed downwards injuring the posterior aspect, or the heel strikes the ground forcefully injuring the anterior aspect Causes: foot is forcefully flexed downwards injuring the posterior aspect, or the heel strikes the ground forcefully injuring the anterior aspect Symptoms: pain, athlete will refuse to move, inability to move the foot, deformity, rapid swelling Symptoms: pain, athlete will refuse to move, inability to move the foot, deformity, rapid swelling Treatment: call 911, splint the lower leg/ankle, ice, team physician should relocate the bone Treatment: call 911, splint the lower leg/ankle, ice, team physician should relocate the bone

Muscle and Tendon Injuries  Achilies tendonitis Inflammation of the achilles tendon Inflammation of the achilles tendon Causes: repetitive running jumping and landing, causes the cells in the tendon to break down prematurely Causes: repetitive running jumping and landing, causes the cells in the tendon to break down prematurely Symptoms: gradual onset of pain, tenderness, swelling, redness, crepitus, and you can sometime feel it creaking when you press your fingers into the tendon and ankle Symptoms: gradual onset of pain, tenderness, swelling, redness, crepitus, and you can sometime feel it creaking when you press your fingers into the tendon and ankle Treatment: ice and pressure, refer to physician, gentle stretching and strengthening exercises Treatment: ice and pressure, refer to physician, gentle stretching and strengthening exercises

Muscle and Tendon Injuries Cont…  Achilles Tendon Rupture Largest tendon in the body Largest tendon in the body Grow weak and thin with age Grow weak and thin with age Illnesses such as arthritis and diabetes and some antibiotics increase the chance of this injury Illnesses such as arthritis and diabetes and some antibiotics increase the chance of this injury Most commonly occurs in middle- aged male athletes Most commonly occurs in middle- aged male athletes Causes: forceful push off while knee is straight, trip or stumble, fall from high heights Causes: forceful push off while knee is straight, trip or stumble, fall from high heights Symptoms: severe pain on tendon sound of a loud pop or snap, feel gap in tendon, swelling and stiffness, bruising, weakness Symptoms: severe pain on tendon sound of a loud pop or snap, feel gap in tendon, swelling and stiffness, bruising, weakness Treatment: iced, call 911, surgery Treatment: iced, call 911, surgery

Bone Injuries  Fifth Metatarsal Avulsion Fracture (Jones Fracture) Most common avulsion fracture Most common avulsion fracture When the ankle is forced into inversion the muscles contract forcefully to stabilize the lateral aspect of the ankle and the proneus brevis tendon pulls apart of the bone away at its attachment When the ankle is forced into inversion the muscles contract forcefully to stabilize the lateral aspect of the ankle and the proneus brevis tendon pulls apart of the bone away at its attachment Symptoms: swelling, bruising, pain in the middle out side of the foot Symptoms: swelling, bruising, pain in the middle out side of the foot Treatment: cast, doctor Treatment: cast, doctor

Bone Injuries Cont…  Epiphyseal Injury of Distal Tibia and Fibula Growth plates become injured when ankle is forced into planter flexion and inversion Growth plates become injured when ankle is forced into planter flexion and inversion Symptoms: pain, swelling, difficulty walking Symptoms: pain, swelling, difficulty walking Treatment: splint, refer to a doctor Treatment: splint, refer to a doctor  Stress Fracture Most commonly occurs on tibia, fibula, and metatarsals Most commonly occurs on tibia, fibula, and metatarsals Causes: repetitive stress, usually running Causes: repetitive stress, usually running Symptoms: pain, swelling, Symptoms: pain, swelling, Treatment: rest, refer to physician, sometimes casted Treatment: rest, refer to physician, sometimes casted

Other Common Injuries  Shin splints Causes: wearing bad shoes, being out of shape for the type of running event, tight calf muscles Causes: wearing bad shoes, being out of shape for the type of running event, tight calf muscles Symptoms: pain, swelling, lumps redness Symptoms: pain, swelling, lumps redness Treatment: PRICE Treatment: PRICE  Anterior Compartment Syndrome Muscles on the anterior aspect of the tibia are enclosed by connective tissue and if overused or severely impacted the tissue swells Muscles on the anterior aspect of the tibia are enclosed by connective tissue and if overused or severely impacted the tissue swells Symptoms: pain, hot, red, loss of movement, area is hard Symptoms: pain, hot, red, loss of movement, area is hard Treatment: refer to physician immediately where they will make an incision Treatment: refer to physician immediately where they will make an incision

Other Common Injuries Cont…  Contusions Impact of a ball stick or foot on shin Impact of a ball stick or foot on shin Symptoms: swelling, pain, discoloration, limp, loss of motion Symptoms: swelling, pain, discoloration, limp, loss of motion Treatment: ice and rest Treatment: ice and rest  Toe abnormalities Hammer Toe- the middle joint of the toe is flexed and the metatarssal and distal phalangeal joint is hyperextended Hammer Toe- the middle joint of the toe is flexed and the metatarssal and distal phalangeal joint is hyperextended Halux Valgus (Bunion) – excessive pressure on the great toe toward the midline from poor footwear Halux Valgus (Bunion) – excessive pressure on the great toe toward the midline from poor footwear

Other Common Injuries Cont…  Ingrown Toenail – where the nail grows into the surrounding soft tissue from poor trimming of the nail. (trim nail straight across and not too short)

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