The Lower Leg The Lower Leg and Ankleand Ankle

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Anatomy of Lower LegAnatomy of Lower Leg

Comprised of two long bones. Comprised of two long bones. Tibia is the larger of the two, and is Tibia is the larger of the two, and is

located toward the middle of the lower located toward the middle of the lower leg (medially). leg (medially).

Fibula is the smaller bone and it is Fibula is the smaller bone and it is located on the outside of the lower leg located on the outside of the lower leg (laterally). (laterally).

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Bone StructureBone Structure

A. Lateral MalleolusA. Lateral Malleolus

C. FibulaC. Fibula

D. Interosseous D. Interosseous MembraneMembrane

I. Medial CondyleI. Medial Condyle

J. Tibial TuberosityJ. Tibial Tuberosity

L. TibiaL. Tibia

M. Medial MalleolusM. Medial Malleolus

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Muscles in the Lower LegMuscles in the Lower LegDivided into four compartmentsDivided into four compartments

Anterior compartmentAnterior compartment (the front of the shin) (the front of the shin) Has 4 muscles: tibilais anterior, the extensor digitorum longus, the Has 4 muscles: tibilais anterior, the extensor digitorum longus, the

extensor hallucus longus and the peroneus tertius muscles. extensor hallucus longus and the peroneus tertius muscles. These muscles dorsiflex the foot and toes. These muscles dorsiflex the foot and toes. The tibialis anterior also assists turning the foot inward. The tibialis anterior also assists turning the foot inward.

Lateral compartment: (outside). Lateral compartment: (outside). Has 2 muscles: peroneus longus and peroneus brevis muscles. Has 2 muscles: peroneus longus and peroneus brevis muscles. Pull the foot outward. Pull the foot outward. They also help with plantarflexion They also help with plantarflexion

Posterior compartmentPosterior compartment HaHas 2 large muscles: s 2 large muscles:

gastrocnemius shorter, thicker and has two attachments and most visiblegastrocnemius shorter, thicker and has two attachments and most visiblesoleus lies underneathsoleus lies underneath

Also contains plantaris muscle.Also contains plantaris muscle. These three muscles attach to the achilles tendon. These three muscles attach to the achilles tendon. They all aid with plantarflexion. They all aid with plantarflexion.

Deep posterior compartment (deep within the back)Deep posterior compartment (deep within the back) Has 3 muscles: tibialis posterior, flexor digitorum longus, and flexor Has 3 muscles: tibialis posterior, flexor digitorum longus, and flexor

hallucus longus. hallucus longus. All three aide in plantarflexion. All three aide in plantarflexion.

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Understanding the GaitUnderstanding the Gait.. OBSSERVING THE FOLLOWING:OBSSERVING THE FOLLOWING:

Mechanics of foot-strike while walking/running. Mechanics of foot-strike while walking/running. Loading/energy transfer phase. Loading/energy transfer phase. The push off (“toe-off”) with the forefoot. The push off (“toe-off”) with the forefoot.

Each foot-strike delivers a shockwave that travels up the leg. Each foot-strike delivers a shockwave that travels up the leg.

This energy must be absorbed by the musculoskeletal system. This energy must be absorbed by the musculoskeletal system.

The harder the running surface the greater the shockwave.The harder the running surface the greater the shockwave.Soft grass, smooth dirt, asphalt, and concrete. Soft grass, smooth dirt, asphalt, and concrete. Basketball court, track, baseball field, tennis courtBasketball court, track, baseball field, tennis court

M.S.T.T.M.S.T.T.MilesMilesShoesShoesTechniqueTechniqueTerrainTerrain

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Calf StrainCalf Strain

Most commonly injured is at the Most commonly injured is at the musculotendinous junction of the Gastrocnemius musculotendinous junction of the Gastrocnemius (half way between the knee and the heel). (half way between the knee and the heel). Soleus muscle damage pain lower in the leg Soleus muscle damage pain lower in the leg

pain when you contract the muscle against resistance pain when you contract the muscle against resistance with the knee bent with the knee bent

Symptoms of calf strain include: Symptoms of calf strain include: A sudden pain at the back of the leg, particularly at the A sudden pain at the back of the leg, particularly at the musculotendinous junction.musculotendinous junction.Difficulty in contracting the muscle or standing on tip toes Difficulty in contracting the muscle or standing on tip toes Pain and swelling or bruising in the calf muscle Pain and swelling or bruising in the calf muscle Pain on resisted plantar flexion (pointing the toes away Pain on resisted plantar flexion (pointing the toes away from you) or contracting the muscles against resistance,from you) or contracting the muscles against resistance,

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What are Shin What are Shin Splints?Splints?

General name given to pain at the front of the lower General name given to pain at the front of the lower leg. leg. Shin splints is not a diagnosis in itself but a Shin splints is not a diagnosis in itself but a description of symptoms of which there could be a description of symptoms of which there could be a number of causes. number of causes. The most common cause is inflammation of the The most common cause is inflammation of the periostium of the tibia sheath surrounding the bone). periostium of the tibia sheath surrounding the bone).

Traction forces occur from the muscles of the lower leg Traction forces occur from the muscles of the lower leg on the periostium causing shin pain and inflammationon the periostium causing shin pain and inflammation

Symptoms of shin splints:Symptoms of shin splints: Tenderness over the inside of the shin. Tenderness over the inside of the shin. Lower leg pain which goes after a period of rest but comes back Lower leg pain which goes after a period of rest but comes back

when running starts again. when running starts again. Sometimes some swelling. Sometimes some swelling. Lumps and bumps may be felt when feeling the inside of the Lumps and bumps may be felt when feeling the inside of the

shin bone. shin bone. Pain when the toes or foot are bent downwards. Pain when the toes or foot are bent downwards. A redness over the inside of the shin. A redness over the inside of the shin.

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Shin SplintsShin SplintsMedial Tibial Stress Syndrome Medial Tibial Stress Syndrome

(MTSS)(MTSS)

Four basic grades you can follow:Four basic grades you can follow:

Grade 1Grade 1- Shin pain 2-3 hours after exercise.  - Shin pain 2-3 hours after exercise.  Dull soreness; low impact activity can reduce pain.Dull soreness; low impact activity can reduce pain.

Grade 2Grade 2- Shin pain before and after exercise- Shin pain before and after exercisebut doesn’t affect performance.but doesn’t affect performance.

Grade 3Grade 3- Shin pain before, during, and after, - Shin pain before, during, and after, exerciseexercise

affects performance.affects performance. Grade 4Grade 4- Severe pain, cannot perform activity.  - Severe pain, cannot perform activity. 

Should be referred to a physician or physiotherapist if Should be referred to a physician or physiotherapist if pain persists after one week.pain persists after one week.

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Two types of muscular shin splints Two types of muscular shin splints

(different problems)(different problems)Tibialis posteriorTibialis posterior

Most common of shin splintsMost common of shin splints

Inflammation of the muscle Inflammation of the muscle attachments and interosseous  attachments and interosseous  membranes to the tibia (shin bone) on membranes to the tibia (shin bone) on the inside of the front of the lower leg. the inside of the front of the lower leg.

Affecting the inner part of the lower Affecting the inner part of the lower leg at the insertion of a major leg at the insertion of a major decelerator muscle of the foot, namely decelerator muscle of the foot, namely tibialis posterior.tibialis posterior.

Pain is felt on palpation or when Pain is felt on palpation or when walking/running approximately half walking/running approximately half way up the inner shin.way up the inner shin.

Pain is only felt in the muscular region Pain is only felt in the muscular region right next to the tibia (shin bone) and right next to the tibia (shin bone) and not when touching the bone itselfnot when touching the bone itself

Tibilas anteriorTibilas anterior

These are known as anterior These are known as anterior shin splints and are shin splints and are almost almost as commonas common as the posterior as the posterior shin splints. shin splints.

These are caused by These are caused by inflammation of the insertion inflammation of the insertion of the  second decelerator of of the  second decelerator of the foot:the foot:

namely tibialis anterior.namely tibialis anterior.

Pain is felt on the other side Pain is felt on the other side of the shin bone (on the outer of the shin bone (on the outer part of the leg). part of the leg).

Again pain will not be felt Again pain will not be felt when touching the bone itself when touching the bone itself

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Achilles Tendon InjuryAchilles Tendon Injury

The Achilles tendon, or tendon calcaneusThe Achilles tendon, or tendon calcaneus Large ropelike band of fibrous tissue in the Large ropelike band of fibrous tissue in the

back of the ankle that connects the powerful back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus). calf muscles to the heel bone (calcaneus).

It is the largest tendon in the human body It is the largest tendon in the human body

Injury often occurs during recreational Injury often occurs during recreational sports that require bursts of jumping, sports that require bursts of jumping, pivoting, and running. pivoting, and running. Most often these are tennis, racquetball, Most often these are tennis, racquetball,

basketball, and badminton. basketball, and badminton.

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Retrocalcaneal BursitisRetrocalcaneal Bursitis

An inflammation in the bursa An inflammation in the bursa behind the heel bone. Pain at behind the heel bone. Pain at the back of the heels the back of the heels especially when running uphill especially when running uphill or on soft surfaces. or on soft surfaces. Tenderness and swelling Tenderness and swelling which might make it difficult to which might make it difficult to wear certain shoes on the feet. wear certain shoes on the feet. When pressing fingers in both When pressing fingers in both sides of the heel a spongy sides of the heel a spongy resistance may be felt. resistance may be felt.

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The AnkleThe Ankle

The ankle is a joint which is formedThe ankle is a joint which is formed tibia and fibula and the talus (below the ankle joint). tibia and fibula and the talus (below the ankle joint).

The ankle joint allows for:The ankle joint allows for: upwards (dorsiflexion) and upwards (dorsiflexion) and downwards (plantarflexion) motion. downwards (plantarflexion) motion.

The end of the shin bone (tibia) forms the inner bony The end of the shin bone (tibia) forms the inner bony prominence of the ankle called the medial malleolus. prominence of the ankle called the medial malleolus. The outer bony prominence is called the lateral The outer bony prominence is called the lateral malleolus and is formed by the small outer bone in the malleolus and is formed by the small outer bone in the foreleg called the fibula. foreleg called the fibula. Stability of the joint comes from several factors: Stability of the joint comes from several factors:

the unique structural arrangement of the bones forming the joint the unique structural arrangement of the bones forming the joint the surrounding ligamentsthe surrounding ligaments

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On the lateral (outside) of the ankle is a complex On the lateral (outside) of the ankle is a complex of three ligaments. of three ligaments. These three ligaments provide stability by These three ligaments provide stability by attaching the lateral malleolus to the bones attaching the lateral malleolus to the bones below the ankle joint (talus and calcaneus). below the ankle joint (talus and calcaneus). They are the: (Inversion sprain)They are the: (Inversion sprain) anterior talo-fibular ligament (goes from the talus to anterior talo-fibular ligament (goes from the talus to

the fibula) the fibula) calcaneo-fibular ligament (goes from the calcaneus to calcaneo-fibular ligament (goes from the calcaneus to

the fibula) the fibula) posterior talo-fibular ligament (goes from the talus to posterior talo-fibular ligament (goes from the talus to

the fibula).the fibula).

Medial (inside) of the ankle: (Eversion sprain)Medial (inside) of the ankle: (Eversion sprain) The deltoid ligament is a wide complex ligament over The deltoid ligament is a wide complex ligament over

the inner part of the ankle.the inner part of the ankle. deltoid ligament sprain coupled with an ATFL sprain deltoid ligament sprain coupled with an ATFL sprain

takes longer to heal. takes longer to heal. 1717

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Ankle SprainsAnkle Sprains

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Common Injuries to the Common Injuries to the FootFoot

Turf toe:Turf toe: Turf toe is an injury to the base of the big toe, in which you actually tear the Turf toe is an injury to the base of the big toe, in which you actually tear the

capsule that surrounds the joint at the base of the toe. capsule that surrounds the joint at the base of the toe. The toe is jammed into the ground and bent too far back (hyperextended). The toe is jammed into the ground and bent too far back (hyperextended). This injury occurs most often in sports that require quick direction This injury occurs most often in sports that require quick direction

changes: changes: football, soccer or rugby.football, soccer or rugby.

Plantar Fasciitis: Plantar Fasciitis: Ligament band running from your heel to the ball of your foot. Ligament band running from your heel to the ball of your foot. This band pulls on the heel bone, raising the arch of your foot as it pushes off the This band pulls on the heel bone, raising the arch of your foot as it pushes off the

ground. ground. The fascia may swell and its tiny fibers may begin to fray, causing plantar The fascia may swell and its tiny fibers may begin to fray, causing plantar

fasciitis.fasciitis. Caused by poor foot mechanics Caused by poor foot mechanics

Morton's syndrome:Morton's syndrome: An enlarged nerve that usually occurs in the third interspace, which is between An enlarged nerve that usually occurs in the third interspace, which is between

the third and fourth toes the third and fourth toes localized pain in the inter space localized pain in the inter space

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Turf ToeTurf Toe

Morton’s Morton’s NeuromaNeuroma

Plantar FascitisPlantar Fascitis

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Peroneal TendinitisPeroneal Tendinitis Caused by pes cavusCaused by pes cavus

Foot excessively supinatesFoot excessively supinates

Causes weight bearing on the outside of footCauses weight bearing on the outside of foot Mistaken for ankle sprainsMistaken for ankle sprains

Leg Cramps and SpasmsLeg Cramps and Spasms Sudden, violent, involuntary contractionsSudden, violent, involuntary contractions

Clonic spasm = intermittent contraction and Clonic spasm = intermittent contraction and relaxation (neurological)relaxation (neurological)

Tonic spasm = constant contraction without Tonic spasm = constant contraction without relaxationrelaxation

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Peroneal & SpasmsPeroneal & Spasms

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FractureFractureNormal Ankle X-

ray Fractured Ankle

X-ray Surgery with Plate and

Screws

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Ankle Fracture DislocationAnkle Fracture Dislocation

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TapingTaping

ArchesArches LongitudinalLongitudinal TransverseTransverse

Barber PollBarber Poll

ShinsShins

Great ToeGreat Toe Turf toeTurf toe

AnkleAnkle preventionprevention

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