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Understand: the anatomy of the foot, ankle, & lower leg. Principles of rehabilitation for the foot, ankle, & lower leg Preventive/supportive techniques for lower extremity Identify: Components of an evaluation format Recognize: Common injuries Foot Supports 3 times the body weight.

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objectives

Understand:

the anatomy of the foot, ankle, & lower leg.

Principles of rehabilitation for the foot, ankle, & lower leg

Preventive/supportive techniques for lower extremity

Identify:

Components of an evaluation format

Recognize:

Common injuries

Foot Supports 3 times the body weight.

Foot contains ¼ of the total number (24 bones and 38 joints)

Objectives

bones lower leg foot
Bones Lower Leg & Foot
  • Tibia- lower leg
  • Fibula- lower leg
  • Tarsals-(7) Talus, Calcaneus, navicular, cuboid, cuneiforms (medial, intermediate, & lateral)
    • Talus-one of the largest foot bones
    • Calcaneus-one of the largest foot bones
  • Metatarsals-(5)mid-foot
  • Phalanges-(14)
  • The bony prominences (malleoli) on the sides of your ankle are the distal ends of the tibia (medially) & fibula (laterally)
ligaments
Ligaments

Ligaments- named for the bones they connect.

  • Lateral aspect of the ankle is most commonly injured.

-anterior talofibular

-anterior tibiofibular

-calcaneofibular

-posterior talofibular

  • Medial aspect of the ankle most commonly injured
    • deltoid ligament
muscles tendons
Muscles & Tendons

Tendon: Most important for ankle support

Achilles Tendon -attach the gastrocnemius and soleus muscles (calf muscles) to the calcaneus.

Muscles:Peroneus Brevis & Peroneus Longus-

run along the lateral side of the leg and foot.

-evertsand abducts

-plantar flexes

- helps to prevent sprains.

muscles tendons continued
Muscles & Tendons Continued
  • Anterior Lower Leg (shin): associated with shin pain: interosseous membrane: connects the tibia & fibula
  • -Tibialis anterior-dorsiflexes foot, inverts & adducts
  • -extensor halluscislongus-extends great toe, dorsiflexes
  • -extensor digitorumlongus-extends toes, dorsiflexes foot, evertsfoot
  • Posterior Lower Leg:
  • -gastrocnemius-plantar flexes, flexes lower leg
  • -soleus-plantar flexes
  • -tibialis posterior-plantar flexes foot, inverts and adducts foot, supports arch
  • -flexor digitormlongus-flexes toes, plantar flexes foot, inverts and adducts foot
  • -flexor hallucislongus
joints of the foot
Joints of the Foot
  • Talocrural joint (ankle joint)-most commonly injured joint in athletics.

-bones: Tibia, Fibula, & Talus

-hinge joint-flexion (dorsiflexion) and extension (plantarflexion.)

  • Subtalar joint (ankle joint)

-bones: Talus & Calcaneus

-triplanar-movement around the oblique axis.

-most stable when in dorsiflexion

range of motion
Range of Motion
  • Dorsiflexion-draw toes towards body
  • Plantar Flexion- draw toes away from lower leg
  • Inversion- turning sole inward
  • Eversion- turning sole outward
  • Flexion- toes forward
  • Extension- toes backward
  • Pronation- foot abduction, eversion
  • Supination- foot adduction, inversion
  • Abduction- away from the midline of the body
  • Adduction- toward midline of the body
arches
Arches
  • Metatarsal
  • Transverse
  • Medial longitudinal (inner)
  • Lateral longitudinal (outer)

balance, movement, support, and shock absorption

evaluation format
Evaluation Format

H.O.P.S.

  • (H)-History: how did it happen, where does it hurt, did you hear a pop or snap, have you hurt it before.
  • (O)-Observation: compare the uninjured to the injured lower extremity. Bleeding, deformity, swelling, discoloration, scars, etc.
  • (P)-Palpation: above and below injured site, then affected site.

-neurological (motor and sensory)

-circulation (pulse & capillary refill)

-anatomical structures (palpate)

-fracture test (palpation, compression, and distraction)

  • (S)-Special Tests-joint stability, disability, and pain.
assessment tests
Assessment Tests

-Test for bony integrity:

1. Heel Tap test: integrity of tibia, fibula and talus

2. Squeeze Test: bony integrity of tibia and fibula

-Tests for ligamentous stability:

1. anterior drawer test: anterior talofibular and calcaneofibular ligaments

2. Inversion or lateral stress test (talar tilt): calcaneofibular and anterior talofibular ligaments

3. Eversion or medial stress test (talar tilt): deltoid ligament

4. external rotation test (kleiger test): anterior and posterior tibiofibular ligaments and interosseous membrane

-Tests for Muscle Function & Flexibility:

1. Thompson test: achilles tendon

2. Gastrocnemius Tightness test: degree of tightness in the ankle due to inflexibility

3. Soleus Tightness test: degree of tightness in the ankle due to inflexibility.

common injuries
Common Injuries
  • Blisters
  • Ankle Sprains: (PRICES)

-80% of ankle sprains are inversion and plantar flexion.

-Ligament most injured is anterior talofibular

-Eversion sprain less common-deltoid ligament (thick)

1. First degree sprain -one or more ligaments are STRETCHED.

2. Second degree sprain -portion of one or more ligaments is torn.

3. Third degree sprain -one or more ligaments have been completely torn.

common injuries1
Common Injuries
  • Arch Sprains: (transeverse, metatarsal, inner or outer longitudinal (most common)
    • fail to hold bones of foot in position. Might get shine splints. Achilles tendon strain, foot fatigue, strained muscles, blisters.
    • Causes: overuse, overweight, fatigue, training on hard surfaces, non-supportive shoes.
  • Great Toe Sprain (turf toe): (balance, movement, and speed)(PRICES)
    • ligament supporting the toe will become sprained
    • 1stmetatarsal phalangeal joint (Sprain)
common injuries2
Common Injuries
  • Shin Splints: (Medial Tibia Stress Syndrome): Inflammation of the interosseous membrane and strain to the soleus.
  • -poor blood supply, slow to heal.
  • -muscle inbalance or weakness
  • -poor flexibility or lack of stretching
  • -lack of proper conditioning
  • -running on hard surfaces
  • -improper running form
  • -improper running shoes
common injuries3
Common Injuries
  • Anterior Compartment Syndrome: muscles that dorsiflex the foot and ankle. (tibialis anterior, extensor hallucislongus, extensor digitorumlongus, peroneus tertius)
    • Direct trauma or excessive exercise results in hemorrhage and swelling in compartment.
    • Pressure on peroneal nerve, the veins, and arteries.
    • Muscle cells will die.
    • Signs: pain (even after cold treatment), firmness of the muscle, numbness of foot, pain with passive motion of ankle, lack of strength.
    • MEDICAL EMERGENCY!!!
common injuries4
Common Injuries
  • Achilles Tendon Strain: (strongest in body) (PRICES, but move more conservatively than most muscle injuries)

-causes: overuse, muscle imbalance, inflexibility, or sudden movement.

  • Stress Fractures: bones are living tissue.

-causes: lack of exercise, severe exercise or too long, change in bone structure.

-signs: specific point tenderness, increased pain during exercise, hurt when athlete presses fingers just above and below site of most pain.

-Later stages: pain is constant, especially at night.

  • Muscle Cramps: a sudden, involuntary contraction of a muscle.

-cause: unknown, several factors seem to contribute: Fatigue, fractures, dehydration, lack of electrolytes, poor flexibility, previous injury, improper fitted equipment.