Foot, Ankle and Lower Leg

1. Foot, Ankle and Lower Leg AT 243-Acute Care Lab Krzyzanowicz-Spring ‘10

2. Anatomy • 3 major lateral ligaments • Anterior Talofibular ligament (ATF) • Most commonly sprained ligament • Calcaneofibular Ligament (CF) • Posterior Talofibular ligament (PTF) • 1 major medial ligament • Deltoid ligament • High ankle sprain (syndesmosis) • Distal Tibiofibular ligament

3. Lateral Ankle Ligaments

4. Medial Ankle Ligament

5. Foot Anatomy

6. Ankle Sprains • Closed basketweave taping • Start with shaving their legs (do we really do this?) • Pre-wrap • Start at the mid-calf and work your way down • Overlapping by half • Anchor strips • Apply 3 anchor strips • Mid-calf • Overlapping by half • Apply 1 anchor strip at the mid-foot

7. Ankle Taping • Closed basketweave taping • Apply 3 stirrups • With an anchor strip after each stirrup • Medial to lateral (know the mechanism of injury) • Apply 2 heel-locks (on each side) • Apply 1 figure eight (on each side) • Close tape job

11. Ankle Braces • More cost effective way to prevent ankle sprains • Cost of an ankle brace vs. taping supplies • $15-20 for a brace (one time cost) vs. $45 for a box of tape • Hundreds of different braces • All have same principle • Prevent excessive movement of the ankle

12. Ankle Braces

13. Open basketweave • Same as closed basketweave, but its open in the middle • Helps with “pushing” swelling • Not used very often • Close off with an ace wrap

16. Achilles’ Tendon Taping • Spray/Heel-lace pad • Pre-wrap from calf to mid-foot • Places two anchor strips over the calf; one over mid-foot • Measures two strips of elastic tape from calf to mid-foot • Splits both pieces down the middle (only about 1’) • Places strip on mid-foot-places an anchor strip • Pulls up to calf and places anchor strip • Repeats again • Closes tape job

17. Achilles’ Tendon Taping

18. Arch Taping • Places anchor at the head of the metatarsals • Beginning at the 1st metatarsal • Place strip of tape (1’ tape) and pull around outside of foot; once at the medial aspect of the calcaneous pull diagonally ending at the metatarsal head • Repeat for toes 2-5 • Place tape strips (1.5’ tape) on the mid-foot, starting at the metatarsal heads, pulling lateral to medial- repeat about 3-4 times • Close tape job

19. Arch Taping

20. Arch Taping

21. Arch Support • Many different supports • Dr. Scholls supports-over the counter • Custom orthotics • Mold of your foot • Custom supports • Helps in shin splints, stress fractures

22. Turf Toe Taping • Places a 1’ anchor around the great toe; and a 1.5’ anchor around the mid-foot • Creates two fans of 3-6 pieces of tape • Places one fan on the great toe, anchors it down and then pulls to the mid-foot-anchors it down • Places second fan on the great toe, anchors it down and then pulls to the mid-foot and anchors it down • Makes a figure eight around the great toe (1-2x) • Closes tape job

23. Turf Toe Taping

24. Patellar Tendon Straps • These are meant to help change the angle of pull of the patellar tendon • More biomechanically efficient • Helps in persons with “jumpers knee” aka patellar tendonitis

25. Patellar Tendon Straps

26. Shin Splint Taping • Have athlete stand and flex their knee about 20 degrees • Apply two anchor strips inferior to patellar tendon • Apply two anchor strips superior to ankle • Apply tape in an oblique direction, pulling medial to lateral the entire way up the leg • Overlapping by half • Repeat, pulling lateral to medial • Apply a closing strip inferior to patellar tendon and superior to ankle • Close tape job

27. Shin Splint Taping

28. Ace wraps • For the ankle • Use a 6’ single wrap • Starts distal to proximal (at the toes) • Medial to lateral • Pulls enough force to push out the swelling • Overlaps in a weaving manner • Check pulse • Many different sizes • 3 inch • 4 inch • 6 inch • 6 inch double • Used to help push out swelling • Must always check pulse and capillary bed refill!

29. Ace Wraps

30. Horseshoes • These are used to help push out swelling as well • Used in conjunction with an ace wrap • Very easy to make • Make a horseshoe design out of felt