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Injuries to the Foot, Ankle and Lower Leg

Injuries to the Foot, Ankle and Lower Leg. SPHS Sports Medicine John Hardin, Instructor. Bony Anatomy. Tibia Fibula Tarsals Metatarsals Phalanges Sesamoid Bones. Tibia. Weight bearing bone Articulates with fibula both inferiorly and superiorly Landmarks

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Injuries to the Foot, Ankle and Lower Leg

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  1. Injuries to the Foot, Ankle and Lower Leg SPHS Sports Medicine John Hardin, Instructor

  2. Bony Anatomy • Tibia • Fibula • Tarsals • Metatarsals • Phalanges • Sesamoid Bones

  3. Tibia • Weight bearing bone • Articulates with fibula both inferiorly and superiorly • Landmarks • Tibialtuberosity (proximal) • Tibial Plateau • Medial Malleolus • Shaft

  4. Fibula • Non-weight bearing bone • Extends down past calcaneus providing bony support to prevent eversion • Serves as site for muscle attachments • Landmarks • Head of fibula (proximal) • Lateral malleolus

  5. Tarsals • Talus—articulates with the tibia/fibula • Calcaneus • Navicular • Cuboid • Medial, intermediate and lateral cuneiforms

  6. Joints • Tibiofibular joint--syndesmosis • Ankle joint (talocrural) Ankle mortise • Subtalar joint • Metatarsalphalangeal joints (MP) • Interphalangeal joints • PIP • DIP

  7. Arches • Transverse: proximal across tarsals • Medial longitudinal arch: from calcaneus to 1st metatarsal • Strengthened by spring ligament (plantar calcaneonavicular ligament) • Lateral longitudinal arch: from calcaneus to 5th metatarsal • Metatarsal arch: shaped by distal heads of metatarsals

  8. Muscles of lateral compartment • Peroneuslongus • Peroneusbrevis • Both do eversion

  9. Muscles of the anterior compartment • Tibialis Anterior • Extensor DigitorumLongus • Extensor HallicusLongus • All do dorsiflexion and some inversion • EDL—extension of toes 2-5 • EHL—extension of great toe • **EDB—extends toes 2-4 (dorsum of foot)

  10. Muscles of Superficial Posterior compartment • Tibialis Posterior (Tom) • Flexor DigitorumLongus (Dick) • Flexor HallicusLongus (Harry) • All do Plantar Flexion and Inversion • FDL– flexion of toes 2-5 • FHL—flexion of great toe

  11. Muscles of Deep Posterior Compartment • Gastrocnemius—crosses knee and ankle joint. Knee flexion/plantar flexion • Soleus---crosses ankle joint. Plantarflexion • Join together at the Achilles tendon • Plantaris—cross ankle and knee joints. Knee flexion/plantar flexion • Tendon run parallel to the Achilles tendon medially

  12. Miscellaneous • Plantar Fascia • From calcaneus to heads of metatarsals. • Maintain stability of foot and supports medial longitudinal arch • Interosseus Membrane • Thick connective tissue runs length of tib/fib and holds them together

  13. Plantar fasica

  14. Medial Ligaments • Deltoid ligament • 4 parts • Very strong • Not injured as often

  15. Lateral ligaments • Anterior talofibular • Posterior talofibular • Calcaneofibular

  16. Other ligaments • Anterior inferior tibiofibular ligament • Posterior inferior tibiofibular ligament

  17. Prevention of Injuries • Wear properly fitting shoes • Ankle support • Protective equipment • Maintain adequate strength and flexibility • Heel cord stretching • Strengthening in inversion, eversion, plantar and dorsiflexion • Proprioception (balance training)

  18. Heel Bruise (Stone Bruise) • Mxn: Landing on heels, hitting heel on something hard—causing a contusion to the bottom of calcaneus • S/S: Severe pain in heel, difficulty weight bearing, POT • TX: ice, rest/non weight bearing til pain subsides, heel cup or doughnut when returning • Complication: inflammation of periosteum

  19. Plantar Fasciitis • Mxn: tight heel cord, inflexibility of longitudinal arch, improper footwear, leg length discrepancy, rapid increase/change in training

  20. S/S: POT over the anteriomedialcalcaneus and plantar fascia, stiffness and pain in AM or after prolonged sitting, pain with passive extension of toes combined with dorsiflexion

  21. TX: long term—8-12 weeks vigorous heel cord stretching, ice massage, heel cup, taping, ultrasound, NSAIDS, Last resort: surgery to cut the fascia Complications: can develop a bone spur if not cared for—surgery to remove it

  22. Metatarsal Fracture • Mxn: direct force or twisting/torsion force or overuse • Most common is the Jone’s fracture—near base of 5th, avulsion (at the base), midshaft

  23. S/S: POT over metatarsal, swelling, pain, “pop” or “crack”, possible deformity

  24. Tx: Ice, Compression wrap, crutches, send to Dr. for x-ray. • Possibly on crutches for 6-8 weeks, non-weight bearing to allow for healing • Complication: Non union fracture. May require surgery to fix

  25. Longitudinal Arch Strain • Mxn: Unaccustomed stresses/forces placed on foot when in contact with a hard playing surface. • Flattening of the foot (arch) when in midsupport phase • May occur suddenly or over a longer period of time

  26. S/S: Pain felt just distal to the medial malleolus when running • Swelling and POT along the calcaneonavicular ligament (spring ligament) and the first cuneiform • POT over the FHL tendon as a result of compensation for stress on ligament

  27. TX: Rest, ice, reduction of weight bearing until relatively pain free • Ultrasound • Arch taping

  28. Turf Toe • Sprain of the MP joint of the great to • Mxn: Hyperextension of great toe—trauma or overuse • Usually occurs on an unyielding surface such as turf • Kicking an unyielding object

  29. S/S: POT over MP joint of great toe • Swelling • Discoloration • Pain with movement especially pushing off big toe when taking a step

  30. TX: Rest, ice, compression • Insert a hard insole into shoe to prevent hyperextension of MP joint • Tape for hyperextension

  31. Subungual Hematoma • Mxn: being stepped on or something being dropped onto the toe • Toes being jammed into the end of the shoe while running

  32. S/S: Bleeding into the nail bed (under nail) • Throbbing pain • Pressure against nail exacerbates the problem

  33. TX: drain the blood from the nail • Use a drill bit • Heat a paperclip and burn through nail • Use a scalpel to make hole in nail

  34. Blisters • Mxn: shearing force on the skin that causes fluid to accumulate below top layer of skin • May be clear, bloody or become infected

  35. S/S: area of fluid under skin • Can be painful • May break open • May become infected—redness, heat, pus

  36. TX: cover with skin lube, bandage, foam or felt doughnut around it. • If large, then drain, but clean it and treat as open wound • Cover prior to practices/competitions

  37. Ankle Sprains • Inversion • Eversion • High Ankle Sprain

  38. Inversion Ankle Sprain • Most common, resulting in injury to the lateral ligaments • ATF ligament is the weakest of the 3 • Mxn: “rolling” the ankle, landing on another athlete’s foot, stepping in a hole, etc. • Inversion/plantar flexion

  39. The inversion mxn

  40. Structures injured • ATF lig. injured with the plantar flexion/inversion mxn • Calcaneofibularlig. and posterior talofibularlig. injured when then inversion force is increased

  41. 3rd degree Lateral Ankle sprain

  42. S/S: Pain, Swelling, discoloration, POT over the sinus tarsi, the distal end of the lateral malleolus and posterior of the lateral malleolus, joint instability, joint stiffness, decreased ROM, “+” anterior drawer test • Will vary with the degree of the injury

  43. Tx: RICE, “horseshoe” shaped felt/foam pad fit around the lateral malleolus • Treat for shock • crutches if necessary • Medical attention if severe or possibility of fracture

  44. Complications • Avulsion fracture of lateral malleolus • Avulsion fracture of base of 5th metatarsal • Push-off fracture of medial malleolus

  45. Eversion Ankle Sprain • Less common due to bony structure of ankle • Deltoid ligament damage (any or all 4 portions

  46. Mxn: ankle everts due to----someone/something landing on the lateral aspect of leg during weight bearing or--- • S/S: Pain, swelling, discoloration, joint instability, joint stiffness, decreased ROM, POT over medial malleolus and deltoid ligament • Will vary depending on severity

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