1. ATC 328 Lower Body Evaluation The Ankle and Leg Chapter 5

2. Bony Anatomy Tibia –Periosteum –Interosseous membrane Fibula –Weight bearing??? –Distal 1/3 thinner

3. Bony Anatomy Talus –Anterior 1/3 wider –Steda’s process Calcaneus –Calcaneal tubercle

4. Ligamentous Anatomy Anterior Talofibular Ligament (ATF) Posterior Talofibular Ligament (PTF) Calcaneofibular Ligament (CF) Deltoid Ligament Anterior Inferior Tibiofibular Ligament (AITF) Interosseous membrane

5. Articulations Closed-packed position Open-packed position Syndesmosis

6. Articulations Talocrual joint = (mortise and tenon) 1 degree of freedom of movement Dorsiflexion/plantarflexion Subtalar joint –1 degree of freedom of movement Inversion/eversion Distal tibiofibular Proximal tibiofibular

7. Motions Functional motion = multiplanar Supination = PF, INV, ADD Pronation = DF, EVER, ABD

8. Muscular Anatomy Triceps Surae –Gastrocnemius and soleus Plantaris Peroneal group Posterior tibialis Anterior tibialis EHL, EDL FDL, FHL

9. Leg Compartments Anterior –TA, EDL, EHL, PT, deep peroneal nerve Lateral –PL, PB, superficial peroneal nerve Superficial posterior –Triceps surae, plantaris, tibial nerve Deep posterior –Tibialis posterior, FDL, FHL

10. Bursae Superficial calcaneal bursa Deep retrocalcaneal bursa

11. Range of Motion 10 degrees DF for normal walk, 15 run PF/DF = 20 degrees and 50 degrees Inv/Ever = 20 degrees and 5 degrees

12. Lateral Ankle Sprain

13. Etiology –Tension laterally, compression medially S/S Testing –Anterior drawer –Talar tilt Complications

14. Syndesmosis Sprains Etiology S/S Testing –Kleiger’s test –Passive DF –Tibiofibular compression test Maisonneuve fracture = proximal 1/3 of tibia

15. Medial Ankle Sprain Etiology S/S Testing –Talar tilt –External rotation Complications

16. Stress Fractures Signs and Symptoms Common sites Predisposing factors

17. Os Trigonum Injury Steida’s process – develops at age 8-13 Fracture of Steida’s process –Acute, stress, or developmental non-union Common with dancers, kickers, repetitive PF

18. Os Trigonum Injury S/S –Pain in posterior calcaneus –Swelling –Pain with PF

19. Achilles Tendonitis Limited blood supply to tendon Common causes Typical signs and symptoms

20. Achilles Tendon Rupture Males 30+ Common etiology PF MMT greater than 0/5 Positive Thompson test

21. Subluxating Peroneal Tendons Causes –DF and Ever –PF and Inv –Biomechanical and structural abnormalities –Rupture of retinaculum S/S –Audible and visible subluxation

22. Anterior Compartment Syndrome Traumatic or exertional S/S –Pain –Paresthesia –Weakness –Decreased pulse/cap. Refill

23. Deep Vein Thrombophlebitis Common in post-surgery S/S –Leg pain –Vascular changes –Positive Homan’s sign

24. Acute Ankle Dislocations OUCH!!!

25. Acute Leg Fractures Common sites

26. Sever’s Syndrome Etiology S/S