C & p ch 6
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C & p ch 6 C & p ch 6 Presentation Transcript

  • Chapter Six Foot, Ankle & Lower Leg
  • Anatomy
    • The foot is the site of some of the most debilitating conditions suffered by athletes.
    • Include:
    • Blisters
    • Calluses
    • Athletes foot
    • Turf toe
    • Ligament Sprains
    • Ingrown toe nails
    • Heel bruises
    • Arch strains
    • Fractures
  • Anatomy
    • The foot has stresses that exceed the demands placed on any other area of the body.
    • Stabilizes & Supports During:
      • Standing
      • Walking
      • Running
      • Jumping
      • The foot absorbs up to 3 times the body weight!
  • Anatomy
    • Individually, the parts of the foot (bones, muscles, ligaments) are weak.
    • Collectively, they can withstand most of the demands placed on them in athletics.
  • Anatomy
    • The key to proper function of the foot is a set of four arches.
    • Help absorb the impact of walking, running, & jumping.
    • The arches are:
    • Metatarsal
    • Transverse
    • Medial Longitudinal (inner)
    • Lateral Longitudinal (outer)
  • Anatomy
    • The foot contains ¼ of the total number of bones in the body.
    • 26 Bones
      • 7 Tarsal bones
      • 5 Metatarsal bones
      • 14 Phalanges
      • There are also 38 joints!
  • Anatomy
    • Tarsal Bones:
    • Talus
    • Calcaneus
    • Navicular
    • Cuboid
    • Medial, Intermediate, & Lateral Cuniform Bones (that’s 3 of them)
    • Mid-foot region has 5 Metatarsal Bones
    • The toes (AKA Phalanges ) have 14 Bones
  • Anatomy METATARSAL
  • Anatomy
    • The ankle joint (Talocrural Joint)
    • The most commonly injured joint in athletics.
      • Most injuries are either ligament sprains or muscle strains.
  • Anatomy
    • The ankle joint has 2 joints:
    • Talocrural Joint
      • Bones: Tibia, Fibula, & Talus
    • Subtalar
      • Bones: Talus & Calcaneus (2 largest Bones of the foot)
    • Note:
    • Large boney Prominences on either side of the foot are the Medial Malleoli (tibia) & Lateral Malleoli (fibula)
  • Anatomy
    • Tibia
    • Transmits the weight or force placed on the lower leg to the talus.
      • Mounted directly on top of the talus & extends over the medial side forming the medial malleolis
    • Fibula
    • On the lateral side forming the lateral malleolis helps to stabilize the ankle joint
  • Range of Motion
    • Talocrural J oint
    • a hinge joint.
    • Dorsiflexion “toes to the nose”
    • Plantar Flexion extension “Point the Toes”
  • Range of Motion
    • Subtalar Joint
    • triplanar movement with around the oblique axis.
    • Most stable when placed in dorsiflexion
  • Range of Motion
    • Talus
    • Moves Anteriorly (forward) & Posteriorly (Backward)
    • Talus sit on top of the calcaneous
    • The ankle joint despite # of injuries in the area is still very strong.
    • Stresses in athletics is the cause of ankle injuries
  • Anatomy
    • After bony structure strong ligaments make up the first line of defense against ankle sprains.
    • Most ligaments involved in supporting the ankle are attached to the rough edges of the malleoli.
  • Anatomy / Ligaments
    • Ligaments are named for the bones they connect.
      • Most commonly injured are on the Lateral side (outside) of the ankle.
        • Anterior talofibular (ATF)
        • Anterior tibiofibular
        • Calcaneofibular
        • Posterior talofibular
      • Ligaments on the Medial side (inside) of the ankle (fyi, sprain to medial ligaments often associated with a fx)
        • Deltiod
  • Anatomy / Muscles
    • 13 Major Muscle that support the ankle joint
    • 2 of the most important:
      • Achilles Tendon
      • Peroneus Muscle Group
  • Anatomy / Muscles
    • Achilles Tendon
    • The attachment of the Gastronemius and Soleus Muscles (Calf Muscles)
      • Attach to the Calcaneus
      • Tightness of Achilles Tendon is often the cause of recurrent ankle sprains.
  • Anatomy / Muscles
    • Peroneal Muscle
    • Group of muscles along the Lateral side of the leg & foot
      • The Peroneal Brevis attach to several areas of the foot
      • The Peroneal Longus runs across the plantar surface of the foot
      • When the Peroneal group contracts it everts the foot
      • This helps to prevent Lateral ankle sprains.
  • Anatomy / Shin
    • 2 Bones of the Leg:
    • Tibia
    • Fibula
    • Shin – is the area in the front of the leg
    • Interosseous Membrane – associated with anterior (front) shin pain (Shin Splints)
    • Dermatome – A sensory distribution of a nerve root.
      • Produces sensation in the corresponding area
    • Myotome – a single nerve root
      • Produces movement of anatomical structures
  • Bones
    • Tibia
    • Fibula
    • Talus
    • Calcaneus
    • Navicular
    • Cuniforms (1-3)
    • Cuboid
    • Metatarsals (1 – 5)
    • Phalanges (1 – 5)
  • Ligaments / Muscles
    • Anterior Talofibular Ligament
    • Posterior Talofibular Ligament
    • Deltoid Ligament
    • Gastrocnemius – Plantar Flexes the foot &
    • Flexes the lower leg.
    • Soleus - Plantar Flexes the foot
    • Peroneus Longus – everts & abducts foot,
    • Plantar Flexes foot
    • Peroneus Brevis – everts & abducts foot, Plantar
    • Flexes foot
    • Popliteus – Knee Flexon, medial rotation of tibia
    • Metatarsal
    • Transverse
    • Medial Longitudinal (inner)
    • Lateral Longitudinal (outer)
    Arches
  • Range of Motion
    • Dorsiflexion – the act of drawing the toe or
    • foot toward the dorsal aspect
    • of the proximally conjoined
    • body segment.
    • Toes to the nose
    • Plantar Flexion – the act drawing the toe or
    • foot toward the dorsal aspect
    • of the proximally conjoined body
    • segment.
    • Point the toe
  • Range of Motion
    • Inversion – turning the sole of the foot inward
    • Eversion – turning the sole of the foot outward
    • Flexion (toes) – decreasing the angle between
    • the toes and the sole of the
    • foot
    • Extension (toes) – Increasing the angle
    • between the toes and the sole of
    • the foot
  • Range of Motion
    • Pronation – combined motions of calcaneal
    • eversion, foot abduction and
    • dorsiflexion.
    • Supination - combined motions of calcaneal
    • inversion, foot adduction and
    • plantar flexion.
    • Abduction – movement of body segments
    • away from the midline
    • Adduction - movement of body segments
    • towards from the midline
  • Evaluation
    • The first purpose of an evaluation is to determine if a serious injury has occurred.
    • Always suspect a fx till proven otherwise
    • Signs of Fracture
    • Direct or indirect pain
    • Deformity
    • Grating sound
    • Loss of function
  • Evaluation
    • Note: some fractures are not accompanied by swelling or pain.
    • If a Fracture is suspected the extremity should be splinted & the athlete transported for medical evaluation.
  • HISTORY
    • Mechanism of Injury
      • How did it happen?
    • Location of Pain
      • Where does it hurt?
    • Sensation experienced
      • Did you hear a “pop” or a “snap”?
    • Previous History
      • Have you injured this area before?
  • Observation
    • Look for signs of trauma: Compare involves vs.
    • Uninvolved
    • Bleeding
    • Deformity
    • Swelling
    • Discoloration
    • Scars
  • Palpation
    • Palpate above & below injury site.
    • Work your way down to injury.
      • Gain confidence of athlete
      • Involve the athlete as much as possible
      • Compare
    • Areas to check:
    • Neurological (motor/sensory)
    • Circulation
    • Anatomical Structures
    • Fracture Test (palpation, compression, distraction)
  • Special Test
    • Testing instability, disability, & pain.
    • Before you start, can you make it worse?
    • Only a NATABOC certified athletic trainer is considered competent to perform these test and give a proper evaluation (other medical professional as well)
    • Test performed to assess the following:
    • 1. Joint Stability 2. Muscles / Tendons
    • 3. Accessory Anatomical Structures
    • 4. Inflammation 5. ROM ( active, assistive, passive, resistive )
    • 6. Pain / weakness
  • Special Test
    • Assessment Test:
    • Bony Integrity
    • Heel Tap Test : Check the Tibia, Fibula, & Talus
    • Squeeze Test: Check the Tibia & Fibula
    • Ligament Stability
    • Anterior Drawer Test: Test anterior talofibular and
    • calcaneofibular ligaments
    • Talar Tilt: Calcaneofibular, anterior talofibular, but
    • also the (medial) deltoid ligaments
  • Special Test
    • Muscle Function
    • Thompson Test: Test the Achilles tendon
  • Refer When
    • There is:
    • Gross Deformity
    • Significant Pain
    • Increase swelling
    • Circulation or Neurological Issues
    • Joint Instability
    • Suspected Fracture
    • Abnormal Sensations ( clicking, popping, grating, or
    • weakness)
    • Any doubts!
  • Injuries
    • Ankle Sprains
    • Most common injury to the ankle
      • Usually caused by excessive plantar flexion with inversion
      • “ stepping in a hole”
  • Injuries (Ankle Sprain)
      • 3 Categories
      • 1. First Degree – (mild) 1 or more supporting ligaments
      • are stretched
        • Minor discomfort, point tenderness, swelling.
        • No instability
      • 2. Second Degree – (moderate) a portion 1 or more
      • ligaments are torn
        • There is pain, point tenderness, swelling, disability, & loss of function
        • There is some abnormal movement in the joint
      • 3. Third Degree – (Severe) 1 or more ligaments are
      • completely torn
        • Joint is unstable
        • Pain can be extreme to very little (torn nerve endings), loss of function, point tenderness, rapid swelling
        • Usually associated with a fracture
  • Injuries (Arch Sprain)
    • Arches are designed to act as “shock absorbers”
    • Most common injuries occur to the metatarsal or the inner longitudinal arches
    • Any of the 4 arches can sprain a ligament
    • Causes:
      • Flat feet
      • Overuse
      • Overweight
      • Fatigue
      • Training on hard surfaces
      • Wearing non supportive, worn, or shoes that do not FIT!
  • Injuries (Great Toe Sprain) “Turf Toe”
    • A sprain given to the First Metatarsophalangeal Joint.
    • Mechanism of injury – hyperextension of the
    • great toe.
  • Injuries (Medial Tibia Stress Syndrome) Shin Splints
    • Thought to be an inflammation of the interosseous membrane, strain to the soleus muscle, or other chronic lower leg condition.
    • Cause : muscle weakness or imbalance , lack of proper conditioning , improper or incomplete warm-up , poor flexibility , lack of stretching , running on hard surfaces , improper running form or habits , improper running shoe , or poor anatomical structures .
  • Injuries (Plantar Fasciitis)
    • The plantar fascia is a wide, non – elastic ligamentous tissue that extends from the anterior portion of the calcaneus to the heads of the metatarsals.
    • Supply support to the longitudinal arch of the foot.
    • Can strain tissue from overuse, unsupportive footwear, a tight Achilles tendon, or running o hard surfaces.
  • Injuries (Heel Spur)
    • A bony growth on the calcaneus that causes painful inflammation of the accompanying soft tissue and is aggravated by exercise.
  • Injuries (Anterior Compartment Syndrome) 4 Compartments
    • Once suspected, anterior compartment syndrome should be treated as a medical emergency
  • Injuries (Anterior Compartment Syndrome)
    • Cause:
    • Direct trauma or excessive exercise can result in hemorrhage & swelling inside the compartment.
    • Swelling will increase the pressure on the peroneal nerve, the veins, and finally, the arteries inside the compartment.
    • Without arterial circulation, muscle cells will become necrotic and die.
  • Injuries (Anterior Compartment Syndrome)
    • Signs:
      • Pain even after icing down
      • Firmness of the muscle
      • Numbness of the foot
      • Pain with passive ROM
      • Lack of strength
  • Injuries (Achilles Tendon Strain)
    • Achilles Tendon is the strongest in the body
    • Injuries range from a minor strain to a complete tear.
    • Minor strains should be treated conservatively because many strains will lead to complete tear
    • Remember Thomson Test for eval.
  • Injuries (Stress Fracture)
    • If exercise is too severe, or too long in a duration, a negative change in bone structures will occur and cause stress fracture.
  • Injuries (muscle cramps)
    • A cramp is a sudden, involuntary contraction of a muscle.
    • Cause: unknown
    • Can be because of several factors:
    • Fatigue
    • Fractures
    • Dehaydration
    • Poor Flexibility
    • Previous injury, rehab not completed
    • Improper fitted equipment.