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Ankle and Lower Leg Chapter 17. Ankle Bony Anatomy Talus (link between lower leg & foot) Tibia –Medial malleolus Fibula –Lateral malleolus Mortise Tibial.

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Presentation on theme: "Ankle and Lower Leg Chapter 17. Ankle Bony Anatomy Talus (link between lower leg & foot) Tibia –Medial malleolus Fibula –Lateral malleolus Mortise Tibial."— Presentation transcript:

1 Ankle and Lower Leg Chapter 17

2 Ankle Bony Anatomy Talus (link between lower leg & foot) Tibia –Medial malleolus Fibula –Lateral malleolus Mortise Tibial tuberosity Tibial condyles

3 Bony Anatomy

4 Functional Anatomy Ankle is a stable hinge joint Medial/lateral dislocation is prevented by malleoli Square shape of talus adds stability of ankle Most stable during dorsiflexion, least stable in plantar flexion

5 Ankle Motions Plantar Flexion Dorsiflexion Inversion Eversion Pronation Supination

6 Ankle Articulations Talar Joint (Talocrural joint) Tibia & fibula with talus Dome of talus articulates with mortise formed by tibia & fibula Motions: dorsiflexion & plantar flexion Subtalar Joint Articulation of talus with calcaneus Motions: inversion & eversion

7 Soft Tissue Gastrocnemius Soleus Tibialis posterior Tibialis anterior Peroneus longus Peroneus brevis Plantaris Plantar fascia Anterior talofibular Anterior tibiofibular Calcaneofibular Posterior talofibular Deltoid ligament –Tibionavicular –Calcaneotibial –Anterior talotibial –Posterior talotibial

8 Muscles of the Lower Leg Flexor hallucis longus Flexor digitorum longus Anterior tibialis

9 Muscles of the Lower Leg Peroneus tertius Peroneus longus Peroneus brevis

10 Muscles of the Lower Leg Gastrocnemius Soleus

11 Muscles of the Lower Leg


13 Compartments of the Lower Leg Anterior –Tibialias anterior –Extensor digitorum longus –Peroneus tertius –Extensor hallucis muscles Peroneal –Peroneus longus –Peroneus brevis Deep Posterior –Popliteus –Flexor digitorum longus –Flexor hallucis longus –Tibialis posterior Superficial Posterior –Gastrocnemius –Soleus –Plantaris

14 Compartments of the Lower Leg


16 Ligaments Lateral aspect –Anterior talofibular (ATF) –Anterior tibiofibular –Calcaneofibular (CF) –Posterior talofibular Medial aspect –Deltoid Ligament



19 Common Injuries to the Ankle & Lower Leg

20 Contusions Occur most often on tibia Can be painful and disabling Complication  compartment syndrome

21 Muscle Strains Most common in calf Result from: –violent contraction –Overstretching –Continued overuse Usually occur in area of MTJ or insertion of Achilles tendon Result from: –Repetitive overuse –Single violent contraction Acute strain to Achilles have tendency to become chronic

22 Cramps A sudden, involuntary contraction of a muscle Contributing factors include: –Fatigue –Fractures –Dehydration –Lack of nutrients in diet –Poor flexibility –Improperly fitted equipment

23 Cramps—Treatment Passive stretching Fluid replacement –Water –Sports drink Massage Rest Ice

24 Achilles Tendonitis Inflammation of Achilles tendon Tearing of tendon tissues caused by excessive stress Occurs at point where tendon attaches to heel

25 Achilles Tendonitis Symptoms develop gradually Repeated or continued overstress increases inflammation Pain, crepitus, redness Treatment –Prevention –Stretching –Biomechanical problems? –Ice/Rest –NSAIDs –Heel lift/Achilles taping

26 Achilles Tendon Rupture Rupture occurs w/in tendon, approx 1-2” proximal to insertion Eccentric force applied to dorsiflexed foot –Poor conditioning –Overexertion Direct trauma Surgically repaired Rehab = 1yr + Thompson test


28 Medial Tibial Stress Syndrome aka shin splints Catchall term for pain that occurs below knee –Anterior shin –Medial shin Result of doing too much too soon Associated with: –repetitive activity on hard surface –forcible excessive use of leg muscles (running, jumping) –tightness of gastroc and/or soleus muscles –improper footwear –running biomechanics

29 MTSS Treatment Ice Reduce activity level Gentle stretching Biomechanical assessment Orthotics NSAIDs Strengthening and flexibility program

30 Stress Fractures Incomplete crack in bone Microscopic fractures in bone that will eventually lead to full fracture if left untreated Repeated stress placed on bone greater than body’s ability to heal it

31 Stress Fractures—S/Sxs “hot spot” of sharp, intense pain upon palpation Shin-splint Pain more generalized Pain worse in am Stress Fx Pain worse in pm

32 Compartment Syndrome Swelling within one or more of the compartments of the lower leg Caused by: –Contusion –Fracture –Crush injury –Localized infection –Excessive exercise –Overstretching

33 Ankle Sprains MOI: combo of excessive inversion and PF –aka lateral ankle sprain Anterior Talofibular Ligament (ATF) –Calcaneofibular (CF) –Posterior talofibular (PTF) Eversion (medial) ankle sprain less common –Deltoid ligament

34 Ankle Sprains Injury to ligamentous and capsular tissue Traumatic joint twist that results in stretching of total tearing of the stabilizing connective tissue One of most common & disabling sports injuries General Symptoms: Joint swelling Local temperature increase Pain Point tenderness Skin discoloration

35 Ankle Sprains

36 Inversion –Anterior Talofibular –Calcaneofibular –Posterior Talofibular Eversion –Deltoid Ligament Syndesmotic –High ankle sprain

37 Ankle Sprain—S/SXS  Grade 1  Some pain  Minimum LOF  Mild point tenderness  Little or no swelling  No abnormal motion  Grade 2  Pain  Moderate LOF  Swelling  Slight to moderate instability  Grade 3  Severe sprain  Extremely painful initially  LOF  Severe instability  Tenderness  Swelling  May represent subluxation that reduced spontaneously

38 Ankle Sprain—Treatment R.I.C.E. Crutches Boot Splint, tape, brace Compressive wrap Horseshoe

39 Special Tests & Rehabilitation

40 Anterior Drawer Tests integrity of anterior talofibular ligament Talar Tilt Tests integrity of calcaneofibular ligament

41 Squeeze Test Squeezing the tibia and fibula together Can indicate fracture or high ankle sprain Bump Test/Tap Test Bump calcaneus –Indicate fracture to tibia/fibula –Indicate high ankle sprain Tap mallelous –Indicate fracture of particular bone

42 Ankle Rehab 4-way TheraBand ® Heel walks/Toe walks 3-way heel raises Unilateral Balance 3-way Tramp throw

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