1. Unit 5:Understanding Athletic-Related Injuries to the Lower Extremity
Foot and Ankle, Anatomy and Injuries
Sports Medicine

2. The Foot and Ankle

3. The Foot (Bones)
Bones = 26
14 phalanges
5 metatarsals
7 tarsals

4. Toes (Phalanges)
Designed to give wider base for balance and propelling the body forward.
1st toe (Hallux)
Two sesamoid bones located under the 1st MP joint.

5. Metatarsals
5 Bones
1st metatarsal is the largest and strongest and functions as the main body support during walking and running.
Palpable at the ball of the foot.
5th metatarsal most common fractured.

6. Tarsals 7 bones Aids in the support of the body.
Calcaneous = largest tarsal bone, supports talus and shapes heel, and provides attachment for achilles tendon.

7. Joints of the Foot Interphalangeal joint (IP)
Flexion / Extension
Metarsalphalangeal joint (MP)
Abduction / Adduction

8. Bones of the Ankle Tibia Fibula Talus
Main weight bearing bone of LOWER LEG
Forms medial malleolus
Fibula
Non-weight bearing
Mainly muscle and ligament attachment
Forms lateral malleolus
Talus
Main weight bearing bone of the ANKLE

9. Lateral Ligaments of the Ankle
Resist ankle inversion
Anterior talofibular (ATF)
Most commonly sprained
Calcaneofibular (CF)
Posterior talofibular (PTF)

10. Medial Ankle Ligaments
Deltoid
Resists ankle eversion
Low rate of injury

12. Quiz Which bone in the lower leg is the most weight bearing?
What does ATF stand for?
Which ligaments resist inversion?
Which ligaments resist eversion?
What does MP stand for?
How many tarsal bones are there?
How many bones are in the foot?

13. Answers: Tibia Anterior Talofibular
Anterior Talofibular, tibiofibular, calcaneofibular (lateral)
Deltoid ligaments (medial)
Metatarsalphalangeal 7 26

14. Muscles of the Foot and Ankle
Anterior Muscles (3)
Extensor Hallucis Longus/Brevis
extension of great toe
Extensor Digitorum Longus/Brevis
extension of 2 – 5 phalanges

17. Muscles of the Foot and Ankle
Anterior Muscles cont. (3)
Tibialis anterior
inversion and dorsiflexion of foot / ankle

20. Anterior Muscles

21. Muscles of the Foot and Ankle
Medial Muscles (3)
Tibialis Posterior
Inversion and plantarflexion
Flexor Hallucis Longus
Flexor of great toe and plantarflexion of ankle
Flexor Digitorum Longus
Flexors of 2 – 5 toes and plantarflexion of ankle

22. Muscles of the Foot and Ankle

24. Muscles of the Foot and Ankle
Posterior Muscles (2)
Gastrocnemius
plantarflexion of ankle
Soleus

25. Muscles of the Foot and Ankle

27. Muscles of the Foot and Ankle
Lateral Muscles (2)
Peroneus Longus / Brevis
eversion, plantar flexion of ankle

30. Quiz
What is the primary function of the Extensor Hallucus Longus and Brevis?
What is the primary function of the tibialis anterior?
What two motions does the peroneus longus and brevis perform?
What motion does the Gastrocnemius/ Soleus perform?
What are the two main motions of the tibialis posterior muscle?

31. Answers Extension of great toe Inversion and dorsiflexion of foot
Eversion and plantar flexion of the ankle
Plantarflexion of ankle
Inversion and plantarflexion

32. Arches of the Foot

33. Supinated Arches (High Arches)

34. Supinated Arches

35. Pronated Arches (Flat Feet)

36. Pronated Arches

37. Pronated Arches

38. Pronated Arches

39. Orthotics

40. Orthotics

41. Orthotics

42. Foot and Ankle Injuries

43. Ankle Sprain Cause: Excessive inversion or eversion of the ankle
S/S: Point tenderness, swelling, discoloration,
laxity, inability to walk or run properly (extent
based on degree).
TX: RICE, rehabilitation immediately (Grade
III requires immobilization)
Prevention: Strengthening exercises, proper
shoes/ equipment

44. Lateral Ankle Sprain Mechanism (MX) ATF most common sprained
1st Degree Ankle Sprain
Mechanism (MX)
Inversion and/or plantarflexion
ATF most common sprained
Occurs during contact or non – contact.

45. Lateral Ankle Sprain S/S 1st degree Mild pain Pt – ATF
Possible swelling
Fast recovery to FWB and ROM
No joint laxity

46. Lateral Ankle Sprain 2nd Degree Ankle Sprain MX Involves the ATF, CF
Same as 1st degree, more severe.
Involves the ATF, CF
Possible growth plate involvement
Most cases x-ray needed

48. Lateral Ankle Sprain S/S 2nd degree Felt a pop Localized severe pain
Pt – more then one ligament
Rapid swelling
Decrease ROM
Laxity in joint
Unable to FWB

49. Lateral Ankle Sprain 3rd Degree Ankle Sprain
Rupture of ligaments (ATF, CF, PTF)
Consider a FX
X-ray is mandatory

50. Lateral Ankle Sprain S/S 3rd Degree Felt or heard pop Extreme pain
Extreme/rapid swelling
No ROM
Unable to FWB

51. Lateral Ankle Sprain Treatment
1st Degree Ankle Sprain
2nd Degree Ankle Sprain
3rd Degree Ankle Sprain
RICE
Return to Play
(Toe raise, heel walk, Full go w/ full ROM
Tape to Play
Reevaluate 24hrs
(Horseshoe w/ compression wrap)
Crutches 24 hours
Reevaluate 24hrs
Refer to Dr.
X-rays
RICE (Horseshoe w/ compression wrap)
Crutches
Posterior Splint

53. Ankle Special Tests Anterior Drawer Test
Tests for ligament instability
Mainly tests ATF integrity but can also test the CF and PTF depending on severity
Ankle must be relaxed
Ankle in slight plantar flexion

54. Ankle Special Tests Talar Tilt Test for lateral ankle instability
Positive test indicates tear in ATF, and CF

55. Ankle Special Tests
Thompson Test
Test for achilles tendon rupture

56. Ankle Dislocation Mx: S/S:
Anterior – Heel strikes ground forcefully
Posterior – blow to anterior lower leg
S/S:
PN deformity, inability to move foot, rapid
swelling, refusal to allow moving or touching foot
TX:
Splint, ICE, 911 or transport to hospital

58. Turf Toe Sprain of the 1st MP joint Mx: S/S
Hyperextension/ hyperflexion of great toe
Common on artificial surface
Flexible types of footwear can contribute
S/S
Pain over the first MP joint

60. Achilles Tendonitis MX: S/S: TX: Prevention:
Repetitive motions such as running and jumping that cause tendon breakdown
S/S:
Swelling, crepitus, pn with palpation, pn with dorsiflexion, weak with plantarflexion
TX:
RICE
Limiting or restricting the activity that caused the irritation
Aggressive stretching of heel cord
Crepitus (crackling and grinding) may mean it is too late
Prevention:
Achilles and gastroc/solues stretching, proper acclimization to activity.

62. Achilles Tendon Rupture
MX:
Sudden, forceful plantar flexion of the ankle with a chronically tight tendon.
S/S:
Feel or hear a pop. Feel as if they’ve been kicked in the leg. Inability to plantar flex foot.
TX:
Surgery or a cast
Prevention:
Stretching and proper care of any tendonitis

64. Longitudinal Arch Strain
Mx –
Downward force to the foot causing depression of the arch
Most common with overuse (running)
S/S
Sharp pain with weight bearing
Painful during dorsiflexion

65. Lower Leg Problems “Shin Splints”: MX: S/S: TX:
catch all term related to lower leg pain.
MX:
constant pounding associated with running
S/S:
sharp pain in lower leg around medial/lateral aspect of lower leg and connective tissue between tibia and fibula
TX:
RICE (cold whirlpool), heal lift, arch support, shoes, change running surface

67. Compartment Syndrome MX: S/S: TX: Prevention:
Increased pressure within one of four compartments of lower leg causes compression of the structures in the leg.
S/S:
Deep aching pain, tightness, and swelling. Pain with stretching.
TX:
Acute~ immediate surgery
Chronic~ activity modification & ice and some times surgery
Prevention:
Stretching (Hard to prevent)

72. Toe Abnormalities Hammer Toes MX: TX: Poor shoe choices
Middle joint (PIP) flexed, other joints (MP, DIP) hyperextended
TX:
Refer, orthotics or surgery

73. Bunion / Hallux Valgus MX: S/S: TX: Prevention:
Bony enlargement of the head of the 1st metatarsal caused from wearing improperly fitting shoes
S/S:
Obvious deformity, tenderness, and swelling
TX:
Proper shoe selection, protection devices, surgery may be necessary
Prevention:
Properly fitting shoes

76. Ingrown Toenail MX: S/S: TX: Prevention:
Improper shoe fitting and nail cutting
S/S:
Increased pain, swelling, redness around the nail bed
TX:
Hot, soapy water, antibiotics, raise nail up
Prevention:
Proper shoes, proper nail trimming