in your notebooks: list at least 9 bones of the foot and lower leg that we learned last class

In Your Notebooks:

• List at least 9 bones of the foot and lower leg that we learned last class.

#1

A. Anterior Talofibular Ligament

B. Calcaneofibular ligament

C. Deltoid Ligament

D. Posterior Talofibular Ligament

Answer

C. Deltoid Ligament

#2

A. Deltoid, Calcaneofibular, Tibularfibulia

B. Anterior Talfibular, Posterior Talofibular, Calcaneofibular

C. Tibularfibulia, Anterior Cruciate Ligament, Posterior Cruciate ligament

D. None of these

Answer

B. Anterior Talfobular, Posterior Talofibular, Calcaneofibular

#3

• A. Eversion• B. High Ankle Sprain• C. Forced Dorsiflexion• D. Inversion

Answer

• D. Inversion

#4

• A. The ligaments on the laterasl side of the ankle are amaller and weaker

• B. The length of the fibula stops the ankle from being forced outward

• C. Neither of these• D. Both A and B

Answer

• D. Both A and B

#5

• A. Tibialis Anterior and Gastrocnemius• B. Soleus and Gastrocnemius • C. Tibialis Anterior and Tibialis Posterior• D. Peroneus Longus and Perones Brevis

Answer

• B. Soleus and Gastrocnemius

#6

• A. Tibialis Anterior and Gastrocnemius• B. Soleus and Gastrocnemius • C. Tibialis Anterior and Tibialis Posterior• D. Peroneus Longus and Perones Brevis

Answer

• A. Tibialis Anterior

#7

• A. Tibialis Anterior and Gastrocnemius• B. Soleus and Gastrocnemius • C. Tibialis Anterior and Tibialis Posterior• D. Peroneus Longus and Perones Brevis

Answer

• A. Tibialis Anterior

#8

• A. Tibialis Anterior and Gastrocnemius• B. Soleus and Gastrocnemius • C. Tibialis Anterior and Tibialis Posterior• D. Peroneus Longus and Perones Brevis

Answer

• D. Peroneus Longus and Peroneus Brevis

#9

• A. The back view• B. The side view• C. The front view• D. Inside of

Answer

• C. The front view

#10

• A. The back view• B. The side view• C. The front view• D. Inside of

Answer

• A. The back View

#11

• A. microtrauma• B. direct contact• C. avulsion• D. none of these

answer

• B. direct contact

#12

• A. The broken bone comes through the skin• B. A piece of bone is pulled off by the tendon• C. Repeated microtrauma• D. None of these

Answer

• B. A piece of bone is pulled off by the tendon

#13

• A. Swelling, deformity & inability to bear weight

• B. Redness, swelling & signs of infection• C. Mild pain, discoloration, & loss of function• D. None of these

answer

• A. Swelling, deformity & inability to bear weight

#14

• A. Send immediatley to the ER• B. Treat for shock, care for open wounds,

immobilize & transport• C. Immobilize & transport• D. have parent come pick up the athlete

answer

• B. Treat for shock, care for open wounds, immobilize & transport

#15

• A. Inversion• B. High ankle sprain• C. Eversion• D. Bad Ones

answer

• C. Eversion

#16

• A. The amount of pain only• B. The amount of swelling, disability & pain• C. The amount of disability only• D. There is no difference

answer

• B. The amount of swelling, disability & pain

#17

• A. RICE and a horseshoe pad to direct the swelling

• B. RICE only• C. Crutches always• D. Send to the hospital

answer

• A. RICE and a horseshoe pad to direct the swelling

#18

• A. All degrees• B. only 3rd degree• C. 2nd and 3rd degree• D. Never

answer

• C. 2nd and 3rd degree

#19

• A. Inversion• B. Forced Dorsiflexion• C. Forced Plantarflexion• D. Eversion

answer

• B. Forced Dorsiflexion

#20

• A. RICE only• B. RICE & crutches for the first 72 hours• C. Cast• D. Send to ER

answer

• B. RICE & crutches for the first 72 hours

#21

• A. The tape is not as strong as a brace• B. The tape is too expensive• C. The tape loses effectiveness after

approximately 20 minutes• D. There is no disadvantage of taping

answer

• C. The tape loses effectiveness after approximately 20 minutes

#22

• A. Not stretching • B. Explosive motions• C. Rapid change of exercise intensity or

training surfaces• D. Ankle Sprains

answer

• C. Rapid change of exercise intensity or training surfaces

#23

• A. Swelling & deformity• B. Pain & disability• C. loss of function & motion• D. pain & redness

answer

• A. Swelling & deformity

#24

• A. Posterior• B. medial• C. Lateral• D. Anterior

answer

• D. Anterior

#25

• A. Sharp pain, throbbing and infection• B. Swelling, loss of sensation, inability to

dorsiflex & loss of pedal pulse• C. Infection, fluid build-up and loss of

plantarflexion• D. Cramping and Achilles tightness

answer

• B. Swelling, loss of sensation, inability to dorsiflex & loss of pedal pulse

#26

• A. Rest• B. Ice• C. Compression• D. Elevation

answer

• C. Compression

#27

• A. Direct Trauma• B. microtrauma• C. Repetitive Stress• D. Unknown

answer

• D. Unknown

#28

• A. The absence of plantar fascia• B. Inflammation of the plantar fascia• C. A tear in the plantar fascia• D. Has nothing to do with plantar fascia

answer

• B. Inflammation of the plantar fascia

#29

• A. Extreme pain all throughout the day• B. Extreme pain only when jumping• C. Extreme pain first thing in the morning that

eases throughout the day• D. Tight Achilles

answer

• C. Extreme pain first thing in the morning that eases throughout the day

#30

• A. Rest, ice, anti-inflammatories & stretching of achilles

• B. Ice only• C. Rest only• D. Stretching only

answer

• A. Rest, ice, anti-inflammatories & stretching of achilles

#31

• A. Callus formations on the heel• B. A possible result of untreated plantar

faciitis in which ossification occurs forming a painful piece of bone on the heel

• C. Medial leg pain brought about by walking, running or related activity

• D. Brought about by repeated friction from tightly fitting shoes

answer

• B. A possible result of untreated plantar faciitis in which ossification occurs forming a painful piece of bone on the heel

#32

• A. 3rd metatarsal is longer than the 1st metatarsal

• B. 2nd metatarsal is longer than the 3rd metatarsal

• C. 2nd metatarsal is longer than the 1st metatarsal

• D. A neuroma is present

answer

• C. 2nd metatarsal is longer than the 1st metatarsal

#33

• A. Morton’s Toe• B. Bunion• C. Morton’s Neuroma• D. Blisters

answer

• C. Morton’s Neuroma

#34

• A. Having an abnormally high arch• B. Having an abnormally flat arch• C. Not being able to plantarflex• D. Not being able to dorsiflex

answer

• B. Having an abnormally flat arch

#35

• A. Having an abnormally high arch• B. Having an abnormally flat arch• C. Not being able to plantarflex• D. Not being able to dorsiflex

answer

• A. Having an abnormally high arch

#36

• A. Improperly fitting shoes• B. Getting kicked in the foot• C. getting stepped on• D. You are born with bunions

answer

• A. Improperly fitting shoes

#37

• A. The size• B. the palcement• C. A blister is filled with fluid while a callus is

not• D. A callus is filled with fluid while a blister is

not

answer

• C. A blister is filled with fluid while a callus is not

#38

• A. A bruise• B. An ingrown toenail• C. A bunion• D. A hematoma

answer

• D. A hematoma

#39

• A. A cleat stepping on the toe• B. Improperly fitting shoes• C. bad Hygiene• D. You are born with ingrown toenails

answer

• B. Improperly fitting shoes

#40

• A. Navicular and Cuboid• B. Talus and Tibia• C. Tibia and Fibula• D. Navicular and Cuneiforms

answer

• C. Tibia and Fibula

Injuries to the: Lower Leg, Ankle and

Foot

Anatomy Review

Bones and Ligaments of the Ankle and Foot

•Tibia•Fibula•Tarsals•Metatarsals•Phalanges

Note the subtalar joint that is responsible forinversion and eversion of the foot

Anatomy Review (cont.)

Foot Bones (medial view)

1.2.

3.

4.

5.

6.

7.8.

9.

Bones

1.2.

3.

4.

5.

Joints

1. Tarsal-metatarsal joints

2.Metatarsal-phalangeal joints

3.Inter-phalangeal joints

4.Subtalar joint

5.Talocrural joint

1.

2.

3.

4.

5.

6.

Ligaments

1.

2.

3.

4.

5.

6.

1.

2.

3.

4.

Muscles

Foot Anatomy Quiz Word Bank -Calcaneus-Talus-Posterior Talofibular-Navicular-Gastrocnemius-Cuneiforms-Inter-phalangeal-Phalanges-Talocrural-Cuboid-Metatarsal-phalangeal-Tibia

-Tarsal-metatarsal

-Subtalar-Tibialis Anterior-Deltoid-Anterior Talofibular-Posterior Tibiofibular-Metatarsals-Calcaneofibular-Anterior Tibiofibular-Fibula-Peroneus Longus/Brevis-Soleus

In your Notebooks:

• List 4 joints of the foot and ankle discussed last class

Ligaments

The deltoid ligament is the primary stabilizer of the medial side of the talocrural (ankle) joint.

Ligaments (cont.)

Ligaments of the Ankle (lateral view)The three primary

ligaments are:• Anterior

talofibular• Posterior

talofibular• Calcaneofibular

In Your Notebooks:

• What ligament(s) are located on the medial side of the ankle?

• What ligament(s) are located on the lateral side of the ankle?

Directional Term Review:• Anterior:• Posterior:• Medial:• Lateral:• Proximal:• Distal:• Superior:• Inferior:• Superficial:• Deep:• Dorsal:• Plantar:• Intermediate:

In Your Notebooks:

• Define the following directional terms:

• Anterior:• Posterior:• Medial:• Lateral:• Proximal:• Distal:

The Lateral Ankle

• These ligaments are NOT as large or strong as the deltoid.

• Additional lateral stability is provided by the length of the fibula on the lateral side of the ankle.

• The talocrural joint is strongest in dorsiflexion and weakest in plantar flexion.

Motions of the Foot & Ankle:• Plantarflexion:

• Dorsiflexion:

• Inversion:

• Eversion:

Anatomy Review:Muscles

• Plantarflexion:

• Gastrocnemius

• Soleus

• Eversion:

• Peroneus Brevis

• Peroneus Longus

• Dorsiflexion:

• Tibialis Anterior

• Inversion:

• Tibialis Anterior

You have 2 minutes to:

• List all 11 bones of the foot, ankle and lower leg we have learned.

You have 2 minutes to:

• List all 7 ligaments of the foot, ankle and lower leg we have learned about.

You have 1 minute to:

• List the 4 joints of the foot, ankle and lower leg we have learned.

In your notebooks:

• List 5 major muscles of the foot, ankle and lower leg along with their actions.

Review Question Answers1. Tibia and Fibula

2. The Fibula is on the lateral side of the lower leg and supports approximately 2% of the body weight.

3. Talocrural Joint

4. Deltoid Ligament

5. Anterior Compartment- Tibialis Anterior- Dorsiflexion

Medial Compartment- Tibialis Anterior- Inversion

Lateral Compartment- Peroneal longus and Peroneal Brevis- Eversion

Posterior Compartment- Gastrocnemius and Soleus- Plantarflexion

6. Anterior Compartment7. Swelling, deformity, discoloration, inability to bear

weight, possible bone projecting through skin, athlete reports hearing/feeling a snap or pop.

8. True9. An Eversion ankle sprain is more severe.10. The Achilles Tendon attaches to the gastrocnemius

and the soleus muscles down to the calcaneus. Signs and Symptoms of injury are swelling and deformity,athlete reports and snap or a pop, pain, loss of function. Treatment includes ice and compression, immobilization and transport to a medical facility.

11. Compromising the blood vessels and nerves.

12. Suggest a change in workout routine and have their gate analyzed

13. 1.) Almost unbearable pain in the plantar aspect of the foot with the first steps taken on getting out of bed in the morning and pain that eases with each following step. 2.) Point tenderness on the plantar aspect of the calcaneal tuberosity. Heel spurs are ossifications at the site of the attachment on the plantar aspect of the calcaneus.

14. The first and second metatarsal bone. 15. Pes planus is an abnormally flat foot and pes

cavus is an abnormally high arch in the foot

16. A blister is the separation of the layers of skin and a callus is a build up of tissue.

17. Wash area, use sterile needle to puncture and drain blister without removing the top layer of the blister, check area daily for redness or signs of infection, apply antibiotic ointment and cover with sterile dressing.

18. It is definitely best to help prevent blisters by having properly fitted footwear and giving new shoes a short break-in period before using them in practice or competition

19. False. When there is friction between the callus and layers of skin, a blister can form between the callus and the next lower layer of skin

20. True. A callus should be shaved regularly to allow for only a small amount of buildup.

Common Sports Injuries

Fractures• Most often caused by direct trauma

through contact. Contact causes most fractures to the lower leg and foot.

• Repeated micro trauma can result in a stress fracture.

• Avulsion fracture of 5th metatarsal can occur with a lateral ankle sprain.

FracturesSigns and symptoms include:• Swelling and/or deformity at the site of fracture.• Discoloration at the site.• Possible broken bone end projecting through

skin.• Athlete reports a snap or pop was heard or felt.• Inability to bear weight on the affected leg.For a stress fracture or growth plate fracture that

did not result from traumatic event, the athlete complains of extreme point tenderness and pain at the site of injury.

Fractures (cont.)

First Aid

• Watch and treat for shock, if necessary.• Apply sterile dressing to any open wounds.• Carefully immobilize the foot and leg using

a splint.• Arrange for transport to a medical facility.

Soft Tissue Injuries

Ankle Injuries

Ankle sprains are one of the most common injuries to this region.

• Lateral sprains are more common; 80% to 85% of all ankle sprains are to the lateral ligaments (inversion sprains).

• Eversion sprains, while less frequent, are often severe.

Ankle Injuries: Sprains

Signs and symptoms depend on degree of sprain.• 1st degree: Pain, mild disability, point

tenderness, little laxity, little or no swelling• 2nd degree: Pain, mild to moderate disability,

point tenderness, loss of function, some laxity, swelling (mild to moderate)

• 3rd degree: Pain and severe disability, point tenderness, loss of function, laxity, moderate to severe swelling

Ankle Injuries: Sprains (cont.)

First Aid

• Apply ice and compression.

• Elevate.• Apply a horseshoe-

or doughnut-shaped pad.

Courtesy of Brent Mangus

Ankle Injuries: Sprains (cont.)

First Aid (cont.)

• Have athlete use crutches if a second- or third- degree sprain has occurred.

• If there is any question regarding the severity of the sprain, refer athlete to a medical facility for physician’s evaluation.

Ankle Injuries: Sprains (cont.)

Tibiofibular (tib-fib) Sprains• These injuries are often treated

inappropriately as lateral ankle sprains, hindering recovery.

• The difference is the mechanism of injury. Tib-fib sprains involve dorsiflexion followed by axial loading with external rotation of the foot.

• Symptoms include a positive sprain test, but athlete is also in great pain. “Squeeze test” elicits pain in area.

Ankle Injuries: Sprains (cont.)

First Aid

• Immediately apply ice and compression, and elevate the leg.

• Apply a doughnut-shaped pad kept in place with an elastic bandage to provide compression.

• Have athlete rest and use crutches for first 72 hours, followed by wearing a walking boot for 3 to 7 days.

Preventing Ankle Injuries• Taping or bracing will

reduce the number of ankle injuries.

• Prophylactic adhesive taping supports the ankle only for a short time.

• Bracing may be better than taping.

• Bracing combined with some high-top shoes may be helpful.

Courtesy of McDavid

Tendon-Related InjuriesAchilles tendon is commonly injured by long-

distance runners, basketball players, and tennis players.• Onset of tendonitis may be slow among

runners, but more rapid among basketball and tennis players.

• Athletes who dramatically increase workout times or running distances, or who run on hard, uneven, or uphill surfaces are prone to Achilles tendonitis.

• The injury can be either acute or chronic. • Acute injuries are often associated with

explosive jumping or blunt trauma.

Achilles Tendon InjuriesSigns and symptoms include:

• Swelling and deformity at site of injury.• Athlete reports a pop or snap associated with the

injury.• Pain in lower leg that ranges from mild to extreme.• Loss of function, mainly in plantar flexion.

First Aid • Immediately apply ice and compression.• Immobilize with air cast or splint.• Arrange for transport to nearest medical facility.

Compartment Syndrome

Compartment syndrome usually involves the anterior compartment of the lower leg.

Chronic form is related to overuse of the compartment’s muscles that causes swelling of tissues.• Acute trauma, such as being kicked in the leg,

can result in swelling within the compartment as well.

• In either case, swelling puts pressure on vessels and nerves.

• Properly sized shin guards can protect lower leg in soccer.

Compartment Syndrome (cont.)Signs and symptoms include:• Pain and swelling in the lower leg.• Athlete may complain of chronic or acute injury to the area.• There may be loss of sensation or motor control to the

lower leg and/or foot.• There can be loss of pulse in the foot.• Inability to extend the big toe or dorsiflex the foot.First Aid• Apply ice and elevate. Do NOT apply compression.• If there is numbness, loss of movement, or loss of pulse to

the foot, seek medical advice immediately; this is a true medical emergency.

Shin Splints• “Shin splints” is a very common disorder of

lower leg. Term describes exercise-induced leg pain.

• The types of activities that produce this problem and the manifestations of the injury vary depending on the athlete.

• The etiology,(cause) and pathology (injury) of this disorder are unclear.

Shin Splints (cont.)Signs and symptoms include:• Lower leg pain either medially or posteromedially.• Typically, the athlete reports a chronic problem that

progressively worsens.• Pain can be unilateral (one-side) or bilateral (both sides) .First Aid• Apply ice and have the athlete rest.• Use of NSAIDs may be helpful.• Athlete may need to have his or her gait analyzed for

biomechanical deficiencies. • If problem worsens, athlete should seek medical advice.

Plantar FasciitisThe plantar fascia is a dense collection of tissues

that traverses from the plantar aspect of the metatarsal heads to the calcaneal tuberosity.• If this tissue becomes tight or inflamed by

overuse or trauma, it can produce pain and disability.

• Typical symptom is extreme pain in the plantar aspect of the foot with the first steps taken after getting out of bed in the morning. Pain eases with subsequent steps.

• Athlete also has point tenderness in the region of the calcaneal tuberosity.

Plantar Fasciitis (cont.)Treatment is typically conservative and includes:• Rest.• Anti-inflammatories.• Applying cold and heat alternatively to enhance

healing.• A heel pad and stretching the Achilles tendon

complex can assist in recovery.

Re-aggravating the injury increases the healing time.

Heel Spurs• Heel spurs can be related to chronic plantar fasciitis.• Chronic inflammation can result in ossification at the

site of attachment on the plantar aspect of the calcaneus.

• Heel spurs result in long-term disability for many athletes.

Treatment of Heel Spurs• Athlete should consult a physician if spurs become

unbearable. • Applying a doughnut-shaped pad beneath the heel

spur may help but rarely do they improve the problem.

Morton’s FootMorton’s foot typically involves either a shortened 1st

metatarsal or an elongated 2nd metatarsal bone.

• The result shifts weight bearing to the 2nd metatarsal

instead of along the 1st metatarsal.

• Results in pain throughout the foot during

weightbearing.

Morton’s Foot

Morton’s foot may result in Morton’s neuroma.

• The problem is usually with the nerve between the 3rd and 4th metatarsal heads.

• Pain radiates to 3rd and 4th toes.

• A neuroma is an abnormal growth on a nerve.

• Tight-fitting shoes may be the cause. Going barefoot may help.

• This condition is best cared for by a physician.

Arch ProblemsThere are two groups of arch problems: pes

planus and pes cavus.• Pes planus (flat feet) related to pronation.

• Excessive pronation can cause difficulties in the navicular bone and some of the joints around the ankle.

• Arch taping has limited effectiveness. • Corrective arch orthotics may be

beneficial.• Pes cavas (high arches) associated with

plantar fasciitis and clawing of the toes. • Athlete may benefit from orthotic device.

Bunions

Bunions are uncommon in high school and college athletes. • Can be inflamed bursae or bone or joint

deformities.• Can be caused by improperly fitting shoes.• Chronic bunion should be evaluated by

physician.

Blisters & CallusesBlisters and calluses are very common formations,

resulting from friction between layers of skin.• When a blister forms, fluid collects between skin

layers, occasionally the fluid will contain blood.• If the blister is large, it should be drained and the

area padded to prevent further friction.• When draining a blister, it is best to leave top layer

of skin in place. • Use sterile instruments and wear latex gloves or

some other barrier to avoid contact with athlete’s body fluid.

Blisters & Calluses (cont.)NSC First Aid Procedures• Wash area with soap and warm water; sterilize area with

rubbing alcohol.• Use sterile needle to puncture the base of the blister and drain

by applying light pressure. Process may need to be repeated during the first 24 hours.

• Do not remove the top of the blister.• Apply antibiotic ointment to the top and cover with sterile

dressing.• Check daily for signs of infection (redness or pus).• After 3–7 days, remove the top of blister and apply antibiotic

ointment and sterile dressing.• Watch for signs of infection. Pad area with gauze

pads or moleskin.

Toe InjuriesCommon injuries are torn-off nails or hematoma

formation under the nail. • Collection of blood under nail needs to be released.• Use commercially available nail bore to drill small hole

in nail to release blood.Ingrown toenails may result from improperly fitting shoes. • Soak affected toe in warm antibacterial solution. • Elevate toenail by placing a small cotton roll under it

and leave in place as nail grows. • Have athlete obtain shoes that fit more comfortably.

In your Notebooks:• List the signs and symptoms of a lower leg/foot

fracture:

( yes, the information is in your notes!)

You have 5 minutes to:• Retrieve and look over your posters you constructed

before we left for break

Get in your Poster Groups• You will have 6 minutes at each poster to gather information on

the following “common sports injuries to the lower leg, foot and ankle:

• Shin Splints • Arch Problems• Sprains• Fractures• Toe Injuries• Heel Spurs• Plantar Fasciitis • Blisters• Tendonitis• Morton’s Toe• Compartment Syndrome• Bunions

In Your Notebooks:

• List and define the two foot arch abnormalities we have talked about in class.

• http://www.youtube.com/watch?v=HJf5hn5jLF4

Basic Taping

1. 2. 3.

Basic Taping (cont.)

4. 5. 6.

7. 8. 9.

Basic Taping (cont.)

10. 11. 12.

Basic Taping (cont.)

Basic Taping (concluded)

13. 15.14.