This document discusses the muscles, injuries, and treatments related to the lower leg and foot. It begins by listing the muscles responsible for ankle movements like dorsiflexion, plantarflexion, inversion, and eversion. It then describes common injuries like ankle sprains, fractures, stress fractures, shin splints, compartment syndrome, Achilles tendinitis, and plantar fasciitis. For each injury, it covers causes, signs, grading (for sprains), and treatment approaches like RICE, bracing, surgery, stretching, and modifying activities. Functional tests for the ankle and feet are also outlined.

1. Presenter:
Nazri Azeli
Mohd Sharul Azrin
Jeff Fakhruddin Shamsudin
Azham Afzanizam Hamzah
Mohd Razmi Rozan

6. Muscles of the Lower Leg and Foot

7. Action Muscles
Ankle dorsiflexion Extensor Digitorium longus,
extensor hallucis longus, tibialis
anterior
Ankle
plantarflexion
Soleus, gastrocnemius
Ankle inversion Tibialis posterior, flexor
digitorium longus, flexor hallucis
longus
Ankle Eversion Peroneus longus, peroneus brevis

8.  Functional Tests
 While weight bearing the following should be
performed
 Walk on toes (plantar flexion)
 Walk on heels (dorsiflexion)
 Walk on lateral borders of feet (inversion)
 Walk on medial borders of feet (eversion)
 Hop on injured ankle
 Start and stop running
 Change direction rapidly
 Run figure eights

9.  Ankle Injuries: Sprains
 Single most common injury in athletics caused by sudden
inversion or eversion moments
 Inversion Sprains
 Most common and result in injury to the lateral
ligaments
 Anterior talofibular ligament is injured with inversion,
plantar flexion and internal rotation

11. -The foot is twisted outwards.
-The inner ligament, called the
deltoid ligament, is stretched too far.
-Patients will have pain on the inner
side of the ankle

12.  injury to the
ligaments around the
ankle
 ligaments above the
joint, syndesmosis
ligaments injured

13.  Graded Ankle Sprains
 Signs of Injury
 Grade 1
 Grade I ankle sprains cause stretching of the ligament.
The symptoms tend to be limited to pain and swelling.
Most patients can walk without crutches, but may not be
able to jog or jump.
 Grade 2
 A grade II ankle sprain is more severe partial tearing of
the ligament. There is usually more significant swelling
and bruising caused by bleeding under the skin. Patients
usually have pain with walking, but can take a few steps.
 Grade 3
 Grade III ankle sprains are complete tears of the
ligaments. The ankle is usually quite painful, and walking
can be difficult. Patients may complain of instability, or
a giving-way sensation in the ankle joint.

14. Sign/symptom Grade I Grade II Grade III
Tendon No tear
Partial
tear
Complete
tear
Loss of functional ability Minimal Some Great
Pain Minimal Moderate Severe
Swelling Minimal Moderate Severe
Ecchymosis
Usually
not Frequently Yes
Difficulty bearing weight No Usually
Almost
always

15. Care
 Must manage pain and swelling
 Apply horseshoe-shaped foam pad for
focal compression
 Apply wet compression wrap to facilitate
passage of cold from ice packs
surrounding ankle
 Apply ice for 20 minutes and repeat every
hour for 24 hours
 Continue to apply ice over the course of
the next 3 days
 Keep foot elevated as much as possible
 Avoid weight bearing for at least 24 hours
 Begin weight bearing as soon as tolerated
 Return to participation should be gradual
and dictated by healing process

18.  There are 2 common type of bone fracture in
your feet:
i. Hairline stress fractures
ii. Traumatic fractures

19.  Ankle Fractures/Dislocations
 Cause of Injury
 Number of mechanisms – often similar to those seen in
ankle sprains
 Signs of Injury
 Swelling and pain may be extreme with possible deformity
 Care
 Splint and refer to physician for X-ray and examination
 RICE to control hemorrhaging and swelling
 Once swelling is reduced, a walking cast or brace may be
applied, immobilization lasting 6-8 weeks
 Rehabilitation is similar to that of ankle sprains once range
of motion is normal

20.  Tiny litle hairline cracks in bones.
 Some fractures are Straight and spiral in
nature.
 This tiny cracks from excessive pounding,
twisting and repetitive actions during
activities.(own explainations)

21.  Cause from blow, impact or accident are much
more obvious.
 TF are very painful and related with pain and
swelling.
 If skin broken, the injury susceptible to
infection.(need medical)

25. Tibial and Fibular Fracture

26.  Acute Leg Fractures
 Cause of Injury
 Result of direct blow or indirect trauma
 Fibular fractures seen with tibial fractures or as the result
of direct trauma
 Signs of Injury
 Pain, swelling, soft tissue insult
 Leg will appear hard and swollen (Volkman’s contracture)
 Deformity – may be open or closed
 Care
 X-ray, reduction, casting up to 6 weeks depending on the
extent of injury

29.  Stress Fracture of Tibia or Fibula
 Cause of Injury
 Common overuse condition, particularly in those with
structural and biomechanical insufficiencies
 Result of repetitive loading during training and conditioning
 Signs of Injury
 Pain with activity
 Pain more intense after exercise than before
 Point tenderness; difficult to discern bone and soft tissue
pain
 Bone scan results (stress fracture vs. periostitis)

30.  Care
 Eliminate offending
activity
 Discontinue stress inducing
activity 14 days
 Use crutch for walking
 Weight bearing may return
when pain subsides
 After pain free for 2 weeks
athlete can gradually
return to activity
 Biomechanics must be
addressed

31. Medial Tibial Stress Syndrome (Shin Splints)
 Cause of Injury
 Pain in anterior portion of shin
 Stress fractures, muscle strains, chronic anterior compartment
syndrome, periosteum irritation
 Caused by repetitive microtrauma
 Weak muscles, improper footwear, training errors, varus foot,
tight heel cord,
hypermobile or pronated feet
and even forefoot supination
can contribute to MTSS
 May also involve stress
fractures or exertional
compartment syndrome

32.  Shin Splints (continued)
 Signs of Injury
 Diffuse pain about disto-medial aspect of lower leg
 As condition worsens ambulation may be painful, morning pain
and stiffness may also increase
 Can progress to stress fracture if not treated
 Care
 Physician referral for X-rays and bone scan
 Activity modification
 Correction of abnormal biomechanics
 Ice massage to reduce pain and inflammation
 Flexibility program for gastroc-soleus complex
 Arch taping and orthotics

34.  Compartment Syndrome
 Cause of Injury
 Rare acute traumatic syndrome due to direct blow or
excessive exercise
 May be classified as acute, acute exertional, or chronic
 Signs of Injury
 Excessive swelling compresses muscles, blood supply and
nerves
 Deep aching pain and tightness is experienced
 Weakness with foot and toe extension and occasionally
numbness in dorsal region of foot

35.  Care
 If severe acute or chronic case, may present as medical
emergency that requires surgery to reduce pressure or
release fascia
 RICE, NSAID’s and analgesics as needed
 Avoid use of compression wrap = increased pressure
 Surgical release is generally used in recurrent conditions
 May require 2-4 month recovery (post surgery)
 Conservative management requires activity modification,
icing and stretching
 Surgery is required if conservative management fails

36.  Achilles Tendonitis
 Cause of Injury
 Inflammatory condition involving tendon, sheath or paratenon
 Tendon is overloaded due to extensive stress
 Presents with gradual onset and worsens with continued use
 Decreased flexibility exacerbates condition
 Signs of Injury
 Generalized pain and stiffness, localized proximal to calcaneal
insertion, warmth and painful with palpation, as well as
thickened
 May progress to morning stiffness

37.  Care
 Resistant to quick resolution due to slow healing nature of
tendon
 Must reduce stress on tendon, address structural faults
(orthotics, mechanics, flexibility)
 Aggressive stretching and use of heel lift may be beneficial
 Use of anti-inflammatory medications is suggested

39.  Achilles Tendon Rupture
 Cause
 Occurs when sudden stop and go; forceful plantar flexion
when
 Commonly seen in athletes > 30 years old
 Generally has history of chronic inflammation
 Signs of Injury
 Sudden snap (kick in the leg) with immediate pain which
rapidly subsides
 Point tenderness, swelling, discoloration; decreased ROM
 Obvious indentation and positive Thompson test

40.  Care
 Usual management involves surgical repair for serious
injuries
 Non-operative treatment consists of RICE, NSAID’s,
analgesics, and a non-weight bearing cast for 6 weeks to
allow for proper tendon healing
 Must work to regain normal range of motion followed by
gradual and progressive strengthening program

42. Before
surgery During
surgery

43.  Shin Contusion
 Cause of Injury
 Direct blow to lower leg (impacting periosteum anteriorly)
 Signs of Injury
 Intense pain, rapidly forming hematoma
 Increased warmth
 Care
 RICE, NSAID’s and analgesics as needed
 Maintaining compression for hematoma (which may need to
aspirated)
 Fit with doughnut pad and orthoplast shell for protection

44.  Attach elastic to
secure object.
 Place elastic around
forefoot.
 Pull foot toward shin
• Place elastic around
ball of foot.
• Push down against
elastic.

45.  Attach elastic to
secure object.
 Pull forefoot outward.
 Loop elastic around
forefoot.
• Attach elastic to
secure object.
• Pull forefoot inward
against.
• Loop elastic around
forefoot.

46. • Place bandage on floor
• Slide the bandage
backward from the
forward using one foot
only.

47. Plantar fasciitis injury
• The “plantar fascia” is a piece of connective
tissue that runs from the heel bone
(calcaneus) to the base of the toes, on the sloe
of your foot.

48. Sign and symptoms
• Sharp pain at the bottom of your heel, almost like
walking on glass.
• Mild swelling within your foot and around your heel.
• The pain, tends to be worse with the first few steps in
the morning, going up stairs or standing on tiptoes.
• Pain after long periods of standing or getting up from
sitting.
• Post exercise pain, usually wont occur during exercise.

49. Treatment..?
• Wearing a splint fitted to your calf and foot while you sleep,
to stretch the fasica, tendons and surrounding tissue.
• Doctors may prescribe off-the-shelf or make custom-fitted
orthotics to help distribute pressure to your feet more
effectively.
• Physiotherapy can provide you with a series
of exercises and stretches designed to decrease
pain, improve range of motion and strengthen
lower leg muscles, all of which will help your
ankle and heel.

50. Penilaian kecederaan pergelangan
kaki dan bahagian bawah kaki

51. Komponen penilaian
• Mekanisme kecederaan
• Tanda-tanda
• Simptom-simptom
• Ujian ketahanan
• Ujian yang khas atau spesifik

52. Terkoyak bahagian sisi pergelangan
kaki
• Mekanisme kecederaan
- plantarflexion
- inversion
• Tanda:
- bengkak (swell)
- perubahan warna (discoloration)
• Simptom-simptom:
- merasa sakit sepanjang sisi pergelangan kaki(ankle)

53. julat pergerakan yang normal untuk
pergelangan kaki(ankle)
• Dorsifleksi - 20 darjah
• Plantarfleksi - 50 darjah
• Inversi - 20 darjah
• Eversi - 5 darjah

54. Pemegangan bahagian utama pada
pergelangan kaki:
• Anterior talofibular ligamen (ATF)
• Calcaneal fibular (CF)
• Poterior talofibular (PTF)
• Bahagian sisi (lateral) molleolus
• Kuboid (cuboid)
• Sinus tarsi
• Metatarsal
• Peroneal tendon

56. Menilai pergelangan sisi kaki
• Anterior drawer
- penilaian ligamen anterior talofibular
(ATF)

57. • Inversi talar tilt
- penilaian ke atas ligamen Calcaneal
fibular.

58. • Eversi talar tilt
 Untuk menilai deltoid ligamen
 Tekanan akan diberikan sedikit demi sedikit
untuk melihat tahap kecederaan melalui dorsifleksi
dan plantarfleksi.

59. Terseliuh (sprain) bahagian
tengah(medial)
• Mekanisme kecederaan:
- Dorsifleksi
- eversi
- Putaran ekternal(external rotation)
• Tanda :
- Bengkak
- Perubahan warna (discoloration/subacute)
• Simptom-simptom :
-kesakitan sepanjang bahagian tengah (medial)
pergelangan kaki

60. Pemegangan bahagian utama pada
pergelangan kaki:
• Anterior tibiotalar
• Tibionavicular
• Tibiocalcaneal
• Posterior tibiotalar
• Medial malleolus
• Lateral malleolus
• Sustentaculum tali
• Navicular
• Sendi talocrural

61. Penilaian keretatkan bahagian bawah kaki dan
Pergelangan kaki
• Bump test
- Tekan pada bahagian atas tumit
- Beri tekanan sehingga
merasa sakit pada bahagian
yang retak.
- Tekanan di tambah dan berhenti
apabila kesakitan di rasai oleh
pesakit

62. That’s ALL…..
Thank you…….