1. FOOT, ANKLE AND LOWER LEG
Care and Prevention

2. Bony Anatomy Toes=phalanges Metatarsals-long bones in the foot
Have 3 joints, except big toe has only 2
Metatarsals-long bones in the foot
Joins with phalanges to make MTP joint
Talus & Calcaneus bigger bones in foot & ankle
Tibia and fibula
Form medial & lateral malleolus

3. Arches of the Foot Arches are found on plantar aspect Shock absorbers
Transverse: front of heel to 5th metatarsal
Longitudinal: calcaneus to metatarsals
Metatarsal: across distal metatarsals

4. Muscles and Tendons Peroneal muscles
Perform eversion
Gastrocnemius and soleus attach via achilles tendon
Perform plantarflexion
Tibialis anterior, extensor digitorum, and extensor hallucis-TDH muscles
Perform dorsiflexion

5. Ligaments Lateral ankle: Medial ankle: Anterior talofibular (ATF)
*Most commonly sprained
Posterior talofibular (PTF)
Calcaneofibular (CF)
Medial ankle:
Deltoid ligament
Stronger than all the lateral ligs combined

6. INJURIES Bone injuries: Muscle/Tendon injuries: Ligament Injuries
Jones Fx
Tibia/Fibula Fx
Stress Fx
Muscle/Tendon injuries:
Medial tibial stress syndrome (Shin splints)
Achilles Tendinitis
Achilles Tendon Rupture
Ligament Injuries
Great Toe sprain (Turf toe) (check this)
Plantar fasciitis
Lateral/Medial ankle sprains
Ankle dislocation
Tissue Injuries
Contusions
Toe abnormalities
Anterior compartment syndrome

7. Jones Fracture What is it? MOI: Inversion Signs and Symptoms:
Avulsion fx of peroneus brevis tendon
MOI: Inversion
Perenous brevis muscle contracts quickly and forcefully to stabilize ankle
Direct impact
Signs and Symptoms:
Pain, ttp over 5th metatarsal,swelling
HIGH reinjury rate
Why?
Immobolize in boot and use crutches along with rehab

8. Tibia/Fibula Fractures
MOI: direct or indirect impact
Fibular fractures are most common
Signs and symptoms:
Obvious deformity (sometimes)
Loss of function
Severe pain
Swelling
Management:
EMS for displaced tibia fracture
Casting and in severe cases surgery to reduce fracture

9. Stress Fractures Hairline fx Common areas:
Tibia, fibula, metatarsals
MOI: repetitive stress i.e. running
S&S:
Pain and swelling
TTP over stress fx site
Pain with walking, running, night pain
Management:
Xrays
Rest
If not diagnosed in time can lead to complete fx

10. Medial Tibial Stress Syndrome A.K.A. Shin Splints
What is it?
Tiny tears of the muscle from the tibia on the medial aspect of the lower leg.
MOI:
overuse
Tight calves
Old shoes
Low arches
Management:
Rest, ice massage
Change running shoes, add arch supports if needed
Tape lower leg to pull muscle towards the tibia
Stretch calves & strengthen tibialis anterior muscle

11. Achilles Tendonitis Connects Gastroc muscle to calcaneus
MOI: overuse from running and jumping
Signs & Symptoms:
TTP, swelling, crepitus
↓ strength in PF
Visible thickened tendon
Management:
Rest, ice, anti-inflammatories
Stretch calves
Strengthening calves
Complications?

12. Achilles Tendon Rupture
MOI:
Forced DF
Blow over achilles tendon
Sudden, strong contraction of gastroc
Signs & symptoms:
Ath c/o….
Pain
Obvious deformity/depression
Unable to complete PF
Management:
Splint, ice, crutches
Refer to MD for surgery

13. Great Toe Sprain A.K.A. “Turf Toe” MOI: forced hyperextension
Sprains lig of MTP joint
Happens more on artificial turf than real grass
Signs & Symptoms:
Pain, swelling, ttp
Inability to DF/ “push off”
Discoloration
Management:
Rest, ice
Ice in bucket rather than w/bag
Rehab
Taping

14. PLANTAR FASCIITIS What is it? MOI: Signs & Symptoms: Management:
Inflammation of fasica (thick band/layer) on plantar asepct of foot.
MOI:
Overuse, tight calves
Signs & Symptoms:
Pain on calcaneus, moves towards the toes
Pain when taking the first steps in the morning
Pain with excessive DF
Management:
Rest, ice
Stretch calves
Provide orthotics/arch supports if necessary
Anti-inflammatory (oral vs injection)

15. Lateral/Inversion Ankle Sprain
85% of ankle sprains are inversion sprains
2 reasons:
Deltoid ligament is stronger than lateral ligs
Fibula prevents excessive eversion
MOI: Plantarflexion and excessive inversion
Some examples?
Severity depends on force, strength of muscles, protective devices worn
Signs & Symptoms:
Pain, swelling, discoloration
TTP over ATF ligament typically
Loss of ROM and strength (depends on severity)
Management:
RICE
Anti-inflammatories
Stretching and strengthening
Bracing
Balance exercises
Refer for XRAYs if rapid swelling occurs or TTP over bone

16. Medial/Eversion Ankle Sprains
Only account for 15% of ankle injuries.
More severe than inversion sprains
Longer recovery time
MOI: Excessive eversion
Signs & Symptoms:
Pain, swelling, TTP over deltoid ligament
Bruising
Loss of ROM and strength especially eversion
Management:
RICE
NWB
XRays to rule out fracture of fibula
Rehab and balance activities

17. ANKLE DISLOCATION Can occur either anteriorly or posteriorly. MOI:
Anterior: Forceful heel strike against the ground.
Posterior: Direct blow to the anterior portion of the lower leg when ankle is in PF.
Signs & Symptoms:
Obvious deformity and severe pain
Swelling
Management:
Activate EMS
Emergency because nerves and blood vessels can be damaged
Splint lower leg and ankle and transport to ER

18. TOE ABNORMALITIES

19. TOE ABNORMALITIES Toe Abnormality MOI and Description Signs & Symptoms
Management
Hammertoes
When PIP is flexed and MTP and DIP are extended.
Congenital or from wearing small shoes frequently
Callus on PIP joint, blisters, swelling, pain
Wearing larger shoes, padding over callus, shaving callus. Surgery to fix toes
Hallux valgus a.k.a.bunions
Wearing shoes that are too tight which force the big toe towards the smaller toes
Tenderness, swelling, and enlarged joint
Wearing shoes w/larger toe box, padding the bunion, or surgery to align toe(s).
Ingrown toenail
Trimming nail too short, trimming nails in a rounded way rather than straight across.
Nail grows into skin
Swelling, redness, pain, infection
Antibiotic ointment, trim nail straight across. If severe dr. takes out side of nail.

20. Anterior Compartment Syndrome
Muscles are covered by fascia.
Pressure can accumulate between the fascia and muscle.
MOI: Overuse or direct impact
Signs & Symptoms:
Severe pain that doesn’t go away after activity
Heat, redness
Hardness of area
Loss of ROM/Strength
Management:
Refer to Dr. immediately
Increased pressure places pressure on blood vessels and nerves
Surgery to relieve pressure
Fasciotomy: Remove piece of fascia

21. References
Cartwright AL, Pitney AW, Fundamentals of Athletic Training. 3rd edition. Human kinetics. Champaign, IL.