1. Ankle and Leg Injuries ROP SPORTS MEDICINE Stacy Camou

2. Skeletal Anatomy Talus Tibia –Medial aspect –Larger of the two leg bones –Second longest bone in body –Primary weight bearing bone in leg Fibula –Lateral aspect –Functions to provide muscle attachments –Non-weight bearing

3. Skeletal Anatomy

4. Articulations Talocrural joint = Ankle joint –Made up of the tibia, fibula, and talus –Talus is wedge shaped –Lateral malleolus extends more distally than the medial malleolus Proximal to Distal tibiofibular joint is connected by –Syndesmosis Joint (HIGH ANKLE SPRAIN)

5. Articulations- Talocrural Joint

6. Articulations

7. Musculoskeletal Anatomy 4 Compartments of the leg –Anterior compartment (most commonly Injured) Tibialis anterior Extensor hallicus longus Extensor digitorum longus Peroneus tertius Anterior tibial artery and vein Deep peroneal nerve –Lateral compartment Peroneus longus Peroneus brevis Superficial peroneal nerve

8. Musculoskeletal Anatomy Compartments of the leg –Deep posterior compartment Tibialis posterior Flexor hallucis longus Flexor digitorum longus Posterior tibial artery and vein Tibial nerve Superficial posterior Gastrocnemius Soleus Plantaris

9. Musculoskeletal Anatomy

10. Ligamentous Anatomy Ankle –Medial aspect Deltoid ligament Thick and strong –Lateral aspect Anterior talofibular Posterior talofibular Calcaneofibular Leg –Proximal and distal anterior and posterior tibiofibular ligaments + Interosseous membrane = Syndesmosis Ligaments

11. Ligamentous Anatomy

13. Gastrocnemius Soleus Achilles Tendon Tibialis Anterior Peroneus Longus Peroneus Brevis

14. Fractures Avulsions –Piece of tibia/fibula is pulled off by ligament –Fairly common –X-rays for all ankle sprains

15. Fractures

16. Tibia –Traumatic fractures are serious due to size of bone –Stress fractures Medial tibial stress syndrome “shin splints” Fibula –Fairly common –Non-weight bearing; competition possible –Stress fractures Reasonably common due to muscle attachments Both bones –Usually requires surgery to stabilize

17. Fractures

18. Strains Gastrocnemius/Soleus strain occurs: –Muscle belly –Musculotendinous junction Anterior extensors strain –Often called “shin splints” (lateral to tibial ridge) –M.O.I = Hill, climbing, or speed work –May lead to chronic compartment syndrome Toe flexors –Often called “shin splints” (medial to tibial ridge) –M.O.I = Pronation increases odds Achilles tendon –Strain vs tendonitis ( can lead to rupture )

19. Strains Achilles tendon rupture –Most common over 30 years old –Chronic history of inflammation or –Acute Sudden push off –Signs and symptoms “I was kicked in the back of the leg!!” Immediate pain Palpable defect Positive Thompson’s test

20. STRAINS

21. Thompson’s Test

22. Sprains Lateral ankle sprains –M.O.I = Inversion/plantar flexion mechanism –Most common injury in body –90-95% of all ankle sprains occur to lateral ligaments…..Why? Strong medial ligaments Fibular block –Ligaments involved Anterior talofibular or ATFL Calcaneofibular or CFL Posterior talofibular or PTFL –Mild to severe grades (1°-3°)

23. Lateral Ankle Sprain

24. Sprains Medial ankle sprains –M.O.I = Eversion mechanism –Rare (5%) occur medially….WHY???? Strong deltoid ligament Fibular block –Deltoid ligaments Injured –Graded Mild to severe (1°-3°) Syndesmosis sprain –M.O.I = Forced dorsiflexion and/or eversion –“High ankle sprain” –Slow to heal –Anterior tibiofibular (ATFL) ligament and interosseous membrane are the ligaments injured

25. Medial Ankle Sprain

26. Other Conditions Achilles tendonitis/tenosynovitis –Inflammation of the tendon or sheath surrounding the tendon –Causes hypertrophic scarring Achilles Tendon Rupture

27. Achilles Tendonitis

28. ACHILlES TENDON RUPTURE

29. Other Conditions Compartment syndrome –Typically anterior or deep posterior compartments –Acute Caused by direct blow or injury within fascial compartment Medical emergency Taut, shiny appearance of skin Foot drop if advanced Requires surgical decompression –Chronic Muscle hypertrophy during exercise –Decreased space in compartment Slow, continual rise in temperature –Treatment???

30. If pressure is too high surgery will be required.