THE FOOT & ANKLE

1. THE FOOT & ANKLE

2. Foot & Ankle Anatomy • Bones • Tibia • Fibula • 7 Tarsal Bones • 5 Metatarsals • Phalanges

3. Foot & Ankle Anatomy • Muscles • Plantar Flexors point the toe/ankle • Dorsiflexors flex foot toward the shin • Everters pull heel out • Inverters pull heel in • Pronation= Plantar flexion + eversion • Supination= Dorsiflexion + inversion

4. Foot & Ankle Injury • Difficult to assess secondary to the impact of other structural abnormalities. Is it really the foot that is pronated or is it being caused by the rotation of the tibia? If you notice a significant abnormality you may want to refer the athlete to a physician or a PT for exam to maximize efficiency and minimize risk of injury.

5. Foot and Ankle Injury • Stress Fractures • Primarily occur in smaller slimmer metatarsal bones (usually 5th) in runners. • Caused by improper loading on the lateral side of the foot due to weakness, instability. • Treatment: “R”ICE • Athlete should be referred by a Physician/PT for biomechanical evaluation prior to returning to activity.

6. Foot and Ankle Injury • Achilles Tendonitis • Inflammation of the thick tendon that connects the calf muscles to the heel. • Look for pain increasing with activity, palpable crepitus in the tendon, pain increases with uphill walking or climbing stairs. • Can be caused by abnormal foot mechanics, improper footwear, poor conditioning, decreased flexibility. • Primarily affects distance runners. • Important to catch early and treat with RICE. Need to have athlete assessed for proper footwear and may need to adjust training surfaces.

7. Foot and Ankle Injury • Calf Strains • Usually results from overuse or overloading of the muscles in the calf. • Can involve the Gastrocnemius, Soleus, or the Plantaris muscles. • Can be caused by abnormal foot mechanics, improper footwear, poor conditioning, decreased flexibilty • Different grades I-overstretch, II-partial tear may see bruising from torn muscle fibers (should treat both grade I & II with RICE and keep ankle flexed up toward shin), III-complete rupture (inability to point toe, WB) requires immediate medical attention.

8. Foot and Ankle Injury • Ankle Sprains • Varying degrees as in other sprains. • Usually “inversion” sprains landing on the outside of your foot/ankle. • Common in basketball, volleyball and most sports where lateral movements are common. Also commonly caused by jumping and landing on another athlete’s foot etc. • Typically if you witness a severe “eversion” injury should be careful to have athlete checked for fracture. • Treatment: RICE, 2-3 days rest with mild sprain depending on severity of symptoms. May consider bracing or taping to support joint multidirectionally.

9. Foot and Ankle Injury • Plantar Fascitis • Pain through arch of foot caused by overloading and poor foot mechanics • Usually the result of an imbalance between muscle strength and muscle flexibility. • Should be medically evaluated as early as possible. There is a chance that bone spurs can develop in response to the stresses being placed on the attachment of the PF.

10. STRETCHING/ STRENGTHENING LAB