The lower leg and ankle f09

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  • 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 .

      • 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
    • M.S.T.T.
      • Miles
      • Shoes
      • Technique
      • Terrain

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).