EDUCATIONAL OBJECTIVES
The learner should, at the completion of the chapter, be able to perform the following:
The foot is the site of some of the most minor, yet some of the most debilitating conditions suffered by athletes. Examples of these conditions include blisters, calluses, athlete's foot, turf toe, and ingrown toenails. Left untreated, these conditions can be just as disabling for an athlete as some of the more serious foot problems, such as heel bruises, arch strains, and fractures. The foot has stresses that exceed the demands placed on any other area of the body. The foot stabilizes and supports the rest of the body while standing, walking, running, or jumping. Whether the impact with the ground is on the heel, the ball of the foot, or the toes, the foot responds by absorbing several hundred pounds of force up to three times the body weight. Individually, the parts of the foot (bones, muscles, ligaments) are relatively weak. As a whole, however, the foot is strong enough to withstand most of the demands of athletics. The key to the foot's function is a set of four arches, which help in absorbing the impact of walking, running, and jumping. The arches are called: Metatarsal, Transverse, Medial (inner) Longitudinal, and Lateral (outer) Longitudinal. The feet contain about one-fourth of the total number of bones in the body. Each foot has 26 bones (seven tarsal bones, five metatarsal, and 14 phalanges) and 38 joints. The tarsal bones are the talus, calcaneus, navicular, cuboid, and the medial, intermediate, and lateral cuneiform bones. The mid foot region is made up of the five metatarsal bones. The toes have 14 bones known as the phalanges.
The talocrural joint (ankle joint) is the most commonly injured major joint in athletics. Fortunately, most injuries are either ligament sprains or muscular strains. Knowledge of the ankle's anatomy, its mechanism of injury, evaluation and first aid procedures, preventive and supportive techniques are essential in reducing injury severity.
The talocrural joint is formed by these two joints: Talocrural joint (bones: Tibia, Fibula, and Talus) and Subtalar (bones: Talus and Calcaneus). The tibia and fibula are the two bones of the lower leg, while the talus and calcaneus are the two largest bones of the foot. Those large, bony prominences (malleoli) on either side of the ankle are the distal ends of the tibia (medially) and the fibula (laterally).
The tibia, which transmits the weight or force placed on the lower leg to the talus, is mounted almost directly on top of the talus and extends over its medial side. On the lateral side of the talus the fibula extends, forming the lateral malleolus and helping to stabilize the ankle joint. The talocrural is a hinge joint with most of its movement in flexion (dorisflexion) and extension (plantarflexion) and the subtalar is triplanar with movement around the oblique axis. This joint is most stable when placed in dorsiflexion.
Covered by a layer of cartilage, the talus moves anteriorly (forward) and posteriorly (backward) in the cup-like cavity formed by the distal heads of the tibia and fibula. The talus acts as a movable saddle for the two bones of the lower leg. The talus, in turn, sits forward and on top of the calcaneus. The talus allows forward and downward movement of the ankle. The ankle joint, because of its arrangement of bones attaching ligaments, is structurally very strong. However, because of the stresses of athletics, the ankle is often injured. Since ankle injuries occur often, a comprehensive treatment and rehabilitation program must be followed prior to allowing an athlete to return to activity.
After the bony structure, the first line of defense against ankle sprains is the joint’s strong ligamentous support. Just as with the bony structure, the ligaments of the ankle make the joint more stable medially. Most of the ligaments involved in supporting the ankle are attached to the rough edges of the malleoli. The ligaments are named for the bones they connect. The ligaments most commonly injured on the laterial aspect of the ankle are the anterior talofibular, anterior tibiofibular, calcaneofibular, and posterior talofibular. On the medial aspect the deltoid ligament is commonly injured. For evaluation purposes, the student athletic trainer should know the location of all the ankle joint ligaments.
Thirteen major muscles support the ankle joint. Two of the muscle tendon groups most important in preventing ankle injuries are the Achilles tendon and the peroneus muscle group. A tight Achilles tendon, which is the attachment of the gastrocnemius and soleus muscles (calf muscles) to the calcaneus, is often the cause of recurrent ankle sprains. The peroneal muscle group runs along the lateral side of the leg and foot, attaching at several areas on the foot. The peroneal brevis attaches on the lateral aspect of the foot, at the base of the fifth metatarsal whereas the peroneal longus runs across the plantar surface of the foot and inserts into the lateral base of the first metatarsal and medial cunneiform. When the peroneal group contracts, it causes the foot to evert, which helps to prevent a sprain to the lateral ligaments.
The two bones of the lower leg are the tibia and fibula. The area on the front of the lower leg is called the shin which include the following muscles: tibialis anterior, extensor hallucis longus, and extensor digitorum longus. Often associated with shin pain is the interosseous membrane, which connects the tibia and fibula. On the posterior aspect of the lower leg are the gastrocnemius and soleus muscles, the Achilles tendon, and the tibialis posterior, flexor digitorum longus, and flexor hallucis longus. Often called the heel cord, the Achilles tendon of the calf muscles attaches to the calcaneus, or heel bone. This area of the body is innervated by a number of different nerves. The sensory distribution of a nerve root is called a dermatome, which produces sensation in a corresponding anatomical area. The motor distribution of a group of muscles innervated by a single nerve root is called a mytome and it produces movement of anatomical structures. Additionally, anatomical structures that can be injured include the fat pads, bursi and plantar fascia. Fat pads are specialized soft tissue structure for weight bearing and absorbing impact, whereas synovial sacs located over bony prominences throughout the body are called bursi.
FOOT, ANKLE, AND LOWER LEG ANATOMY
Bones
Arches
Dorsiflexion: decreasing angle between the top of the foot and
lower leg
Plantar flexion: increasing angle between the top of the foot
and lower leg
Inversion: turning the heel inward (subtalar/talocalcaneal joint
movement)
Eversion: turning the heel outward (subtalar/talocalcaneal joint
movement)
Flexion (toes): decreasing the angle between the toes and the
sole of the foot
Extension (toes): increasing the angle between the toes and
the sole of the foot
Pronation: combined motions of calcaneal eversion, foot abduction
and dorsiflexion
Supination: combined motions of calcaneal inversion, foot adduction
and plantar flexion
Abduction: movement of body segment away from midline of the
body
Adduction: movement of body segment toward the midline of the
body
Muscles and Function
L4 - Anteriomedial aspect of lower leg and rear 1/3 of foot
L5 - Anteriolateral and posterior aspect of lower leg and dorsum (posterior
aspect) of foot
S1 - Phalanges and plantar aspect of foot
S2 - Proximal 1/3 of posterior aspect of lower leg
Myotomes
L4 - Dorsiflexion of ankle
L5 - Extensor Halluces Longus - toe extension
S1 - Plantar flexion of ankle or Hamstring Curl,foot eversion, hip
extension
S2 - Knee flexion
When determining strength of myotomes, provide resistive force.
EVALUATION FORMAT
The first purpose of an evaluation is to determine if a serious injury has occurred. Initially, a fracture should always be suspected. Signs of a fracture include, but are not limited to, direct or indirect pain, deformity, or a grating sound at the injury site. Some fractures are not accompanied by swelling or pain. If a fracture is suspected, the extremity should be splinted and the athlete transported for medical evaluation. Young athletes are especially susceptible to fractures, due to their immature bone structure. Often, ligaments and muscles are stronger than the bones. The evaluation process to help determine the type of injury involves four steps: history, observation, palpation, and special tests.
(H) History: This involves asking questions of the athlete to help determine the mechanism of injury. Answers to these questions will help the certified athletic trainer to adequately assess the injury and the physician in a diagnosis.
1. Mechanism of injury (How did it happen?)(O) Observation: The athletic trainer should compare the uninjured to the injured lower extremity and look for bleeding, deformity, swelling, discoloration, scars, and other signs of trauma.
2. Location of pain (Where does it hurt?)
3. Sensations experienced (Did you hear a pop or snap?)
4. Previous injury (Have you injured this anatomical structure before?)
(P) Palpation: Palpation is the physical inspection of an injury. First, palpate the anatomical structures/joints above and below the injuried site. Then, palpate the affected area. The entire area around the injury may be sore, but the athletic trainer should try to pinpoint the site of severe pain. From knowledge of the lower extremity’s anatomy and injury mechanism, the type and extent of injury can be evaluated. Involve the athlete in the evaluation as much as possible. Using bilateral comparison, these items should be palpated/performed:
ASSESSMENT TESTS
All injured joints should be properly evaluated. The purpose of a thorough evaluation is to enable the allied health professional to properly assess the severity of the injury and to make recommendations regarding treatment and possible return to participation. Listed below is a review of evaluation techniques utilized by certified athletic trainers. For further information, the learner should consult this chapter's references for a comprehensive description of evaluation techniques.
Tests for Bony Integrity
Heel Tap Test: examines the integity of the tibia, fibula and
talus
Squeeze Test: tests the bony integrity of the tibia and fibula
Tests for Ligamentous Stability
Anterior Drawer Test: assesses the integrity of the anterior
talofibular and calcaneofibular ligaments
Inversion or Lateral Stress Test (Talar Tilt): assesses the
integrity of the calcaneofibular and anterior talofibular ligaments
Eversion or Medial Stress Test (Talar Tilt): assesses the integrity
of the deltiod ligament
External Rotation Test (Keiger Test): assesses the integrity
of the anterior and posterior tibiofibular ligaments and the interosseous
membrane of the tibiofibular syndesmosis.
Tests for Muscle Function and Flexibility
Thompson Test: tests the integrity of the Achilles Tendon
Gastrocnemius Tightness Test: determines the degree of tightness in the ankle due to gastrocnemius inflexibility
Soleus Tightness Test: determines the degree of tightness in the ankle due to soleus inflexibility
CONDITIONS THAT INDICATE AN ATHLETE SHOULD BE REFERRED FOR PHYSICIAN EVALUATION
Blisters: Although blisters can occur on any part of the body where friction exists, in athletics blisters are most often found on the feet. As the layers of the skin rub together, friction causes separation. The body responds with fluid formation in this separation. This fluid creates pressure on nerve endings, which is perceived as pain. If the blister is neglected, it may break, creating an open wound. Once formed, blisters cannot be ignored. Proper treatment of a blister is mandatory in order to ensure maximum comfort of the athlete and to reduce the possibility of infection. Blisters can be very painful, and even debilitating, if not properly treated.
Ankle Sprains: Ankle injuries range from muscle strains and ligament sprains to dislocations and fractures. The most common injury is the sprain. Its mechanism of injury is usually a combination of excessive inversion and plantar flexion. The mechanism is similar to an athlete stepping into a hole. More than 80 percent of all ankle sprains are of this type of mechanism. The ligament most often injured is the anterior talofibular. Since most sprains are of the lateral, or inversion type, ankle tapings have been designed to prevent the inversion sprain. Less common is the eversion sprain. On the medial side of the ankle is the tough, thick deltoid ligament, which helps prevent excessive eversion or turning of the heel outward movement.
Whether the sprain is of the inversion or eversion type, it is usually placed into one of three categories: first degree (mild), second degree (moderate), or third degree (severe).
First degree sprain: One or more of the supporting ligaments and surrounding tissues are stretched. There is minor discomfort, point tenderness, and little or no swelling. There is no abnormal movement in the joint to indicate lack of stability.
Second degree sprain: A portion of one or more ligaments is torn. There is pain, swelling, point tenderness, disability and loss of function. There is slight abnormal movement in the joint. The athlete may not be able to walk normally and will favor the injured leg.
Third degree sprain: One or more ligaments have been completely torn, resulting in joint instability. There is either extreme pain or little pain (if nerve damage has occurred), loss of function, point tenderness, and rapid swelling. An accompanying fracture is possible.
Arch Sprains: Most people are unaware that there are four arches in the foot. Each contributes to balance, movement, support, and shock absorption. To help understand these arches, place a wet foot down on an absorbent paper towel and observe the footprint. Any of the four arches of the foot (transverse, metatarsal, inner, or outer longitudinal) can suffer supportive ligament sprains. Once the ligaments are stretched, they fail to hold the bones of the foot in position. When an arch is weakened in this manner, it can not absorb shock as well as it is designed to do. Resulting manifestations the student athletic trainer might see include shin splints, achilles tendon strain, foot fatigue, strained muscles, and even blisters. If the student athletic trainer treats only the symptoms, the arch sprain may worsen. Causes of arch problems include overuse, overweight, fatigue, training on hard surfaces, and wearing non-supportive, worn shoes. First aid, as with other ligament sprains, includes cold, compression, and elevation. Most arch sprains are to the metatarsal arch or inner longitudinal arch.
Shin Splints: The term shin splints has inaccurately become a catch-all term to describe pain or injury of the anterior portion of the lower leg. However, for the student athletic trainer to assume that any lower leg pain in athletics is a symptom of shin splints would be a mistake. Two other much more serious injuries often have similar symptoms to shin splints. These injuries are stress fractures and anterior compartment syndrome. By determining the mechanism of injury, the athletic trainer can treat the specific injury. The shin splint injury is thought to be an inflammation of the interosseous membrane, strains to the soleus muscle, or other chronic lower leg conditions. Because of the lower leg's poor blood supply, any injury in this region can be slow to heal. Shin Splints have been attributed to tight deep posterior muscles, specifically posterior tibialis, which becomes irritated due to decreased dorsiflexion and improper medial longitudinal arch support. Preferred treatment should include cryotherapy, foot support (orthotics) and medical referral. Left untreated and uncorrected, the condition can worsen until it is disabling. Some causes of shin splints are muscle weakness or imbalance, lack of proper conditioning, improper or incomplete warmup, poor flexibility or lack of stretching, running on hard surfaces, improper running form or habits, improper or worn running shoes, or poor support for anatomical structures.
Great Toe Sprain (Turf Toe): The great toe is very important in balance, movement, and speed. Occasionally, the ligaments supporting the toe will become sprained, severely limiting the athlete’s performance. Turf toe is the name given to such a sprain. Often, the mechanism of the injury will be the foot sliding back on a slippery surface, which forcefully hyperextends the toe. As with any acute sprain, immediate care of turf toe is protection, rest, ice, compression, elevation, and support. The physician may take X-rays to rule out a more severe injury. Most sprains of the great toe are minor. Once normal function returns, the athletic trainer encourages constant foot/toe support to prevent limit movement.
Plantar Fasciitis: The plantar fascia is a wide, non-elastic ligamentous tissue that extends from the anterior portion of the calcaneus to the heads of the metatarsals, supplying support to the longitudinal arch of the foot. This tissue can become strained from overuse, unsupportive footwear, a tight Achilles tendon or running on hard surfaces. Most often, the cause of plantar fasciitis is chronic irritation. Cross-country and track athletes are prone to overuse injuries in which the plantar fascia is continually strained from running and jumping. Basketball and volleyball athletes are also susceptible to plantar fasciitis from repeated jumping and landing. An athlete with plantar fasciitis will experience pain and tenderness on the bottom of the foot near the heel. Untreated, this condition causes bone imbalance which can lead to heel spurs, muscle strains, shin splints, and other problems. Besides basic treatment of ice and massage, the athletic trainer must evaluate and correct the cause of the problem.
Heel Bruise: The heel receives, absorbs, and transfers much of the impact from sports activities, especially running and jumping. Therefore, the ligaments, tendons, and fat pad of the heel are all subject to stress and injury. The heel bruise is among the most disabling contusions in athletics. The heel must be protected during physical activity. Cold application before activity, and cold and elevation afterwards can help reduce swelling and pain. The athletic trainer can also supply the athlete with heel cups to help absorb the force of the heel's impact with the ground or floor, or a donut pad can be constructed to protect the bruised area. In order to prevent muscle imbalance and problems from misalignment of the body, both shoes, not just the shoe of the injured foot, should contain equal amounts of padding.
Heel Spur: A heel spur is a bony growth on the calcaneus that causes painful inflammation of the accompanying soft tissue and is aggravated by exercise. The student athletic trainer can locate a heel spur by pressing on the heel. As the foot flattens, the plantar fascia is stretched and pulled at the point where it attaches to the calcaneus. Over a period of time, the calcaneus reacts to this irritation by forming a spur of bony material. The team physician may recommend taping the arch or using shoe inserts (orthoses) to help reduce the plantar fascia's pull on the calcaneus.
Anterior Compartment Syndrome: Anterior compartment syndrome is a condition that, when suspected by the coach or student athletic trainer, should be referred immediately to the physician. The four compartments of the lower leg are: Anterior Compartment (Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum longus, Peroneus Tertius); Lateral Compartment (Peroneal Longus and Peroneal Brevis); Superficial Posterior Compartment (Gastrocnemius, Soleus and Plantaris); and Deep Posterior Compartment (Tibialis Posterior, Flexor Digitorum Longus and Flexor Hallucis Longus, popliteus)
Most compartment syndromes in athletics are to the anterior compartment. As with stress fractures, anterior compartment syndrome can be mistaken for shin splints. In addition, anterior compartment syndrome can be misdiagnosed as a contusion of the shin, muscle cramps, or spasms. The anterior compartment is tightly filled with the muscles that dorsiflex the foot and ankle. It is almost entirely enclosed with rigid walls of bone or tissue. Misdiagnosis of this condition could lead to permanent muscle tissue damage, resulting in permanent disability. Direct trauma or excessive exercise can result in hemorrhage and swelling inside the compartment. This swelling will increase the pressure on the peroneal nerve, the veins, and, finally, the arteries inside the compartment. Without arterial circulation, muscle cells will die. Signs of anterior compartment syndrome include pain even after cold treatment, a firmness of the muscle, numbness of the foot, and warmth. Once suspected, anterior compartment syndrome should be treated as a medical emergency.
Achilles Tendon Strain: Although the Achilles tendon is the strongest in the body, it is a vulnerable area for athletes. Severe damage, such as a tear, can be career-threatening. The tendon is formed by the union of the gastrocnemius and soleus muscles on the back of the leg. The tendon inserts on the calcaneus. Injuries can be caused by overuse, muscle imbalance inflexibility, or a sudden movement. Depending on the force and the condition of the tendon, the injuries can range from mild strains to complete ruptures. Strains of this important tendon must be treated more conservatively with protection, rest, ice, compression, elevation, and support (P.R.I.C.E.S.) than most muscle injuries. This is because of the disability the injury produces and the tendency for the strain to develop into a complete tear. The Achilles tendon is sometimes strained when the ankle is sprained, and may take longer to heal than the injured ligaments. A strong and flexible Achilles Tendon can prevent many ankle sprains.
Stress Fractures: Bones are not inanimate objects. They are living tissue. Just like muscle cells, bone cells respond to exercise, growing stronger to meet new demands. Lack of exercise can lead to deterioration or deossification of the bone. If the exercise is too severe, or of too long a duration, the change in the bone structure will be negative and a stress fracture can begin to develop. Continued stress will lead to a worsening of the fracture. Because stress fractures often occur in the lower extremity, there is a tendency to dismiss pain in this anatomical region. Early X-rays may not reveal evidence of the stress fracture, but after conversative treatment and rest, a second series of X-rays may be indicated to confirm or rule out stress fractures. Signs of a stress fracture might be initial increased pain every time the athlete exercises and specific point tenderness. Usually, a stress fracture will hurt when the athlete presses with the fingers just above and below the site of most pain. In later stages of stress fractures, pain is constant, especially at might. If a stress fracture is suspected, medical referral is recommended.
Muscle Cramps: In athletics, athletic trainers often see an athlete make a rapid recovery from what appears to be a painful, disabling knee or ankle injury. In those cases, the injury may simply be a cramp in the muscles of the lower extremity. A cramp is a sudden, involuntary contraction of a muscle. While the cause is unknown, several factors seem to contribute to their incidence:
Sending an athlete back to competition before healing is complete leaves the player susceptible to further injury. The best way to determine when healing is complete is by the absence of pain during stressful activity and by the return of full range of motion and strength, power and endurance to the affected muscle group. Prior to the beginning of any rehabilitation exercise program, the athletic trainer should consult with the sports medicine team to establish an individual program tailored for that individual athlete and the specific injury to be rehabilitated. The following list of exercises can be used as rehabilitative or preventive exercises.
Range of Motion Exercises
Dorsiflexion
Plantar flexion
Inversion
Eversion
Flexion (toes)
Extension (toes)
Circumduction
Lower Leg
Heel Raises
Toe Raises
Ankle
Ankle Alphabet
Heel Raises
Toe Raises
Incline Board
Mini Squats
Proprioception Exercises
Foot
Sponge Pick-ups
Marble Pick-ups
Towel Gathering
Included in any rehabilitation protocol is the following:
Before returning to competition, the following rehabilitation guidelines must be met.
The application of preventive and supportive techniques is a time-honored and time-consuming tradition. It is also a very expensive practice. Whether to apply adhesive and/or elastic bandages to an uninjured anatomical structure is a decision the athletic trainer will have to make. All injured joints should be supported initially. Here is an outline of basic taping and wrapping techniques.
Wrapping Techniques for Compression
AnkleWrapping Techniques for Support
Ankle ClothTaping Techniques for the Ankle, Foot and Lower Leg
The use of protective devices is beneficial, if they are properly selected, used in the appropriate setting, correctly fitted, properly applied, and used within the rules and guidelines of the specific sport. Consultation with an equipment specialist is highly encouraged. Listed below are various protective devices that are commercially available to use as an adjunct or as a replacement to taping or wrapping procedures.
Achilles Brace (achilles tendons tendonitis straps)MUSCULOSKELETAL CONDITIONS/DISORDERS
Ankle Braces (lace-up, air, prophylactic, etc.)
Arch supports
Boots (hockey, ski, wrestling, etc)
Bunion pads
Corn and callous pads
Heel Cups
Heel lifts
Orthosis (soft, semirigid, rigid)
Shin Guards
Shoes (basketball, baseball, racing, running, golf, track, cross trainer, etc)
Steel insoles (full, half)
Toe guards
Turf toe strips
Listed below are other musculoskeletal conditions/disorders that affect the foot, ankle, and lower leg. A valuable learning experience would be to review and define these conditions/disorders using a medical dictionary.
References
American Academy of Orthopedic Surgeons (1991) Athletic Training and Sports Medicine (2nd ed.). Park Ridge, IL; American Academy of Orthopedic Surgeons.
American Medical Association (1968) Standard Nomenclature of Athletic Injuries. Chicago: American Medical Association.
Arnheim, D. & Prentice, W. (1997). Principles of Athletic Training (9th ed.). St. Louis: McGraw-Hill.
Anderson M. and Hall S. (1995) Sports Injury Management Baltimore: Williams and Wilkins.
Daniels, Lucille and Worthingham, Catherine. Muscle Testing: Techniques
of Manual Examination. Philadelphia: W.B. Saunders, 5th ed., 1986.
Donnelly, J. (1990)
Living Anatomy, Champaign, Human Kinetics
Gallaspy, J. & May D. (1996) Signs and Symptoms of Athletic Injuries St. Louis, Mosby
Harrelson G. & Andrews J. (1993) Physical Rehabilitation of the Injured Athlete Philadeplhia: W.B. Saunders
Herring S & Nilson K (1997) Introduction to overuse injuries. In Clinics in sports medicine 6(2) Philadelphia: W.B. Saunders
Hoppenfield, S. (1976) Physical Examination of the Spine and Extremities New York: Appleton, Century, and Crofts.
Norkin C. & Levangie P (1992) Mjoint structure and function: A comprehensive analysis Philadelphia: F.A. Davis Co.
Norkin & White (1985) Measurement of Joint Motion: A Guide to Goniometry Philadelphia: F.A. Davis Co.
Stone R. & Stone J. (1997) Atlas of Skeletal Muscles (2nd ed.) Dubuque: McGraw Hill.
Thibodeau G. & Patton, K. (1996) Anatomy and Physiology (3rd ed.) St. Louis: Mosby.
Wright K. & Whitehill W. (1996) The Comprehensive Manual of Taping
and Wrapping Techniques Gardner: Cramer Products
Suggested Multimedia Resources
Wright, K, Harrelson, G. Fincher L & Floyd, R. (1996) Sports Medicine Evaluation Series: Ankle and Lower Leg Dubuque, IA: McGraw Hill.
Wright K. & Whitehill W. (1997) Sports Medicine Taping Series: Foot and Lower Leg Dubuque, : McGraw Hill.
Wright K. & Whitehill W. (1997) Sports Medicine Taping Series: Ankle and Lower Leg Dubuque, McGraw Hill.
Chapter 6 - Review Questions
Short Answer:
1. Define the acronym:
3. Name two tests for ligamentous stability:
4. List the four arches of the foot:
5. Identify some of the exercises used to rehabilitate the ankle.
6. Define strain to the Achilles Tendon.
7. Define sprain to the Great Toe.
8. What are the symptoms of anterior compartment syndrome?
9. How are stress fractures evaluated?
PICTURES and DESCRIPTION for Chapter 6
Textbook Source: Comprehensive Manual of Taping and Wrapping Techniques
Ankle Compression Wrap
Supplies needed: 4" elastic wrap, and 1 1/2 adhesive tape
Wrapping Procedure:
1. Begin the 4" elastic wrap at the distal part of the phalanges, spiral the wrap around the foot and ankle and on the distal aspect of the lower leg.
2. Secure the wrap with a small strip of 1 1/2" adhesive tape.
Ankle Cloth Wrap
Purpose: To provide support to the ankle joint.
General Condition Procedure Used For: Ankle Sprains
Anatomical Structure: Ankle joint
Anatomical Position: Ankle in neutral position (90 degrees)
Supplies needed: 1-1/2" cloth wrap, 72-96 inches, and 1-1/2" adhesive
tape.
Pre-Wrapping Procedure: With the ankle in neutral position, apply the
athletic sock. Instruct the athlete to contract the muscles of the lower
leg.
Wrapping Procedures: A continuous wrap is used in this procedure and
consists of a figure of eight, medial heel lock, lateral heel lock, finishing
with a figure of eight.
1. Figure of eight. Starting on the dorsal aspect of the foot, move
medially down the inside of the foot, across the plantar portion, up the
outside of the foot to the starting point. Continuation of the wrap will
proceed medially around the lower leg, crossing the achilles tendon, returning
to the origin of this figure of eight technique.
2. Apply the medial heel lock. This wrap continues across the medial
malleolus, crossing the achilles tendon, around the lateral aspect of the
heel, angling underneath the foot and moving up to the foot’s dorsum.
3. The lateral heel lock wrap continues across the lateral malleolus,
crosses the achilles tendon, around the medial aspect of the heel, angles
underneath the foot and moves up to the foot’s dorsum.
4. Repeat Step 1 (figure of eight wrap).
5. This procedure can be reinforced by applying 1-1/2" adhesive tape
to construct extra figures of eight and heel locks over the cloth wrap.
Ankle Taping
Purpose: To support and stabilize the ankle joint for INVERSION
sprains.
General Condition Procedure Used For: Sprains.
Anatomical Structure: Ankle joint.
Anatomical Position: Ankle joint in neutral position.
Supplies Needed: 1-1/2" or 2" adhesive tape, and heel and lace pads
Pre-taping Procedures: Before you begin taping, apply heel and lace
pads at high friction areas: one at the distal aspect of the achilles tendon
, the other at the dorsal aspect of the ankle joint. Additionally, apply
underwrap to secure the two heel and lace pads in place and reduce skin
irritation. It is critical that the foot remain at a 90 degree angle for
this procedure.
Taping Procedures
1. Apply an adhesive tape anchor strip around the lower leg at approximately the musculo-tendon junction of the gastrocnemius. Since the leg at this site is not cylindrically shaped the tape must be angled slightly to conform to the leg.
2. Apply an additional anchor at the instep. Remember that excessive tension on the 5th metatarsal could cause pain on weight bearing.
3. Apply the first of three stirrup strips. Beginning on the medial aspect of the upper anchor, this stirrup continues down the inside of the leg, over the medial malleolus, across the plantar aspect of the foot, over the lateral malleolus, up the lateral aspect of the leg, and ends at the lateral aspect of the upper anchor. Proper tension must be applied to cause some eversion of the foot, thus helping to reduce inversion.
4. Apply the first of three horse shoe strips. The first horizontal strip is started on the medial aspect of the foot, continues toward the heel and below the medial malleolus, crosses the achilles tendon below the lateral malleolus, and ends on the lateral aspect of the foot.
5. Repeat steps #3 and #4 twice, overlapping the tape one-half its width. These interlocking strips should provide additional support for this technique. The completed portion of this closed basket weave has sets of interlocking stirrups and horse shoe strips. Apply a proximal anchor for support. For proper adherence, apply compression to the tape so that the tape conforms to the body part.
6. Apply the first heel lock strip. Begin on the anterior portion of the upper anchor. This lateral heel lock will continue down the outside of the leg, crossing the achilles tendon, around the medial aspect of the heel, angling underneath the foot, and moving up the lateral aspect of the leg. Proper tension must be applied to ensure stabilization of the calcaneus.
7. Apply the second heel lock strip. Begin on the anterior portion of the upper anchor. This medial heel lock will continue down the inside of the leg, crossing the achilles tendon, around the lateral aspect of the heel, angling underneath the foot, and moving up the medial aspect of the leg.
8. A figure of eight is applied next. Starting on the dorsal aspect of the foot, move medially down the inside of the foot, across the plantar portion, up the outside of the foot to the starting point. Continuation of the tape will proceed medially around the lower leg crossing the achilles tendon, and finishing at the origin of this figure of eight technique. By encircling the foot and lower leg, this technique will assist in dorsal flexion and eversion.
9. Final closure strips are then applied. Begin proximally and work distally. From the upper anchor, apply individual circular strips around the extremity to cover tapeends. Make sure you overlap the tape approximately one-half its width on each strip.
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