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Chapter 15
Foot, Ankle, and Lower Leg
Injuries
Anatomy
• 28 bones in the foot
– Phalanges
• Numbered 1-5
• Distal, middle, and
proximal phalanges in
each (except great toe)
– Metatarsals
• 1-5
• Metatarsophalangeal
joint in between
• Talus
– Above the calcaneus
• Calcaneus
– Heel bone
– Achilles attaches to
posterior
• Navicular
• Cuboid
• Medial, Intermediate, and
•
Lateral Cunieform
Medial malleolus
– Tibia (ankle)
• Lateral Malleolus
– Fibula (ankle)
• Sesamoids
– Floating bones
– Tibial and fibular (usually
2)
Arches of the foot
• Longitudinal
– From calcaneus to
metatarsal heads
– Functions: absorbing shock
and balance
• Metatarsal
– Runs along metatarsal
heads
– Major weight bearing arch
• Transverse
– Located in front of the
calcaneus, runs from 5th
metatarsal to the navicular
Longitudinal arches
Muscles
• There are 20 muscles in
•
the foot
Tibialis anterior
– Allows for dorsiflexion
• Tibialis posterior
– Helps with arch support
• Peroneus longus and
brevis
– Foot eversion
• extensors
– Aid in dorsiflexion
• flexors
– Aid in foot plantarflexion
and toe flexion
Lateral Ankle Ligaments
• anterior talofibular
ligament
– Prevents ankle from
moving forward
– Most commonly injured
ligament in an inversion
sprain
• posterior talofibular
•
ligament
calcaneofibular ligament
– Aids in preventing ankle
inversion
Medial Ankle Ligaments
• Deltoid ligament
– Covers entire
surface of the
ankle
– Maintains
stability
– Prevents
extreme
eversion
– Stronger than all
of the lateral
ligaments
combined
Preventing foot, ankle, and lowerleg injuries
• Protective measures
– Supportive shoes worn
correctly, taping,
bracing
– Maintenance of playing
surface
• Strengthening and
conditioning programs
– Proper stretching and
strengthening prior to
participation
Treating foot, ankle, and lower-leg
injuries and conditions
• Ligament injuries
– Great toe sprain (turf toe)
– Arch sprain
– Lateral and medial ankle sprains
– Ankle dislocation
• Great-toe sprain (turf toe)
– injury to the joint capsule and
ligaments of the
metatarsophalangeal joint
– Primary mechanism of injury
(m.o.i) is hyperextension
– Signs/symptoms: pain,
tenderness and swelling,
bruising and restriction of
motion
– Treatment: RICE, antiinflammatory, taping, stiff soled
shoe; severe cases may be
require surgery
• Arch Sprain
– MOI-prolonged
activity on hard
surfaces or with
overuse
– S/S-tenderness
and swelling ,
and pain upon
weight bearing
– Treatment: RICE,
antiinflammatory,
supportive taping
• Lateral ankle sprain
– MOI-inversion,
plantarflexion
– S/S- swelling,
discoloration, point
tender over lateral
ligaments
– Treatment- RICE, antiinflammatory, refer for
x-ray to r/o fx
– Prevention- proper
strengthening, taping,
bracing
• Medial Ankle sprains
– MOI- eversion
– S/S-swelling,
discoloration, point
tender over deltoid
ligament
– Treatment- RICE, antiinflammatory, refer for
x-ray to r/o fx
– Prevention- proper
strengthening, taping,
bracing
• Ankle
dislocation
– MOIplantarflexion
and forced
inversion
– S/S- deformity,
swelling, pain
– Treatment:
immobilize,
refer for xray/reduction
– Immediate
medical
attention
necessary
Treating foot, ankle, and lower-leg
injuries and conditions
• Muscle and tendon injuries
– Achilles tendinitis
– Achilles tendon rupture
Achilles tendinitis
• Inflammation of the
•
•
•
achilles tendon
MOI-overuse
S/S- pain over
achilles, swelling, may
predispose athlete to
tendon rupture
Treatment-RICE, antiinflammatories,
stretching,
strengthening, taping
Achilles tendon rupture
• http://www.arthroscopy.c
•
•
•
om/achrup.avi
MOI-sudden, unexpected
force, or weakened
achilles due to chronic
tendinitis
S/S-visual deformity,
depression site, positive
Thompson’s test
Treatment- surgical repair
or casting, often takes up
to 6 months to heal
Treating foot, ankle, and lower-leg
injuries and conditions
• Bone injuries
• Fifth metatarsal avulsion fracture (Jones
fracture)
• Epiphyseal injury of distal tibia and fibula
• Stress fracture
Jone’s fracture (base of 5th metatarsal)
• MOI-forced
inversion and
plantarflexion
• S/S-pain,
tenderness over
base of 5th
metatarsal,
swelling
• treament- nondisplaced
fracture=conservati
ve (boot),
displaced=surgical
repair
Epiphyseal injury of distal tibia and
fibula
• Occurs in youth
• MOI-supination and
•
•
external rotation
S/S-swelling, point
tenderness, limited ROM
Treatment-confirm w/xray, open or closed
reduction, cast 4-6
weeks, full return to
activity approx 3 months
Stress fracture
• MOI-repetitive stress
(running, jumping) most
often occur in tibia or
metatarsal bones
• S/S- point tenderness in
specific area
• Treatment-Rest, Ice,
gradual return to activity,
need bone scan or MRI to
confirm
• Prevention-increasing the
level of exercise slowly,
adequately warming up
and stretching before
exercise, and using
cushioned insoles and
appropriate footwear
Treating foot, ankle, and lower-leg
injuries and conditions
•
•
•
•
•
•
•
•
•
•
Shin splints, or medial tibial stress syndrome
Anterior compartment syndrome
Contusions
Toe abnormalities
Bunions
Plantar Fascitis
Callouses
Blisters
Athlete’s foot
Foot drop
Shin splints and medial tibial stress
syndrome
• MOI-overuse, running on
hard surfaces
• S/S- point tenderness
over the medial border of
the leg
• Treatment-conservative,
RICE, condition often
recurring, rehab
• Prevention- supportive
shoes, avoid running hills
and hard surfaces
Anterior compartment syndrome
• Cause-muscle becomes
•
•
•
too big for the sheath
that surrounds it causing
pain
MOI-direct impact that
causes bleeding, muscle
tear, overuse
S/S- increased pain with
exercise, pain with
plantarflexion, weakness
with dorsiflexion, swelling
and tenderness over
tibialis anterior
Treatment-RICE, NSAIDs,
orthodics, rehab, surgery
Contusions
• MOI-direct blow,
•
•
•
muscle tear
S/S-pain, swelling,
discoloration, limited
function
Treatment-RICE,
compression
Complication-myositis
ossificans-damage to
the muscle and bone
periosteum causing
new bone
growth(calcification)
within the muscle
Toe abnormalities
• Claw toe
– Contracture of ligaments and
tendons causing toes to curl
downward
• Hammer toe
– Similar to claw toe, DIP joint
less affected
• Mallet toe
– Inability to straighten DIP
joint
Cause: result from a muscle
imbalance which causes the
ligaments and tendons to
become unnaturally tight
Bunions
• Causes-most common
•
•
cause is wearing shoes
that fit too tightly. They
can also develop as a
result of injury, stress on
your foot or another
medical condition. 10X
more likely in women.
Treatment-conservative
steps that may include
changing your shoes,
padding your bunion and
wearing shoe inserts,
surgery an option as well.
Prevention-wear shoes
with a wide enough
toebox
Plantar Fasciitis
• Causes-improper training,
improper shoes, irregular
arch, lack of flexibility in
foot and lower leg
• S/S-point tenderness
either on the bottom or
the back of the heel,
possible limp, minimal
swelling
• Treatment-heel cup/lift,
NSAIDs, ultrasound,
stretching, modified
activity
Calluses
• Causes-repeated
•
•
•
friction and pressure
formed to protect the
skin and the
structures behind it
from injury
Treatment- soaking
and sanding,
moisturizer, shoe
insoles or custom
orthodics
DO NOT cut or trim,
seek MD advice/attn if
diabetic
Foot drop
• Damage to the
•
•
•
peroneal nerve
Inability to dorsiflex
foot
Treatment depends
on actual cause
Can be caused by
other injury or
surgery
Athlete’s foot
• skin disease caused by a
•
•
•
•
•
fungus, usually occurring
between the toes
warm, dark, and humid
environment which
encourages fungus
growth
S/S-are dry skin, itching,
scaling, inflammation,
and blisters
can be spread to other
parts of the body
Treatment-Fungicidal and
fungistatic chemicals
Prevention-
– Avoid walking barefoot; use
shower shoes.
– Reduce perspiration by
using talcum powder.
– Wear light and airy shoes.
– Wear socks that keep your
feet dry
Blisters
• Causes
– Form as a result of heat,
moisture and friction.
– Friction forces caused by
inappropriate footwear.
– fungal infections of the
skin, allergic reactions or
burns.
– Excessive foot perspiration.
• Prevention-proper fitting
•
shoes/socks, keep feet
dry, foot powder
Treatment- drain if
painful, apply antibiotic,
do not remove protective
“roof” skin, cover with
bandaid