Transcript Chapter 19 Ankle/Lower Leg

By: Kelsey Showalter & Taylor Douglass
 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.
 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.
 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.
 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.
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.

 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.
 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.
 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.
 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.
 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.
 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.
 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.
 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.
 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.
 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
 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
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.

 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.
 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.
 General

Injured patient should maintain cardiorespiratory
conditioning during the entire rehab process
 Weight


Body Conditioning
Bearing
Minimum or non-weight bearing immediately
following injury
Early limited stress following initial period of
inflammation may promote faster and stronger
healing
 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.
 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
 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