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Objectives

Understand: the anatomy of the foot, ankle, & lower leg. Principles of rehabilitation for the foot, ankle, & lower leg Preventive/supportive techniques for lower extremity Identify: Components of an evaluation format Recognize: Common injuries Foot Supports 3 times the body weight.

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Objectives

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  1. Understand: the anatomy of the foot, ankle, & lower leg. Principles of rehabilitation for the foot, ankle, & lower leg Preventive/supportive techniques for lower extremity Identify: Components of an evaluation format Recognize: Common injuries Foot Supports 3 times the body weight. Foot contains ¼ of the total number (24 bones and 38 joints) Objectives

  2. Bones Lower Leg & Foot • Tibia- lower leg • Fibula- lower leg • Tarsals-(7) Talus, Calcaneus, navicular, cuboid, cuneiforms (medial, intermediate, & lateral) • Talus-one of the largest foot bones • Calcaneus-one of the largest foot bones • Metatarsals-(5)mid-foot • Phalanges-(14) • The bony prominences (malleoli) on the sides of your ankle are the distal ends of the tibia (medially) & fibula (laterally)

  3. Ligaments Ligaments- named for the bones they connect. • Lateral aspect of the ankle is most commonly injured. -anterior talofibular -anterior tibiofibular -calcaneofibular -posterior talofibular • Medial aspect of the ankle most commonly injured • deltoid ligament

  4. Muscles & Tendons Tendon: Most important for ankle support Achilles Tendon -attach the gastrocnemius and soleus muscles (calf muscles) to the calcaneus. Muscles:Peroneus Brevis & Peroneus Longus- run along the lateral side of the leg and foot. -evertsand abducts -plantar flexes - helps to prevent sprains.

  5. Muscles & Tendons Continued • Anterior Lower Leg (shin): associated with shin pain: interosseous membrane: connects the tibia & fibula • -Tibialis anterior-dorsiflexes foot, inverts & adducts • -extensor halluscislongus-extends great toe, dorsiflexes • -extensor digitorumlongus-extends toes, dorsiflexes foot, evertsfoot • Posterior Lower Leg: • -gastrocnemius-plantar flexes, flexes lower leg • -soleus-plantar flexes • -tibialis posterior-plantar flexes foot, inverts and adducts foot, supports arch • -flexor digitormlongus-flexes toes, plantar flexes foot, inverts and adducts foot • -flexor hallucislongus

  6. Joints of the Foot • Talocrural joint (ankle joint)-most commonly injured joint in athletics. -bones: Tibia, Fibula, & Talus -hinge joint-flexion (dorsiflexion) and extension (plantarflexion.) • Subtalar joint (ankle joint) -bones: Talus & Calcaneus -triplanar-movement around the oblique axis. -most stable when in dorsiflexion

  7. Range of Motion • Dorsiflexion-draw toes towards body • Plantar Flexion- draw toes away from lower leg • Inversion- turning sole inward • Eversion- turning sole outward • Flexion- toes forward • Extension- toes backward • Pronation- foot abduction, eversion • Supination- foot adduction, inversion • Abduction- away from the midline of the body • Adduction- toward midline of the body

  8. Arches • Metatarsal • Transverse • Medial longitudinal (inner) • Lateral longitudinal (outer) balance, movement, support, and shock absorption

  9. Evaluation Format H.O.P.S. • (H)-History: how did it happen, where does it hurt, did you hear a pop or snap, have you hurt it before. • (O)-Observation: compare the uninjured to the injured lower extremity. Bleeding, deformity, swelling, discoloration, scars, etc. • (P)-Palpation: above and below injured site, then affected site. -neurological (motor and sensory) -circulation (pulse & capillary refill) -anatomical structures (palpate) -fracture test (palpation, compression, and distraction) • (S)-Special Tests-joint stability, disability, and pain.

  10. Assessment Tests -Test for bony integrity: 1. Heel Tap test: integrity of tibia, fibula and talus 2. Squeeze Test: bony integrity of tibia and fibula -Tests for ligamentous stability: 1. anterior drawer test: anterior talofibular and calcaneofibular ligaments 2. Inversion or lateral stress test (talar tilt): calcaneofibular and anterior talofibular ligaments 3. Eversion or medial stress test (talar tilt): deltoid ligament 4. external rotation test (kleiger test): anterior and posterior tibiofibular ligaments and interosseous membrane -Tests for Muscle Function & Flexibility: 1. Thompson test: achilles tendon 2. Gastrocnemius Tightness test: degree of tightness in the ankle due to inflexibility 3. Soleus Tightness test: degree of tightness in the ankle due to inflexibility.

  11. Common Injuries • Blisters • Ankle Sprains: (PRICES) -80% of ankle sprains are inversion and plantar flexion. -Ligament most injured is anterior talofibular -Eversion sprain less common-deltoid ligament (thick) 1. First degree sprain -one or more ligaments are STRETCHED. 2. Second degree sprain -portion of one or more ligaments is torn. 3. Third degree sprain -one or more ligaments have been completely torn.

  12. Common Injuries • Arch Sprains: (transeverse, metatarsal, inner or outer longitudinal (most common) • fail to hold bones of foot in position. Might get shine splints. Achilles tendon strain, foot fatigue, strained muscles, blisters. • Causes: overuse, overweight, fatigue, training on hard surfaces, non-supportive shoes. • Great Toe Sprain (turf toe): (balance, movement, and speed)(PRICES) • ligament supporting the toe will become sprained • 1stmetatarsal phalangeal joint (Sprain)

  13. Common Injuries • Shin Splints: (Medial Tibia Stress Syndrome): Inflammation of the interosseous membrane and strain to the soleus. • -poor blood supply, slow to heal. • -muscle inbalance or weakness • -poor flexibility or lack of stretching • -lack of proper conditioning • -running on hard surfaces • -improper running form • -improper running shoes

  14. Common Injuries • Anterior Compartment Syndrome: muscles that dorsiflex the foot and ankle. (tibialis anterior, extensor hallucislongus, extensor digitorumlongus, peroneus tertius) • Direct trauma or excessive exercise results in hemorrhage and swelling in compartment. • Pressure on peroneal nerve, the veins, and arteries. • Muscle cells will die. • Signs: pain (even after cold treatment), firmness of the muscle, numbness of foot, pain with passive motion of ankle, lack of strength. • MEDICAL EMERGENCY!!!

  15. Common Injuries • Achilles Tendon Strain: (strongest in body) (PRICES, but move more conservatively than most muscle injuries) -causes: overuse, muscle imbalance, inflexibility, or sudden movement. • Stress Fractures: bones are living tissue. -causes: lack of exercise, severe exercise or too long, change in bone structure. -signs: specific point tenderness, increased pain during exercise, hurt when athlete presses fingers just above and below site of most pain. -Later stages: pain is constant, especially at night. • Muscle Cramps: a sudden, involuntary contraction of a muscle. -cause: unknown, several factors seem to contribute: Fatigue, fractures, dehydration, lack of electrolytes, poor flexibility, previous injury, improper fitted equipment.

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