Ankle and Lower Leg Do Now What do

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?

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

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

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

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

Common Injuries to the Ankle & Lower Leg

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

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

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

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

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

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

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 = 1 yr + Thompson test

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

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

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

Stress Fractures—S/Sxs • “hot spot” of sharp, intense pain upon palpation Shin-splint Stress Fx • Pain more generalized • Pain worse in am • Pain worse in pm

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

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

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: ü Joint swelling ü Local temperature increase ü Pain ü Point tenderness ü Skin discoloration

Ankle Sprains

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

Ankle Sprain—S/SXS Ø Grade 1 § § § Some pain Minimum LOF Mild point tenderness Little or no swelling No abnormal motion Ø Grade 2 § § Pain Moderate LOF Swelling Slight to moderate instability Ø Grade 3 § Severe sprain § Extremely painful initially § LOF § Severe instability § Tenderness § Swelling § May represent subluxation that reduced spontaneously

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

Special Tests & Rehabilitation

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

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

Ankle Rehab • • • 4 -way Thera. Band® Heel walks/Toe walks 3 -way heel raises Unilateral Balance 3 -way Tramp throw