The lower leg and ankle f09
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Transcript of The lower leg and ankle f09
- 1.The Lower Leg and Ankle
2. Anatomy of Lower Leg
- Comprised oftwo long bones .
- Tibia is the larger of the two, and is located toward the middle of the lower leg (medially).
- Fibula is the smaller bone and it is located on the outside of the lower leg (laterally).
3. Bone Structure
- A. Lateral Malleolus
- C. Fibula
- D. Interosseous Membrane
- I. Medial Condyle
- J. Tibial Tuberosity
- L. Tibia
- M. Medial Malleolus
4. Muscles in the Lower Leg
- Divided into four compartments
- Anterior compartment (the front of the shin)
- Has 4 muscles: tibilais anterior, the extensor digitorum longus, the extensor hallucus longus and the peroneus tertius muscles.
- These muscles dorsiflex the foot and toes.
- The tibialis anterior also assists turning the foot inward.
- Lateral compartment: (outside).
- Has 2 muscles: peroneus longus and peroneus brevis muscles.
- Pull the foot outward.
- They also help with plantarflexion
- Posterior compartment
- Ha s 2 large muscles:
- gastrocnemius shorter, thicker and has two attachments and most visible
- soleus lies underneath
- Also contains plantaris muscle.
- These three muscles attach to the achilles tendon.
- They all aid with plantarflexion.
- Deep posterior compartment (deep within the back)
- Has 3 muscles: tibialis posterior, flexor digitorum longus, and flexor hallucus longus.
- All three aide in plantarflexion.
5. 6. Understanding the Gait .
- OBSSERVING THE FOLLOWING:
- Mechanics of foot-strike while walking/running.
- Loading/energy transfer phase.
- The push off (toe-off) with the forefoot.
- Each foot-strike delivers a shockwave that travels up the leg.
- This energy must be absorbed by the musculoskeletal system.
- The harder the running surface the greater the shockwave.
- Soft grass, smooth dirt, asphalt, and concrete.
- Basketball court, track, baseball field, tennis court
7. Calf Strain
- Most commonly injured is at the musculotendinous junction of the Gastrocnemius (half way between the knee and the heel).
- Soleus muscle damage pain lower in the leg
- pain when you contract the muscle against resistance with the knee bent
- Symptoms of calf strain include:
- A sudden pain at the back of the leg, particularly at the musculotendinous junction.
- Difficulty in contracting the muscle or standing on tip toes
- Pain and swelling or bruising in the calf muscle
- Pain on resisted plantar flexion (pointing the toes away from you) or contracting the muscles against resistance,
8. 9. What are Shin Splints?
- General name given to pain at the front of the lower leg.
- Shin splints is not a diagnosis in itself but a description of symptoms of which there could be a number of causes.
- The most common cause is inflammation of the periostium of the tibia sheath surrounding the bone).
- Traction forces occur from the muscles of the lower leg on the periostium causing shin pain and inflammation
- Symptoms of shin splints:
- Tenderness over the inside of the shin.
- Lower leg pain which goes after a period of rest but comes back when running starts again.
- Sometimes some swelling.
- Lumps and bumps may be felt when feeling the inside of the shin bone.
- Pain when the toes or foot are bent downwards.
- A redness over the inside of the shin.
10. Shin Splints Medial Tibial Stress Syndrome (MTSS)
- Four basic grades you can follow:
- Grade 1 - Shin pain 2-3 hours after exercise.
- Dull soreness; low impact activity can reduce pain.
- Grade 2 - Shin pain before and after exercise
- but doesnt affect performance.
- Grade 3 - Shin pain before, during, and after, exercise
- affects performance.
- Grade 4 - Severe pain, cannot perform activity.
- Should be referred to a physician or physiotherapist if pain persists after one week.
11. Two types of muscular shin splints(different problems)
- Tibialis posterior
- Most common of shin splints
- Inflammation of the muscle attachments and interosseous membranes to the tibia (shin bone) on the inside of the front of the lower leg.
- Affecting the inner part of the lower leg at the insertion of a major decelerator muscle of the foot, namely tibialis posterior.
- Pain is felt on palpation or when walking/running approximately half way up the inner shin.
- Pain is only felt in the muscular region right next to the tibia (shin bone) and not when touching the bone itself
- Tibilas anterior
- These are known as anterior shin splints and arealmost as commonas the posterior shin splints.
- These are caused by inflammation of the insertion of the second decelerator of the foot:
- namely tibialis anterior.
- Pain is felt on the other side of the shin bone (on the outer part of the leg).
- Again pain will not be felt when touching the bone itself
12. 13. Achilles Tendon Injury
- The Achilles tendon, or tendon calcaneus
- Large ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus).
- It is the largest tendon in the human body
- Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running.
- Most often these are tennis, racquetball, basketball, and badminton.
14. 15. Retrocalcaneal Bursitis
- An inflammation in the bursa behind the heel bone. Pain at the back of the heels especially when running uphill or on soft surfaces.
- Tenderness and swelling which might make it difficult to wear certain shoes on the feet.
- When pressing fingers in both sides of the heel a spongy resistance may be felt.
16. The Ankle
- The ankle is a joint which is formed
- tibia and fibula and the talus (below the ankle joint).
- The ankle joint allows for:
- upwards (dorsiflexion) and
- downwards (plantarflexion) motion.
- The end of the shin bone (tibia) forms the inner bony prominence of the ankle called the medial malleolus.
- The outer bony prominence is called the lateral malleolus and is formed by the small outer bone in the foreleg called the fibula.
- Stability of the joint comes from several factors:
- the unique structural arrangement of the bones forming the joint
- the surrounding ligaments
- On the lateral (outside) of the ankle is a complex of three ligaments.
- These three ligaments provide stability by attaching the lateral malleolus to the bones below the ankle joint (talus and calcaneus).
- They are the: (Inversion sprain)
- anterior talo-fibular ligament (goes from the talus to the fibula)
- calcaneo-fibular ligament (goes from the calcaneus to the fibula)
- posterior talo-fibular ligament (goes from the talus to the fibula).