Topic #3 THE ANKLE

The ankle is a complex joint

I. Anatomy A. Bones *Phalanges (toes)- proximal, middle, distal used for balance *Metatarsals- 1st-5th arch of foot, used for support

More bones *Tarsals- Cuneiforms (3), -Cuboid (below pinky) -Navicular -Talus- fibula and tibia sit on this Calcaneous- heel bones, attaches to achilles tendon

*Fibula- non weight bearing *Malleolus- bump on end of ankle, *Tibia- shin bone *Fibula- non weight bearing *Malleolus- bump on end of ankle, Tibial Malleolus (Medial) 2) Fibular Malleolus(Lateral)

Lower leg bones *Tibia- shin bone *Fibula- non weight bearing *Malleolus- bump on end of ankle, Tibial Malleolus Medial , Fibular Malleolus (R)

Bones

II. Anatomy Continued B. Ligaments Lateral *ATF-Anterior Talofibular Ligament *CF- Calcaneofibular Ligament *PTF- Posterior Talofibluar Ligament Medial *Deltoid ligament-four strong overlapping ligaments *Interosseous Membrane- between Fibular and Tibia

Ligaments

C. Muscles of Lower Leg Muscle Movement Tibialis Anterior- front of leg Peroneus Longus-Head of Fibula to bottom of foot Peroneus Brevis-Fibula to base of 5th Metatarsal Gastrocnemius- above knee to Calcaneus Soleus- Tibia to Calcaneus Dorsiflexion Eversion Plantar Flexion

Gastrocnemius

More Muscles of Lower Leg Extensor Digitorum Longus-top of toes Plantar Fascia- along bottom of foot Extends the toes Supports arch of foot

Extensor Digitorum Longus

Plantar Fascia

II. Injuries

Sprain vs Strain What is torn/stretched? What degree? Repair? Some prior knowledge needed What is torn/stretched? What degree? Repair?

Find the mechanism, Symptom and TX for: More prior knowledge Find the mechanism, Symptom and TX for: Inversion ankle Sprain Eversion Ankle Sprain Turf toe Achilles Tendonitis Achilles Tendon Rupture Plantar Faciitis Anterior Compartment Syndrome

Inversion Sprain ATF, CF, PTF Mechanism-Sole of foot turns in (more common) Symptoms-PT in area of one or more of the above ligaments, edema, ecchymosis TX: RICE, tape, brace, balance and strength exercises, possible surgery

Inversion Sprains occur 85% of time Because: 1) Deltoids are stronger 2) The Lateral Malleous extends down further than the Medial Malleous which prevents eversion

Second degree tear and Ecchymosis

Eversion Sprain Deltoid Mechanism-sole of foot turns out Could be possible avulsion fx Symptoms-PT on medial side of foot, edema, ecchymosis TX-RICE, tape in neutral, strength and balance exercises.

Turf Toe Mechanism: Running on turf and/or wearing loose shoes Symptoms:Sprain, pain in MTP joint TX:RICE, very Chronic, can tape and support

Achilles Tendon Rupture Thanksgiving Injury Mechanism- Middle age, tendon rips from inactivity, quick movement Symptoms- Hear a pop, sharp pain in posterior lower leg TX: Walking boot, surgery to reattach achilles

Achilles Tendon Rupture

Plantar Fasciitis Mechanism-tight gastroc/soleus complex, wearing high heels, overweight Symptoms-pain across bottom of foot, tight in the A.M. TX- Stretching, taping, flat shoes, possible surgery

Plantar Fasciitis

Achilles Tendonitis Mechanism-increase distance, tight gastroc/soleus complex, chronic Symptoms-inflammation, tight, PT on achilles TX: stretch gastrocnemius and soleus, heel lift, taping, reduce actvity, RICE

Achilles Tendonitis

Anterior Compartment Syndrome Mechanism-small bunch of muscles in between tibia and fibula-tight space. When they swell-put pressure on nerves. Increased mileage Symptoms-Tingling numbness in ant area, shiny look. TX-stop activity and rest, stretch strengthen, possible surgery

Anterior Compartment Syndrome

Fractures Jones FX- peroneus brevis breaks off a piece of the bases of the 5th Stress FX-To tibia or metatarsals

Fractures

III. Assessment H-Mechanism? When did it happen? Position? Hear a noise? When does it hurt? Point to one spot. O (Bilateral)-Gait, deformity, ecchymosis, edema, form/technique, shoes P- Malleolus, toes, tibia/fibula, metarsals, base of 5th

Special Tests 1) Anterior Drawer Test Slide Calcaneous past tibia.fiblua to see if pain or movement (Bilateral). If positive possible tear of ATF, CF, or PTF

Anterior Drawer Test

2) Evert the Heel Test Deltoid Ligament Grab Calcaneous to hold Talus- and evert If pain or movement- positive tear Bilateral comparison

3) Talus Rock Check both ATF/CF/PTF and Deltoid Grab Calcaneous- to hold Talus and rock back and forth

Thompson Test Squeeze gastrocnmeius/soleus complex and check for plantar flexion movement in foot. If movement- achilles is fine. If none- achilles rupture or swollen

Fracture Test Squeeze Tibia and Fibula together and look for pain and/or movement Tap on toes and mallelous- look for pain in different spot Squeeze metatarsals together- look for pain and/or movement Bang on end of Calcaneous- look for pain in different location

Fracture test

IV. Rehabilitation Phase I- Phase II- Phase III- Phase IV-

Phase I Reduce Inflammation

Phase II Increase ROM

Phase III Strengthen

Phase V Functional Exercises

Phase IV Improve Balance