1. LOWER LEG, FOOT & ANKLE ANATOMY, RECOGNITION, TREATMENT, THERAPY TIM AMSHOFF LAT MOORE TRADITIONAL SCHOOL

2. ANKLE JOINT 3 main bones Lower leg: tibia & fibula Foot: Talus

3. ANKLE MOVEMENTS (ROM) Inversion Eversion Plantar flexion (gas pedal) Dorsiflexion (toes up)

4. ANKLE STABILITY (LIGAMENTS) ATF (anterior talo-fibular) PTF (posterior talo-fibular) Calcaneofibular Deltoid ligament (medial aspect) Tib-fib (anterior and posterior)

5. LOWER LEG Fibula (lateral malleolus) Tibia (medial malleolus) Gastrocnemius Soleus

6. ANTERIOR MUSCLES Anterior compartment: Anterior tibialis Extensor Muscles Peroneus Muscles

7. COMPARTMENT SYNDROME SHIN SPLINTS Do you see ecchymosis?

8. OTHER ANATOMY Fascia (foot) Arches

9. MEASURING ARCHES

10. HOW DO ARCHES FALL? Managing/treating painful arches Is it plantar fasciitis? orthotics Is it a strained (fallen) arch? Replace insoles; support arches? Taping of the arches

11. CALF PAIN Ruptured Achilles/gastrocnemius Thompsons test Age of patients typically

12. CAN YOU SEE THE 2 MUSCLES AND THE TENDON? Gastroc. soleus Achilles tendon

13. CALF PAIN CONTINUED How do I stretch out a calf that is cramping? During game/practice Middle of night Is it dehydration really? Do bananas really help? Can you tape the calf? Yes, but support is for achilles

14. OTHER WAYS TO STRETCH IT… Push against resistance

15. HOPS Always rule out a fracture and set a standard on Active ROM before asking participant to move

16. ANKLE SPRAINS 3 types or degrees 1 st degree: Mild; slight tear in fibers of ligaments & capsule; some minor swelling and ecchymosis 3

17. ANKLE SPRAINS CONTINUED 2 nd degree Swelling is definite, ecchymosis, pain is uncomfortable (but not sharp), pain could be over several areas; will need help to ambulate

18. 3 RD DEGREE ANKLE SPRAINS Swelling is noticeable, ecchymosis, not able to apply weight, usually when landing on another person’s foot; improper foot wear; severe force applied Rehab. Is necessary at extensive level; surgery may occur Definite tear or rupture of ligaments in ankle

20. WHAT CAN IT LOOK LIKE? High ankle sprain

21. ANKLE SPRAIN TREATMENT (TX.) Varies Whirlpool is great use; ice bags Follow RICE for 24-48 hours before changing plan May need physician referral May need crutches or WC Dependent upon outcome of FX. Tests Do not allow to sleep in ACE bandages

22. OTHER CONDITIONS Stress fractures Cast shoe or walking boot Stop activity Morton’s Neuroma Padding at Ball of foot

23. MORE… Turf toe Sprained toe Plantar fasciitis Tear occurs Muscle/tendon herniates Most pain: 1 st step in morning

24. MORE… Ingrown toenails Tinea Pedis Athlete’s Foot (viral; socks color, dry; shower?) Blisters Hot spots, improper footwear? Wet shoes, socks Do not pop and drain Allow to dry out, cover up

25. Ankle taping