1. Foot, Ankle and Lower Leg
Sports Medicine Chapters 14 & 15

2. Lower Leg Anatomy of the foot, ankle and lower leg Common Injuries
Treatment
Prevention
Rehabilitation

3. Vocabulary apophysis, exostoses, metatarsalgia, Morton’s neuroma,
pes planus, pronation, pes cavus
supination, eversion,
dorsiflexion, inversion,
plantar flexion,proprioception,
Thompson test

4. Anatomy Foot: 1.Lateral/Medial Mallelous 2.Talus 3. Calcaneus
Bones of the foot and ankle
Foot:
1.Lateral/Medial Mallelous
2.Talus
3. Calcaneus
4.Navicular
5.Cuboid
6. 1st, 2nd, 3rd or medial, middle, lateral Cuneiforms
7.Metatarsals/phalanges

5. Ligaments 1.Anterior Talo Fibular 2.Posterior Talo Fibular
Most common lig. Injured. Injured by plantar flexion/inversion
2.Posterior Talo Fibular
Injured by dorsiflexion and inversion
3.Calcaneofibular
4.Deltoid/post. talotibial
Largest lig. In the ankle. Eversion sprain
5.Ant/Post tibiofibular
attaches tibia/fibula

6. MUSCLES Gastrocnemius/soleus Tibialis Anterior
plantar flexion
forms the achilles tendon and attaches to the calcaneus
Tibialis Anterior
in front of your tibia
attaches to the 1st metatarsal
produces dorsi flexion and inversion
Flexor Hallucis longus/brevis
flexes big toe
is part of your arch

7. Muscles cont. Peroneal Longus/brevis Peroneal tertius
attaches to base of 5th metatarsal
produces eversion
Peroneal tertius
same as above
Extensor digitorum longus
extends your phalanges
Flexor digitorum longus
flexes toes
goes by the deltoid lig.

8. Injuries Blisters. Ingrown toenails. Heel bruise.
Caused by friction. Rx: donut and cover.
Ingrown toenails.
Toenail is growing down into the toe. Rx: soaking the toe, cleaning it out, lifting the nail up. Or dr.
Heel bruise.
Direct blow to the heel. Very painful, rest ice and heel cup or tape.
Arch strain: metatarsal, transverse, inner/outer longitudinal arches.
Very painful while running/walking.
Rx. RICE, arch tape job, ultrasound, whirlpool and stiff sole shoe.
Morton’s neuroma: 2nd or 3rd metatarsal.
- RX pad.

9. Injuries Cont. Fractures of your toes: Fracture of the metatarsals.
Dr. Referral if great toe involved. If not tape together and wear wide fitting shoes.
Fracture of the metatarsals.
Direct blow or twisting type of an injury.
Jones fracture.
fx. Base of 5th metatarsal, caused by same mechanism of sprain ankle. High incidence of nonunion.
Bunion: hallux valgus.
Most common injury to the great toe. Bursa becomes inflamed due to poor fitting shoes or a congenital deformity.
Tape like turf toe but off to the side.

10. Injuries Cont. Hammer toes: 2nd or 3rd toe Bony outgrowths (exostoses)
May be congenital, or wears shoes too small
Overly contracted flexor tendons/overly stretched extensor tendons
Surgery or taping of the toes
Bony outgrowths (exostoses)
Heel spurs
Located at the head of the 1st metatarsal or heel
Apophysitis
Where the achilles tendon attaches. Rx= 1/4” heel lift

11. Stress fractures: 18% occur here
Plantar fasciitis
Heel spur syndrome. Most frequent hind foot problem. S/S burning, sharp pain around the heel. Rx.= NSAID’s ultrasound, ice and stretch
Stress fractures: 18% occur here
In the metatarsals Rx.= Cast, rest for 3-4 weeks

12. Ankle Injuries Sprains. Achilles tendonitis. Shin contusion.
Grade1=3-7 days out.
Grade 2=7-14 days out.
Grade 3= 2-6 weeks out.
Rx.= RICE, horseshoe.
Achilles tendonitis.
Rx.= Ice/stretch, NSAID’s, heel lift, ultrasound.
May take weeks/months to heal.
If untreated may result in rupture.
Shin contusion.
Very painful and takes very long to heal especially the distal 1/3 of the tibia because of the low blood supply.
Rx.= Ice compression and elevation.

13. Shin splints. Tennis leg: gastrocnemius strain.
Calf strain cause by quick starts and stops with foot planted and extends the knee. Rx.= Same care for a muscle strain.
Shin splints.
Medial Tibial stress syndrome. Pain in the distal anterior 1/3 of the tibia.
Causes: poor fitting shoes, bad arches in shoes, poor conditioning, running on hard surfaces, muscle fatigue, ankle pronation.
Rx.= Ice massage, ice whirlpool after workouts, tape arches, run on soft surfaces, proper shoes.

14. Injuries Continued Anterior compartment syndrome.
Four compartments in the lower leg.
Muscle, nerves, arteries become compressed by swelling.
S/S= weakness in foot dorsiflexion and extension of big toe = foot drop.
Numbness or tingling over the dorsal surface of the foot.
Foot is cold. Lack of circulation.
Rx.= Ice, elevation and to dr. ASAP don not compress.

15. Ankle Injuries Cont. Stress fracture: Common overuse injuries.
Athletes who have hypermobile, pronated, or flat feet (pes planus) are susceptible to fibular stress fx.
Athletes who have rigid pes cavus are susceptible to tibial stress fx.
Intense pain while running but subsides while resting. Very point tender.
Rx.= X-ray with bone scan.
Depending on where the fx. Is will determine if non weight bearing or walking cast.
Rest is the key.
Swimming and biking is ok.
Ankle Injuries Cont.

16. Ankle Injuries Cont. Achilles tendon rupture.
S/S= felt like I got kicked in the calf. Possible deformity, poor plantarflexion strength.
Treatment: perform Thompson test, splint in relaxed position and send to dr. Also ice.
Could be caused by chronic tendonitis and is common to people in their mid 30’s.

17. Rehabilitation Rehab for Ankle sprain Evaluation: see handout
Anterior drawer test= ATF lig.
Talor tilt test= CF/Deltoid lig.
Rehab for Ankle sprain

18. Rehabilitation of an ankle injury
Stage 1:
RICE with horseshoe and elevation as much as possible
Non weight bearing if athlete can not bear weight without a lot of pain
After swelling has subsided use contrast baths
CV by bike or pool w/out legs
Progression to stage 2:
Swelling has subsided and pain is at a minimum, Full weight bearing
Stage 2
Contrast baths
PNF- balance board, tubing and pool workouts with balance
Manual resistance: plantar/dorsiflexion first than eversion/inversion
Flexibility
CV- bike and pool workouts using legs a little bit more
Progression to stage 3:
Pain free, full ROM, Almost full strength

19. Rehab continued Stage 3: Ice after activity PNF
SAID principle- sports specific
Protective taping
Jogging straight then slowly introduce jogging with big curves
Jog sprint jog
Jogging with cuts
Jog fig. 8’s
Back pedal
Sprints straight
Sprint with cuts
Sprint with change of direction
Side steps
Activity specific to their sport
Ice after activity