Foot_ Ankle_ Lower Leg

					Chapter 16
 Midline=  middle of the body or closest to
  the middle of the body
 Distal= farthest from the trunk of the
 Proximal= closest to the trunk of the
 Anterior= the front
 Posterior= the back
 Supine= stomach up
 Prone= back up
 Supination (forearm)= palm up
 Pronation (forearm)= palm down
 Ventral= belly side
 Dorsal= back side
 Inferior= below
 Superior=above
 Deep=   below the surface
 Superficial= near the surface
 Lateral= to the side
 Medial=middle or center
 External rotation= bone or limb rotates to
  the lateral or outside of the body
 Internal rotation= bone or limb rotates to
  the medial or inside of the body
 Anatomy:    26 bones
 • Phalangies (5)
 • Metatarsals (5)
 • Tarsals
    Cuboid, navicular, lateral, medial and intermeidate
     cuneiforms, cuboid, Can have 2 sesmoid bones under
     the head of the first metatarsal
 • Calcaneus
 • Talus
 • Arches
 Anatomy: Talocrural           joint
  • Talus
  • Tibia
  • Fibula
  • Ligaments:
     Medial side= deltoid ligament
     Lateral side= Calcaneofibular, Anterior talofibular,
      posterior talofibular, anterior tibiofibular, posterior
 Anatomy:
 • Tibia
 • Fibula
 • Muscles:
    Compartments- anterior, posterior, lateral
    Anterior= dorsiflexion and extension of the toes
    Posterior=plantarflexion of the foot (calf muscle),
     achillies tendon
    Lateral= everters (peroneus longus and brevis)
     brevis attaches at the base of the 5th
 Skeletal   injuries
  • Fracture= usually through direct trauma to the
   lower leg
    Foot= also through direct trauma
  • Stress fractures
     Microtrauma or overuse
  • Avulsion fracture=bone tears off with tendon or
    Base of the 5th when lateral ankle sprain
 Fracture
 1. swelling  and/or deformity at location
 2. discoloration at the site
 3. bone projecting through skin
 4. heard or felt snap or pop
 5. may not be able to bear weight
 6. stress fracture= extreme point
  tenderness and pain at one spot
 Fracture
 1. Watch and treat for shock if necessary
 2. apply sterile dressing to any wounds
 3. immobilize the foot and leg
 4. arrange for transportation
    Ankle sprains, 2. Syndesmosis sprain,
         3. Tendonitis, 4.Tendon rupture,
5. compartment syndrome, 6. shin splints
 Sprain=   abnormal stresses placed on
  ligamentous structures and cause various
  level of damage.
 Occur lateral or medial
 80-85% of ankle sprains occur on the
  lateral side
 Thought that eversion sprains are more
 1. First-degree  sprain- pain, mild disability,
  point tenderness, little laxity, little or no
 2. Second-degree sprain- pain mild to
  moderate disability, point tenderness, loss of
  function, some laxity (abnormal movement),
  swelling (mild to moderate)
 3. Third-degree sprain- pain and severe
  disability, point tenderness, loss of function,
  laxity (abnormal movement), swelling (
  moderate to severe)
 1. Immediately   apply ICE, horseshoe or
  doughnut-shaped pad
 2. Rest, use crutches with a second or
  third degree sprain
 3. If any concerns about severity, splint
  and send to doctor
 Sprain  of the interosseous
  membrane(between the tibia and fibula)
 Caused by dorsiflexion of the ankle,
  followed by a load while the ankle is in
  external rotation and the lower leg is in
  internal rotation
 Foot is usually planted, ankle facing
  outward and an internal twist is applied
  on the upper leg.
 1. mechanism   is different
 2. positive ankle sprain tests, but point
  tender over syndesmosis
 3. pain with the squeeze test
 First Aid
  • ICE, horseshoe
  • Rest and crutches first 72 hrs., walking boot
    minimum 3 days
  • Questions concerning severity splint and send to
                      inflammation of the
 Achillies Tendonitis=
 tendon sheath or subctaneous bursa
 dorsal to the tendon
  • Athletes who dramatically increase their running
    distance or workout times and who do so
    running on hard, uneven or uphill surfaces are
    more prone
  • injured by long-distance runners, basketball
    players, tennis players
  • 1. increased temperature in the immediate area
  • 2. painful to touch
  • 3. movement appears thickened
  • 4. pain localized to small area of tendon and
    intensifies when movement is initiated after rest
 Fist   Aid
  • 1. immediate rest until swelling is gone
  • 2. ice and NSAIDs
  • 3. heel lift
  • 4. stretching
 Caused    by explosive jumping or direct
 Signs & Symptoms
  • 1. swelling and deformity at site
  • 2. report pop or snap
  • 3. pain in lower leg, range from mild to extreme
  • 4. loss of function
 First   Aid
  • Ice and compression, immobilize, transport to
    medical facility
 Usually in the anterior compartment of
 the lower leg, cause by either over use or
 direct trauma to the area.
  • Problem occurs when swelling collects in the
    small anterior compartment and puts pressure
    on the blood vessels and nerves
  • Can be cause by being kicked in the leg, or hit
    by a ball
  • Common in soccer athletes
 Can   happen in other compartment of the
   1. pain and swelling lower leg
   2. complain of chronic or acute injury to leg
   3. loss of sensation or motor control to lower leg and/or
   4. loss of pulse to the foot
   5. inability to extend great toe or dorsiflex the foot
   First Aid
     • Ice and elevate, do not apply compression
     • If foot becomes numb, loss of movement, or loss of
       pulse seek medical attention immediately
     • Seek medical advice early
 Exercise  induced leg pain, no real cause,
  or specific activities that cause it
 Signs & Symptoms
  • 1. Lower leg pain either medially or posterior
  • 2. chronic problem that progressively gets worse
  • 3. pain and discomfort can be bilaterally or
 First   Aid
  • 1. Ice, rest, NSAIDs
  1. Plantar Fasciitis, 2. Heel spurs 3.
   Morton’s foot 4. Arch problems 5.
Bunions 6. Blisters & Calluses 7.Toe
   Pain or disability in the bottom of the foot caused by
    tightness or inflammation in the tendons and muscles
    of the plantar aspect of the foot caused by over use or
   Change in shoes, training techniques, or activity can
    cause it
   Will state that first getting out of bed is worse, then gets
    better with each step, point tender at plantar aspect of
   Treatment: conservative- rest, anti-inflammitories, cold
    and heat contrast
    • Heel pad, stretch achillies tendon, semi-rigid orthotics ( can be
      uncomfortable to exercise in)
 Chronic   inflammation can cause
  ossification at the site where the plantar
  fascia attaches
 Can also be located at the posterior
  aspect, where the achilles tendon
 Causes problems for athletes, can use a
  doughnut to relieve the symptoms
 Should consult a doctor for treatment
 Invloves either a shortened first
  metatarsal or an elongated second
  metatarsal, resulting in all the weight
  being at the second instead of the first
 Causes pain and problems walking, can
  pad the area
 Morton’s neuroma tumor between the 3rd
  and 4th metatarsal, causes pain, must be
  taken care of by a doctor
2  catagories: Pes planus (flat foot) and
  Pes cavus( high arches)
 Flat foot- can be due to foot pronation,
  causing problems at the navicular, can
  tape or use orthotics
 High arches- associated with plantar
  fasciitis and clawing of the toes, can also
  hinder shock absorption
Pes Cavus   Pes Planus
 Can   be inflamed bursae or involve
  complicated bone and joint deformities
 Can be caused by improper shoe fit, can
  be fix by changing shoes
 If an athlete has had for weeks or months
  then they should see a doctor
 Caused   by friction between the layers of
 Blister treatment: large ones should be
  drained and padded, should leave the
  layer of skin in tact to prevent infection
 If it bursts, clean the area, and cover
 Callus treatment: do not let get large, can
  shave the callus to keep it small
 Nails  torn off, hematoma forms under the
  nail, ingrown toe nail.
 Hematoma must be drained via nail drill
 Ingrown toe nail, nail must be elevated

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