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Transcript
CHAPTER 15 – FOOT,
ANKLE AND LOWER LEG
FOOT ANATOMY
FOOT ANATOMY
 It is complex!
 26 bones
 33 joints
 Over 100 muscles, tendons and ligaments
ANATOMY - BONES
 PHALANGES (Toes) – 14
 Big toe has two
phalanges, the rest of the
toes have three
 Proximal, middle, and
distal
FOOT ANATOMY - BONES
 METATARSALS – 5
 1ST one is medial and 5th one
is lateral
FOOT ANATOMY – 26 BONES
 TARSAL BONES – 7
 Calcaneus – heel bone
 Talus – forms the ankle
 Navicular – medial in respect to
the talus
 Cuboid - lateral
 Cuneiforms (3)
FOOT ANATOMY
 PLANTAR FASCIA
 Broad, flat tendonous structure that runs on the
undersurface of the foot
 Starts on the calcaneus and inserts onto the heads of
the metatarsals
 Supports the arch of the foot
FOOT ANATOMY - ARCHES
 Support body weight and absorb shock
 There are four arches:
 MEDIAL LONGITUDINAL ARCH
 LATERAL LONGITUDINAL ARCH
 METATARSAL ARCH
 TRANSVERSE ARCH
FOOT - MOTIONS
 Toes
 Flexion and Extension
 Foot
 Pronation – like fallen arch
 Supination – high arch
ANKLE ANATOMY - BONES
 BONES
 Two bones in the lower leg
 Tibia – medial, larger, weight
bearing
 Medial Malleolus
 Fibula
 Lateral Malleolus
 Two tarsal bone
 Talus
 Calcaneus
ANKLE ANATOMY - JOINTS
 TRUE ANKLE JOINT
 Tibia, fibula and talus
 Mortise
 Definition: where the talus fits
into the tibia and the fibula
ANKLE ANATOMY - JOINTS
 Subtalar joint
 Between the Talus and
the Calcaneus
ANKLE ANATOMY - LIGAMENTS
 LATERAL –
 3 ligaments named for
bones
 Anterior talofibular
 (ATF)
 Calcaneofibular
 (CF)
 Posterior talofibular
 (PTF)
ANKLE ANATOMY - LIGAMENTS
 MEDIAL
 Deltoid
 Strong ligament
 4 parts that form one
ligament
ANKLE ANATOMY - LIGAMENTS
TIBIOFIBULAR
LIGAMENTS –
holds tibia and
fibula together
Anterior tibiofibular
Posterior tibiofibular
ANKLE MOTIONS
 Dorsiflexion
 Plantarflexion
 Inversion
 Eversion
LOWER LEG ANATOMY
 Bones
 Tibia
 Fibula
LOWER LEG MUSCLES
 The muscles are in four compartments with 2-4
muscles in each compartment
 Compartments are held together by fascia
LOWER LEG MUSCLE COMPARTMENTS
1.
LATERAL – everts the ankle
2.
ANTERIOR – dorsiflexes the ankle
3.
DEEP POSTERIOR – plantarflexes the ankle (the
calf muscle)
4.
POSTERIOR MEDIAL – inverts and plantarflexes
the ankle
LOWER LEG - Major Muscles and Actions
 Anterior Tibialis - dorsiflexor
 Peroneals - evertors
 Gastrocnemius – plantarflexor
 Soleus – plantarflexor
 Posterior Tibialis – invertor
PLANTAR FASCIITIS
 Common with athletes who are on toes and/or have high
arches
 Causes: Not enough arch support in shoes, tight calf
muscle
 Signs/Symptoms: Pain occurs in the heel to mid-foot,
especially with dorsiflexion
 Hurts in the morning, feels better as they warm up
 Treatment: Gentle stretches, roll on tennis ball or frozen
can, arch taping or orthodics.
JONES FRACTURE
 Fracture of the base of the 5th metatarsal
 Causes: overuse; inversion; rotational forces
 S/S: Feels and hears a ‘pop’; pain in the lateral foot
 Tx: immobilization (cast) 6-8 weeks or longer, often
requires surgery
BUNIONS (HALLUX VALGUS)
 Deformity of the head of the 1st metatarsal
 Cause: extra bone is laid down on head of 1st
metatarsal
 Great toe becomes malaligned
 S/S: Pain, swelling and deformity of big toe joint
 Treatment: Proper shoes; doughnut pad over the
bunion; surgery?
MORTON’S NEUROMA
 Neuroma is a mass about the nerve sheath
 S/S: burning, cramping, numb feeling in space between third and
fourth toes.
 Cause: Hyperextension of toes and wearing shoes with narrow toe
boxes can increase symptoms
 Tx: teardrop pad under the metatarsal heads, good shoe
selection, possible surgery
TURF TOE
 Great Toe sprain
 Cause: Hyperextension of the big toe at the metatarsal
phalangeal joint; kicking something
 Common on artificial turf b/c turf shoes allow more motion
 S/S: swelling and pain in the joint
 Tx: RICE, rigid insoles or toe boxes, taping to prevent
hyperextension of toe
INGROWN TOENAILS
 Cause: leading side of toenail grows into skin, usually
results in infection and pain
 May trim nails too short or ill-fitting shoes
 S/S: Inflammed nail bed, may have drainage/pus
 Tx: May need to refer to doctor; soak in betadine bath;
pack cotton under toenail
PUBLIC SERVICE
ANNOUNCEMENT
 HIGH HEELS
 Loads 5 times your body weight onto your heel
 Overloads forefoot
 Deforms the arch
 Reduces shock absorption
 Plantar fasciitis
 Leads to inflamed nerves in your toes
 Morton’s Neuroma
 Shortens your calf
 Achilles tendinitis
 Changes your center of gravity – more forward
 Have to extend back to compensate
ANKLE SPRAINS
 Inversion
 Most common type of ankle sprain
 Accounts for 80% of all sprains
 AKA ‘a lateral ankle sprain’
 First degree sprain
 Only involves the anterior talofibular ligament
 Mild pain, tenderness, and swelling
 No instability
ANKLE SPRAINS
 Inversion
 Second degree sprain
 Anterior talofibular ligament is torn and calcaneofibular ligament
is injured as well
 Most painful
 Moderate swelling
 Mild Instability
ANKLE SPRAINS
 Inversion
 Third degree sprain
 Complete tear of all three lateral ligaments
 Uncommon
 Lots of pain, but it can subside
 Very unstable
 Usually requires surgery
ANKLE SPRAINS
 Eversion
 Not as common
 Can occur more on tartan surfaces and artificial turf
 Everything is worse (pain, swelling, etc) when compared to
an inversion injury
 If the deltoid tears, the tibiofibular ligaments may tear also
High Ankle Sprain
Involves
Anterior
Inferior
Tibiofibular
(AITFL)
Ligament
Injury allows
tibia and
fibula to
separate
High Ankle Sprain
 Cause: Inversion
with rotation;
rotation of foot
 S/S: pain with
external rotation of
foot; tender over
AITFL
 Treatment: RICE,
may need to be
immobilized; possible
surgery if severe
enough
Ankle Fractures
 Always need to suspect a fracture when evaluating a potential
sprained ankle
 Cause: Too much motion
 S/S: immediate swelling, point tender over the bone, does not want
to weight bear
 Treatment: splint, ice, x-ray
Cast 6-8 weeks
MEDIAL TIBIAL STRESS SYNDROME
 ‘SHIN SPLINTS’
 Occurs in distal 2/3 of posterior/medial tibia
 Causes: pronation, lack of flexibility in the lower legs, hard
surfaces, hills, muscle weakness, poor shoes, increasing
running distance too quickly
 S/S: resisted plantar flexion and inversion should hurt, pain
is just off the tibia
 Treatment : prevention (shoes, arch support), strengthening,
stretching, ice massage, contrast bath, tape arches
 Refer to MD if no improvement to rule out stress fracture
COMPARTMENT SYNDROME
 Occurs when pressure increases in compartment and
shuts off blood and nerve supply to the foot
 Most often occurs in the anterior and deep posterior
compartment
 THREE TYPES
 Acute
 Acute Exertional
 Chronic
ACUTE COMPARTMENT SYNDROME
 Medical emergency
 Causes: direct blow to the lower leg
 Usually in the anterior lower leg
 Symptoms come about several hours later
 S/S: compartment is tense, warm, red and shiny; complains of
(c/o) deep aching pain; circulation and sensory problems in foot
 Tx: ice, elevation – refer to ER immediately
ACHILLES TENDINITIS
 Chronic, overuse condition that comes about gradually
 Causes: running and jumping, repetitive stress, running
up hills, poor flexibility
 S/S: achy type pain, Achilles is tender on palpation, pain
with standing plantarflexion, may have crepitus, hurts to
warm up and to cool down
 TREATMENT
 If there is crepitus, no running for 1-2 weeks
 Stretch!
 Heel lift in both shoes
 Orthodics
 Heat and/or ice
ACHILLES TENDON RUPTURE
 Achilles in largest tendon in body
 For Gastronemius and Soleus muscles
 Most common tearing spot is 1” above its insertion on the
calcaneus
 Causes: Sudden, forceful plantar flexion and extension of the
knee, age, previous tendinitis
 S/S: Feel and hear a snap, “kicked in the leg”, very weak
plantarflexion, no Achilles observed
 Tx: Immobilization to ER, surgery?