1. Posterior and Anterior Anatomy of the Leg and Ankle

2. Plantarflexors of the Lower Leg
Gastrocnemius
Soleus
Plantaris

3. Gastrocnemius O: Medial and Lateral Femoral Condyles
I: Calcaneus (heel bone) via Achilles or Calcaneal Tendon (strongest and thickest tendon in the body A:
Plantarflexion of
Ankle
Flexion of Knee

4. Integrated Function of Gastrocnemius
Assists in eccentric deceleration of ankle dorsiflexion
Assists in eccentric deceleration of knee extension
Assists in dynamic stabilization of the subtalar and tibio-femoral joint during functional movement

5. Soleus The soleus is deep to the gastrocnemius,
but medial and laterally superficial

6. Soleus I: Calcaneus via Achilles Tendon A: Plantarflexion of ankle
O: Posterior Tibia and Fibula
I: Calcaneus via Achilles Tendon A:
Plantarflexion of
ankle
Inversion of ankle

7. Integrated Function of Soleus
Assists in eccentric deceleration of ankle dorsiflexion
Assists in eccentric deceleration of ankle eversion
Assists in dynamic stabilization of the subtalar joint during functional movement

8. Triceps Surae
Gastrocnemius and Soleus make up triceps surae and they are the primary movers of plantarflexion

9. Plantaris
O: Lateral Epicondyle of Femur I: Calcaneus via Achilles Tendon A: Plantarflexion of Ankle

10. Integrated Function of Plantaris
Assists in eccentric deceleration of ankle dorsiflexion
Assists in dynamic stabilization of the tibio-femoral joint during functional movement

11. Popliteus Located in the posterior knee
The popliteus is deep to the gastrocnemius and plantaris
Most important stabilizer of the posterior knee
Unlocks the knee by laterally rotating the femur on the tibia during a closed chain movement (foot in contact with the ground)

12. Popliteus O: Lateral Condyle of Femur I: Proximal Posterior Tibia A:
Medial rotation of the tibiofemoral joint
Knee Flexion

13. Integrated Function of Popliteus
Assists in dynamic stabilization of the tibiofemoral joint
Assists in eccentric deceleration of lateral rotation of the tibiofemoral joint
Assists in eccentric deceleration of knee extension

14. Calf Raise
When the knees are extended, the gastrocnemius is the prime mover, because it is fully stretched and is more effective at producing force in an extended knee position, when compared to a flexed knee position.
The seated calf raise causes the gastrocnemius to shorten and the soleus, which does not cross the knee, takes most of the load

15. Exercises for Gastrocnemius
Standing Calf Raise (Floor, BOSU, Disk)
Standing Single Leg Calf Raise
Standing Calf Raise with Tubing
Calf Raise on horizontal leg press
Prone or Seated Leg Curl
SB Leg Curl

16. Seated Calf Raise (Machine, SB) Single Leg Seated Calf Raise
Exercises for Soleus
Seated Calf Raise (Machine, SB)
Single Leg Seated Calf Raise

17. Stretches
ProStretch
Slant Board

18. Gastrocnemius Stretch
Stretches
Gastrocnemius Stretch
Soleus Stretch

19. PNF Flexed Knee Hold-Relax
With the knee flexed it focuses the stretch on the Soleus.
This stretch is appropriate for all clients who are free of ankle and knee pathology, i.e., sprained ankle, torn meniscus, post-op ACL.
Have client lie prone
With client lying prone, flex knee to 90 degrees
Passive prestretch (10 seconds), isometric hold (6 seconds), passive stretch (30 seconds)
Autogenic Inhibition

20. Injuries Achilles Tendon Rupture Achilles Tendonitis Calf Strain
Sudden forced plantar flexion of the foot, direct trauma, result of chronic tendonitis
Achilles Tendonitis
Common in runners and
walkers
Calf Strain
Gastrocnemius or soleus
Calf Tear
is pulled from the achilles

21. Primary Dorsiflexor of the Lower Leg
Tibialis Anterior
Superficial anterior
muscle of the leg
Lies just lateral to the tibia

22. Tibialis Anterior
O: Lateral Condyle of Tibia and Lateral Surface of Tibia
I: Medial Foot: 1st cuneiform and 1st metatarsal A:
Dorsiflexion of ankle
Inversion of ankle

23. Integrated Function of Tibialis Anterior
Assists in eccentric deceleration of ankle plantarflexion
Assists in eccentric deceleration of ankle eversion

24. Plantar Fasciitis Pronounced “plantar fash-eee-eye-tiss”
Most common condition of heel pain
The pain is usually located close to where the achilles tendon inserts into the calcaneus
It is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis (Mayo Clinic)

25. Plantar Fascia Ligament
The plantar fascia ligament is located on the bottom of the foot and extends out towards the toes
It is a continuation of the Achilles tendon
It supports the medial arch of the foot
During walking, the plantar fascia ligament will stretch and contract as the weight is put through the foot

26. Plantar Fasciitis
The condition occurs when the plantar fascia ligament is under constant stress and stretch. The ligament becomes inflamed and begins to tear off from the calcaneus bone

27. Symptoms of Plantar Fasciitis
Heel pain
Pain is usually felt in the morning because the fascia ligament tightens up during the night during sleep
It is difficulty to get out of bed and place pressure on the ligament
Pain usually decreases as the tissue warms up, but may easily return again after long periods of standing or weight bearing, physical activity, or after getting up after long periods of sitting

28. Plantar Fasciitis Risk factors include:
Foot arch problems (both flat foot and high arches)
Obesity or sudden weight gain
Pregnancy
Excessive Running or Jumping
Tight Achilles tendon
People with Arthritis in their foot
People with Diabetes due to peripheral neuropathy
Wearing high-heeled shoes or improperly fitted shoes
Occupation-people who are on their feet throughout the day

29. Treatment of Plantar Fasciitis
PRICE
Protection, Rest, Ice, Compression, Elevation
Calf Stretches
Calf Strengthening
Arch Supports
Medication prescribed by physician

30. Exercises for Plantar Fasciitis
Gastrocnemius Towel Stretch
Loop a towel around the ball of the foot and pull the towel toward the body, hold this position for 30 seconds. Repeat 3 times
Frozen Can Roll
Roll the affected foot back and forth from the heel to your mid-arch over a frozen juice can. This exercise may be helpful if done first thing in the morning
Towel Pick-Up
Pick up a towel with the toes
Seated Toe Tapping

31. Exercises for Plantar Fasciitis
Resisted Dorsiflexion and Plantarflexion
Resisted Inversion and Eversion
Standing Gastrocnemius Stretch
Standing Soleus Stretch
Single-leg Balance

32. Anterior Compartment Syndrome
Shin Pain Conditions
Shin Splints
Anterior Compartment Syndrome
Stress Fracture

33. Shin Splints
The shins have to bear as much as six times our body weight during sports and exercise
Shin splints, also called Periostitis is the name given to pain at the front of the lower leg.
There are two types of shin splints:
Anterior and Posterior

34. Shin Splints
Anterior shin splints occur in the front portion of the shin bone (tibia).
Posterior shin splints occur on the inside (medial) part of the leg along the tibia.
Excessive pronation contributes to both anterior and posterior shin splints

35. Shin Splints
Inflammation of the periosteum (sheath surrounding the bone) of the tibia
Causes:
OVERUSE!!!
Runners who increase their mileage
Poor running shoes/insufficient shock absorption
Runners who change the surface on which they are running
Excessive pronation (eversion) of foot

36. Walking faster than normal Jumping Running stairs
Causes of Shin Splints
Muscle imbalances
tibialis anterior is tight
Walking uphill
Overtraining
Walking faster than normal
Jumping
Running stairs

37. Symptoms of Shin Splints
Tenderness over the inside of the shin
Lower leg pain
Sometimes some swelling
Lumps and bumps over the bone
Pain when the toes or foot are bent downwards
A redness over the inside of the shin

38. Treatment of Shin Splints
PRICE: Protection, Rest, Ice, Compression, Elevation
Ice: Apply ice packs to your shin for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain goes away.
Ice massage: Freeze water in a Styrofoam cup. Peel the top of the cup away to expose the ice and hold onto the bottom of the cup while you rub ice over your leg for 5 to 10 minutes.
Medicine: Take anti-inflammatory medicine as prescribed by your health care provider.

39. Treatment of Shin Splints
Shoe supports: Arch supports (orthotics) help correct over-pronation. They can be prescribed and custom-made or you can buy pre-made arch supports at your local pharmacy, shoe store, or sporting goods store.
Strengthening and Stretching the posterior and anterior calf muscles
Running in water
Surgery

40. Prevention of Shin Splints
Prevent shin splints by strengthening the tibialis anterior muscle
Exercises for strengthening the tibialis anterior include:
Sit down and write the letters of the alphabet in the air with your toes
Walk on your heels. Do several repetitions of 10 seconds and gradually work your way up to 30-second intervals

41. Prevention of Shin Splints
Walk with feet turned inward and outward.
With socks off, gather up a towel that is flat on the floor, using only the toes
Pick up marbles using the toes

43. Anterior Compartment Syndrome
A condition of the lower leg in which there is excessive muscle swelling or increased pressure in the muscles due to limited flexibility of the fascia surrounding the muscles in the lower leg
This swelling puts pressure on the blood vessels and the nerve supply of the lower leg and foot
If swelling continues, the blood vessels are compressed so much that blood flow to and from the muscle is shut off, and the nerves are pinched to the extent that the feet and lower legs go numb
Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus, and Peroneus Tertius may be affected

44. Causes of Compartment Syndrome
Overuse through exercise
Pain which increases during exercise
Bleeding/swelling in the compartment
Weakness
Motor loss
The sheath becomes inelastic and
unable to expand
Treatment
Rest
Diagnosis and Treatment by a health care provider
Surgery- a small cut or two is made in the muscle sheath to allow the muscle to expand out

45. Stress Fracture
An overuse injury that occurs when muscles become fatigued and are unable to absorb added shock
Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture

46. Stress Fractures
Usually a result of increasing the amount or intensity of an activity too rapidly
Other causes:
Unfamiliar surface (tennis player switching surfaces, i.e. soft clay to a hard court)
Improper equipment (worn out shoes)
Increased physical stress (an athlete with a substantial increase in playing time)
Smoking makes it worse because it interferes with bone healing

47. Treatment of Stress Fractures
PRICE:
Protection, Rest, Ice, Compression, Elevation
New Shoes
Non-weight bearing exercises
Swimming or cycling
Cane or crutches