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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Slide1

The Ankle and Lower Leg

By: Kelsey Showalter & Taylor Douglass

Slide2

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.

Slide3

Articulations

Talocrural

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

talocrural

joint are plantar flexion and dorsiflexion.

Subtalar

Joint- The

subtalar

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

Slide4

Stabilizing Ligaments

Tibiofibular

Ligaments- Joins the tibia and fibula with a strong

interosseous

membrane.

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

Lateral Ligaments-Anterior

taliofibular

, the posterior

talofibular

, and the

calcaneofibular

.

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

Slide5

Nerve Supply- The lower leg is supplied by the common

peroneal

nerve anteriorly. The

tibial

nerve runs posteriorly and supplies the ankle and the foot.

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

tibial

artery and posterior

tibial

arteries.

Slide6

Preventing injury to the ankle and lower leg

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

dorsiflex

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

activites

for which they were not intended.

Preventive Ankle Taping and

Orthoses

- Properly applied tape can provide some prophylactic protection.

Slide7

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.

Slide8

Special Tests

Lower Leg

Lower leg alignment test- determining

malalignment

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.

Slide9

Special Test

Ankle Stability Test

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

talofibular

ligament and to the other lateral ligaments.

Talar

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

Kleiger’s

Test- Used to determine injury to the deltoid ligament.

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

Slide10

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.

Slide11

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.

Slide12

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.

Slide13

Ankle Injuries

Osteochondritis

Dissecans

– Occurs in the superior medial articular surface of the

talar

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

subchondral

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

Slide14

Lower Leg Injuries

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

Achilles

Tendinosis

(Achilles

Tendinoapathy

) – no evidence of inflammation. Injured areas of the

achilles

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

achilles

tendon are disorganized, scarred and degenerated. Achilles

tendinosis

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

Slide15

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

microtears

.

Anterior

Tibialis

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

Posterior

Tibialis

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

Slide16

Lower Leg Injuries

Fibularis

Tendinitis – Can be a problem in individuals with pes

cavus

. In pes

cavus

, 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

Slide17

Lower Leg Injuries

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

clonic

or tonic.

Clonic

– intermittent contraction and relaxation

Tonic- constant muscles contraction without an intervening period of relaxation

Slide18

Lower Leg Injuries

Gastrocnemius

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.

Medial

Tibial

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

shinsplints

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

shinsplints

.

Slide19

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.

Slide20

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.

Slide21

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

Slide22

Rehabilitation Techniques for the ankle and lower leg

Joint Mobilizations

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

Flexibility

Early stages of rehab, inversion and eversion should be avoided

Stretching plantar flexors and

dorsiflexors

may improve range of motion

Neuromuscular Control

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

Dynadisk

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

Slide23

Rehabilitation Techniques for the ankle and lower leg

Balance and Postural Stability

BAPS Board,

Bosu

Balance Trainer, Rocker Board, Tremor box,

Ployback

, and

Dynadisk

are all useful in regaining balance.

Strengthening

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

As healing progresses, athlete may begin strengthening exercises in all

Slide24

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

Slide25


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