Sports Med 1; Foot and Ankle; part 2

Anterior Muscle; Tibialis Anterior

Dorsiflexion, inversion. Active around foot strike to control lowering of the foot to the ground after heel strike.

Anterior Muscle; Extensor Digitorum

extension of toes 2-5, dorsiflexion. Stretched by PROM of four toes into full flexion with foot inverted and plantarflexed

PROM

passive range of motion

Anterior muscle; Extensor Hallucis

extension of big toe, dorsiflexion.

Posterior Muscle; Tibialis Posterior

inversion, plantar flexion. behind medial malleolus. Implicated in shin splints. Linked to over pronating in running

Posterior muscle; Gastrocnemius

plantar flexion, part of calf muscle, runs to achilles tendon, from two heads attached to femur

Posterior muscle; soleus

plantar flexion, below gastrocnemius

Lateral muscle; peroneals

eversion, plantar flexion. Important in preventing ankle sprains, strengthen by everting ankle with resistance

Anterior compartment

muscles that dorsiflex ankle and extend the toes. (anterior tibial nerve and tibial artery)

Lateral compartment

peroneals-evert ankle

superficial peroneal nerve

superficial posterior compartment

gastrocnemius and soleus

deep posterior compartment

muscles that invert ankle-posterior tibial artery

selecting appropriate shoes

critical in preventing foot problems

pronation of foot

hypermobility-needs footwear with more stability and firmness

Percussion Fracture Test

gentle percussive blow to tibia or fibula. below or above suspected site. Can be applied upward on bottom of heel, blows set a vibration that resonates at the fracture, causing pain

Compression Fracture Test

tibia and fibula compressed either above or below the fracture site. Increased pain over area may indicate fracture

Thompson Test

used to determine if the achilles tendon is ruptured. Squeeze the calf muscle while the leg is extended and teh foot is hanging over the edge of a table. If the foot does not move, the test is positive

Anterior drawer test

determine injury to anterior talofibular ligament-pt sits on edge of table, AT holds lower tibia with one hand and the calcaneus in the palm of the other, tibia should be stabilized as calcaneus is pulled forward. positive if the foot slides forward, sometimes with a clunking sound.

Kleiger's test

determine injury to deltoid ligament. one hand to stabilize the lower leg, other to hold medial foot and rotate it laterally.

turf toe

excessive flexion or extension of the big toe. s/s pain, swelling, discoloration, inability to walk or run normally.

subungual hematoma

(blood under toenail) MOI: being stepped on, dropped object, kicking an object

plantar fasciitis

pain in the proximal arch and heel. inflation of the plantar fascia.

Jones Fracture

5th metatarsal avulsion fx. moi: forced inversion, peroneus brevis will pull off the bone.

lateral ankle sprain

most common ankle injury, anterior talofib ligament is most commonly injured. MOI: plantar flexion and inversion, pain, swelling, decreased ROM.

medial ankle sprain

uncommon because the deltoid ligament is strong. MOI: excessive eversion

high ankle sprain

anterior tibiofibular ligament sprain, posterior tibiofibular sprain, or syndesmosis sprain. MOI: severe eversion or rotation. Refer to a physician for x-ray to rule out fibula fx.

syndesmosis

the tissue that keeps the distal tibia and fibula together

ankle dislocation

MOI: heel forcefully strikes the ground, a blow to the anterior leg with ankle plantar flexed, severe rotation. S/S: Obvious deformity.

crepitus

a crackling or grating sound usually of bones(occurs in joints too)

Achilles Tendon rupture

forced dorsiflexion of the foot, a blow over the Achilles tendon, or sudden forceful contraction of the gastrocnemius muscle. May hear a pop or feel the tearing of the tendon.

Medial Tibial Stress Syndrome (Shin Splints)

usually occurs in athletes with tight calves, wearing shoes with little support. Pain in the distal med tibia.