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Chapter 8

Chapter 8. Foot and Ankle. Bones of the Foot and Ankle. Calcaneus. 28 bones: Tarsals (7) Metatarsals (5) Phalanges (14) Tibia Fibula. Talus. Cuboid. 3rd Cuneiform. Navicular. 2nd Cuneiform. 1st Cuneiform. Metatarsals. Proximal Phalanx. Intermediate Phalanx.

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Chapter 8

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  1. Chapter 8 Foot and Ankle

  2. Bones of the Foot and Ankle Calcaneus • 28 bones: • Tarsals (7) • Metatarsals (5) • Phalanges (14) • Tibia • Fibula Talus Cuboid 3rd Cuneiform Navicular 2nd Cuneiform 1st Cuneiform Metatarsals Proximal Phalanx Intermediate Phalanx Proximal Phalanx of Great Toe Distal Phalanx Distal Phalanx of Great Toe

  3. Arches of the Foot • 4 arches • Longitudinal • Medial • Lateral • Metatarsal • Transverse • Plantar Fascia Metatarsal Arch Medial Longitudinal Arch Lateral Longitudinal Arch Transverse Arch

  4. Bones of the Ankle and Lateral Ligaments • Lateral View (Left Ankle) • 4 Bones • Tibia • Fibula • Talus • Calcaneus • 3 Main Lateral Ligaments • ATF • PTF • CF

  5. Medial Ligaments of the Ankle • Deltoid Ligament (Medial View of Left foot) • 4 strong ligaments • Post. Tibiotalar Lig. • Tibiocalcaneal Lig. • Ant. Tibiotalar Lig. • Tibionavicular Lig.

  6. ROM of Foot and Ankle • Dorsiflexion • Plantar flexion • Inversion • Eversion • Abduction • Adduction • Toe Flexion • Toe Extension

  7. Muscles of the Lower Leg • Tibialis Anterior (In front of the Tibia) • Origin: from the lateral condyle and upper portion of the lateral surface of the tibia. • Insertion the 1st cuneiform and base of the 1st metatarsal • Action

  8. Tibialis Posterior • (Behind the Tibia) • Origin from the interosseous membrane between the tibia and fibula, lateral portions of the posterior surface of the tibia, proximal 2/3 of the medial surface of the fibula • Insertion The bottom of the navicular, cuboid, and three cuneiforms • Action

  9. Extensor Hallicus Longus • Hallicus = Big Toe • Origin Middle 2/4 of the anterior surface of the fibula • Insertion Base of the distal phalanx of the great toe • Action

  10. Extensor Digitorum Longus • Origin Lateral condyle of the tibia and proximal ¾ of anterior surface of body of fibula • Insertion by 4 tendons to the 2nd thru 5th digits. Each tendon forms and expansion on the dorsal surface of the foot. Ends at the base of each distal phalanx 2-5 • Action

  11. Gastrocnemius and Soleus • Gastrocnemius • Origin proximal and posterior part of medial condyle and lateral condyle • Insertion middle part of the posterior surface of the calcaneus • Action • Soleus • Origin posterior surface of the head of the fibula and proximal 1/3 of its body, middle 1/3 of the medial border of the tibia • Insertion with tendon of gastrocnemius (achilles tendon) to middle part of the posterior of the calcaneus • Action • “Calf Muscle”

  12. Peroneal Muscles • Peroneus Longus • Origin lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula • Insertion lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula • Action • Peroneus Brevis • Origin lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula • Insertion Tuberosity at the base of the 5th metatarsal, lateral side • Action • Peroneus Tertius • OriginDistal 1/3 of anterior surface of fibula and interosseous membrane • Insertion Dorsal surface, base of 5th metatarsal • Action

  13. Flexor Digitorum Longus • Origin Middle 3/5 of the posterior surface of the tibia • Insertion Bases of the distal phalanges of the 2nd thru 5th digits • Action

  14. Flexor Hallicus Longus • Hallicus = Big Toe • Origin Posterior surface of distal 2/3 of the fibula and interosseous membrane • Insertion Base of distal phalanx of great toe, plantar surface • Action

  15. Plantaris • Origin Distal part of lateral supracondylar line of the femur. • Insertion Posterior part of the calcaneus • Action

  16. Great Toe Sprain • “Turf Toe” • Most common injury is foot sliding back on slippery surface and hyperextending toe. • Treatment

  17. Arch Sprain • Once the supportive ligaments are stretched they can no longer absorb the shock they were designed to take. • Most common are metatarsal or inner longitudinal. Causes Treatment

  18. Ankle Sprains • Most common ankle injury. • Anterior Talofibular Ligament is the most commonly injured ligament. • Usually the first is the worst! • Usually caused by excessive inversion and plantar flexion. More than 80% are inversion sprains.

  19. Ankle Sprains • 1st degree • 2nd degree • 3rd degree

  20. Ankle Sprains • Treatment P.R.I.C.E., braces, and taping. • 3rd degree ankle sprains may require surgical repair.

  21. Ankle Dislocation • Causes • Treatment • Do not attempt to reduce

  22. Achilles Tendon Strain • Formed by a union between the gastrocnemius and soleus muscles. • Strongest tendon in the body. • Causes • Treatment

  23. Achilles Tendon Rupture • Cause • Treatment • In this case, the Achilles was so tight, it caused an avulsion fracture.

  24. Jones Fracture • Fracture of the base of the 5th Metatarsal • Causes • Treatment

  25. Stress Fractures • Caused either by too little activity, or too much activity. • Early x-rays may not show stress fracture, but conservative treatment and follow-up x-rays usually confirm the injury. • Treatment

  26. Fractures • The sudden breaking of bone, usually due to an externally applied force. • Treatment • Splint fracture in position found.

  27. Blisters • Causes • Treatment

  28. Shin Splints • Catch-all phrase • Slow healing due to poor blood flow • Causes • Treat with ice, orthotics, taping, and/or possible medical referral.

  29. Anterior Compartment Syndrome • Treatment • Medical emergency that usually results in surgery • Have to do a release on the compartment • Athlete should be referred to a physician right away if suspected. • Can be mistaken for shin splints • Causes • Direct trauma • Excessive exercise---hemorrhage and swelling inside the compartment • Pressure on nerves, veins and arteries cause loss of circulation.

  30. Heel Bruise • Most disabling of contusions in athletics • May involve ligaments, tendons, and/or fat pad of the heel • Treatment

  31. Plantar Fasciitis • Plantar Fascia = a ligamentous tissue that extends from the calcaneous to metatarsal heads to support the longitudinal arches

  32. Plantar Fascitis cont. • Causes • Most common though is chronic irritation. • Pain is on bottom of foot near heel and is usually worse in the morning. • Treatment

  33. Heel Spur • Bony growth on the calcaneous that causes inflammation of surrounding soft tissue. • Usually results from improper treatment of plantar fasciitis. • Plantar fascia pulls on the heel causing the bone to spur • Treatment

  34. Muscle Cramps • Sudden, involuntary contraction of the muscle. • Factors • Treatment • **Very common in calf muscles

  35. Tinel’s Sign Tarsal Tunnel Syndrome Morton’s Test Neuroma/metatarsalgia Percussion Test “Heel Tap”—fracture of tib/fib Compression Test Squeeze test—fracture of tib/fib Thompson Test Achilles tendon rupture Homan’s Sign Deep vein thrombophelbitis Anterior Drawer Test Injury to ATF and other lateral ankle ligaments Talar Tilt Test Extent of damage to ankle ligaments Kleiger’s Test Deltoid ligament injury Special Tests

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