1. The Foot & Ankle

2. Foot & Ankle There are 28 bones in the lower leg/foot including:
Tibia & Fibula: Malleolus – (medial & lateral) ends of the tibia & fibula (commonly referred to as the ankle bones)
Talus: sits on top of the calcaneus (forms the ankle joint along with tibia & fibula)
Calcaneus: heel bone (Achilles Tendon attaches posteriorly to it)
5 Tarsals:
Navicular, Cuboid, and 3 Cuneiforms
5 Metatarsals: #1-#5; #1 is the big toe
14 Phalanges
2 Sesamoid (small bones under 1st metatarsal)

5. Foot & Ankle
Ankle injuries are among the most common injuries (most frequently injured joint)
Lower leg roles:
Balance
Shock absorption
movements
Foot/Ankle Movements:
Plantar and dorsiflexion
Inversion and eversion
Pronation and supination

6. Arches of the Foot The foot has 3 arches
Metatarsal Arch: across the heads of metatarsals
Transverse Arch: in front of the heel from the 5th metatarsal to navicular bone
Longitudinal Arch: runs the length of the foot from the calcaneus to metatarsal heads

7. Arches of the Foot

8. Pes Planus
Pes Planus = flat feet
Shallow or flat longitudinal arch

9. Foot & Ankle Muscles Peronues Brevis & Longus Gastrocnemius Soleus
Provide stability to the lateral aspect of ankle
Gastrocnemius
Provides plantar flexion allowing for running and jumping
Attaches by the Achilles Tendon onto the posterior of the calcaneus
Soleus
Muscle underneath the gastrocnemius that assists in plantar flexion
Tibialis Anterior
Provides dorsiflexion of the ankle

10. Muscles

11. Ligaments of the Foot/Ankle
Lateral Ligaments
Anterior Talofibular
Posterior Talofibular
Calcaneofibular

12. Lateral Ligaments

13. Medial Ligaments: Deltoid
Tibiocalcaneal
Anterior/Posterior Tibitalar
Tibionavicular

14. The deltoid ligament is stronger than all lateral ligaments combined
Medial Ligaments
The deltoid ligament is stronger than all lateral ligaments combined

15. Foot/Ankle Injuries

16. Preventing Injuries Good shoes Ankle Tape Shin Guards
Proper Strength/Conditioning Programs

17. Great Toe Sprain Aka: Turf Toe Functions of Great Toe:
Kick a ball, push off when running, balance
Cause: excessive forced flexion/extension
Symptoms: pain, swelling, discolored, inability to walk or run normally
Treatment: rice, tape/padding
More common on turf than grass

18. Arch Sprain Sprain of the transverse and longitudinal arch
Caused by: running on hard surfaces, improper footwear, overuse
Symptoms: pain, difficulty walking/running, discoloration over plantar surface
Treatment: PRICE, padding, strengthen muscles, & stretch Achilles Tendon

19. Ankle Sprains Inversion and Eversion Sprains
Inversion Sprains are much more common (85% of all sprains):
Deltoid ligament (medial) is much stronger than lateral ligaments
Lateral malleolus prevents eversion from occurring

20. Severity of Ankle Sprain
The severity of the sprain will depend on:
Amount of force
Amount of protective taping
Type of shoe
Strength of muscles

21. Ankle Sprain Evaluation
Symptoms:
Swelling
Discoloration
Loss of ROM

22. Treatment
If there is no decrease in ROM or strength – athlete can be taped and return to play
If there is a decrease in ROM: PRICE
If there is crepitus, rapid swelling, deformity: refer to doctor
This could be a sign of a possible fx

23. Ankle Dislocation The talus dislocates from tibia & fibula
Anterior Dislocation
The heel of foot strikes ground forcefully
Posterior Dislocation
A blow to anterior aspect of leg while ankle is plantar flexed

24. Ankle Dislocation Symptoms: Treatment: Pain/refusal to move
Not allow touching of foot
Deformity & inability to use foot
Rapid swelling
Treatment:
911
Ligaments, Nerves, Blood Vessels all injured

25. Tendinitis Occurs from repetitive running, jumping, and landing
Achilles Tendon is susceptible
Symptoms
Swelling, tenderness, crepitus, pain upon palpation (dorsiflexion)
Treatment
Rest, ice, refer to doctor & gentle stretching

26. Achilles Tendon Tendon may get thicker as the body responds to injury
Limits ROM and decreased ability in running/jumping
Severe Damage: feel crepitus or tendon may completely rupture

27. Achilles Tendon Rupture
Athlete falls and feels like they have been shot in back of leg
Caused by:
Forced dorsiflexion
Blow over Achilles tendon
Sudden contraction of gastrocnemius

28. Achilles Tendon Rupture
Symptoms
Weakness, loss of plantar flexion, depression at attachment site
Treatment
Must be surgically reattached to calcaneus

29. Common Foot/Ankle Fractures
Jones Fracture
Avulsion Fracture
Epiphyseal Fracture
Stress Fracture

30. Jones Fracture Most common avulsion fracture
5th metatarsal is fractures as a result of forced inversion
Peroneus brevis tendon pulls part of bone away

31. Distal Tibia & Fibula Avulsion Fracture
Medial & Lateral Malleolus is fractured
Caused by forced plantar flexion & inversion or eversion

32. Epiphyseal Fracture Occurs to the tibia and fibula
Caused by forced plantar flexion & inversion

33. Stress Fracture Occurs to the tibia, fibula, and metatarsals
Caused by repetitive stress due to running
Not visible in x-ray

34. Shin Splints Aka: Medial Tibial Stress Syndrome
Muscle fibers on medial side of tibia becomes torn and irritated

35. Shin Splints Caused by: Symptoms
Tight calf muscle, improper footwear, improper conditioning/out of shape for running
Symptoms
Pain/inability to walk/run, pain over distal medial tibia, swelling on lateral side

36. Shin Splints
Treatment: PRICE

37. Anterior Compartment Syndrome
Lower leg is broken down into 4 compartments
Anterior Compartment Syndrome can sometimes be mistaken for shin splints

38. Anterior Compartment Syndrome
Muscles in the anterior aspect of the lower leg are enclosed in connective tissue
Swelling can cause severe pain & pressure
Cause: overuse or impact
Symptoms:
Hot, red skin
Loss of foot motion
Severe pain

39. Anterior Compartment Syndrome
Treatment:
Doctor
May need surgery
Incision in leg to relieve pressure

40. Hammer Toe
PIP joint of toe is flexed while MTP & DIP joints are hyper- extended

41. Plantar Faciitis
Irritation of fascia on the bottom of the foot – commonly at the attachment on the calcaneus
Causes: excessive running or standing on hard surfaces; sudden increase in activity; improper footwear; and tight Achilles Tendon

42. Plantar Faciitis
Symptoms: pain upon initial weight bearing, especially in the morning