The Foot and Ankle

Agust Olafsson Brennan Watch David Graham Keaton Adams Mark Ghafari

Bone Anatomy of the Foot

26 bones
Phalanges Metatarsals Tarsals Calcaneus and Talus

33 Joints
3 joints make up the ankle Talocrural Joint Subtalar Joint Inferior Tibiofibular Joint

Foot and Ankle Musculature

Main Muscles
Anterios Tibial, Posterior Tibial, Peroneal Tibial,

Extensors, Flexors

The Ankle Joints

Talocrural Joint
Tibia, fibula, and talus Dorsiflexion and plantar flexion

Subtalar Joint
Talus and calcaneus Inversion and eversion

Inferior Tibiofibular Joint

Tibia and fibula

Fibrous Joint

Ankle Joint

Low Ankle Sprains

Most common injury
Basketball

MOI
Moves beyond normal ROM Anterior Talofibular Ligament POP 3 Grades 1. Slight stretch, mild ligament damage 2. Partial tear, loose ankle 3. Full tear, very unstable

Low Ankle Sprain Signs and Symptoms

Immediate Swelling

Joint Instability
Contusion

Ankle Injury

Low Ankle Sprain Treatment

Treatment
RICE RICE baby Grade 1 Weight bearing as neceesary No splinting necessary Full ROM & Stretching as tolerated Grade 2 Immobilization with splint PT with ROM and stretching/strengthening Grade 3 Immobilization PT similar to grade 2 Possible Surgery

Low Ankle Sprain Complications and Prevention

Complications
Chronic Issue Re-injury

Prevention
Good shoes Proper warm up

High Ankle Sprain

Common in high impact sports
Cutting

MOI
Lateral Twisting Syndesmosis Ligaments

High Ankle Sprain Signs and Symptoms

Radiating pain upwards

Pain when cutting

Light swelling Hard to diagnose

High Ankle Sprain Treatment

RICE

Syndesmosis is constantly in use

2x the normal healing

Complications
Stiffness Arthritis

Kinesiotape Treatment

Turf Toe
Umbrella Term
Ligament and joint damage

Most commonly Big Toe MOI

Hyperextension (dorsiflexion) 3 Grades 1. Small tear, moderate swelling 2. Small tear, severe swelling, contusion 3. Complete tear

Mechanism of Injury
When changing directoion, the ground doesnt

give, and the metatarsophalangeal joint does. Turf is harder than grass, so it doesnt give. Long cleats are more likely to get stuck and cause Turf Toe, which is why turn cleats are much shorter.

Turf Toe Sign and Symptoms

Pain

Swelling
Limited joint movement POP

Turf Toe Treatment

General Treatment

Antinflammatory Orthodic inserts Walking boot Taping

Grade 3 often requires surgery

Complications

Unresolved tenderness and swelling Joint pain/stiffness Cocking up Lack of push off strength

Torn Achilles Tendon

Achilles Tendon
Strongest tendon in body

MOI
Sudden plantarflexion or dorsiflexion Forced dorsiflexion outside ROM Direct trauma Activation of atrohied tendon 20:1 male to female injury ratio

Torn Achilles Tendon Signs and Symptoms

Sharp pain in ankle

Gap above heel

Simmonds test positive Inability to walk Musculoskeletal ultrasonography and MRI

Its Kobe Kobe Snaps His Achilles

Torn Achilles Treatment

Surgical vs. Nonsurgical Nonsurgical
Minor rupture Less active patient Plaster cast

Open Surgery
Suture of Achilles tendon May use vestigial muscle replacement

Percutaneous Surgery
Several small incisions Suture Achilles Delayed action

General Complications
Constant weight on feet and joint

Flat Feet
Long toenails Gout Athletes foot