1. The Ankle & Lower Leg Lecture 10

2. Lower leg and ankle ankle injuries most frequent in sports tibia
is major weight bearing bone of the lower leg
fibula
assists minimally with weight bearing aprrox 2 % , serves as a site for muscle attachment and contributes to the stability of the ankle

3. Crural Bones med / lat. malleolus and talus
Talocrural Joint (ankle joint)
is a uniaxial modified hinge joint - (talus, tibia and fibula)
plantar flexion and dorsiflexion occur here
talus wider ant vs post - stability

4. Lateral Ankle Support ATF, PTF , CF (static) (AITF)
b) peroneals (dynamic)
the lateral ligaments of the ankle joint are relatively weaker than the medial ligaments
hence the larger number of lateral ankle sprains

6. Medial Ankle a) Deltoid ligament (static)
b) Tom, Dick and Harry (dynamic)
Dynamic TA TP

8. Distal Tib-Fib Joint a) ant & post tibiofibular lig
b) interosseos membrane

9. Muscles 4 compartments anterior , deep , superficial and lateral
i) anterior - tibialis anterior - extensor digitorum longus - extensor hallucis longus and peroneous tertius
ii) deep - tibialis posterior - flexor digitorum longus - flexor hallicus longus

10. iii) superficial - gastrocnemius - soleus, plantaris
iv) lateral - peroneus brevis , peroneus longus

12. Ankle Movements
Plantarflexion
Dorsiflexion
Inversion
Eversion

14. General Ligament Sprains
1st, 2nd, 3rd degree

15. Common Lower Leg & Ankle Injuries

16. Inversion Ankle Sprain
more common than eversion because of ligament and bony support
stress is applied to the lateral side of the foot during plantar flexion and inversion
most often injuring the Anterior Talofibular ligament (ATF)
if stress is continued the Calcaneal Fibular Lig (CF) may be injured as well

17. individual will report cracking or tearing sound at time of injury
swelling and ecchymosis will be rapid and diffuse
point tenderness over ATF may extend over CF
Rx - PIER, modalities -horseshoe pad
Should probably xray to rule out any possible fractures

23. Eversion Ankle Sprain
less common than lateral ankle sprains because of strong deltoid ligament, thus many are associated with fibular fractures
mild to moderate pain with ankle eversion
slower and less evident swelling
point tenderness over deltoid ligament
Rx – X-ray, PIER, modalities -horse shoe

27. First Aid Care Immediately apply ice, compression and elevate
Apply a horseshoe or doughnut pad, keep it in place with a elastic wrap.
Have athlete rest , use crutches
If needed refer to physician or hospital for x-rays .

28. Syndesmotic ankle sprain
AKA: high ankle sprain
Approximately 10 – 15% of all ankle sprains involve the syndesmosis
30 % for collision sports ( football etc)
MOI – almost always involves a direct blow to the lateral aspect of the leg with foot planted in external rotation

30. s/s Min lateral swelling Possible med swelling
Pain in anterolateral lower leg
Point tenderness over the AITF lig , the interosseus membrane
Pont tenderness over the ATF and possibly the sup ATF lig
Disomfort /pain with DF ( AROM )
Loss of ankle function

31. First Aid Care Immediately apply ice, compression and elevate
Apply a horseshoe or doughnut pad, keep it in place with a elastic wrap.
Have athlete rest , use crutches , may want to put in walking boot or cast for short period of time
If needed refer to physician or hospital for xrays .

32. Achilles Tendon Strain or Rupture
probably the most severe acute muscular problem in lower leg
75% seen in males between years
mechanism of injury - usually pushing off of the forefoot while knee is extending (racquet sports )

33. most ruptures occur 1 to 2 inches proximal to the distal attachments of the tendon on the calcaneus
individual experiences sharp pain and hears or feels a POP in the tendon region - often described as a gun shot sound
a common sensation is one of being hit in the back of the leg
visible defect in the tendon

34. inability to actively extend the foot (especially against resistance)
swelling - bruising and a palpable defect in the tendon
immediate referral to physician

35. First Aid Care Immediately apply ice, compression and elevate
Immobilize the area in a splint or walking boot.
Have athlete rest , use crutches
Send to hospital or nearest medical facility.

36. Achilles Tendinitis most common in lower leg
tight heel cord – hyper-pronation - repetitive heel running - a recent change in shoes or running surfaces - increase in distance or intensity
pain present during and after activity

37. increases with passive dorsiflexion and resisted plantar flexion
point tenderness - diffuse or localized swelling
aching or burning in the posterior heel
occasionally fine crepitation can be palpated in the tendon with movement
Rx - PIER, Modalities, NSAIDS-heel lifts - reduced activity (rest) - especially running

38. Lower Leg Contusion usually gastroc
results in immediate pain and weakness and loss of function
haemorrhage and muscle spasm quickly lead to a tender firm mass that is easily palpable
ice on a mild stretch
care must be taken for myositis ossificans

39. Exercise Induced Compartment Syndrome
50-60% are anterior – characterised by exercise induced pain and swelling that is relieved by rest
exercise induced aching leg pain and a sense of fullness, both over the involved compartment
symptoms are almost always relieved with rest, usually with in 20 minutes

40. exercise will produce swelling and tenderness
to confirm a intra-compartmental pressure must be measured
RX involves stretching and strengthening , PIER, and NSAIDS
If symptoms persist , surgery is recommended

41. Muscle Spasms and Cramps
fatigue , loss of fluids or electrolyte,
acute treated with ice , pressure and slow static stretch
prevention - adequate water intake (electrolyte solution) - regular stretching program

42. Lower Leg Strain may be acute or chronic
acute may be result of tearing followed by the inability to walk without pain
point tenderness, swelling and muscle weakness will be present
Rx - PIER, modalities, depends on severity

43. Medial Tibial Stress Syndrome
AKA : Shin splints
Microscopic tears in the muscle attachment site on posterior medial border
pain along the posterior-medial tibial border
usually in the distal third

44. Possible factors - excessive pronation , prolonged pronation , recent training changes (speed, form , running surface , distance)
pain usually present at start of activity ,but decreases with activity only to return after activity, later stages pain present at all times - may restrict activity
RX - PIER, NSAIDS, (modalities) activity modification (rest) - low impact - non impact - stretching and strengthening of intrinsic muscle of the foot
Real key is to find cause ….