1. Ch. 6 Foot, Ankle, and Lower Leg
Athletic Training
Ch. 6 Foot, Ankle, and Lower Leg

2. Objectives Standards –2.2, 2.7, 2.8, 5.5, 6.5, 6.6, 6.7, 6.9
SWBAT label the bones of the foot, ankle and lower leg
SWBAT label the ligaments of the foot, ankle and lower leg
SWBAT label the arches of the foot, ankle and lower leg
SWBAT label the joints of the foot, ankle and lower leg
SWBAT label the muscles of the foot, ankle and lower leg
SWBAT label the arteries of the foot, ankle and lower leg
SWBAT demonstrate reflex testing of the Achilles tendon
SWBAT measure the ROM of the foot, ankle and lower leg
SWBAT demonstrate special tests of the foot, ankle and lower leg
SWBAT define common injuries of the foot, ankle and lower leg
SWBAT describe treatments used for common injuries of the foot, ankle and lower leg
SWBAT describe protective devices used for common injuries of the foot, ankle and lower leg
SWBAT demonstrate taping and wrapping techniques for the foot, ankle and lower leg
SWBAT demonstrate the Purpose, Position and Procedure for each taping and wrapping technique

3. Bones of the foot and ankle

4. Bones of the foot and ankle
Medial malleolus
Lateral malleolus
Sesamoid

5. Foot and ankle ligaments

6. Foot and ankle ligaments

7. Foot arches

8. Foot and ankle arteries

9. Muscles of the foot and ankle

10. Muscles of the foot and ankle

11. Muscles of the foot and ankle

12. Range-of-Motion ROM ROM is measured with a goniometer.
See p. 30 for Typical ROM of many joints

13. Movement directions
Dorsiflexion –Def from book - the act of drawing the toe or foot toward the dorsal aspect of the proximally conjoined body segment (decreasing the angle between the top of the foot and the leg). Def from CD - Decreasing the angle between the foot and lower leg
Plantarflexion –Def from book- the act of drawing the toe or foot toward the plantar aspect of the proximally conjoined body segment (increasing the angle between the top of the foot and the leg). Def from CD - Increasing the angle between the foot and lower leg
Inversion – to turn the sole of the foot inward (subtalar/talocalcaneal joint movement)
Eversion – to turn the sole of the foot outward (subtalar/talocalcaneal joint movement)
Flexion (toes) – to decrease the angle between the toes and the sole of the foot
Extension (toes) – to increase the angle between the toes and the sole of the foot
Pronation – combined motions of calcaneal eversion, foot abduction, and dorsiflexion
Supination – combined motions of calcaneal inversion, foot adduction, and plantarflexion
Abduction – to move a body part away from the mid-line
Adduction – to move a body part toward the mid-line

14. Common Injuries
Shin Splints

15. Common Injuries Medial Tibial Stress Syndrome (MTSS) or Shin Splints
MOI – overuse, poor conditioning, shoes, type of activity, training habits, posture, foot mechanics
Tx – rest or non-WB activity, cryotherapy, massage, stretch, US, heat before participation, orthotics, new shoes, strengthening, posture and gait training, taping or wrapping???, proprioception, altered training routine, decrease overall activity.

16. Common Injuries
Stress Fracture – a crack in the cortical bone. Usually occurs if bone pain such as shin splints is ignored. They can be in any bone though, not just the shin
MOI - overuse, poor conditioning, shoes, type of activity, training habits, posture, foot mechanics
Tx – 6 weeks rest or non-WB activity

17. Common Injuries
Tibia/Fibula Fracture

18. Common Injuries Heel Bruise – also called a stone bruise.
MOI – usually stepping on a rock or similar object
Tx – cryotherapy, donut pad, heel cups, rest or non-WB activity
Heel Spur – bony growth on calcaneous.
MOI – plantar fascia pulls on calcaneous
Tx – orthotics, cryotherapy, cortisone injection, NSAIDS

19. Ankle Sprains

20. Common Injuries Ankle sprain – stretch or tear of ligaments
3 degrees of sprain-
First degree (grade I) – stretch of ligaments
Second degree (grade II) – partial tear of ligaments
Third degree (grade III) – complete tear of ligaments
Tx- PRICES, rehab

21. Common Injuries Inversion Ankle Sprain (lateral ankle sprain) –
MOI - PlantarFlexion and Inversion
Damages the ATLF 1st, CFL 2nd and PTFL 3rd
Most common MOI – about 85% of sprains
Eversion Ankle Sprain (medial ankle sprain) –
MOI - Eversion
Damages the Deltoid ligament
High Ankle Sprain (Syndesmosis sprain) –
MOI - Dorsiflexion and Inversion
Damages the Ant Tib-Fib Ligament and Post Tib-Fib Ligament

22. Common Injuries Muscle Cramps – spasm in muscle.
Causes (MOI) – fatigue, dehydration, poor conditioning, poor diet, not enough carbohydrate, injury, electrolyte deficiency, poor flexibility, bad shoes or equipment, poor technique.
Tx – stretch, massage, fluids, salt, ice, heat, IV

23. 1st degree (grade I) – overstretch.
Common Injuries
Achilles Tendon Strain (stretch or tear of muscle/tendon) – connects the gastrocnemius and soleus to the calcaneous
1st degree (grade I) – overstretch.
2nd degree (grade II) – partial tear.
3rd degree (grade III) – complete tear
MOI – overstretch
Tx – PRICES, decrease activity, US, stretch, taping, heel lift or orthotics, strengthening, extended rest, surgical repair

24. Common Injuries
Achilles Tendinitis or Tenosynovitis – inflammation of the tendon or tendon sheath
MOI - overuse, poor conditioning, shoes, type of activity, training habits, posture, foot mechanics
Tx - Rest, ice, US, modified activity, heel lift or orthotics, inspect shoes

25. Common Injuries
Achilles Tendon rupture/tear

26. Arches
Pes Cavus – a high arch
Pes Planus – flat foot (low arch)

27. Common Injuries
Arch sprain – usually the medial longitudinal arch. Next most common is transverse arch.
MOI – foot stepped on, arch stretched
Tx – arch roller, taping, cryotherapy, towel curls, marble pickups, stretching, orthotics

28. Common Injuries
Plantar Fasciitis - inflammation similar to an arch sprain but chronic. Pain on plantar/medial calcaneous and bottom of the foot.
MOI – overuse, poor conditioning, shoes, type of activity, training habits, posture, foot mechanics
Tx – rest or non-WB, US, cryotherapy, stretching, arch roller, taping, orthotics, cortisone injection, NSAIDS. Very slow healing

29. Common Injuries Turf toe
MOI - hyperextension of big toe (1st MtP joint)
Tx – PRICES, US, taping, rest

30. Common Injuries Bunion – Hallux Valgus deformity
MOI – congenital, shoes, posture, gait
Tx – taping or brace, toe wedge, stretching, surgery

31. Common Injuries Compartment Syndrome
4 compartments of lower leg (see p. 61)-
Anterior Compartment
Lateral Compartment
Superficial Posterior Compartment
Deep Posterior Compartment

32. Common Injuries
Compartment Syndrome - pressure builds up in the compartment from bleeding or other fluid accumulation and can interfere with muscle function, nerve conduction and blood flow.
Traumatic compartment syndrome
MOI- is usually a direct blow such as getting kicked in the shin area.
Symptoms – swelling and bruising over the anterior compartment, inability to actively DF ankle, diminished dorsipedal pulse, numbness on dorsum of foot. If this MOI and these symptoms are present it is a medical emergency. Send them to the doctor immediately!
Dx – measure pressure in compartment.
Tx – fasciotomy.

33. Common Injuries
Exertional compartment syndrome
MOI – overuse.
Symptoms- usually only occur during hard effort such as running or jumping. Mild numbness and tingling, difficulty DF ankle, diminished pulse, swelling.
Tx – rest, ice, elevation, no compression, edema
reduction massage, refer to M.D.

34. Common Injuries Blisters
MOI - friction, fluid accumulation under skin. If they break open there is a risk of infection.
Tx- aspirate blister, clean and bandage, moleskin or foam donut, bandage and pad. If open blister – clean, antibiotic ointment, bandage and pad.

35. Common Injuries
Athlete’s Foot (Tinea Pedis)
MOI – fungal infection. Moisture, locker room or shower floors.
Tx- Clean and dry feet, apply antifungal products 3 times a day, moisture wicking socks, foot powder.

36. Protective Devices
Achilles Brace

37. Protective Devices
Ankle Braces

38. Protective Devices
Arch Supports

39. Protective Devices
Boots (hockey, ski, wrestling)

40. Protective Devices
Bunion Pads

41. Protective Devices
Corn and Callous Pads

42. Protective Devices
Heel Cups

43. Protective Devices
Heel Lifts

44. Protective Devices
Orthotics

45. Protective Devices
Shin Guards

46. Protective Devices
Shoes

47. Protective Devices
Shin Splints Brace

48. Protective Devices
Turf Toe Brace

49. Taping and Wrapping Ankle Compression Wrap
Purpose – limit swelling, pain control, hold bandages or padding in place
Position – ankle at 90˚ angle to lower leg
Procedure –
Begin distally
Circle the foot
Bisect the heel
2 heel locks
Continue proximally, overlapping by ½ width
Clip or wrap to secure bandage
Check distal circulation and sensation

50. Taping and Wrapping Ankle Taping (Closed Basketweave)
Purpose – limit ROM, pain control
Position - ankle at 90˚ angle to lower leg
Procedure –
Apply spray adherent
Apply heel & lace pads
Apply underwrap over area to be taped
2 leg anchors
1 foot anchor
3 stirrups
Figure 8
Medial and lateral heel locks
Horseshoe fill-in strips
Heel locks
Cover any open areas (except calcaneus)

51. Taping and Wrapping Great Toe Sprain (Turf Toe)
Purpose – immobilize the 1st MtP joint
Position – Big toe in neutral (straight) position, foot at 90˚angle to lower leg
Procedure –
Anchor around mid-foot
Anchor around big toe
Apply 3-5 longitudinal strips from toe anchor to foot anchor
Repeat toe anchor
Repeat foot anchor
(See pictures on next slide)

52. Taping and Wrapping
Turf Toe taping

53. Taping and Wrapping Toe Buddy Taping
Purpose – stabilize the injured toe
Position – toes straight and adjacent
Procedure –
Apply 1 or 2 strips of ½” width tape around the injured toe and adjacent toe.

54. Taping and Wrapping Metatarsal (Transverse) Arch pad taping
Purpose – Compression on metatarsal arch, stability of MT arch
Position – foot at 90° angle to lower leg
Procedure –
Place pad over MT arch at ball of foot (2nd, 3rd, 4th metatarsals)
Apply circular strips of elastic tape to secure pad
Anchor with 1 ½ “ white tape

55. Taping and Wrapping Medial Longitudinal Arch taping – Simple method
Purpose – Compression on arch, limit pes planus and pronation
Position – foot at 90° angle to lower leg
Procedure –
Anchor at heads of metatarsals
Horseshoe anchor around heel
Simple arch strips on plantar surface of foot pulling lateral to medial, cover from MT heads to calcaneus
Repeat horseshoe anchor
Anchor over dorsum of foot

56. Taping and Wrapping
Medial Longitudinal Arch taping – X-arch or Teardrop
Purpose – Compression on arch, limit pes planus and pronation
Position – foot at 90° angle to lower leg
Procedure –
Anchor at heads of metatarsals
Horseshoe anchor around heel
Tear-drop or “X” strips from MT anchor around heel – 4-5
Simple arch strips on plantar surface of foot pulling lateral to medial, cover from MT heads to calcaneous
Repeat horseshoe anchor
Anchor over dorsum of foot
(see pictures on next slide)

57. Taping and Wrapping
Medial Longitudinal Arch taping

58. Taping and Wrapping Shin Splints taping Purpose – pain control
Position –foot at 90˚angle to the lower leg
Procedure –
Apply longitudinal strip on medial and lateral side of leg
Begin distally
Apply alternating strips in “X” pattern over affected area
Repeat longitudinal strip on medial and lateral side of leg
Cover with elastic bandage or elastic tape
(see picture on next slide)

59. Taping and Wrapping
Shin Splints taping

60. Taping and Wrapping Achilles Tendon taping
Purpose – to limit dorsiflexion and assist plantarflexion
Position – leg extended, foot plantarflexed 10˚
Procedure –
Apply 2 leg anchors at the base of the calf
Apply 1-2 foot anchors at mid-foot
Apply 2 strips of elastic tape from the foot anchor, across the plantar surface (sole) of the foot, to the leg anchor
Repeat leg anchors and foot anchors
Cover with elastic bandage or elastic tape
(see picture on next slide)

61. Taping and Wrapping
Achilles Tendon taping