The Ankle and Lower Leg By: Kelsey Showalter & Taylor Douglass

The Ankle and Lower Leg By: Kelsey Showalter & Taylor Douglass The Ankle and Lower Leg By: Kelsey Showalter & Taylor Douglass - Start

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The Ankle and Lower Leg By: Kelsey Showalter & Taylor Douglass - Description

Anatomy of the ankle and lower leg. Tibia- Serves as the principle weight bearing bone of the leg. . Fibula- Main function is to provide for the attachment of muscles.. Talus- Forms a link between the lower leg and the foot.. ID: 667802 Download Presentation

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The Ankle and Lower Leg By: Kelsey Showalter & Taylor Douglass

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The Ankle and Lower Leg

By: Kelsey Showalter & Taylor Douglass


Anatomy of the ankle and lower leg

Tibia- Serves as the principle weight bearing bone of the leg.

Fibula- Main function is to provide for the attachment of muscles.

Talus- Forms a link between the lower leg and the foot.

Calcaneus- The bone that forms the heel.




Joint- The ankle joint that is formed by the articular facet on the distal portion of the tibia. The ankle movements that occur at the


joint are plantar flexion and dorsiflexion.


Joint- The


joint consist of the articulation between the talus and the calcaneus. The ankle movements that occur here are inversion, eversion, pronation, and supination.


Stabilizing Ligaments


Ligaments- Joins the tibia and fibula with a strong



Ankle Ligaments- Support of the ankle consist of three lateral ligaments and the medial, or deltoid, ligament.

Lateral Ligaments-Anterior


, the posterior


, and the



Medial Ligaments- Is the primary resistance to foot eversion and helps maintain the inner longitudinal arch.


Nerve Supply- The lower leg is supplied by the common


nerve anteriorly. The


nerve runs posteriorly and supplies the ankle and the foot.

Blood Supply-The ankle and lower leg are supplied by the anterior


artery and posterior




Preventing injury to the ankle and lower leg

Achilles Tendon Stretching- It is critical for normal gait that the ankle


at least 10 degrees or more.

Strength training- It is important to achieve both static and dynamic joint stability.

Neuromuscular Control Training- Involves adapting to uneven surfaces by controlling motion at the ankle joint.

Footwear- Shoes should not be used in


for which they were not intended.

Preventive Ankle Taping and


- Properly applied tape can provide some prophylactic protection.


Assessing the Ankle and Lower Leg

History- The athletic trainer should ask the patient questions about their ankle history.

Observation- The athletic trainer should observe the injury.

Palpation- The area of injury should be palpated to determine obvious structural deformities, areas of swelling, and points of tenderness.


Special Tests

Lower Leg

Lower leg alignment test- determining


of the lower leg can reveal the causes of abnormal stress applied to the foot, ankle and lower leg.

Percussion and compression test- A gentle percussive blow sets up a vibratory force that causes pain if fractured.

Thompson Test- Used to determine whether there is a rupture of the Achilles tendon.


Special Test

Ankle Stability Test

Anterior Drawer Test- Used to determine the extent of injury to the anterior


ligament and to the other lateral ligaments.


Tilt Test- Used to determine the extent of inversion or eversion injuries.


Test- Used to determine injury to the deltoid ligament.

Functional Tests-Athletic trainers routinely have individuals with traumatic ankle sprains perform these test.


Ankle Injuries

Inversion Ankle Sprains- Result in injury to the lateral ligaments.

Grade I Ligament Sprain- Most common type of sprain. Symptoms and signs include, mild pain and disability. A sign is swelling.

Grade II ligament Sprain- Moderate force on the ankle while it is in a position of inversion, plantar flexion, and/or adduction can cause a grade 2 sprain. Symptoms and signs include, patient feeling a pop or snap. They will also have moderate pain.


Ankle Injuries

Grade 3 ligament sprain- Is relatively uncommon and caused by a significant inversion force to the ankle, usually combined with plantar flexion and adduction. Symptoms and signs include, severe pain and swelling.

Eversion Ankle Sprains- Represents about 5 percent to 10 percent of all ankle sprains. A foot that excessively pronates, is hypermobile, or has a depressed medial longitudinal arch is more predisposed to eversion ankle injuries. Signs and symptoms include pain and unable to bear weight.


Ankle Injuries

Chronic Ankle Instability- Develops following about one third of all acute ankle sprains.

Ankle Fracture/Dislocation- A foot that is forcibly abducted can produce a transverse fracture of the distal tibia and fibula. In contrast, a foot that is planted in combination with a force internal rotation of the leg can produce a fracture to the distal and posterior tibia.


Ankle Injuries



– Occurs in the superior medial articular surface of the


dome. One or several fragments of articular cartilage and its underlying


bone are either partially or completely detached and moving within the joint space.


Lower Leg Injuries

Achilles Tendon Strain – common in sports and occur most often after ankle sprains or sudden excessive dorsiflexion of the ankle





) – no evidence of inflammation. Injured areas of the


tendon have lost their normal appearance and the collagen fibers that make up the


tendon are disorganized, scarred and degenerated. Achilles


is a soreness and stiffness that comes on gradually and continues to worsen.


Lower leg injuries

Achilles Tendon Rupture – Common in “stop and go” activities and athletes who are 30 years of age or older. It usually occurs in an individual with history of chronic inflammation and





Tendinitis – Common condition in individuals who run downhill for an extended period of time.



Tendinitis – Overuse condition among runners with hypermobility or pronated feet.


Lower Leg Injuries


Tendinitis – Can be a problem in individuals with pes


. In pes


, the foot tends to supinate excessively.

Shin Contusion – because of the absence of muscular or adipose padding, the periosteum receives the full force of any impact delivered to the shin.

Muscle Contusions – common in sports, particularly to the gastrocnemius muscle


Lower Leg Injuries

Leg Cramps and Spasms – sudden, violent, involuntary contractions of one or several muscles and may be either


or tonic.


– intermittent contraction and relaxation

Tonic- constant muscles contraction without an intervening period of relaxation


Lower Leg Injuries


Strains – the medial head of the gastrocnemius is particularly susceptible to muscle strain. Activities that require quick starts and stops or occasional jumping can cause this strain.

Acute Leg Fractures – the fibular fracture has the highest incidence. Fractures of both the tibia and fibula result from either direct or indirect trauma.



Stress Syndrome (MTSS) – has in the past been referred to as


. Conditions such as stress fractures, muscle strains, and chronic anterior compartment syndrome have all been termed




Lower Leg Injuries

Compartment Syndromes – conditions in which increased pressure within one of the four compartments of the lower leg causes compression of muscular and neurovascular structures within that compartment.

3 Categories: Acute Compartment Syndrome, Acute Exertional Compartment Syndrome, and Chronic Compartment Syndrome.


Lower Leg Injuries

Stress fracture of the Tibia or Fibula – are a common overuse stress condition, especially among distance runners. Like many other overuse syndromes, these are more likely to occur in individuals with structural deformities of the foot.


Rehabilitation Techniques for the ankle and lower leg

General Body Conditioning

Injured patient should maintain cardiorespiratory conditioning during the entire rehab process

Weight Bearing

Minimum or non-weight bearing immediately following injury

Early limited stress following initial period of inflammation may promote faster and stronger healing


Rehabilitation Techniques for the ankle and lower leg

Joint Mobilizations

Movement of an injured joint can be improved my manual joint mobilization techniques


Early stages of rehab, inversion and eversion should be avoided

Stretching plantar flexors and


may improve range of motion

Neuromuscular Control

Exercises performed on unstable surfaces (BAPS Board, wedge board, or


) may be beneficial for range of motion and for regaining neuromuscular control.


Rehabilitation Techniques for the ankle and lower leg

Balance and Postural Stability

BAPS Board,


Balance Trainer, Rocker Board, Tremor box,


, and


are all useful in regaining balance.


Should concentrate on achieving a balance in muscle groups surrounding the ankle

As healing progresses, athlete may begin strengthening exercises in all


Rehabilitation Techniques for the ankle and lower leg

Taping and Bracing

May prevent further injury

Functional Progressions

Can be as complex or as simple as needed

More severe injuries need a more detailed

functional progression


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