Download FACTS

Understand:
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the anatomy of the foot, ankle, & lower leg.
Principles of rehabilitation for the foot, ankle, &
lower leg
Preventive/supportive techniques for lower
extremity
Identify:
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Components of an evaluation format
Recognize:
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Common injuries
Foot Supports 3 times the body weight.
Foot contains ¼ of the total number (24 bones and
38 joints)
Bones Lower Leg & Foot
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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
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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- named for the bones they connect.
 Lateral aspect of the ankle is most commonly
injured.
-anterior talofibular
-anterior tibiofibular
-calcaneofibular
-posterior talofibular
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Medial aspect of the ankle most commonly
injured
 deltoid ligament
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.
-everts and abducts
-plantar flexes
- helps to prevent sprains.
Muscles & Tendons Continued
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Anterior Lower Leg (shin): associated with shin pain:
interosseous membrane: connects the tibia & fibula
-Tibialis anterior-dorsiflexes foot, inverts & adducts
-extensor halluscis longus-extends great toe,
dorsiflexes
-extensor digitorum longus-extends toes, dorsiflexes
foot, everts foot
Posterior Lower Leg:
-gastrocnemius-plantar flexes, flexes lower leg
-soleus-plantar flexes
-tibialis posterior-plantar flexes foot, inverts and
adducts foot, supports arch
-flexor digitorm longus-flexes toes, plantar flexes foot,
inverts and adducts foot
-flexor hallucis longus
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
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Range of Motion
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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
Metatarsal
 Transverse
 Medial longitudinal (inner)
 Lateral longitudinal (outer)
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balance, movement, support, and shock
absorption
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
-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
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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 Injuries
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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.
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Great Toe Sprain (turf toe): (balance, movement,
and speed)(PRICES)
 ligament supporting the toe will become sprained
 1st metatarsal phalangeal joint (Sprain)
Common Injuries
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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 Injuries
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Anterior Compartment Syndrome: muscles
that dorsiflex the foot and ankle. (tibialis
anterior, extensor hallucis longus, extensor
digitorum longus, peroneus tertius)
 Direct trauma or excessive exercise results in
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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 Injuries
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Achilles Tendon Strain: (strongest in body) (PRICES,
but move more conservatively than most muscle injuries)
-causes: overuse, muscle imbalance, inflexibility, or
sudden movement.
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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.
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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.