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

• Complicationcompartment 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 = 1yr +

• 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• Pain more

generalized• Pain worse in

am

Stress Fx• 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:Joint swellingLocal temperature

increasePain Point tendernessSkin discoloration

Ankle Sprains

• Inversion – Anterior Talofibular– Calcaneofibular– Posterior Talofibular

• Eversion– Deltoid Ligament

• Syndesmotic– High ankle sprain

Ankle Sprain—S/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

Ankle Sprain—Treatment

• R.I.C.E.

• Crutches

• Boot

• Splint, tape, brace

• Compressive wrap

• Horseshoe

Special Tests&

Rehabilitation

Anterior Drawer

• Tests integrity of anterior talofibular ligament

Talar Tilt

• 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 TheraBand®

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