Ankle and Lower Leg

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Ankle and Lower Leg
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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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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

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Ankle Motions

• Plantar Flexion
• Dorsiflexion
• Inversion
• Eversion
• Pronation
• Supination

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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

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Ligaments

• Lateral aspect
• Anterior talofibular (ATF)
• Anterior tibiofibular
• Calcaneofibular (CF)
• Posterior talofibular
• Medial aspect
• Deltoid Ligament

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Common Injuries to theAnkle Lower Leg
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Contusions

• Occur most often on tibia
• Can be painful and disabling
• Complication?
• compartment syndrome

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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

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Cramps

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

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CrampsTreatment

• Passive stretching
• Fluid replacement
• Water
• Sports drink
• Massage
• Rest
• Ice

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Achilles Tendonitis

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

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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

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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

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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

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MTSS Treatment

• Ice
• Reduce activity level
• Gentle stretching
• Biomechanical assessment
• Orthotics
• NSAIDs
• Strengthening and flexibility program

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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
  bodys ability to heal it

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Stress FracturesS/Sxs

• hot spot of sharp, intense pain upon palpation

• Shin-splint
• Pain more generalized
• Pain worse in am

• Stress Fx
• Pain worse in pm

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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

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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

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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

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Ankle Sprains
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• Inversion
• Anterior Talofibular
• Calcaneofibular
• Posterior Talofibular
• Eversion
• Deltoid Ligament
• Syndesmotic
• High ankle sprain

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Ankle SprainS/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

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Ankle SprainTreatment

• R.I.C.E.
• Crutches
• Boot
• Splint, tape, brace
• Compressive wrap
• Horseshoe

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Special TestsRehabilitation
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• Anterior Drawer

• Talar Tilt

• Tests integrity of anterior talofibular ligament

• Tests integrity of calcaneofibular ligament

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• Squeeze Test

• Bump Test/Tap Test

• Squeezing the tibia and fibula together
• Can indicate fracture or high ankle sprain

• Bump calcaneus
• Indicate fracture to tibia/fibula
• Indicate high ankle sprain
• Tap mallelous
• Indicate fracture of particular bone

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Ankle Rehab

• 4-way TheraBand
• Heel walks/Toe walks
• 3-way heel raises
• Unilateral Balance
• 3-way Tramp throw