1. Draw and label all the foot bones you know.
10/25/17 Bell Work
Draw and label all the foot bones you know.

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

3. Objectives 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

4. The Foot and Ankle
It has been estimated that 15% of all sports injuries involve the ligaments, bones, and tendons of the ankle.
The ankle absorbs 3x the force of the body during running and jumping
Up to 20,000 ankle injuries each day in the U.S.

5. The Foot and Ankle
The feet cushion up to one million pounds of pressure during a single hour of strenuous exercise
The feet log approx 1,000 miles per year
The foot can experience debilitating conditions: athlete’s foot, turf toe, calluses, ingrown toenails, and blisters

6. Basic Anatomy of the Foot and Ankle
The foot stabilizes and supports the rest of the body during standing, walking, running, or jumping
Individually, the structures of the foot are weak, but together the foot is able to withstand most of the demands of athletics

7. Basic Anatomy of the Foot and Ankle
The key to the foot’s function is a set of 3 arches, which help in absorbing the impact of walking, running, and jumping
Transverse arch
Medial longitudinal arch
Lateral longitudinal arch

8. Basic Anatomy of the Foot and Ankle
Each foot has 26 bones and 38 joints
Tarsals- talus, calcaneous, navicular, cuboid, and cuneiforms
Mid-foot- 5 metatarsal bones
Toes- 14 bones that make up phalanges

9. Basic Anatomy of the Foot and Ankle
The ankle joint is made up of combination of 2 joints
Talocrural joint- tibia, fibula, and talus
Subtalor joint- talus and calcaneous
Malleoli- located on either side of the ankle. They are the distal ends of the tibia and fibula

10. Ligaments of the Foot and Ankle
Provide strength and support the joints of the foot and ankle
Ligaments are named after the bones they connect
Lateral ankle: anterior talofibular, anterior tibiofibular, calcaneofibular, and posterior talofibular
Medial ankle: deltoid ligament- triangular-shaped ligament that attaches the talus and medial malleolus

14. Basic Anatomy of the Lower Leg
Consists of 2 bones: tibia and fibula
Tibia is larger of the 2 bones and is often referred to as the shin

15. Muscles of the Lower Leg and Foot
Intrinsic muscles are located within the foot and cause movement of the toes and also help support the arches of the foot
Plantar flexors - Dorsiflexors
Abductors - Adductors

16. Muscles of the Lower Leg and Foot
Extrinsic muscles are located outside the foot, in the lower leg
They have long tendons that cross the ankle and attach the bones of the foot, to assist movement

18. Common Injuries to the Foot and Ankle
Combined account for the most common health concerns in the US
¾ of the population experiences foot problems of some degree of seriousness at some time in their lives

19. Common Injuries to the Foot and Ankle
150 lb jogger runs 3 miles = 150 tons of impact on each foot

20. Muscles That Move the Foot
Function
Gastrocnemius
Plantar Flexion, Flex knee
Soleus
Plantar Flexion
Peroneus Longus
Eversion, Plantar Flexion
Peroneus Brevus
Eversion
Tibialis Anterior
Dorsal Flexion

21. Muscles That Move the Toes
FUNCTION
Flexor Hallucis Brevis
Great toe flexion
Flexor Hallucis Longus
Extensor Hallucis Longus
Great toe extension
Flexor Digitorum Longus
Toe Flexion
Extensor Digitorum Longus
Toe Extension

22. Ankle Sprains
Sprains are the most common presentation in orthopedic practice and the most common reason for ER visits
Sprains account for 45% of all basketball injuries, 31% of soccer injuries, and 24% of volleyball injuries

23. Ankle Sprains
The ankle is susceptible to a variety of injuries, which range from muscle strains and ligament sprains to dislocations and fractures
Mechanism of injury to the ankle is usually a combination of excessive inversion and plantar flexion 80% of the time

24. Ankle Sprains
This type of injury usually affects the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament
A less common type of sprain is the eversion ankle sprain. This less commonly injured due to the thick deltoid ligament and the lateral malleolus

25. Ankle Sprains: Signs and Symptoms
All sprains are categorized as either 1st degree (mild), 2nd degree (moderate), or 3rd degree (severe)

26. Ankle Sprains: Signs and Symptoms
1st degree (mild):
One or more of the supporting ligaments and surrounding tissues are stretched
Minor discomfort, point tenderness, and little or no swelling
No abnormal movement in the joint to indicate lack of stability

28. Ankle Sprains: Signs and Symptoms
2nd degree (moderate):
A portion of one or more ligaments is torn
There is pain, swelling, point tenderness, disability, and loss of function
Slight abnormal movement
May walk with a slight limp

30. Ankle Sprains: Signs and Symptoms
3rd degree (severe):
One or more ligaments have been completely torn; obvious joint instability
Can have either extreme or little pain (depends on nerve damage), loss of function, point tenderness, and rapid swelling
Possible to have a fracture associated

32. Ankle Sprains

33. Ankle Sprain: Treatment
Immediate treatment should consist of PRICE
Splinting, taping, or bracing can help protect from further injury
Discontinue any activity that cause increase in pain

35. Ankle Sprain: Treatment
During the first 24 hrs, ice should be applied for 15 mins at a time and the use of compression wrap around the ankle and calf
Elevate the ankle above the level of the heart

36. Ankle Sprain: Rehabilitation
Goal is to restore function to the ankle, begin ROM exercises
Begin stretching exercises to loosen muscles and prevent stiffness
Strengthen exercises to help facilitate recovery

37. Blisters
Can occur anywhere in the body where there is friction, but are most commonly found on the feet in athletics
As the layers of skin rub together, friction causes separation
The body responds with fluid formation in the separation
Fluid then creates pressure on nerve endings, which is perceived as pain

38. Blisters
Proper treatment of blisters are mandatory to ensure maximum comfort of the athlete and to reduce the possibility of infection

39. Blisters: Treatment
Goal is to relieve pain, keep the blister from enlarging, and avoid infection
Signs of infection are red or warm skin around the blister, and pus coming from the blistered area
Small, intact blisters that do not cause discomfort usually need no treatment

40. Blisters: Treatment
The best protection against infection is the blister’s own skin
Skin should NEVER be removed from the blister unless it is flapping and causing additional discomfort
Should be covered with a bandage that is changed daily

41. Blisters: Treatment Prevention: Friction must be eliminated
Choose appropriate shoe and sock selection
Shoes should fit properly and the right type for that particular sport

42. Great Toe Sprain (Turf Toe)
The great toe is very important in balance, movement, and speed
The ligaments supporting the toe will become sprained, severely limiting the athlete’s performance
“Turf Toe” is the name given to such a sprain

43. Great Toe Sprain (Turf Toe)
Mechanism of injury is the foot sliding backward on a slippery surface, which forcefully hyperextends the big toe

44. Great Toe Sprain (Turf Toe): Treatment
Immediate care of turf toe is PRICE
Rehabilitation of the joint and surrounding structures to facilitate regeneration of proper function

45. Common Injuries to the Lower Leg
Contusions
Muscle Cramps
Achilles Tendon Injuries
Medial Tibial Stress Syndrome

46. Contusions Contusions occur mostly over the shin
The tibia is very sensitive to direct trauma which can cause trauma to this area to be very painful and temporary disabling
Contusions can also occur in the muscles of the lower leg

47. Contusions
These types of contusions can be more serious than contusions to other muscles in the body
The lower leg is made up of compartments that will only allow a relatively small amount of swelling
If not treated properly, serious complications can occur

48. Contusions
Another structure to watch out for is the peroneal nerve that lies along the lateral lower leg into the foot and ankle
A severe enough blow to this area may result in numbness and tingling to the lower leg and foot along with loss of function to the foot and ankle

50. Muscle Cramps A sudden involuntary contraction of a muscle
There is no single reason for these cramps to occur, but there are several factors that may be in play.

51. Muscle Cramps
Fatigue- working a muscle beyond its limits may cause the muscle to cramp
Fractures- in the process of healing a fracture, the muscle associated with that bone will atrophy
Dehydration- lack of fluids can cause muscle cramps

52. Muscle Cramps
Lack of nutrients in diet- a electrolyte imbalance may cause muscles to cramp. Electrolytes are minerals, such as sodium, magnesium, calcium, and potassium that helps the cells function normally

53. Muscle Cramps
Poor Flexibility- good flexibility allows muscles to work through their full ROM; poor flexibility makes muscles work beyond their limit
Improperly fitted equipment- may cause excessive strain on the muscle/body part

54. Achilles Tendon Injuries
Name is derived from Greek mythology
Connects the gastroc and soleus to the Calcaneus on the posterior lower leg
Vital to the ability to walk upright

56. Achilles Tendonitis Inflammation of the tendon
May be caused by a single incident of overstressing the achilles tendon or it may result from an accumulation of smaller stresses that produce numerous small tears over time

57. Achilles Tendon Rupture
Achilles tendon ruptures occur within the tendon substance itself, usually just above the insertion on the calcaneus
Causes include poor conditioning and overexertion
Most common mechanism of injury is when a sudden force is applied downward on a dorsiflexed foot
This condition requires surgical repair

59. Medial Tibial Stress Syndrome (Shin Splints)
A catchall term for pain that occurs below the knee either on the front outside part of the leg or on the inside of the leg

60. Medial Tibial Stress Syndrome (Shin Splints)
Muscle most often involved is the tibialis anterior
Usually the result of doing too much activity too soon
Usually occurs during the beginning of pre-season conditioning or after activity has been resumed after a significant rest

61. Medial Tibial Stress Syndrome (Shin Splints)
Appears to be associated with repetitive activity on hard surfaces or forcible excessive use of the lower leg muscles with running and jumping activities
Other causes can be due to tightness of the gastroc and soleus, old, worn-down shoes, and excessive running on the toes

62. Medial Tibial Stress Syndrome (Shin Splints): Treatment
Icing immediately after practice or competition
Reducing the activity level
Gentle stretching of the posterior muscles
May need further evaluation to check lower leg biomechanics
Orthotics
Anti-inflammatory meds
Strengthening / Flexibility program