1. Ankle Joint

2. Learning Objectives Identify the major ankle joint anatomy Identify ligaments of the ankle joint Recognize ankle pathology Recognize ankle joint fractures Evaluate ankle joint abnormalities using specific tests Practice PT treatment to the ankle post fractures Explain verbally to the patient ankle treatment plan and home exercise

3. The foot and ankle is a complex structural unit and can be considered a closed kinematic chain when in contact with the ground. Although there are thirty (30) synovial joints within the foot and ankle, (3) of themplay a major biomechanical role in function, most of the compensations for abnormal mechanics in the foot and ankle occur at just one of these three joints, the subtalar joint

4. ANATOMY Joints Talocrual Subtalar Midtarsal - Transverse Tarsal Intertarsals Tarsal-Metatarsals Metatarsal-Phalangeal

5. Ligaments 1. Medial Deltoid 2. Lateral collateral ligament (LCL) composed ligaments

6. Muscles and its tendons 1. Anterior Tibialis anterior Extensor halluecis longus Extensor digitorum longus 2. Posterior Peroneal muscle Soleus muscle Gastrocnemius Flexor halluecis longus Tibialis posterior

7. Special Test 1. Talar T 2. Homans Sign (Assessment for thrombophlebitis) 3. Keen’s sign (distal fibular fracture) Increased diameter around the malleoli area

8. Ankle and foot pathology Trauma, fractures, and sprains (Ankle sprain, Fractures of fifth metatarsal) Arthritis (OA &RA) Flat foot Metatarsalgia Congenital disorder (clubfoot) Planter fascitis Spurs Bursitis Morton’s Neuroma Ischemic foot pain Hallux valgus

12. Treatment Plan This is general treatment plan, you need to adapt it to your patient case ROM and stretching of Achilles tendon after healing of tendons trauma Be careful of Weight Baring status (NWB, PWB, FWB) Ice massage and Contrast bath for edema and paraffin wax Mobilization post casting and fracture healing Orthotics for stability after ligament sprains Gait training with assistive device (Crutches, Canadian Cane, Walker)