Topic 3 THE ANKLE The ankle is a
- Slides: 51
Topic #3 THE ANKLE
The ankle is a complex joint
I. Anatomy A. Bones *Phalanges (toes)- proximal, middle, distal used for balance *Metatarsals- 1 st-5 th arch of foot, used for support
More bones *Tarsals- Cuneiforms (3), -Cuboid (below pinky) -Navicular -Talus- fibula and tibia sit on this –Calcaneous- heel bones, attaches to achilles tendon
*Tibia- shin bone *Fibula- non weight bearing *Malleolus- bump on end of ankle, 1) Tibial Malleolus (Medial) 2) Fibular Malleolus(Lateral)
Lower leg bones *Tibia- shin bone *Fibula- non weight bearing *Malleolus- bump on end of ankle, Tibial Malleolus Medial , Fibular Malleolus (R)
Bones
II. Anatomy Continued B. Ligaments Lateral *ATF-Anterior Talofibular Ligament *CF- Calcaneofibular Ligament *PTF- Posterior Talofibluar Ligament Medial *Deltoid ligament-four strong overlapping ligaments *Interosseous Membrane- between Fibular and Tibia
Ligaments
C. Muscles of Lower Leg Muscle Tibialis Anterior- front of leg Peroneus Longus-Head of Fibula to bottom of foot Peroneus Brevis-Fibula to base of 5 th Metatarsal Gastrocnemius- above knee to Calcaneus Soleus- Tibia to Calcaneus Movement Dorsiflexion Eversion Plantar Flexion
Gastrocnemius
More Muscles of Lower Leg Extensor Digitorum Longus-top of toes Plantar Fasciaalong bottom of foot Extends the toes Supports arch of foot
Extensor Digitorum Longus
Plantar Fascia
II. Injuries
Some prior knowledge needed Sprain vs Strain What is torn/stretched? What degree? Repair?
More prior knowledge Find the mechanism, Symptom and TX for: Inversion ankle Sprain Eversion Ankle Sprain Turf toe Achilles Tendonitis Achilles Tendon Rupture Plantar Faciitis Anterior Compartment Syndrome
Inversion Sprain ATF, CF, PTF Mechanism-Sole of foot turns in (more common) Symptoms-PT in area of one or more of the above ligaments, edema, ecchymosis TX: RICE, tape, brace, balance and strength exercises, possible surgery
Inversion Sprains occur 85% of time Because: 1) Deltoids are stronger 2) The Lateral Malleous extends down further than the Medial Malleous which prevents eversion
Second degree tear and Ecchymosis
Eversion Sprain Deltoid Mechanism-sole of foot turns out Could be possible avulsion fx Symptoms-PT on medial side of foot, edema, ecchymosis TX-RICE, tape in neutral, strength and balance exercises.
Turf Toe Mechanism: Running on turf and/or wearing loose shoes Symptoms: Sprain, pain in MTP joint TX: RICE, very Chronic, can tape and support
Achilles Tendon Rupture Thanksgiving Injury Mechanism- Middle age, tendon rips from inactivity, quick movement Symptoms- Hear a pop, sharp pain in posterior lower leg TX: Walking boot, surgery to reattach achilles
Achilles Tendon Rupture
Plantar Fasciitis Mechanism-tight gastroc/soleus complex, wearing high heels, overweight Symptoms-pain across bottom of foot, tight in the A. M. TX- Stretching, taping, flat shoes, possible surgery
Plantar Fasciitis
Achilles Tendonitis Mechanism-increase distance, tight gastroc/soleus complex, chronic Symptoms-inflammation, tight, PT on achilles TX: stretch gastrocnemius and soleus, heel lift, taping, reduce actvity, RICE
Achilles Tendonitis
Anterior Compartment Syndrome Mechanism-small bunch of muscles in between tibia and fibula-tight space. When they swell-put pressure on nerves. Increased mileage Symptoms-Tingling numbness in ant area, shiny look. TX-stop activity and rest, stretch strengthen, possible surgery
Anterior Compartment Syndrome
Fractures A) Jones FX- peroneus brevis breaks off a piece of the bases of the 5 th B) Stress FX-To tibia or metatarsals
Fractures
III. Assessment H-Mechanism? When did it happen? Position? Hear a noise? When does it hurt? Point to one spot. O (Bilateral)-Gait, deformity, ecchymosis, edema, form/technique, shoes P- Malleolus, toes, tibia/fibula, metarsals, base of 5 th
Special Tests 1) Anterior Drawer Test Slide Calcaneous past tibia. fiblua to see if pain or movement (Bilateral). If positive possible tear of ATF, CF, or PTF
Anterior Drawer Test
2) Evert the Heel Test Deltoid Ligament Grab Calcaneous to hold Talus- and evert If pain or movement- positive tear Bilateral comparison
3) Talus Rock Check both ATF/CF/PTF and Deltoid Grab Calcaneous- to hold Talus and rock back and forth
Thompson Test Squeeze gastrocnmeius/soleus complex and check for plantar flexion movement in foot. If movementachilles is fine. If none- achilles rupture or swollen
Fracture Test Squeeze Tibia and Fibula together and look for pain and/or movement Tap on toes and mallelous- look for pain in different spot Squeeze metatarsals together- look for pain and/or movement Bang on end of Calcaneous- look for pain in different location
Fracture test
IV. Rehabilitation Phase IIIIIIIV-
Increase ROM
Improve Balance
Strengthen
Functional Exercises
- Unity and coherence
- Narrow down topic
- Interpharyngeal
- Twisted ankle
- Toes rom
- Offred tattoo ankle
- Class levers 1 2 3
- Sugar tong splint wrist
- Chapter 19 worksheet the ankle and lower leg
- Chaput fragment ankle
- Ankle block frca
- Salter harris fracture
- Posterior long arm splint
- Marko mykkänen
- Phong tran orthopaedic surgeon
- End feel pada ankle
- Perpneal
- Prophylactic taping
- Ankle muslces
- Renaculum
- Tibiotalar
- Foot topography
- Lig calcaneofibulare
- Chapter 15 the ankle and lower leg
- Gastrocenimus
- National robotics initiative
- Flexor digitorum longus muscle
- Aim air egg gore round
- West point ankle sprain grading system
- Foot orthosis instant design challenge
- Soap injury evaluation
- Mtp 1 anatomi
- Ankle foot orthoses
- Ota core curriculum
- Wrist flexion measurement
- Weber classification of ankle fractures
- Inversion of foot
- Physiology of the foot and ankle
- Abi index normal
- Lateral dorsum
- Ankle sprain svenska
- Abi ratio
- The cumberland ankle instability tool
- Arches in foot
- "posterior slab splint"
- Ankle special tests athletic training
- Checkrein taping definition
- Special tests for ankle
- Ottawa ankle rules
- This technique requires two poles and a blanket
- Jeffrey lehrman
- Ankle invertors