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©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning
1
Chapter 17
The Foot, Ankle, and Lower
Leg
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning
2
Objectives
• Upon completion of this chapter, you
should be able to:
– Describe the anatomy of the foot and ankle
– Cite primary extrinsic and intrinsic muscles of
the lower leg
– Explain the common injuries and conditions
affecting the foot, ankle, and lower leg
– Describe medial tibial stress syndrome and its
treatment
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning
33
The Lower Leg
• Exposed to numerous types of trauma
during athletic practices and events
– Common injuries include:
•
•
•
•
•
•
Contusions
Strains
Tendonitis and tendon ruptures
Medial tibial stress syndrome
Stress fractures and other fractures
Compartment syndrome
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning
44
The Foot and Ankle
• 15% of sports injuries involve ankle ligaments, bones,
and tendons
• Arches are key to foot’s function:
– Transverse arch
– Medial longitudinal arch
– Lateral longitudinal arch
• Ankle joint formed by combination of two joints:
– Talocrural joint
– Subtalar joint
• Ligaments: tough bands of tissue that connect bones to
each other
©©2011
Delmar,
Cengage
Learning
2010
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Cengage
Learning
55
Common Injuries of the Foot and
Ankle
• Ankle sprains
– First degree (mild)
– Second degree (moderate)
– Third degree (severe)
• Treatment: protection, rest, ice, compression, and
elevation (PRICE), followed by rehabilitation
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning
66
Animation – Ankle Sprain
Click Here to Play Ankle Sprain Animation
©©2011
Delmar,
Cengage
Learning
2010
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Cengage
Learning
7
Common Injuries of the Foot and
Ankle (cont’d.)
• Arch sprains
– Caused by overuse, overweight, fatigue,
training on hard surfaces, and nonsupportive
shoes
• Treatment: cold, compression, and elevation
• Blisters
– Occur anywhere there is friction
• Treatment: relieve pain, keep from enlarging, and
avoid infection
©©2011
Delmar,
Cengage
Learning
2010
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Cengage
Learning
88
Common Injuries of the Foot and
Ankle (cont’d.)
• Great toe sprain
– Big toe hyperextends
• Treatment: protection,
rest, ice, compression,
elevation, and support
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Delmar,
Cengage
Learning
2010
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Cengage
Learning
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Common Injuries of the Foot and
Ankle (cont’d.)
• Plantar fasciitis
– Tissue becomes strained
from overuse, unsupportive
footwear, a tight Achilles
tendon, or running on hard
surfaces
• Treatment: correct training
errors, icing, and massage
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Cengage
Learning
2010
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Cengage
Learning
1010
Common Injuries of the Foot and
Ankle (cont’d.)
• Heel bruise
– Heel receives, absorbs, and transfers impact
from sports activities
– Ligaments, tendons, and fat pad are subject to
stress and injury
• Treatment: cold application before activity, cold and
elevation afterward, heel cups or pads
©©2011
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Cengage
Learning
2010
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Cengage
Learning
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Common Injuries of the Foot and
Ankle (cont’d.)
• Heel spur
– Bony growth on calcaneus that causes painful
inflammation of soft tissue
• Treatment: taping or shoe inserts
• Fractures
– Immediately impairs ability to perform
– Often the site of point tenderness is present,
and an obvious deformity may be seen
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Cengage
Learning
2010
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Cengage
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Common Injuries to the Lower Leg
• Contusions
– Occur most often over the shin
• May also involve muscular areas of the leg
– Result of a direct blow
• Strains
– Occur anywhere along the muscles
– Normally result from a violent contraction,
overstretching, or continued overuse
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Cengage
Learning
2010
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Cengage
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1313
Common Injuries to the Lower Leg
(cont’d.)
• Muscle cramps
– Sudden, involuntary contraction of a muscle
– Contributing factors may include fatigue,
fractures, dehydration, lack of nutrients, poor
flexibility, improperly fitted equipment
• Treatment: passive stretching, fluid replacement,
massage, rest, and ice
©©2011
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Cengage
Learning
2010
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Cengage
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1414
Common Injuries to the Lower Leg
(cont’d.)
• Achilles tendonitis
– Caused by inflammation of the Achilles tendon
– Tearing of tendon tissues caused by excessive
stress
• Treatment: best is prevention (stretching), ice, antiinflammatory medication, physical therapy, rest
• Achilles tendon rupture
– Caused by poor conditioning and overexertion
• Treatment: must be surgically repaired
©©2011
Delmar,
Cengage
Learning
2010
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Cengage
Learning
1515
Common Injuries to the Lower Leg
(cont’d.)
• Medial tibial stress syndrome (shin splints)
– Normally the result of doing too much too soon
• Treatment: ice, reducing activity level, and gentle
stretching of posterior leg muscles
• Long-term treatment: biomechanical assessment of
lower extremities, physical therapy, orthotic devices,
anti-inflammatory medications, and a strengthening
and flexibility program
©©2011
Delmar,
Cengage
Learning
2010
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Cengage
Learning
1616
Common Injuries to the Lower Leg
(cont’d.)
• Stress fractures
– Incomplete crack in the bone
– Signs include a “hot spot” of sharp, intense pain
• Compartment syndrome
– Develops when there is swelling within one or
more lower leg compartments
• Treatment: immediate transportation to the nearest
medical facility (surgery will usually be needed)
©©2011
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Cengage
Learning
2010
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Cengage
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1717
Common Injuries to the Lower Leg
(cont’d.)
• Fractures
– Tibia can be fractured by a direct blow, a
twisting force, or occasionally from repetitive
overuse
– Fibula is normally fractured by a direct blow to
the outside of the leg
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Cengage
Learning
2010
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Cengage
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1818
Additional Tests for the Foot, Ankle,
and Lower Leg
• Standard methods of testing various
structures of the lower extremity:
– Anterior Drawer Test
– Plantar Fascia Test
– Talar Tilt Test
– Tinel’s Sign
©©2011
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Cengage
Learning
2010
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Cengage
Learning
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Conclusion
• Injuries to the lower extremity are common
in athletics
• Solid understanding of anatomy will help
the examiner assess injuries
• Proper conditioning, equipment, and
training are essential to the overall health of
the athlete
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning
2020