1. Ankle and Lower Leg
Chapter 17

2. Ankle Bony Anatomy Talus (link between lower leg & foot) Tibia Fibula
Medial malleolus
Fibula
Lateral malleolus
Mortise
Tibial tuberosity
Tibial condyles

3. Bony Anatomy

4. Functional Anatomy Ankle is a stable hinge joint
Medial/lateral dislocation is prevented by malleoli
Square shape of talus adds stability of ankle
Most stable during dorsiflexion, least stable in plantar flexion

5. Ankle Motions Plantar Flexion Dorsiflexion Inversion Eversion
Pronation
Supination

6. Ankle Articulations Subtalar Joint Talar Joint (Talocrural joint)
Articulation of talus with calcaneus
Motions: inversion & eversion
Talar Joint (Talocrural joint)
Tibia & fibula with talus
Dome of talus articulates with mortise formed by tibia & fibula
Motions: dorsiflexion & plantar flexion

7. Soft Tissue Gastrocnemius Soleus Tibialis posterior Tibialis anterior
Peroneus longus
Peroneus brevis
Plantaris
Plantar fascia
Anterior talofibular
Anterior tibiofibular
Calcaneofibular
Posterior talofibular
Deltoid ligament
Tibionavicular
Calcaneotibial
Anterior talotibial
Posterior talotibial
tibionavicular ligament, calcaneotibial ligament, anterior talotibial ligament, and the posterior talotibial ligament

8. Muscles of the Lower Leg
Flexor hallucis longus
Flexor digitorum longus
Anterior tibialis

9. Muscles of the Lower Leg
Peroneus tertius
Peroneus longus
Peroneus brevis

10. Muscles of the Lower Leg
Gastrocnemius
Soleus

11. Muscles of the Lower Leg

12. Muscles of the Lower Leg

13. Compartments of the Lower Leg
Anterior
Tibialias anterior
Extensor digitorum longus
Peroneus tertius
Extensor hallucis muscles
Peroneal
Peroneus longus
Peroneus brevis
Deep Posterior
Popliteus
Flexor digitorum longus
Flexor hallucis longus
Tibialis posterior
Superficial Posterior
Gastrocnemius
Soleus
Plantaris

14. Compartments of the Lower Leg

15. Compartments of the Lower Leg

16. Ligaments Lateral aspect Medial aspect Anterior talofibular (ATF)
Anterior tibiofibular
Calcaneofibular (CF)
Posterior talofibular
Medial aspect
Deltoid Ligament

19. Common Injuries to the Ankle & Lower Leg

20. Contusions Occur most often on tibia Can be painful and disabling
Complication
compartment syndrome

21. Muscle Strains Most common in calf Result from:
violent contraction
Overstretching
Continued overuse
Usually occur in area of MTJ or insertion of Achilles tendon
Result from:
Repetitive overuse
Single violent contraction
Acute strain to Achilles have tendency to become chronic

22. Cramps A sudden, involuntary contraction of a muscle
Contributing factors include:
Fatigue
Fractures
Dehydration
Lack of nutrients in diet
Poor flexibility
Improperly fitted equipment

23. Cramps—Treatment Passive stretching Fluid replacement Water
Sports drink
Massage
Rest
Ice

24. Achilles Tendonitis Inflammation of Achilles tendon
Tearing of tendon tissues caused by excessive stress
Occurs at point where tendon attaches to heel

25. Achilles Tendonitis Symptoms develop gradually
Repeated or continued overstress increases inflammation
Pain, crepitus, redness
Treatment
Prevention
Stretching
Biomechanical problems?
Ice/Rest
NSAIDs
Heel lift/Achilles taping

26. Achilles Tendon Rupture
Rupture occurs w/in tendon, approx 1-2” proximal to insertion
Eccentric force applied to dorsiflexed foot
Poor conditioning
Overexertion
Direct trauma
Surgically repaired
Rehab = 1yr +
Thompson test

28. Medial Tibial Stress Syndrome
aka shin splints
Catchall term for pain that occurs below knee
Anterior shin
Medial shin
Result of doing too much too soon
Associated with:
repetitive activity on hard surface
forcible excessive use of leg muscles (running, jumping)
tightness of gastroc and/or soleus muscles
improper footwear
running biomechanics

29. MTSS Treatment Ice Reduce activity level Gentle stretching
Biomechanical assessment
Orthotics
NSAIDs
Strengthening and flexibility program

30. Stress Fractures Incomplete crack in bone
Microscopic fractures in bone that will eventually lead to full fracture if left untreated
Repeated stress placed on bone greater than body’s ability to heal it

31. Stress Fractures—S/Sxs
“hot spot” of sharp, intense pain upon palpation
Shin-splint
Pain more generalized
Pain worse in am
Stress Fx
Pain worse in pm

32. Compartment Syndrome
Swelling within one or more of the compartments of the lower leg
Caused by:
Contusion
Fracture
Crush injury
Localized infection
Excessive exercise
Overstretching

33. Ankle Sprains MOI: combo of excessive inversion and PF
aka lateral ankle sprain
Anterior Talofibular Ligament (ATF)
Calcaneofibular (CF)
Posterior talofibular (PTF)
Eversion (medial) ankle sprain less common
Deltoid ligament

34. Ankle Sprains Injury to ligamentous and capsular tissue
Traumatic joint twist that results in stretching of total tearing of the stabilizing connective tissue
One of most common & disabling sports injuries
General Symptoms:
Joint swelling
Local temperature increase
Pain
Point tenderness
Skin discoloration

35. Ankle Sprains

36. Inversion Eversion Syndesmotic Anterior Talofibular Calcaneofibular
Posterior Talofibular
Eversion
Deltoid Ligament
Syndesmotic
High ankle sprain

37. Ankle Sprain—S/SXS Grade 1 Grade 2 Grade 3 Some pain Severe sprain
Minimum LOF
Mild point tenderness
Little or no swelling
No abnormal motion
Grade 2
Pain
Moderate LOF
Swelling
Slight to moderate instability
Grade 3
Severe sprain
Extremely painful initially
LOF
Severe instability
Tenderness
Swelling
May represent subluxation that reduced spontaneously

38. Ankle Sprain—Treatment
R.I.C.E.
Crutches
Boot
Splint, tape, brace
Compressive wrap
Horseshoe

39. Special Tests & Rehabilitation

40. Anterior Drawer
Talar Tilt
Tests integrity of anterior talofibular ligament
Tests integrity of calcaneofibular ligament

41. Squeeze Test Bump Test/Tap Test
Squeezing the tibia and fibula together
Can indicate fracture or high ankle sprain
Bump calcaneus
Indicate fracture to tibia/fibula
Indicate high ankle sprain
Tap mallelous
Indicate fracture of particular bone

42. Ankle Rehab 4-way TheraBand® Heel walks/Toe walks 3-way heel raises
Unilateral Balance
3-way Tramp throw