1. CHAPTER 18 The Ankle and Lower Leg

2. Introduction
“Have you ever sprained your ankle, or do you know anyone who has?”
What did you do for it?
How long did the pain last?
Do you have any problems with that ankle?

3. Anatomy of the Ankle What bone make up the Ankle joint? Tibia Fibula
Talus
Calcaneus

4. Online Ankle Quiz
Access the following link and take the online bones of the Ankle quiz.

5. Anatomy of the Ankle What type of joint is the Ankle?
The Ankle joint is a HINGE JOINT
The TALOCRURAL Joint

6. Major Ligaments of the Ankle
LATERAL ASPECT
Anterior Tibiofibular
Anterior Talofibular- 3
Calcaneofibular- 6
Posterior Talofibular- 9

7. Major Ligaments of the Ankle
MEDIAL ASPECT
Posterior Talotibial
Posterior Talocalcaneal
Deltoid

8. Muscles and Tendons around the Ankle
Achilles Tendon
Peroneal Tendinitis
Anterior Tibialis Tendinitis
Posterior Tibialis Tendinitis

9. Common Ankle Injuries Inverted Ankle Sprain Everted Ankle Sprain
Ankle Dislocation
Muscle and Tendon Strains

10. Inverted Ankle Sprain
Inversion Ankle Sprain- the foot turns inward rolling over the lateral aspect of the ankle.
Most common ankle sprain- about 85% of all ankle sprains

11. Everted Ankle Sprain
Eversion Ankle Sprain- the turns inward. The ankle rolls in medially.
Uncommon sprain due to bone support.
Occurs in about 10-15% of ankle sprains.

12. Ankle Dislocation/Fracture
Medical Emergency
Usually the foot is inverted.
Frequently both the Tibia and Fibula are fractured.

13. Ankle Dislocation/Fracture - Medical Emergency

14. Muscle and Tendon Strains
Most common is the Achilles Tendon Strain.
THOMPSON Test the Achilles.
Peroneal tendon sometimes damaged with inversion ankle sprain.

15. Video on Ankle Injuries
NOTES on VIDEO:

16. Grading Scales for Sprained Ankles
Most common ankle sprain.
Mild pain, still weight baring.
More painful, report popping sound.
Can not bear weight.
Stretching of lateral ligaments of the ankle.
Extreme pain. Usually complete tear of one of the ankle ligaments.
Sometimes fracture occurs also.
GRADE I
GRADE II
GRADE III

17. Rehab/Treatment Plan for Sprained Ankles
RICE
Modalities
Exercises

18. RICE Rest- stay off the Ankle, crutches may be needed
Ice- 15 minutes a 4 to 5 times a day
Compression- ace wrap with horseshoe keeps the swelling down
Elevation- keep ankle above heart level when possible, allows gravity to pump out swelling

19. Goals of RICE Limit Swelling Reduce pain
Return to sport/activity quicker

20. Modalities Used COLD WHIRLPOOL- 15 minutes a couple times a day
Vasoconstrictors vessels around ankle
Stimulates pain killing receptors
Slows cell metabolism
Aids in reducing swelling

21. Modalities Used HIGH VOLTAGE-
Assists in activating pain killing receptors.
Assists in muscle stimulation around ankle joint to aid in edema removal.
ULTRASOUND-
Assists in edema removal.
Assists in bringing digestive enzymes to clean debris cells of the injured ankle.

22. Rehab Exercises Range of Motion ABC’s One leg Stands BAPS Board
Towel Curls
Toe Pickups
Toe Rises
Theraband

23. Taping Vs. Wrapping TAPING-
Psychologically better feeling to the athlete
Tight fitting at first
Tape looses a large percentage of its support within the first minutes of competition

24. Taping Vs. Wrapping WRAPPING-
Purpose in wrapping is injury prevention.
Wrapping will not eliminate sprained ankle, but it does minimize the severity of the sprain.

25. Ankle Braces ANKLE BRACES- Many varieties and types. Lace Up Hinged
Air Casts
All offer different levels of support.
Large and competitive business market for ankle braces.

26. Ankle Braces

27. Ankle Braces

28. Ankle Braces

29. Video on Cramer Ankle Brace
Notes on Video:

30. Questions Over Ankle
Notes: