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Foot, Ankle and Lower Leg

Foot, Ankle and Lower Leg. Sports Medicine Chapters 14 & 15. Lower Leg. Anatomy of the foot, ankle and lower leg Common Injuries Treatment Prevention Rehabilitation. Vocabulary. apophysis, exostoses, metatarsalgia, Morton’s neuroma, pes planus, pronation, pes cavus

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Foot, Ankle and Lower Leg

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  1. Foot, Ankle and Lower Leg Sports Medicine Chapters 14 & 15

  2. Lower Leg • Anatomy of the foot, ankle and lower leg • Common Injuries • Treatment • Prevention • Rehabilitation

  3. Vocabulary apophysis, exostoses, metatarsalgia, Morton’s neuroma, pes planus, pronation, pes cavus supination, eversion, dorsiflexion, inversion, plantar flexion,proprioception, Thompson test

  4. Anatomy • Bones of the foot and ankle Foot: 1.Lateral/Medial Mallelous 2.Talus 3. Calcaneus 4.Navicular 5.Cuboid 6. 1st, 2nd, 3rd or medial, middle, lateral Cuneiforms 7.Metatarsals/phalanges

  5. Ligaments • 1.Anterior Talo Fibular • Most common lig. Injured. Injured by plantar flexion/inversion • 2.Posterior Talo Fibular • Injured by dorsiflexion and inversion • 3.Calcaneofibular • Injured by dorsiflexion and inversion • 4.Deltoid/post. talotibial • Largest lig. In the ankle. Eversion sprain • 5.Ant/Post tibiofibular attaches tibia/fibula

  6. MUSCLES • Gastrocnemius/soleus • plantar flexion • forms the achilles tendon and attaches to the calcaneus • Tibialis Anterior • in front of your tibia • attaches to the 1st metatarsal • produces dorsi flexion and inversion • Flexor Hallucis longus/brevis • flexes big toe • is part of your arch

  7. Muscles cont. • Peroneal Longus/brevis • attaches to base of 5th metatarsal • produces eversion • Peroneal tertius • same as above • Extensor digitorum longus • extends your phalanges • Flexor digitorum longus • flexes toes • goes by the deltoid lig.

  8. Injuries • Blisters. • Caused by friction. Rx: donut and cover. • Ingrown toenails. • Toenail is growing down into the toe. Rx: soaking the toe, cleaning it out, lifting the nail up. Or dr. • Heel bruise. • Direct blow to the heel. Very painful, rest ice and heel cup or tape. • Arch strain: metatarsal, transverse, inner/outer longitudinal arches. • Very painful while running/walking. • Rx. RICE, arch tape job, ultrasound, whirlpool and stiff sole shoe. • Morton’s neuroma: 2nd or 3rd metatarsal. • - RX pad.

  9. Injuries Cont. • Fractures of your toes: • Dr. Referral if great toe involved. If not tape together and wear wide fitting shoes. • Fracture of the metatarsals. • Direct blow or twisting type of an injury. • Jones fracture. • fx. Base of 5th metatarsal, caused by same mechanism of sprain ankle. High incidence of nonunion. • Bunion: hallux valgus. • Most common injury to the great toe. Bursa becomes inflamed due to poor fitting shoes or a congenital deformity. Tape like turf toe but off to the side.

  10. Injuries Cont. • Hammer toes: 2nd or 3rd toe • May be congenital, or wears shoes too small • Overly contracted flexor tendons/overly stretched extensor tendons • Surgery or taping of the toes • Bony outgrowths (exostoses) • Heel spurs • Located at the head of the 1st metatarsal or heel • Apophysitis • Where the achilles tendon attaches. Rx= 1/4” heel lift

  11. Plantar fasciitis • Heel spur syndrome. Most frequent hind footproblem. S/S burning, sharp pain around the heel. Rx.= NSAID’s ultrasound, ice and stretch • Stress fractures: 18% occur here • In the metatarsals Rx.= Cast, rest for 3-4 weeks

  12. Ankle Injuries • Sprains. • Grade1=3-7 days out. • Grade 2=7-14 days out. • Grade 3= 2-6 weeks out. • Rx.= RICE, horseshoe. • Achilles tendonitis. • Rx.= Ice/stretch, NSAID’s, heel lift, ultrasound. • May take weeks/months to heal. • If untreated may result in rupture. • Shin contusion. • Very painful and takes very long to heal especially the distal 1/3 of the tibia because of the low blood supply. • Rx.= Ice compression and elevation.

  13. Tennis leg: gastrocnemius strain. • Calf strain cause by quick starts and stops with foot planted and extends the knee. Rx.= Same care for a muscle strain. • Shin splints. • Medial Tibial stress syndrome. Pain in the distal anterior 1/3 of the tibia. • Causes: poor fitting shoes, bad arches in shoes, poor conditioning, running on hard surfaces, muscle fatigue, ankle pronation. • Rx.= Ice massage, ice whirlpool after workouts, tape arches, run on soft surfaces, proper shoes.

  14. Injuries Continued • Anterior compartment syndrome. • Four compartments in the lower leg. • Muscle, nerves, arteries become compressed by swelling. • S/S= weakness in foot dorsiflexion and extension of big toe = foot drop. • Numbness or tingling over the dorsal surface of the foot. • Foot is cold. Lack of circulation. • Rx.= Ice, elevation and to dr. ASAP don not compress.

  15. Ankle Injuries Cont. • Stress fracture: • Common overuse injuries. • Athletes who have hypermobile, pronated, or flat feet (pes planus) are susceptible to fibular stress fx. • Athletes who have rigid pes cavus are susceptible to tibial stress fx. • Intense pain while running but subsides while resting. Very point tender. • Rx.= X-ray with bone scan. • Depending on where the fx. Is will determine if non weight bearing or walking cast. • Rest is the key. • Swimming and biking is ok.

  16. Ankle Injuries Cont. • Achilles tendon rupture. • S/S= felt like I got kicked in the calf. Possible deformity, poor plantarflexion strength. • Treatment: perform Thompson test, splint in relaxed position and send to dr. Also ice. • Could be caused by chronic tendonitis and is common to people in their mid 30’s.

  17. Rehabilitation • Evaluation: • see handout • Anterior drawer test= ATF lig. • Talor tilt test= CF/Deltoid lig. • Rehab for Ankle sprain

  18. Stage 1: RICE with horseshoe and elevation as much as possible Non weight bearing if athlete can not bear weight without a lot of pain After swelling has subsided use contrast baths CV by bike or pool w/out legs Progression to stage 2: Swelling has subsided and pain is at a minimum, Full weight bearing Stage 2 Contrast baths PNF- balance board, tubing and pool workouts with balance Manual resistance: plantar/dorsiflexion first than eversion/inversion Flexibility CV- bike and pool workouts using legs a little bit more Progression to stage 3: Pain free, full ROM, Almost full strength Rehabilitation of an ankle injury

  19. Rehab continued • Stage 3: • PNF • SAID principle- sports specific • Protective taping • Jogging straight then slowly introduce jogging with big curves • Jog sprint jog • Jogging with cuts • Jog fig. 8’s • Back pedal • Sprints straight • Sprint with cuts • Sprint with change of direction • Side steps • Activity specific to their sport • Ice after activity

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