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Ankle and Lower Leg. Do Now What do you predict are some of the most common injuries of the foot and ankle? Have you ever injured your ankle?

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Presentation on theme: "Ankle and Lower Leg. Do Now What do you predict are some of the most common injuries of the foot and ankle? Have you ever injured your ankle?"— Presentation transcript:

1 Ankle and Lower Leg

2 Do Now What do you predict are some of the most common injuries of the foot and ankle? Have you ever injured your ankle?

3 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

4 Ankle Motions Plantar Flexion Dorsiflexion Inversion Eversion Pronation Supination

5 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

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

7 Common Injuries to the Ankle & Lower Leg

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

9 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

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

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

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

13 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

14 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


16 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

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

18 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

19 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

20 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

21 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

22 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

23 Ankle Sprains

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

25 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

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

27 Special Tests & Rehabilitation

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

29 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

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

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