chapter six foot, ankle & lower leg. anatomy the foot is the site of some of the most...
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Chapter Six
Foot, Ankle & Lower Leg
Anatomy
The foot is the site of some of the most debilitating conditions suffered by athletes.
Include: Blisters Calluses Athletes foot Turf toe Ligament Sprains Ingrown toe nails Heel bruises Arch strains Fractures
Anatomy
The foot has stresses that exceed the demands placed on any other area of the body.
Stabilizes & Supports During: Standing Walking Running Jumping
The foot absorbs up to 3 times the body weight!
Anatomy
Individually, the parts of the foot (bones, muscles, ligaments) are weak.
Collectively, they can withstand most of the demands placed on them in athletics.
Anatomy
The key to proper function of the foot is a set of four arches.
Help absorb the impact of walking, running, & jumping.
The arches are:1. Metatarsal2. Transverse3. Medial Longitudinal (inner)4. Lateral Longitudinal (outer)
Anatomy
The foot contains ¼ of the total number of bones in the body.
26 Bones 7 Tarsal bones 5 Metatarsal bones 14 Phalanges
There are also 38 joints!
Anatomy
Tarsal Bones: Talus Calcaneus Navicular Cuboid Medial, Intermediate, & Lateral Cuniform
Bones (that’s 3 of them)Mid-foot region has 5 Metatarsal BonesThe toes (AKA Phalanges) have 14 Bones
Anatomy
Anatomy
The ankle joint (Talocrural Joint) The most commonly injured joint in athletics.
Most injuries are either ligament sprains or muscle strains.
Anatomy
The ankle joint has 2 joints:1. Talocrural Joint
Bones: Tibia, Fibula, & Talus
2. Subtalar Bones: Talus & Calcaneus (2 largest Bones of
the foot)
Note:Large boney Prominences on either side of the
foot are the Medial Malleoli (tibia) & Lateral Malleoli (fibula)
Anatomy
TibiaTibia Transmits the weight or force placed on the
lower leg to the talus. Mounted directly on top of the talus & extends
over the medial side forming the medial malleolis
FibulaFibula On the lateral side forming the lateral
malleolis helps to stabilize the ankle joint
Range of Motion
TalocruralTalocrural Jointoint a hinge joint.
Dorsiflexion “toes to the nose”
Plantar Flexion extension “Point the Toes”
Range of Motion
Subtalar JointSubtalar Joint
triplanar movement with around the oblique axis.
Most stable when placed in dorsiflexion
Range of Motion
TalusTalus
Moves Anteriorly (forward) & Posteriorly (Backward)
Talus sit on top of the calcaneous
The ankle joint despite # of injuries in the area is still very strong.
Stresses in athletics is the cause of ankle injuries
Anatomy
After bony structure strong ligaments make up the first line of defense against ankle sprains.
Most ligaments involved in supporting the ankle are attached to the rough edges of the malleoli.
Anatomy / Ligaments
Ligaments are named for the bones they connect. Most commonly injured are on the Lateral side
(outside) of the ankle. Anterior talofibular (ATF) Anterior tibiofibular Calcaneofibular Posterior talofibular
Ligaments on the Medial side (inside) of the ankle (fyi, sprain to medial ligaments often associated with a fx)
Deltiod
Anatomy / Muscles
13 Major Muscle that support the ankle joint 2 of the most important:
Achilles Tendon Peroneus Muscle Group
Anatomy / Muscles
Achilles Tendon The attachment of the Gastronemius and
Soleus Muscles (Calf Muscles) Attach to the Calcaneus Tightness of Achilles Tendon is often the cause
of recurrent ankle sprains.
Anatomy / Muscles
Peroneal Muscle Group of muscles along the Lateral side of
the leg & foot The Peroneal Brevis attach to several areas of
the foot The Peroneal Longus runs across the plantar
surface of the foot When the Peroneal group contracts it everts the
foot This helps to prevent Lateral ankle sprains.
Anatomy / Shin
2 Bones of the Leg: Tibia Fibula
Shin – is the area in the front of the leg
Interosseous Membrane – associated with anterior (front) shin pain (Shin Splints)
Dermatome – A sensory distribution of a nerve root. Produces sensation in the corresponding area
Myotome – a single nerve root Produces movement of anatomical structures
Bones
Tibia Fibula Talus Calcaneus Navicular Cuniforms (1-3) Cuboid Metatarsals (1 – 5) Phalanges (1 – 5)
Ligaments / Muscles
Anterior Talofibular Ligament Posterior Talofibular Ligament Deltoid Ligament
Gastrocnemius – Plantar Flexes the foot & Flexes the lower leg. Soleus - Plantar Flexes the foot Peroneus Longus – everts & abducts foot, Plantar Flexes foot Peroneus Brevis – everts & abducts foot, Plantar Flexes foot Popliteus – Knee Flexon, medial rotation of tibia
Metatarsal Transverse Medial Longitudinal (inner) Lateral Longitudinal (outer)
Range of Motion
Dorsiflexion – the act of drawing the toe or foot toward the dorsal aspect of the proximally conjoined body segment. Toes to the nosePlantar Flexion – the act drawing the toe or foot toward the dorsal aspect of the proximally conjoined body segment. Point the toe
Range of Motion
Inversion – turning the sole of the foot inward
Eversion – turning the sole of the foot outward
Flexion (toes) – decreasing the angle between the toes and the sole of the footExtension (toes) – Increasing the angle between the toes and the sole of the foot
Range of Motion
Pronation – combined motions of calcaneal eversion, foot abduction and dorsiflexion.Supination - combined motions of calcaneal inversion, foot adduction and plantar flexion.Abduction – movement of body segments away from the midlineAdduction - movement of body segments towards from the midline
Evaluation
The first purpose of an evaluation is to determine if a serious injury has occurred.
Always suspect a fx till proven otherwise
Signs of FractureSigns of Fracture Direct or indirect pain Deformity Grating sound Loss of function
Evaluation
Note: some fractures are not accompanied by swelling or pain.
If a Fracture is suspected the extremity should be splinted & the athlete transported for medical evaluation.
HISTORY
1. Mechanism of Injury How did it happen?
2. Location of Pain Where does it hurt?
3. Sensation experienced Did you hear a “pop” or a “snap”?
4. Previous History Have you injured this area before?
Observation
Look for signs of trauma: Compare involves vs.
Uninvolved Bleeding Deformity Swelling Discoloration Scars
Palpation
Palpate above & below injury site. Work your way down to injury.
Gain confidence of athlete Involve the athlete as much as possible Compare
Areas to check:1. Neurological (motor/sensory)2. Circulation3. Anatomical Structures4. Fracture Test (palpation, compression,
distraction)
Special Test
Testing instability, disability, & pain.Before you start, can you make it worse?Only a NATABOC certified athletic trainer is
considered competent to perform these test and give a proper evaluation (other medical professional as well)
Test performed to assess the following:1. Joint Stability 2. Muscles / Tendons3. Accessory Anatomical Structures
4. Inflammation 5. ROM (active, assistive, passive, resistive)6. Pain / weakness
Special Test
Assessment Test:Bony IntegrityHeel Tap Test: Check the Tibia, Fibula, & TalusSqueeze Test: Check the Tibia & Fibula
Ligament StabilityAnterior Drawer Test: Test anterior talofibular and calcaneofibular ligamentsTalar Tilt: Calcaneofibular, anterior talofibular, but also the (medial) deltoid ligaments
Special Test
Muscle FunctionThompson Test: Test the Achilles tendon
Refer When
There is: Gross Deformity Significant Pain Increase swelling Circulation or Neurological Issues Joint Instability Suspected Fracture Abnormal Sensations (clicking, popping, grating, or
weakness)
Any doubts!
InjuriesInjuries
Ankle Sprains Most common injury to the ankle
Usually caused by excessive plantar flexion with inversion
“stepping in a hole”
Injuries (Ankle Sprain)Injuries (Ankle Sprain)3 Categories
1. First Degree – (mild) 1 or more supporting ligaments are stretched
Minor discomfort, point tenderness, swelling. No instability
2. Second Degree – (moderate) a portion 1 or more ligaments are torn
There is pain, point tenderness, swelling, disability, & loss of function
There is some abnormal movement in the joint
3. Third Degree – (Severe) 1 or more ligaments are completely torn
Joint is unstable Pain can be extreme to very little (torn nerve endings), loss of
function, point tenderness, rapid swelling Usually associated with a fracture
Injuries (Arch Sprain)Injuries (Arch Sprain)
Arches are designed to act as “shock absorbers” Most common injuries occur to the metatarsal or
the inner longitudinal arches Any of the 4 arches can sprain a ligament Causes:
Flat feet Overuse Overweight Fatigue Training on hard surfaces Wearing non supportive, worn, or shoes that do not FIT!
Injuries (Great Toe Sprain)Injuries (Great Toe Sprain)“Turf Toe”“Turf Toe”
A sprain given to the First Metatarsophalangeal Joint.
Mechanism of injury – hyperextension of the
great toe.
Injuries (Medial Tibia Stress Injuries (Medial Tibia Stress Syndrome)Syndrome)Shin SplintsShin Splints
Thought to be an inflammation of the interosseous membrane, strain to the soleus muscle, or other chronic lower leg condition.
Cause: muscle weakness or imbalance, lack of proper conditioning, improper or incomplete warm-up, poor flexibility, lack of stretching, running on hard surfaces, improper running form or habits, improper running shoe, or poor anatomical structures.
Injuries (Plantar Fasciitis)Injuries (Plantar Fasciitis)
The plantar fascia is a wide, non – elastic ligamentous tissue that extends from the anterior portion of the calcaneus to the heads of the metatarsals.
Supply support to the longitudinal arch of the foot.
Can strain tissue from overuse, unsupportive footwear, a tight Achilles tendon, or running o hard surfaces.
Injuries (Heel Spur)Injuries (Heel Spur)
A bony growth on the calcaneus that causes painful inflammation of the accompanying soft tissue and is aggravated by exercise.
Injuries Injuries (Anterior Compartment (Anterior Compartment
Syndrome)Syndrome)4 Compartments4 Compartments
Once suspected, anterior compartment syndrome should be treated as a medical emergency
Injuries Injuries (Anterior Compartment (Anterior Compartment
Syndrome)Syndrome)Cause:
Direct trauma or excessive exercise can result in hemorrhage & swelling inside the compartment.
Swelling will increase the pressure on the peroneal nerve, the veins, and finally, the arteries inside the compartment.
Without arterial circulation, muscle cells will become necrotic and die.
Injuries Injuries (Anterior Compartment (Anterior Compartment
Syndrome)Syndrome) Signs:
Pain even after icing down Firmness of the muscle Numbness of the foot Pain with passive ROM Lack of strength
Injuries (Achilles Tendon Injuries (Achilles Tendon Strain)Strain)
Achilles Tendon is the strongest in the body Injuries range from a minor strain to a
complete tear. Minor strains should be treated
conservatively because many strains will lead to complete tear
Remember Thomson Test for eval.
Injuries (Stress Fracture)Injuries (Stress Fracture)
If exercise is too severe, or too long in a duration, a negative change in bone structures will occur and cause stress fracture.
Injuries (muscle cramps)Injuries (muscle cramps)
A cramp is a sudden, involuntary contraction of a muscle.
Cause: unknownCan be because of several factors: Fatigue Fractures Dehaydration Poor Flexibility Previous injury, rehab not completed Improper fitted equipment.
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