Sports Medicine II And the Lower Leg Foot Mrs. Marr

THE 4 BONES OF THE ANKLE JOINT FIBULA TIBIA TALUS CALCANEUS

ANKLE LIGAMENTS – MEDIAL Deltoid Ligament Complex 4 ligaments Broad Flat Overlapping = STRONG! D A C B

ANKLE LIGAMENTS - LATERAL Lateral Collateral Ligaments ATF Anterior From Talus to Fibula Weakest of 3 ligaments PTF Posterior Strongest/Deepest of 3 ligaments CF From Calcaneus to Fibula Largest; Strong and Cord-like

ANKLE MUSCLES: ANTERIOR SIDE TIBIALIS ANTERIOR Muscle starts @ top of Tibia Tendon crosses over Ankle Joint @ Talus Attaches at the base of the 1st foot bone Cross over at joint allows for multiple motions Major Motion: Dorsiflexion of the ankle joint Inversion of the foot Prevents the forefoot slapping AND scrapping the ground

ANKLE MUSCLES: LATERAL SIDE PERONEAL GROUP 3 muscles (peroneus brevis/longus/tertius) Muscle group starts @ top of Fibula Peroneal tendon hooks around the back of Lateral Malleolus Insertion of Peroneal Tendon is at the base of the 5th foot bone Major Motion: Eversion of the Foot @ the Ankle

ANKLE MUSCLES: POSTERIOR GASTROCNEMIUS Muscle starts on distal femur 1 muscle with two points of origin Achilles Tendon is other attachment Crosses two joints Major Motion: Plantarflexion @ the Ankle ACHILLES TENDON Large Tendon/Cord from Gastroc. Inserts firmly at Calcaneus Largest, Strongest Tendon in Body Combination of Gastroc and Soleus Tendons

Compartments of the Leg Anterior Lateral (peroneal) Deep posterior Superficial posterior

Anterior Compartment Musculature Tibialis anterior Extensor digitorum longus Extensor hallucis longus Peroneus tertius anterior tibialis, ext. hallucis longus, extensor digitorum longus, peroneus tertius, deep peroneal nerve and anterior tibial blood vessels. Muscles originate on the proximal 2/3 tibia and fibula, and insert on the bones of the foot.

Tibialis Anterior DF and inversion O: lateral tibial condyle and shaft I: medial/plantar 1st cuneiform and metatarsal N: deep peroneal

Extensor Digitorum Longus Extension of 2nd-5th MP joints, assists with eversion and DF O: lateral tibial condyle, proximal ¾ of anterior fibula I: via 4 tendons into distal phalanges of 2nd-5th toes N: deep peroneal

Extensor Hallucis Longus Extension of 1st MP and IP joints O: middle 2/3 of anterior fibula I: base of distal 1st phalanx N: deep peroneal

Peroneus Tertius Eversion of foot, assists in PF O: distal 1/3 of anterior fibula I: dorsal base of 5th metatarsal N: deep peroneal

Lateral Compartment Musculature Peroneus longus Peroneus brevis peroneus brevis, peroneus longus, peroneal artery, superficial peroneal nerve. Muscles originate on the fibula for the most part and insert on the plantar surface of the foot.

Peroneus Longus Eversion of the foot, assists with PF O: lateral tibial condyle, fibular head, upper 2/3 of lateral fibula I: lateral base of 1st metatarsal, lateral and dorsal aspect of 1st cuneiform N: superficial peroneal

Peroneus Brevis Eversion of the foot, assists with PF O: distal 2/3 of lateral fibula I: styloid process at base of 5th metatarsal N: superficial peroneal

Superficial Posterior Compartment Muscles Gastrocnemius Soleus Plantaris gastroc, soleus, plantaris, popliteal artery, tibial nerve. Muscles originate on the femur and high on the tibia and insert into the calcaneus

Gastrocnemius Ankle PF, assists knee flexion O: medial head – posterior medial femoral condyle, lateral head – posterior lateral femoral condyle I: calcaneus via Achilles tendon N: tibial

Soleus Ankle PF O: posterior fibular head, upper 1/3 of posterior fibular, soleal line on posterior tibial shaft, middle 1/3 of medial tibial border I: calcaneus via Achilles tendon N: tibial

Plantaris Ankle PF, assists knee flexion O: distal supracondylar line of lateral femoral condyle, femoral popliteal surface I: calcaneus via Achilles tendon N: tibial

Deep Posterior Compartment Musculature “Tom, Dick, AND Harry” Tibialis posterior Flexor Hallucis Longus Flexor Digitorum Longus flexor hallucis longus, flexor digitorum longus, tibialis posterior, tibial nerve, peroneal artery, post. tibial artery. These structures originate on the posterior proximal 2/3 of tibia, interosseous membrane and fibula

Tibialis Posterior Inversion of the foot, assists with PF O: posterior/lateral tibia, upper 2/3 of medial fibula I: navicular tuberosity, via slips into sustentaculum tali, cuneiforms, cuboid and bases of 2nd-4th metatarsals N: tibial

Flexor Digitorum Longus Flexion of 2nd-5th PIP/DIP/MP joints, assists with foot inversion and PF O: posterior medial 2/3 of distal tibia I: plantar surface of base of 2nd-5th distal phalanges N: tibial

Flexor Hallucis Longus Flexion of 1st IP joint, assists with flexion of 1st MP joint, foot inversion and PF O: posterior/distal 2/3 of fibula I: plantar surface of 1st proximal phalanx N: tibial

Syndesmosis Interosseous membrane (Syndesmosis) isn't a compartment but ligamentous sheathe that holds the tibia and the fibula together.

Nerves and Blood Vessels Peroneal N. Tibialis Anterior/ Posterior N. Saphenous N. Blood Vessels Dorsal Pedal A. Posterior Tibial A. Greater/ Lesser Saphenous V.

Neuroanatomy Anterior compartment Lateral compartment Deep branch of Peroneal nerve Lateral compartment Superficial branch of Peroneal nerve Deep posterior compartment Tibial nerve Superficial posterior compartment

Deep Branch of Peroneal Nerve Branches from common Peroneal nerve near fibular head “Dives” into anterior compartment

Superficial Branch of Peroneal Nerve Branches from common Peroneal nerve near fibular head Stays superficial and lateral in lateral compartment

Tibial Nerve Runs in fascial sheath between deep and superficial posterior compartments Provides innervation to both, but not “in” either

Vascular Anatomy Anterior compartment Lateral compartment Anterior tibial artery Lateral compartment Peroneal artery Deep posterior compartment Posterior tibial artery Superficial posterior compartment

Anterior Tibial Artery Traverses similar path to deep Peroneal nerve Terminating as dorsal pedal artery

Peroneal Artery Branches off of posterior tibial artery

Posterior Tibial Artery Runs in fascial sheath between deep and superficial posterior compartments Provides vascular supply to both, but not “in” either

Special Tests The Squeeze Test check malleolus Check tibia and fibula May indicate FX Feel for any abnormalities Feeling for grinding or movement

Special Tests Anterior Drawer/Tilt Anterior drawer tests should always be performed with the knee bent to eliminate the Achilles and Gastrocnemius muscles from providing any stability to the ankle. A lateral talar tilt test can be conducted at the same time.

Anterior Drawer Test

Tilt Test

Special Tests Functional Tests (Return to play) a) walking - check gait b) toe raises 1) both feet 2) one foot c) jump and land on both feet and then on one foot