In Your Notebooks:

1
In Your Notebooks

• List at least 9 bones of the foot and lower leg
  that we learned last class.

2
1

1. Anterior Talofibular Ligament
2. Calcaneofibular ligament
3. Deltoid Ligament
4. Posterior Talofibular Ligament

3
Answer

• C. Deltoid Ligament

4
2

1. Deltoid, Calcaneofibular, Tibularfibulia
2. Anterior Talfibular, Posterior Talofibular,
   Calcaneofibular
3. Tibularfibulia, Anterior Cruciate Ligament,
   Posterior Cruciate ligament
4. None of these

5
Answer

• B. Anterior Talfobular, Posterior Talofibular,
  Calcaneofibular

6
3

• A. Eversion
• B. High Ankle Sprain
• C. Forced Dorsiflexion
• D. Inversion

7
Answer

• D. Inversion

8
4

• A. The ligaments on the laterasl side of the
  ankle are amaller and weaker
• B. The length of the fibula stops the ankle from
  being forced outward
• C. Neither of these
• D. Both A and B

9
Answer

• D. Both A and B

10
5

• A. Tibialis Anterior and Gastrocnemius
• B. Soleus and Gastrocnemius
• C. Tibialis Anterior and Tibialis Posterior
• D. Peroneus Longus and Perones Brevis

11
Answer

• B. Soleus and Gastrocnemius

12
6

• A. Tibialis Anterior and Gastrocnemius
• B. Soleus and Gastrocnemius
• C. Tibialis Anterior and Tibialis Posterior
• D. Peroneus Longus and Perones Brevis

13
Answer

• A. Tibialis Anterior

14
7

• A. Tibialis Anterior and Gastrocnemius
• B. Soleus and Gastrocnemius
• C. Tibialis Anterior and Tibialis Posterior
• D. Peroneus Longus and Perones Brevis

15
Answer

• A. Tibialis Anterior

16
8

• A. Tibialis Anterior and Gastrocnemius
• B. Soleus and Gastrocnemius
• C. Tibialis Anterior and Tibialis Posterior
• D. Peroneus Longus and Perones Brevis

17
Answer

• D. Peroneus Longus and Peroneus Brevis

18
9

• A. The back view
• B. The side view
• C. The front view
• D. Inside of

19
Answer

• C. The front view

20
10

• A. The back view
• B. The side view
• C. The front view
• D. Inside of

21
Answer

• A. The back View

22
11

• A. microtrauma
• B. direct contact
• C. avulsion
• D. none of these

23
answer

• B. direct contact

24
12

• A. The broken bone comes through the skin
• B. A piece of bone is pulled off by the tendon
• C. Repeated microtrauma
• D. None of these

25
Answer

• B. A piece of bone is pulled off by the tendon

26
13

• A. Swelling, deformity inability to bear weight
• B. Redness, swelling signs of infection
• C. Mild pain, discoloration, loss of function
• D. None of these

27
answer

• A. Swelling, deformity inability to bear weight

28
14

• A. Send immediatley to the ER
• B. Treat for shock, care for open wounds,
  immobilize transport
• C. Immobilize transport
• D. have parent come pick up the athlete

29
answer

• B. Treat for shock, care for open wounds,
  immobilize transport

30
15

• A. Inversion
• B. High ankle sprain
• C. Eversion
• D. Bad Ones

31
answer

• C. Eversion

32
16

• A. The amount of pain only
• B. The amount of swelling, disability pain
• C. The amount of disability only
• D. There is no difference

33
answer

• B. The amount of swelling, disability pain

34
17

• A. RICE and a horseshoe pad to direct the
  swelling
• B. RICE only
• C. Crutches always
• D. Send to the hospital

35
answer

• A. RICE and a horseshoe pad to direct the
  swelling

36
18

• A. All degrees
• B. only 3rd degree
• C. 2nd and 3rd degree
• D. Never

37
answer

• C. 2nd and 3rd degree

38
19

• A. Inversion
• B. Forced Dorsiflexion
• C. Forced Plantarflexion
• D. Eversion

39
answer

• B. Forced Dorsiflexion

40
20

• A. RICE only
• B. RICE crutches for the first 72 hours
• C. Cast
• D. Send to ER

41
answer

• B. RICE crutches for the first 72 hours

42
21

• A. The tape is not as strong as a brace
• B. The tape is too expensive
• C. The tape loses effectiveness after
  approximately 20 minutes
• D. There is no disadvantage of taping

43
answer

• C. The tape loses effectiveness after
  approximately 20 minutes

44
22

• A. Not stretching
• B. Explosive motions
• C. Rapid change of exercise intensity or training
  surfaces
• D. Ankle Sprains

45
answer

• C. Rapid change of exercise intensity or training
  surfaces

46
23

• A. Swelling deformity
• B. Pain disability
• C. loss of function motion
• D. pain redness

47
answer

• A. Swelling deformity

48
24

• A. Posterior
• B. medial
• C. Lateral
• D. Anterior

49
answer

• D. Anterior

50
25

• A. Sharp pain, throbbing and infection
• B. Swelling, loss of sensation, inability to
  dorsiflex loss of pedal pulse
• C. Infection, fluid build-up and loss of
  plantarflexion
• D. Cramping and Achilles tightness

51
answer

• B. Swelling, loss of sensation, inability to
  dorsiflex loss of pedal pulse

52
26

• A. Rest
• B. Ice
• C. Compression
• D. Elevation

53
answer

• C. Compression

54
27

• A. Direct Trauma
• B. microtrauma
• C. Repetitive Stress
• D. Unknown

55
answer

• D. Unknown

56
28

• A. The absence of plantar fascia
• B. Inflammation of the plantar fascia
• C. A tear in the plantar fascia
• D. Has nothing to do with plantar fascia

57
answer

• B. Inflammation of the plantar fascia

58
29

• A. Extreme pain all throughout the day
• B. Extreme pain only when jumping
• C. Extreme pain first thing in the morning that
  eases throughout the day
• D. Tight Achilles

59
answer

• C. Extreme pain first thing in the morning that
  eases throughout the day

60
30

• A. Rest, ice, anti-inflammatories stretching of
  achilles
• B. Ice only
• C. Rest only
• D. Stretching only

61
answer

• A. Rest, ice, anti-inflammatories stretching of
  achilles

62
31

• A. Callus formations on the heel
• B. A possible result of untreated plantar
  faciitis in which ossification occurs forming a
  painful piece of bone on the heel
• C. Medial leg pain brought about by walking,
  running or related activity
• D. Brought about by repeated friction from
  tightly fitting shoes

63
answer

• B. A possible result of untreated plantar
  faciitis in which ossification occurs forming a
  painful piece of bone on the heel

64
32

• A. 3rd metatarsal is longer than the 1st
  metatarsal
• B. 2nd metatarsal is longer than the 3rd
  metatarsal
• C. 2nd metatarsal is longer than the 1st
  metatarsal
• D. A neuroma is present

65
answer

• C. 2nd metatarsal is longer than the 1st
  metatarsal

66
33

• A. Mortons Toe
• B. Bunion
• C. Mortons Neuroma
• D. Blisters

67
answer

• C. Mortons Neuroma

68
34

• A. Having an abnormally high arch
• B. Having an abnormally flat arch
• C. Not being able to plantarflex
• D. Not being able to dorsiflex

69
answer

• B. Having an abnormally flat arch

70
35

• A. Having an abnormally high arch
• B. Having an abnormally flat arch
• C. Not being able to plantarflex
• D. Not being able to dorsiflex

71
answer

• A. Having an abnormally high arch

72
36

• A. Improperly fitting shoes
• B. Getting kicked in the foot
• C. getting stepped on
• D. You are born with bunions

73
answer

• A. Improperly fitting shoes

74
37

• A. The size
• B. the palcement
• C. A blister is filled with fluid while a callus
  is not
• D. A callus is filled with fluid while a blister
  is not

75
answer

• C. A blister is filled with fluid while a callus
  is not

76
38

• A. A bruise
• B. An ingrown toenail
• C. A bunion
• D. A hematoma

77
answer

• D. A hematoma

78
39

• A. A cleat stepping on the toe
• B. Improperly fitting shoes
• C. bad Hygiene
• D. You are born with ingrown toenails

79
answer

• B. Improperly fitting shoes

80
40

• A. Navicular and Cuboid
• B. Talus and Tibia
• C. Tibia and Fibula
• D. Navicular and Cuneiforms

81
answer

• C. Tibia and Fibula

82
Injuries to the Lower Leg, Ankle and Foot
83
Anatomy Review
Bones and Ligaments of the Ankle and Foot

• Tibia
• Fibula
• Tarsals
• Metatarsals
• Phalanges

Note the subtalar joint that is responsible
for inversion and eversion of the foot
84
Anatomy Review (cont.)

• Foot Bones (medial view)

85
Bones
1.
2.
3.
4.
5.
6.
8.
7.
9.


86
(No Transcript)
87
Joints
5.
4.

1.
2.
3.
88
5.Talocrural joint
4.Subtalar joint

• Tarsal-metatarsal joints

2.Metatarsal-phalangeal joints
3.Inter-phalangeal joints
89
1.
Ligaments
2.
6.
3.
4.
5.
90
1.
2.
6.
3.
4.
5.
91
Muscles
3.
1.
2.
4.
92
(No Transcript)
93
Foot Anatomy Quiz Word Bank

• -Calcaneus
• -Talus
• -Posterior Talofibular
• -Navicular
• -Gastrocnemius
• -Cuneiforms
• -Inter-phalangeal
• -Phalanges
• -Talocrural
• -Cuboid
• -Metatarsal-phalangeal
• -Tibia

-Tarsal-metatarsal -Subtalar -Tibialis
Anterior -Deltoid -Anterior Talofibular -Posterior
Tibiofibular -Metatarsals -Calcaneofibular -Anter
ior Tibiofibular -Fibula -Peroneus
Longus/Brevis -Soleus
94
In your Notebooks

• List 4 joints of the foot and ankle discussed
  last class

95
Ligaments

• The deltoid ligament is the primary stabilizer of
  the medial side of the talocrural (ankle) joint.

96
Ligaments (cont.)

• Ligaments of the Ankle (lateral view)
• The three primary ligaments are
• Anterior talofibular
• Posterior talofibular
• Calcaneofibular

97
In Your Notebooks

• What ligament(s) are located on the medial side
  of the ankle?
• What ligament(s) are located on the lateral side
  of the ankle?

98
Directional Term Review

• Anterior
• Posterior
• Medial
• Lateral
• Proximal
• Distal
• Superior
• Inferior
• Superficial
• Deep
• Dorsal
• Plantar
• Intermediate

99
In Your Notebooks

• Define the following directional terms
• Anterior
• Posterior
• Medial
• Lateral
• Proximal
• Distal

100
The Lateral Ankle

• These ligaments are NOT as large or strong as the
  deltoid.
• Additional lateral stability is provided by the
  length of the fibula on the lateral side of the
  ankle.
• The talocrural joint is strongest in dorsiflexion
  and weakest in plantar flexion.

101
Motions of the Foot Ankle

• Plantarflexion
• Dorsiflexion
• Inversion
• Eversion

102
Anatomy ReviewMuscles

• Plantarflexion
• Gastrocnemius
• Soleus
• Eversion
• Peroneus Brevis
• Peroneus Longus

• Dorsiflexion
• Tibialis Anterior
• Inversion
• Tibialis Anterior

103
You have 2 minutes to

• List all 11 bones of the foot, ankle and lower
  leg we have learned.

104
You have 2 minutes to

• List all 7 ligaments of the foot, ankle and lower
  leg we have learned about.

105
You have 1 minute to

• List the 4 joints of the foot, ankle and lower
  leg we have learned.

106
In your notebooks

• List 5 major muscles of the foot, ankle and lower
  leg along with their actions.

107
Review Question Answers

• Tibia and Fibula
• The Fibula is on the lateral side of the lower
  leg and supports approximately 2 of the body
  weight.
• Talocrural Joint
• Deltoid Ligament
• Anterior Compartment- Tibialis Anterior-
  Dorsiflexion
• Medial Compartment- Tibialis Anterior- Inversion
• Lateral Compartment- Peroneal longus and Peroneal
  Brevis- Eversion
• Posterior Compartment- Gastrocnemius and Soleus-
  Plantarflexion

108

• 6. Anterior Compartment
• 7. Swelling, deformity, discoloration, inability
  to bear weight, possible bone projecting through
  skin, athlete reports hearing/feeling a snap or
  pop.
• 8. True
• 9. An Eversion ankle sprain is more severe.
• 10. The Achilles Tendon attaches to the
  gastrocnemius and the soleus muscles down to the
  calcaneus. Signs and Symptoms of injury are
  swelling and deformity,athlete reports and snap
  or a pop, pain, loss of function. Treatment
  includes ice and compression, immobilization and
  transport to a medical facility.
• 11. Compromising the blood vessels and nerves.

109

• 12. Suggest a change in workout routine and have
  their gate analyzed
• 13. 1.) Almost unbearable pain in the plantar
  aspect of the foot with the first steps taken on
  getting out of bed in the morning and pain that
  eases with each following step. 2.) Point
  tenderness on the plantar aspect of the calcaneal
  tuberosity. Heel spurs are ossifications at the
  site of the attachment on the plantar aspect of
  the calcaneus.
• 14. The first and second metatarsal bone.
• 15. Pes planus is an abnormally flat foot and pes
  cavus is an abnormally high arch in the foot

110

• 16. A blister is the separation of the layers of
  skin and a callus is a build up of tissue.
• 17. Wash area, use sterile needle to puncture and
  drain blister without removing the top layer of
  the blister, check area daily for redness or
  signs of infection, apply antibiotic ointment and
  cover with sterile dressing.
• 18. It is definitely best to help prevent
  blisters by having properly fitted footwear and
  giving new shoes a short break-in period before
  using them in practice or competition
• 19. False. When there is friction between the
  callus and layers of skin, a blister can form
  between the callus and the next lower layer of
  skin

111

• 20. True. A callus should be shaved regularly to
  allow for only a small amount of buildup.

112
Common Sports Injuries

• Fractures
• Most often caused by direct trauma through
  contact. Contact causes most fractures to the
  lower leg and foot.
• Repeated micro trauma can result in a stress
  fracture.
• Avulsion fracture of 5th metatarsal can occur
  with a lateral ankle sprain.

113
Fractures

• Signs and symptoms include
• Swelling and/or deformity at the site of
  fracture.
• Discoloration at the site.
• Possible broken bone end projecting through skin.
• Athlete reports a snap or pop was heard or felt.
• Inability to bear weight on the affected leg.
• For a stress fracture or growth plate fracture
  that did not result from traumatic event, the
  athlete complains of extreme point tenderness and
  pain at the site of injury.

114
Fractures (cont.)

• First Aid
• Watch and treat for shock, if necessary.
• Apply sterile dressing to any open wounds.
• Carefully immobilize the foot and leg using a
  splint.
• Arrange for transport to a medical facility.

115
Soft Tissue Injuries

• Ankle Injuries
• Ankle sprains are one of the most common injuries
  to this region.
• Lateral sprains are more common 80 to 85 of
  all ankle sprains are to the lateral ligaments
  (inversion sprains).
• Eversion sprains, while less frequent, are often
  severe.

116
Ankle Injuries Sprains

• Signs and symptoms depend on degree of sprain.
• 1st degree Pain, mild disability, point
  tenderness, little laxity, little or no swelling
• 2nd degree Pain, mild to moderate disability,
  point tenderness, loss of function, some laxity,
  swelling (mild to moderate)
• 3rd degree Pain and severe disability, point
  tenderness, loss of function, laxity, moderate to
  severe swelling

117
Ankle Injuries Sprains (cont.)

• First Aid
• Apply ice and compression.
• Elevate.
• Apply a horseshoe- or doughnut-shaped pad.

Courtesy of Brent Mangus
118
Ankle Injuries Sprains (cont.)

• First Aid (cont.)
• Have athlete use crutches if a second- or third-
  degree sprain has occurred.
• If there is any question regarding the severity
  of the sprain, refer athlete to a medical
  facility for physicians evaluation.

119
Ankle Injuries Sprains (cont.)

• Tibiofibular (tib-fib) Sprains
• These injuries are often treated inappropriately
  as lateral ankle sprains, hindering recovery.
• The difference is the mechanism of injury.
  Tib-fib sprains involve dorsiflexion followed by
  axial loading with external rotation of the foot.
• Symptoms include a positive sprain test, but
  athlete is also in great pain. Squeeze test
  elicits pain in area.

120
Ankle Injuries Sprains (cont.)

• First Aid
• Immediately apply ice and compression, and
  elevate the leg.
• Apply a doughnut-shaped pad kept in place with an
  elastic bandage to provide compression.
• Have athlete rest and use crutches for first 72
  hours, followed by wearing a walking boot for 3
  to 7 days.

121
Preventing Ankle Injuries

• Taping or bracing will reduce the number of ankle
  injuries.
• Prophylactic adhesive taping supports the ankle
  only for a short time.
• Bracing may be better than taping.
• Bracing combined with some high-top shoes may be
  helpful.

Courtesy of McDavid
122
Tendon-Related Injuries

• Achilles tendon is commonly injured by
  long-distance runners, basketball players, and
  tennis players.
• Onset of tendonitis may be slow among runners,
  but more rapid among basketball and tennis
  players.
• Athletes who dramatically increase workout times
  or running distances, or who run on hard, uneven,
  or uphill surfaces are prone to Achilles
  tendonitis.
• The injury can be either acute or chronic.
• Acute injuries are often associated with
  explosive jumping or blunt trauma.

123
Achilles Tendon Injuries

• Signs and symptoms include
• Swelling and deformity at site of injury.
• Athlete reports a pop or snap associated with the
  injury.
• Pain in lower leg that ranges from mild to
  extreme.
• Loss of function, mainly in plantar flexion.
• First Aid
• Immediately apply ice and compression.
• Immobilize with air cast or splint.
• Arrange for transport to nearest medical
  facility.

124
Compartment Syndrome

• Compartment syndrome usually involves the
  anterior compartment of the lower leg.
• Chronic form is related to overuse of the
  compartments muscles that causes swelling of
  tissues.
• Acute trauma, such as being kicked in the leg,
  can result in swelling within the compartment as
  well.
• In either case, swelling puts pressure on vessels
  and nerves.
• Properly sized shin guards can protect lower leg
  in soccer.

125
Compartment Syndrome (cont.)

• Signs and symptoms include
• Pain and swelling in the lower leg.
• Athlete may complain of chronic or acute injury
  to the area.
• There may be loss of sensation or motor control
  to the lower leg and/or foot.
• There can be loss of pulse in the foot.
• Inability to extend the big toe or dorsiflex the
  foot.
• First Aid
• Apply ice and elevate. Do NOT apply compression.
• If there is numbness, loss of movement, or loss
  of pulse to the foot, seek medical advice
  immediately this is a true medical emergency.

126
Shin Splints

• Shin splints is a very common disorder of lower
  leg. Term describes exercise-induced leg pain.
• The types of activities that produce this problem
  and the manifestations of the injury vary
  depending on the athlete.
• The etiology,(cause) and pathology (injury) of
  this disorder are unclear.

127
Shin Splints (cont.)

• Signs and symptoms include
• Lower leg pain either medially or
  posteromedially.
• Typically, the athlete reports a chronic problem
  that progressively worsens.
• Pain can be unilateral (one-side) or bilateral
  (both sides) .
• First Aid
• Apply ice and have the athlete rest.
• Use of NSAIDs may be helpful.
• Athlete may need to have his or her gait analyzed
  for biomechanical deficiencies.
• If problem worsens, athlete should seek medical
  advice.

128
Plantar Fasciitis

• The plantar fascia is a dense collection of
  tissues that traverses from the plantar aspect of
  the metatarsal heads to the calcaneal tuberosity.
• If this tissue becomes tight or inflamed by
  overuse or trauma, it can produce pain and
  disability.
• Typical symptom is extreme pain in the plantar
  aspect of the foot with the first steps taken
  after getting out of bed in the morning. Pain
  eases with subsequent steps.
• Athlete also has point tenderness in the region
  of the calcaneal tuberosity.

129
Plantar Fasciitis (cont.)

• Treatment is typically conservative and includes
• Rest.
• Anti-inflammatories.
• Applying cold and heat alternatively to enhance
  healing.
• A heel pad and stretching the Achilles tendon
  complex can assist in recovery.
• Re-aggravating the injury increases the healing
  time.

130
Heel Spurs

• Heel spurs can be related to chronic plantar
  fasciitis.
• Chronic inflammation can result in ossification
  at the site of attachment on the plantar aspect
  of the calcaneus.
• Heel spurs result in long-term disability for
  many athletes.
• Treatment of Heel Spurs
• Athlete should consult a physician if spurs
  become unbearable.
• Applying a doughnut-shaped pad beneath the heel
  spur may help but rarely do they improve the
  problem.

131
Mortons Foot

• Mortons foot typically involves either a
  shortened 1st metatarsal or an elongated 2nd
  metatarsal bone.
• The result shifts weight bearing to the 2nd
  metatarsal instead of along the 1st metatarsal.
• Results in pain throughout the foot during
  weightbearing.

132
Mortons Foot

• Mortons foot may result in Mortons neuroma.
• The problem is usually with the nerve between the
  3rd and 4th metatarsal heads.
• Pain radiates to 3rd and 4th toes.
• A neuroma is an abnormal growth on a nerve.
• Tight-fitting shoes may be the cause. Going
  barefoot may help.
• This condition is best cared for by a physician.

133
Arch Problems

• There are two groups of arch problems pes planus
  and pes cavus.
• Pes planus (flat feet) related to pronation.
• Excessive pronation can cause difficulties in the
  navicular bone and some of the joints around the
  ankle.
• Arch taping has limited effectiveness.
• Corrective arch orthotics may be beneficial.
• Pes cavas (high arches) associated with plantar
  fasciitis and clawing of the toes.
• Athlete may benefit from orthotic device.

134
Bunions

• Bunions are uncommon in high school and college
  athletes.
• Can be inflamed bursae or bone or joint
  deformities.
• Can be caused by improperly fitting shoes.
• Chronic bunion should be evaluated by physician.

135
Blisters Calluses

• Blisters and calluses are very common formations,
  resulting from friction between layers of skin.
• When a blister forms, fluid collects between skin
  layers, occasionally the fluid will contain
  blood.
• If the blister is large, it should be drained and
  the area padded to prevent further friction.
• When draining a blister, it is best to leave top
  layer of skin in place.
• Use sterile instruments and wear latex gloves or
  some other barrier to avoid contact with
  athletes body fluid.

136
Blisters Calluses (cont.)

• NSC First Aid Procedures
• Wash area with soap and warm water sterilize
  area with rubbing alcohol.
• Use sterile needle to puncture the base of the
  blister and drain by applying light pressure.
  Process may need to be repeated during the first
  24 hours.
• Do not remove the top of the blister.
• Apply antibiotic ointment to the top and cover
  with sterile dressing.
• Check daily for signs of infection (redness or
  pus).
• After 37 days, remove the top of blister and
  apply antibiotic ointment and sterile dressing.
• Watch for signs of infection. Pad area with gauze
  
• pads or moleskin.

137
Toe Injuries

• Common injuries are torn-off nails or hematoma
  formation under the nail.
• Collection of blood under nail needs to be
  released.
• Use commercially available nail bore to drill
  small hole in nail to release blood.
• Ingrown toenails may result from improperly
  fitting shoes.
• Soak affected toe in warm antibacterial solution.
  
• Elevate toenail by placing a small cotton roll
  under it and leave in place as nail grows.
• Have athlete obtain shoes that fit more
  comfortably.

138
In your Notebooks

• List the signs and symptoms of a lower leg/foot
  fracture
• ( yes, the information is in your notes!)

139
You have 5 minutes to

• Retrieve and look over your posters you
  constructed before we left for break

140
Get in your Poster Groups

• You will have 6 minutes at each poster to gather
  information on the following common sports
  injuries to the lower leg, foot and ankle
• Shin Splints
  
• Arch Problems
• Sprains
• Fractures
• Toe Injuries
• Heel Spurs
• Plantar Fasciitis
• Blisters
• Tendonitis
• Mortons Toe
• Compartment Syndrome
• Bunions

141
In Your Notebooks

• List and define the two foot arch abnormalities
  we have talked about in class.

142

• http//www.youtube.com/watch?vHJf5hn5jLF4

143
Basic Taping
1.
2.
3.
144
Basic Taping (cont.)
4.
5.
6.
145
Basic Taping (cont.)
7.
8.
9.
146
Basic Taping (cont.)
10.
11.
12.
147
Basic Taping (concluded)
13.
15.
14.