Understanding Foot, Ankle, and Lower Leg Injuries: Anatomy, Prevention, and Treatment

1. Chapter 15 Foot, Ankle, and Lower Leg Injuries

2. 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

3. 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)

4. 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

5. Longitudinal arches

6. 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

8. 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

10. Medial Ankle Ligaments • Deltoid ligament • Covers entire surface of the ankle • Maintains stability • Prevents extreme eversion • Stronger than all of the lateral ligaments combined

11. Preventing foot, ankle, and lower-leg injuries • Protective measures • Supportive shoes worn correctly, taping, bracing • Maintenance of playing surface • Strengthening and conditioning programs • Proper stretching and strengthening prior to participation

12. 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

13. 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, anti-inflammatory, taping, stiff soled shoe; severe cases may be require surgery

14. Arch Sprain • MOI-prolonged activity on hard surfaces or with overuse • S/S-tenderness and swelling , and pain upon weight bearing • Treatment: RICE, anti-inflammatory, supportive taping

15. Lateral ankle sprain • MOI-inversion, plantarflexion • S/S- swelling, discoloration, point tender over lateral ligaments • Treatment- RICE, anti-inflammatory, refer for x-ray to r/o fx • Prevention- proper strengthening, taping, bracing

16. Medial Ankle sprains • MOI- eversion • S/S-swelling, discoloration, point tender over deltoid ligament • Treatment- RICE, anti-inflammatory, refer for x-ray to r/o fx • Prevention- proper strengthening, taping, bracing

17. Ankle dislocation • MOI-plantarflexion and forced inversion • S/S- deformity, swelling, pain • Treatment: immobilize, refer for x-ray/reduction • Immediate medical attention necessary

18. Treating foot, ankle, and lower-leg injuries and conditions • Muscle and tendon injuries • Achilles tendinitis • Achilles tendon rupture

19. Achilles tendinitis • Inflammation of the achilles tendon • MOI-overuse • S/S- pain over achilles, swelling, may predispose athlete to tendon rupture • Treatment-RICE, anti-inflammatories, stretching, strengthening, taping

20. Achilles tendon rupture • http://www.arthroscopy.com/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

21. 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

22. Jone’s fracture (base of 5th metatarsal) • MOI-forced inversion and plantarflexion • S/S-pain, tenderness over base of 5th metatarsal, swelling • treament- non-displaced fracture=conservative (boot), displaced=surgical repair

23. 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/x-ray, open or closed reduction, cast 4-6 weeks, full return to activity approx 3 months

24. 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

25. 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

26. 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

27. 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

29. 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

30. 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

32. 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

33. 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

34. 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

35. Foot drop • Damage to the peroneal nerve • Inability to dorsiflex foot • Treatment depends on actual cause • Can be caused by other injury or surgery

36. 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

37. 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