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

3. Objectives Upon completion of this chapter, you should be able to:
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 and its treatment

5. The Lower Leg
Exposed to numerous types of trauma during athletic practices and events
Common injuries include:
Contusions
Strains
Tendonitis and tendon ruptures
Medial tibial stress syndrome
Stress fractures and other fractures
Compartment syndrome

6. The Foot and Ankle
15% of sports injuries involve ankle ligaments, bones, and tendons
Basic anatomy:
Foot- stabilizes and supports rest of body
Individually, parts are weak; as a whole foot is strong
3 arches- transverse, medial, lateral

9. Joints of the Foot and Ankle
Talocrural joint
Tarsometatarsal Joint
Subtalar Joint
Interphalangeal Joint
Talonavicular Joint
Metatarsophalangeal Joint

15. Common Injuries of the Foot and Ankle

16. Common Injuries of the Foot and Ankle
Ankle sprains
First degree (mild)
1+ ligaments stretched; no abnormal movement
Second degree (moderate)
Portion 1+ ligaments torn; slight abnormal movement
Third degree (severe)
1+ ligaments completely torn; joint instability
Treatment: protection, rest, ice, compression, and elevation (PRICE), followed by rehabilitation

18. Animation – Ankle Sprain
Click Here to Play Ankle Sprain Animation

19. Common Injuries of the Foot and Ankle (cont’d.)
Arch sprains
Caused by overuse, overweight, fatigue, training on hard surfaces, and nonsupportive shoes
Treatment: cold, compression, and elevation
Blisters
Occur anywhere there is friction
Treatment: relieve pain, keep from enlarging, and avoid infection

20. Common Injuries of the Foot and Ankle (cont’d.)
Great toe sprain (Turf Toe)
Important for balance, movement, speed
Big toe hyperextends
Treatment: protection, rest, ice, compression, elevation, and support to limit movement
Hematoma
Blood pools in toe and puts pressure on nerves

22. Common Injuries of the Foot and Ankle (cont’d.)
Plantar fasciitis
Tissue becomes strained from overuse, unsupportive footwear, a tight Achilles tendon, or running on hard surfaces
Treatment: correct training errors, icing, and massage, arch supports
Can lead to heel spurs, muscle strains, shin splints

23. Common Injuries of the Foot and Ankle (cont’d.)
Heel bruise
Heel receives, absorbs, and transfers impact from sports activities
Ligaments, tendons, and fat pad are subject to stress and injury
Treatment: cold application before activity, cold and elevation afterward, heel cups or pads

24. Common Injuries of the Foot and Ankle (cont’d.)
Heel spur
Bony growth on calcaneus that causes painful inflammation of soft tissue
Treatment: taping or shoe inserts, ice
Fractures
Immediately impairs ability to perform
S/S: point tenderness, obvious deformity, often presents similar to ankle sprain

25. Common Injuries to the Lower Leg
Contusions
Occur most often over the shin; May also involve muscular areas of the leg as result of a direct blow
Peroneal nerve- if hit here, causes radiating pain, tingling, numbness, and sometimes foot drop
Usually temporary and complete recovery
Strains
Occur anywhere along the muscles
Normally result from a violent contraction, overstretching, or continued overuse

26. Common Injuries of the Foot and Ankle (cont’d.)
Laceration

28. Common Injuries to the Lower Leg (cont’d.)
Muscle cramps
Sudden, involuntary contraction of a muscle
Contributing factors may include fatigue, fractures, dehydration, lack of nutrients, poor flexibility, improperly fitted equipment
Treatment: passive stretching, fluid replacement, massage, rest, and ice

29. Common Injuries to the Lower Leg (cont’d.)
Achilles tendonitis
Vital to walking upright
Caused by inflammation of the Achilles tendon
Tearing of tendon tissues caused by excessive stress
S/S: initial discomfort, increased inflammation, pain, crepitus with palpation, redness
Treatment: best is prevention (stretching), ice, anti-inflammatory medication, physical therapy, rest

30. Common Injuries to the Lower Leg (cont’d.)
Achilles tendon rupture
Caused by poor conditioning and overexertion
Treatment: must be surgically repaired; rehab may take up to a year before athlete ready to return

31. Common Injuries to the Lower Leg (cont’d.)
Medial tibial stress syndrome (shin splints)
Normally the result of doing too much too soon, repetitive activity on hard surfaces, tight calf muscles, worn or ill-fitting shoes, over-pronation
Treatment: ice, reducing activity level, and gentle stretching of posterior leg muscles
Long-term treatment: biomechanical assessment of lower extremities, physical therapy, orthotic devices, anti-inflammatory medications, and a strengthening and flexibility program

32. Common Injuries to the Lower Leg (cont’d.)
Stress fractures
Incomplete crack in the bone
Signs include a “hot spot” of sharp, intense pain
Compartment syndrome
Develops when there is swelling within one or more lower leg compartments
Fracture, contusion, crush injury, infection, excessive exercise, overstretching
Treatment: immediate transportation to the nearest medical facility (surgery will usually be needed)

33. Lateral compartment also called peroneal compartment

35. Common Injuries to the Lower Leg (cont’d.)
Fractures
Tibia can be fractured by a direct blow, a twisting force, or occasionally from repetitive overuse
Fibula is normally fractured by a direct blow to the outside of the leg
Often mistaken for contusion b/c still often able to walk

36. Additional Tests for the Foot, Ankle, and Lower Leg
Standard methods of testing various structures of the lower extremity:
Anterior Drawer Test
Plantar Fascia Test
Talar Tilt Test
Tinel’s Sign- to identify entrapment of tibial nerve (tarsal tunnel syndrome)

39. Conclusion Injuries to the lower extremity are common in athletics
Solid understanding of anatomy will help the examiner assess injuries
Proper conditioning, equipment, and training are essential to the overall health of the athlete