T HE A NKLE Introduction to Athletic Training

N OTES Q UIZ 1. What are the long bones of the foot called?

N OTES Q UIZ 2. What are the three arches of the foot?

N OTES Q UIZ 3. What is the ligament on the medial side of the ankle?

N OTES Q UIZ 4. What is a Jones fracture?

N OTES Q UIZ 5. What is medial tibial stress syndrome in layman’s terms?

N OTES Q UIZ 6. What is the most common ankle sprain? Inversion OR Eversion

A NKLE 101 What motions occur at the ankle? What type of joint is the ankle?

B ONE A NATOMY Lower Leg Bones of the Foot Talus (ankle bone) Calcaneus Medial side Navicular bone Medial cuneiform

B ONE A NATOMY Bones of the foot Lateral Side Cuboid Lateral cuneiform Deep Lateral cuneiform

B ONY P ALPATIONS Fibular head Fibula Lateral malleolus Tibia Medial malleolus Dome of the talus Calcaneus Base of the 5 th metatarsal Phalanges

M USCLE A NATOMY Ankle Dorsiflexors Anterior Tibialis anterior

M USCLE A NATOMY Ankle Plantarflexors Posterior Gastrocnemius Soleus Achilles tendon Medial Tibialis Posterior

M USCLE A NATOMY Ankle Inverters Anterior Tibialis anterior Medial/Posterior Tibialis posterior

M USCLE A NATOMY Ankle Eversion Lateral Peroneal muscles

M AJOR L IGAMENTS Lateral Side Anterior Talofibular Ligament Connects?? Posterior Talofibular Ligament? Connects?? Calcaneofibular Ligament Connects

M AJOR L IGAMENT Medial Side Deltoid Ligament

S OFT T ISSUE P ALPATIONS Anterior tibialis Posterior tibialis Peroneals Extensor tendons Plantar fascia/flexor muscles Achilles tendon Gastrocnemius Ligaments Deltoid ligament Anterior talofibular Calcaneofibular

A NKLE R ANGE OF M OTION What is being measured? Plantarflexion Dorsiflexion Inversion Eversion

A NKLE R ANGE OF M OTION Ankle begins at a 90 degree angle. Measurement is taken from 90 degrees For dorsiflexion and plantarflexion… Fulcrum Stationary Arm Moving Arm

A NKLE R ANGE OF M OTION Ankle Inversion & Eversion Ankle is in plantarflexion Goniometer Set Up Fulcrum Stationary Arm Moving Arm

A NKLE S TRENGTH T ESTS

A NKLE S TRESS T ESTS

A NKLE B ONE I NJURIES Jones Fracture __________________ of the 5 th metatarsal MOI Forced inversion Forceful muscle contraction to stabilize ankle Signs & Symptoms Pain Decreased ROM Treatment?

A NKLE B ONE I NJURIES Epiphyseal Injury Affects the __________ tibia and/or fibular epiphysis MOI Forced plantar flexion and inversion S/S Pain, swelling over epiphysis Treatment? Splint Refer to physician Complications?

A NKLE B ONE I NJURIES Stress Fracture Most common in ______________________________. M.O.I. Chronic injury S/S Pain that increases… Swelling over bone Treatment X-ray vs Bone Scan Complications?

B ONE X-R AY VS. B ONE S CAN

A NKLE M USCLE & T ENDON I NJURIES Shin Splints Aka? Medial muscles affected Which are?? MOI Overuse S/S

A NKLE M USCLE & T ISSUE I NJURIES Shin Splints Treatment PRICES Change of activity Taping for support

A NKLE M USCLE & T ISSUE I NJURIES Achilles Tendinitis M.O.I. Repetitive running, jumping, landing S/S Pain with palpation particularly with ________________. Treatment?

A NKLE & M USCLE T ENDON I NJURIES Achilles Tendon Rupture M.O.I. Forced ____________________ Forced contraction of the gastroc S/S Athlete feels tearing Inability to walk Swelling Obvious depression Treatment? David Beckham Ryan Howard = &vkey=news_phi&c_id=phi

A NKLE L IGAMENT I NJURIES Great Toe Sprain M.O.I. Forced flexion or extension S/S Pain Swelling Discoloration Inability to walk normally Treatment PRICES Taping for support

A NKLE L IGAMENT I NJURIES Arch Sprain MOI Repetitive stress S/S Longitudinal arch Tarsal arch Swelling Possible discoloration Treatment?

A NKLE L IGAMENT I NJURIES Plantar Faciitis MOI Repetitive Stress S/S Moves towards toes Treatment Stretching of… Rest Night splint Heel cup Complications?

A NKLE L IGAMENT I NJURIES Inversion Ankle Sprain Makes up _____% of all ankle sprains Why? Inversion injures lateral ligaments Which are? S/S Swelling Discoloration Decreased ROM depending on severity Treatment Depends on severity Refer when…

A NKLE L IGAMENT I NJURIES Eversion Ankle Sprain Significantly less common Eversion injures medial ligament Which is? S/S Swelling Discoloration Decreased ROM depending on severity Treatment Depends on severity Refer when…

A NKLE L IGAMENT I NJURIES Ankle Dislocation Anterior Dislocation MOI Heel of foot strikes ground forcefully Posterior Dislocation MOI Blow to anterior ankle in plantar flexion S/S Obvious deformity Intense pain Rapid, profuse swelling Treatment IMMEDIATE ACTION REQUIRED – 911 Splint Ice Remove athlete from field

S CENARIO #1 A cross country runner comes into the athletic training room complaining of pain in his shins. You notice one pocket of minimal swelling over the athlete’s distal medial tibia over which he is point tender. He also wakes up through the night with sharp, intense pain in his shin. What is his injury? How do you know?

S CENARIO #2 A basketball player enters the athletic training room with pain in her heel. You don’t notice any swelling, but she is tender along the plantar aspect of the foot, especially over the medial aspect of the calcaneus. She observes that most of her pain is in the morning with her first few steps, but tends to start to feel better once she’s up and moving. Some pain is elicited with toe flexion. What is her injury? How do you know?

S CENARIO #3 You are covering a tennis match when one of the participants goes down. During play she was moving laterally to return a ball and tried to quickly change directions. She says she felt her ankle roll and felt a pop. She is in a moderate amount of pain. You are able to remove her shoe and sock and notice that she has a moderate amount of swelling over the ATF and CF. There is also some discoloration and she is hesitant to put weight on the foot when she gets up. What is her injury? How do you know?