1. Topic #3 THE ANKLE

2. The ankle is a complex joint

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

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

5. *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)

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

7. Bones

8. 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

12. Ligaments

13. 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

18. Gastrocnemius

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

20. Extensor
Digitorum
Longus

21. Plantar Fascia

22. II. Injuries

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

24. 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

25. 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

26. 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

27. Second degree tear and Ecchymosis

28. 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.

31. 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

32. 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

33. Achilles Tendon Rupture

34. 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

35. Plantar Fasciitis

36. 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

37. Achilles Tendonitis

38. 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

39. Anterior Compartment Syndrome

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

41. Fractures

42. 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

43. 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

44. Anterior Drawer Test

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

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

47. 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

48. 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

49. Fracture test

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

51. Phase I Reduce Inflammation

52. Phase II Increase ROM

53. Phase III Strengthen

54. Phase V Functional Exercises

55. Phase IV Improve Balance