3. MEDIAL BONY ANATOMY
• Tibia• Medial
Malleolus
• Talus
• Calcaneus
• Navicular
(Tubercle)

4. LATERAL BONY ANATOMY
FibulaLateral Malleolus
Talus
Calcaneus

5. MEDIAL LIGAMENTOUS ANATOMY
(DELTOID LIGAMENT)
Deep Portion
- Anterior Tibiotalar
Superficial Portion
- Tibonavicular
- Tibialcalcaneal
- Posterior Tibiotalar

6. ANKLE SPRAINS
Inversion Ankle Sprain
Anterior Talo-fibular (ATF)
Calcaneofibular
Posterior Talo-fibular
Eversion Ankle Sprain
Deltoid Ligament
**What type of sprain is more common? Why?

7. LATERAL LIGAMENTOUS ANATOMY
Lateral View
Posterior View

8. MEDIAL MUSCULATURE
“Tom”
Tibialis Posterior
“Dick “
Flexor Digitorum Longus
“An”
Posterior Tibial Artery &
Nerve
“Harry”
Flexor Hallicus Longus

9. LATERAL MUSCULATURE

10. POSTERIOR MUSCULATURE

11. ANTERIOR MUSCULATURE

12. ARCHES OF THE FOOT

13. PLANTAR FASCIA

14. FOOT/ANKLE ASSESSMENT
History
Generic history questions
Questions specific to the foot/ankle
Location of pain - heel, foot, toes, arches?
Training surfaces or changes in footwear?
Changes in training, volume or type?
Does footwear increase discomfort?

15. OBSERVATIONS
Does athlete favor a foot, limp, or is unable to bear weight?
Is there pes planus/cavus?
How is foot alignment?
Are there structural deformities?

16. ANKLE 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
•Occasionally the force is great enough for an avulsion fracture to
occur w/ the lateral malleolus

17. Severity of sprains is
graded (1-3)
The most common type
of sprain in an inversion
ankle sprain
?What structures are
injured?

18. EVERSION ANKLE SPRAINS
Etiology
• Bony protection and ligament
strength decreases likelihood of
injury
• Eversion force results in damage to
deltoid ligament and possibly fx of
the fibula
• Deltoid can also be impinged and
contused with inversion sprains
-(Represent 5-10% of all ankle sprains)

19. SIGNS AND SYMPTOMS
• 1st degree
• Mild pain and disability; weight bearing is minimally impaired; point tenderness
over ligaments and no laxity
•
2nd degree
• Feel or hear pop or snap; moderate pain w/ difficulty bearing weight; tenderness
and edema
• Positive ligament tests
• Possible tearing of the anterior talofibular and calcaneofibular ligaments (inversion
sprain) or deltoid ligament (eversion sprain)
•
3rd degree
• Severe pain, swelling, hemarthrosis, discoloration
• Unable to bear weight
• Positive ligament tests – torn ligaments

20. SYNDESMOTIC SPRAIN
Etiology
• Injury to the distal tibiofemoral joint
(anterior/posterior tibiofibular
ligament)
• Torn w/ increased external rotation or
dorsiflexion
• Injured in conjunction w/ medial and
lateral ligaments
Signs and Symptoms
• Severe pain, loss of function; passive
external rotation and dorsiflexion cause
pain
• Pain is usually anterolaterally located

21. ANKLE FRACTURES/DISLOCATIONS
Etiology
Number of mechanisms
Signs and Symptoms
Swelling and pain may be extreme with possible deformity

23. ACHILLES TENDINITIS
Etiology
• 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 and Symptoms
• Generalized pain and stiffness, localized proximal to calcaneal insertion
• Warm and painful with palpation, also presents with thickening
• May limit strength
• May progress to morning stiffness
• Crepitus with active plantar flexion and passive dorsiflexion
• Chronic inflammation may lead to thickening

25. ACHILLES TENDON RUPTURE
Etiology
• Occurs w/ sudden stop and go; forceful plantar flexion w/ knee moving
into full extension
• Commonly seen in athletes > 30 years old
• Generally has history of chronic inflammation
Signs and Symptoms
• Sudden snap (kick in the leg) w/ immediate pain which rapidly subsides
• Point tenderness, swelling, discoloration; decreased ROM
• Obvious indentation and positive Thompson test
• Occurs 2-6 cm proximal the calcaneal insertion

27. POSTERIOR TIBIALIS TENDINITIS
Etiology
• Common overuse condition in runners with foot
hypermobility or over pronation
• Repetitive microtrauma
Signs and Symptoms
• Pain and swelling in area of medial malleolus
• Edema, point tenderness and increased pain during resistive
inversion and plantar flexion

28. PERONEAL TENDINITIS
Etiology
• Not common, but can be found with athletes that have pes cavus
due to excessive supination placing stress on peroneal tendon
Signs and Symptoms
• Pain behind lateral malleolus during push-off or when rising on ball
of foot
• Pain along distolateral aspect of calcaneus and beneath the cuboid

30. ACUTE LEG FRACTURES
Etiology
• Fibula has highest incidence of fracture, occurring primarily in the
middle third
• Tibial fractures occur predominantly in the lower third
• Result of direct blow or indirect trauma
Signs and Symptoms
• Pain, swelling, soft tissue insult
• Leg will appear hard and swollen (Compartment Syndrome)

32. MEDIAL TIBIAL STRESS SYNDROME
Etiology
• Pain in anterior portion of shin
• Catch all for stress fractures, muscle strains, chronic anterior compartment
syndrome
• Accounts for 10-15% of all running injuries, 60% of leg pain in athletes
• 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

33. MTSS CONTINUED
Signs and Symptoms
• Four grades of pain
• Pain after activity
• Pain before and after activity and not affecting performance
• Pain before, during and after activity, affecting performance
• Pain so severe, performance is impossible
•Recall you may hear “Periostitis”

34. STRESS FRACTURE
Etiology
• Common overuse condition, particularly in those with structural and
biomechanical insufficiencies
• Runners tends to develop in lower third of lower leg (dancers middle
third)
• Often occur in unconditioned, non-experienced individuals
• Often training errors are involved
• Component of female athlete triad
Signs and Symptoms
• Pain more intense after exercise than before
• Point tenderness; difficult to discern bone and soft tissue pain
• Bone scan results (stress fracture vs. periostitis)

36. INJURIES TO THE FOOT
Apophysitis of the Calcaneus (Sever’s Disease)
Etiology
• Traction injury at apophysis of calcaneus, where Achilles attaches
Sign and Symptoms
• Pain occurs at posterior heel below Achilles attachment in
children and adolescent athletes
• Pain occurs during vigorous activity and ceases following activity

37. RETROCALCANEAL BURSITIS
(Pump Bump)
Etiology
• Caused by inflammation of bursa beneath Achilles tendon
• Result of pressure and rubbing of shoe heel counter
• Chronic condition that develops over time and may take extensive
time to resolve, exostosis may also develop
Sign and Symptoms
• Pain w/ palpation superior and anterior to Achilles insertion,
swelling on both sides of the heel cord

39. HEEL CONTUSION
Etiology
• Caused by sudden starts, stops or changes of direction, irritation of fat pad
• Pain often on the lateral aspect due to heel strike pattern
Sign and Symptoms
• Severe pain in heel and is unable to withstand stress of weight bearing
• Often warmth and redness over the tender area

40. INJURIES TO METATARSAL REGION
Pes Planus Foot (Flatfoot)
Etiology
• Associated with excessive pronation, forefoot varus, wearing
tight shoes (weakening supportive structures) being overweight,
excessive exercise placing undo stress on arch
Sign and Symptoms
• Pain, weakness or fatigue in medial longitudinal arch; calcaneal
eversion, bulging navicular, flattening of medial longitudinal arch
and dorsiflexion with lateral splaying of 1st metatarsal

42. PES CAVUS
Etiology
• Higher arch than normal; associated with excessive
supination, accentuated high medial longitudinal arch
Sign and Symptoms
• Poor shock absorption resulting in metatarsalgia, foot pain,
clawed or hammer toes
• Associated with forefoot valgus, shortening of Achilles and
plantar fascia; heavy callus development on ball and heel of
foot

44. PLANTAR FASCIITIS
• Common in athletes and nonathletes
• Attributed to heel spurs, plantar fascia irritation, and bursitis
• Plantar fascia, dense, broad band of connective tissue
attaching proximal and medially on the calcaneus and fans
out over the plantar aspect of the foot

46. PLANTAR FASCIITIS CONT.
Etiology
•
Increased tension and stress on fascia (particularly during push off of running phase)
•
Change from rigid supportive footwear to flexible footwear
•
•
Poor running technique
Leg length discrepancy, excessive pronation, inflexible longitudinal arch, tight gastroc-soleus
complex
•
Running on soft surfaces, shoes with poor support
Sign and Symptoms
•
Pain in anterior medial heel, along medial longitudinal arch
•
Increased pain in morning, loosens after first few steps
•
Increased pain with forefoot dorsiflexion

47. JONES FRACTURE
Etiology
• Fracture of metatarsal caused by inversion and plantar
flexion, direct force (stepped on) or repetitive trauma
• Most common = base of 5th metatarsal
Sign and Symptoms
• Immediate swelling, pain over 5th metatarsal
• High nonunion rate and course of healing is unpredictable

49. METATARSAL STRESS FRACTURES
Etiology
• 2nd metatarsal fracture (March fracture)
• Change in running pattern, mileage, hills, or hard surfaces
• Forefoot varus, hallux valgus, flatfoot or short 1st metatarsal
• Occasional 5th metatarsal fracture at base and insertion of
peroneus brevis

50. BUNION
Etiology
• Exostosis of 1st metatarsal head; associated with forefoot varus; shoes that are too
narrow, pointed or short
• Bursa becomes inflamed and thickens, enlarging joint, and causing lateral malalignment
of great toe
• Bunionette (Tailor’s bunion) impacts 5th metatarsophalangeal joint - causes medial
displacement of 5th toe
Sign and Symptoms
• Tenderness, swelling, and enlargement of joint initially
• As inflammation continues, angulation increases causing painful ambulation
• Tendinitis in great toe flexors may develop

52. TURF TOE
Etiology
• Hyperextension injury resulting in sprain of 1st metatarsophalangeal joint
• May be the result of single or repetitive trauma
Signs and Symptoms
• Pain and swelling which increases during push off in walking, running,
and jumping

53. SUBUNGUAL HEMATOMA
MOI
•
Direct pressure, dropping an object on toe,
kicking another object
•
Repetitive shear forces on toenail
Signs of Injury
•
•
Accumulation of blood underneath toenail
Likely to produce extreme pain and ultimately
loss of nail