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Unit 5:Understanding Athletic-Related Injuries to the Lower Extremity Foot and Ankle, Anatomy and Injuries Sports Medicine
Bones = 26 14 phalanges 5 metatarsals 7 tarsals The Foot (Bones)
Toes (Phalanges) • Designed to give wider base for balance and propelling the body forward. • 1st toe (Hallux) • Two sesamoid bones located under the 1st MP joint.
Metatarsals • 5 Bones • 1st metatarsal is the largest and strongest and functions as the main body support during walking and running. • Palpable at the ball of the foot. • 5th metatarsal most common fractured.
Tarsals • 7 bones • Aids in the support of the body. • Calcaneous = largest tarsal bone, supports talus and shapes heel, and provides attachment for achilles tendon.
Joints of the Foot • Interphalangeal joint (IP) • Flexion / Extension • Metarsalphalangeal joint (MP) • Flexion / Extension • Abduction / Adduction
Bones of the Ankle • Tibia • Main weight bearing bone of LOWER LEG • Forms medial malleolus • Fibula • Non-weight bearing • Mainly muscle and ligament attachment • Forms lateral malleolus • Talus • Main weight bearing bone of the ANKLE
Lateral Ligaments of the Ankle • Resist ankle inversion • Anterior talofibular (ATF) • Most commonly sprained • Calcaneofibular (CF) • Posterior talofibular (PTF)
Medial Ankle Ligaments • Deltoid • Resists ankle eversion • Low rate of injury
Quiz • Which bone in the lower leg is the most weight bearing? • What does ATF stand for? • Which ligaments resist inversion? • Which ligaments resist eversion? • What does MP stand for? • How many tarsal bones are there? • How many bones are in the foot?
Answers: • Tibia • Anterior Talofibular • Anterior Talofibular, tibiofibular, calcaneofibular (lateral) • Deltoid ligaments (medial) • Metatarsalphalangeal • 7 • 26
Muscles of the Foot and Ankle • Anterior Muscles (3) • Extensor Hallucis Longus/Brevis • extension of great toe • Extensor Digitorum Longus/Brevis • extension of 2 – 5 phalanges
Muscles of the Foot and Ankle • Anterior Muscles cont. (3) • Tibialis anterior • inversion and dorsiflexion of foot / ankle
Muscles of the Foot and Ankle • Medial Muscles (3) • Tibialis Posterior • Inversion and plantarflexion • Flexor Hallucis Longus • Flexor of great toe and plantarflexion of ankle • Flexor Digitorum Longus • Flexors of 2 – 5 toes and plantarflexion of ankle
Muscles of the Foot and Ankle • Posterior Muscles (2) • Gastrocnemius • plantarflexion of ankle • Soleus • plantarflexion of ankle
Muscles of the Foot and Ankle • Lateral Muscles (2) • Peroneus Longus / Brevis • eversion, plantar flexion of ankle
Quiz • What is the primary function of the Extensor Hallucus Longus and Brevis? • What is the primary function of the tibialis anterior? • What two motions does the peroneus longus and brevis perform? • What motion does the Gastrocnemius/ Soleus perform? • What are the two main motions of the tibialis posterior muscle?
Answers • Extension of great toe • Inversion and dorsiflexion of foot • Eversion and plantar flexion of the ankle • Plantarflexion of ankle • Inversion and plantarflexion
Ankle Sprain • Cause: Excessive inversion or eversion of the ankle • S/S: Point tenderness, swelling, discoloration, laxity, inability to walk or run properly (extent based on degree). • TX: RICE, rehabilitation immediately (Grade III requires immobilization) • Prevention: Strengthening exercises, proper shoes/ equipment
Lateral Ankle Sprain • 1st Degree Ankle Sprain • Mechanism (MX) • Inversion and/or plantarflexion • ATF most common sprained • Occurs during contact or non – contact.
Lateral Ankle Sprain • S/S • 1st degree • Mild pain • Pt – ATF • Possible swelling • Fast recovery to FWB and ROM • No joint laxity
Lateral Ankle Sprain • 2nd Degree Ankle Sprain • MX • Same as 1st degree, more severe. • Involves the ATF, CF • Possible growth plate involvement • Most cases x-ray needed
Lateral Ankle Sprain • S/S • 2nd degree • Felt a pop • Localized severe pain • Pt – more then one ligament • Rapid swelling • Decrease ROM • Laxity in joint • Unable to FWB
Lateral Ankle Sprain • 3rd Degree Ankle Sprain • Rupture of ligaments (ATF, CF, PTF) • Consider a FX • X-ray is mandatory
Lateral Ankle Sprain • S/S • 3rd Degree • Felt or heard pop • Extreme pain • Extreme/rapid swelling • No ROM • Unable to FWB