Ankle and leg

Gives definitions for bones, ligaments, and muscles in the ankle and lower leg. Also includes common injuries and tests with images to show examples.

Deltoid ligament

Medial ankle ligament

DIP

Distal interphalangeal joints (toes 2-5)

PIP

Proximal interphalangeal joints (toes 1-5)

MTP

Metatarsal phalangeal joint (toes 1-5)

Function of the Inferior Tibiofibular Syndesmosis

Prevent excessive rotation of the fibula on the tibia

Movement of the Tibiotalar joint

Dorsiflexion + plantarflexion

Movement of the subtalar joint

Inversion and eversion

Lateral ligaments of the ankle

PTF, Tarsometatarsal, CF

Function of lateral ligaments

resist excessive inversion

ATF function

Resist excessive plantarflexion

PTF function

Resist excessive dorsiflexion

Medial ligaments function

Resist excessive eversion

Plantarflexion ROM

45

Dorsiflexion ROM

20

Inversion ROM

30-40

Eversion ROM

15-20

Gastrocnemius function

Plantarflexion, flexes the knee

Soleus function

Works when gastrocnemius isn't,

Tibialis posterior function

Inversion of the foot

Flexor digitorum longus function

Toe flexion of the DIP (toes 2-5)

Flexor hallucis longus function

Toe flexion of the DIP (toe 1)

Flexor digitorum brevis function

Toe flexion of the PIP (toes 2-5)

Flexor hallucis brevis function

toe flexion of the MTP (toe 1)

Abductor digiti minimi function

Abduction of the MTP (toe 5)

abductor hallucis function

Abduction of the MTP (toe 1)

Plantar fascia function

Supports the arches of the foot

Tibialis anterior function

Inversion and dorsiflexion

Extensor digitorum longus function

Extends DIP (toes 2-5)

Extensor hallucis longus function

Extends DIP of 1st toe

Extensor digitorum brevis function

Extends PIP (toes 2-5)

Extensor hallucis brevis function

Extends MTP (toe 1)

Peroneus longus function

Eversion

Peroneus brevis function

Eversion

Peroneus tertius function

Eversion

Retinaculum

Tissue that tendons pass under

Mechanism of plantarfasciitis

Inflammation of the plantar fascia

Signs and symptoms of plantarfasciitis

Pain, inflammation (crepitus and adhesions), hurts more in the morning

Causes of plantarfasciitis

Extra weight, stress on attachment point, bad shoes

Mechanism of heel spurs

Calcification of the plantar fascia, hardened nodule, projection of bone

Signs and symptoms of heel spurs

Nodule, pain and discomfort

Causes of heel spurs

Inflammation in the area

Mechanism of Pes Planus

Flatfoot (born with it) no medial or longitudinal arches

Deformities of Pes Planus

Excessive eversion, abduction, and dorsiflexion (pronation)

Signs and symptoms of Pes Planus

Navicular bone drop, pronation, duck footed, medial pain, tendonitis, shin splints

Treatments for pes planus

Resisted inversion exercises, tibialis posterior strengthening, shoe inserts

Mechanism of pes cavus

High arch, curled toes, compact wave, narrow

Signs and symptoms of pes cavus

Isolated impact points, thick skin (calluses), pigeoned toe

Deformities of Pes Cavus

Excessive inversion, abduction, plantarflexion (supination)

Treatments of Pes Cavus

Physical therapy, orthotics (extra depth), plantar fascia

Hammertoe

PIP fixed in flexion

Claw toe

PIP and DIP in flexion

Mallet toe

DIP in flexion

Mechanism of Arch strains

Main arch (longitudinal) subject to sprain when ligaments are overextended

Signs and symptoms of arch strains

Pain and tenderness on bottom of the foot

Valgus

a deformity in which there is an abnormal displacement of part of a limb away from the midline of the body

Hallux valgus (bunion)

A bony bump that forms on the joint at the base of the big toe. Calcification can occur, widening of metatarsals. Prevented with wedges

Tailor's bunion (bunionette)

5th MTP

Mechanism of Turf toe

Sprain of the ball of the foot at great toe (joint capsule). Flexor hallucis brevis

Signs and symptoms of turf toe

Sprain of the muscle, pain tenderness, weakness, can't flex.

Prevention of turf toe

Rigid orthotic, turf toe tape, prevent extending

Mechanism of ingrown toenail

Toenail grows in tissue, inherited or improper trimming

Mechanism of Jones fracture

5th metatarsal base, avulsion fracture

Signs and symptoms of Jones fracture

Excessive eversion, point tenderness and bruising

Mechanism of Lisfranc Fracture

when there are either torn ligaments or broken bones in the midfoot area of one or both feet

Mechanism of Morton's toe

2nd toe is longer than 1st toe

Signs and symptoms of morton's toe

Pain over 2nd metatarsal. Callus and nerve damage

Treatments of morton's toe

Orthotic for transverse arch metatarsal pad

Mechanism of Plantar neuroma

Pinching of interdigital nerve (3rd + 4th metatarsal)

Pain of plantar neuroma

Electric pain, pain when wearing shoes

Treatment for plantars neuroma

Injections of hydrocortisone (non inflammatory)

Lateral sprain joints involved (In injury order)

ATF, CF, PTF

Mechanism of lateral sprains

Excessive inversion

Signs and symptoms of Lateral sprains

Swelling, bruising (mild, moderate, severe)

Laxity

Bones begin to shift

Steps of injury

Sprain, laxity, looseness, instability

Talar tilt (Varus Stress)

CF ligament; heel and tilt talus (test for CF ligament is ruptured)

Anterior drawer

Assesses ATF; instability of ankle. Stabilizes leg, anterior force and talus movement.

Treatment and rehabilitation of lateral sprains

Immobilizing for 4-6 weeks (allowed maximum dorsiflexion and eversion). To fix torn ends (scar tissue). Taping and bracing

4 phases of rehab

Inflammation control, Improve ROM, Improve strength, Improve proprioception

RTP

Return to play

RICE

Rest, ice, compression, elevation

Propioception

Awareness of body's position in space

Mechanism of Medial sprains

Excessive eversion

Medial joints involved in sprain

Capsule, AiTFL, interosseous membrane, TF joint, Possible fibula

Signs of medial sprain

Point tenderness, discoloration

Talar tilt (Valgus test)

Eversion = Abduction, deltoid

Kleiger's

Simulate MOI, deltoid sprain test

Treatment of medial sprains

Strengthen - inversion (tibialis posterior)

High ankle sprain joints

PiTFL, AiTFL (prevent twisting), syndesmotic (semi movable)

Squeeze test

Tibia and fibula (increase in pain/discomfort)

Mechanism of peroneal tendon subluxation

Dorsiflexion, eversion; subluxation of tendon

Signs and symptoms of peroneal tendon subluxation

Torn retinaculum, pain, discoloration

Reasons for leg pain

Not over usage, bad running form, training errors, 60-85% get injuries.

Pronation

Movement of foot in 3 different planes (frontal, sagittal, and horizontal); Eversion, dorsiflexion, abduction

Supination

Movement of foot in 3 different planes (frontal, sagittal, and horizontal); inversion, plantarflexion, adduction

NSAIDs

Non-steroidal anti-inflammatory drugs are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. aspirin,motrin, aleve, celebrex

Internal tibial rotation

Inward twisting of the tibia (in toeing) pigeon toed

External tibial rotation

Outward twisting of tibia (out toeing) duck footed

Medial tibial stress syndrome (shin splints)

Stress to posterior tibialis muscle

Medial tibial stress syndrome (shin splints) Symptoms

Irritation and inflammation