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Ankle

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Calcaneus, Talus, Tibia (Medial Malleolus), Fibula (Lateral Malleolus) Soft Tissue ... Bump (Tap or Percussion) test (stress fracture) ROM AROM, PROM, RROM ... – PowerPoint PPT presentation

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Title: Ankle


1
Ankle Low Leg Evaluation
http//www.csmfoundation.org/Educational_Lower_Ext
remity.html
2
Common Injuries
  • Ankle sprains lateral, medial, syndesmosis
    (high)
  • Fractures
  • Tendinitis
  • Subluxating Peroneal Tendons
  • Compartment Syndromes (Anterior)
  • Achilles Tendon Rupture
  • Deep Vein Thrombosis (Thrombophlebitis)

3
Ankle Anatomy
  • Bony
  • Calcaneus, Talus, Tibia (Medial Malleolus),
    Fibula (Lateral Malleolus)
  • Soft Tissue
  • Muscles
  • Ligaments
  • Interosseous Membrane
  • Retinaculum
  • Peroneal, Extensor (superior, inferior)
  • Circulation
  • Posterior Tibial Artery, Anterior Tibial Artery,
    Peroneal Artery, Veins

4
Joints Ligaments
  • Medial Ligaments
  • Deltoid ligament 2 layers (deep superficial)
  • Superficial 3 parts, Deep 1 part

5
Joints Lateral Ligaments
  • Anterior Talofibular Lig. (ATF)
  • Anterior Tibiofibular Lig.
  • Posterior Talofibular Lig.
  • Posterior Tibiofibular Lig.
  • Calcaneofibular Lig.

6
Joints
  • Talocrural Joint dorsi plantarflexion
  • Subtalar Joint - inversion eversion
  • Classified as gliding or arthrodial
  • Intertarsal tarsometatarsal joints
  • Arthrodial
  • Minimal movement

7
Muscles of the Ankle Low Leg
  • Anterior Compartment
  • Tibialis Anterior
  • EHL
  • EDL
  • Peroneus Tertius
  • Lateral Compartment
  • Peroneus Longus
  • Peroneus Brevis
  • Superficial Posterior Compartment
  • Gastrocnemius
  • Soleus
  • Plantaris
  • Deep Posterior Compartment
  • Tibialis Posterior
  • FHL
  • FDL

8
Anterior Leg Muscles
9
Lateral Medial Leg Muscles
10
Posterior Leg Muscles - Deep
11
Posterior Leg Muscles - Superficial
12
Thanks Katie!
  • MAP(L) OF SCIATIC(L)
  • Medial Obturator Nerve
  • Anterior Femoral Nerve
  • Posterior Sciatic Nerve
  • (L)ateral (L)ateral Cutaneous Nerve

13
Neurological Anatomy - Posterior
14
Nerves
  • Sciatic nerve
  • Tibial division
  • gastrocnemius (medial head)
  • soleus
  • tibialis posterior
  • flexor digitorum longus
  • flexor hallucis longus
  • Medial plantar nerve
  • Lateral plantar nerve

15
Nerves
  • Sciatic nerve
  • Common peroneal (fibular) division
  • Superficial peroneal nerve
  • peroneus longus
  • peroneus brevis
  • Deep peroneal nerve
  • tibialis anterior
  • extensor digitorum longus
  • extensor hallucis longus
  • peroneus tertius
  • extensor digitorum brevis

16
Neurological Anatomy - Anterior
17
Nerves
  • Femoral nerve
  • Iliopsoas
  • Rectus femoris
  • Vastus medialis
  • Vastus intermedius
  • Vastus lateralis
  • Pectineus
  • Sartorius
  • Saphenous nerve
  • Medial leg foot

18
Nerves
  • Obturator Nerve
  • Adductor brevis
  • Adductor longus
  • Adductor magnus
  • Gracilis
  • Obturator externus
  • Sensation to medial thigh

19
Neurovascular Anatomy of Leg
20
Dermatomes (L4 green, L5 purple, S1 flesh)
21
Movements
  • Eversion
  • Turning ankle foot outward abduction, away
    from midline weight is on medial edge of foot
  • 5-15º of eversion
  • Inversion
  • Turning ankle foot inward adduction, toward
    midline weight is on lateral edge of foot
  • 20-30º of inversion
  • Dorsiflexion (flexion)
  • Movement of top of ankle foot toward anterior
    tibia
  • 15-20º of dorsiflexion
  • Plantar flexion (extension)
  • Movement of ankle foot away from tibia
  • 50º of plantar flexion

22
Evaluation of the Ankle Low Leg
  • History
  • What happened? (MOI)
  • Where is the pain?
  • What causes the pain?
  • When did it happen? (onset)
  • Has it happened before?
  • What does it feel like?
  • Pain scale (1-10)
  • What type of surface?
  • How old are the shoes?
  • Type of pain
  • Unusual noises/sensations

23
What is the History? What do you See?
24
Observation
  • Appearance
  • How is their ankle hanging?
  • Bilateral comparison
  • Color
  • Deformity
  • Edema/Swelling
  • Is there a lot of swelling immediately?
  • Gait
  • Infection
  • Weight bearing vs. non-weight bearing

25
What Do You See?
26
Evaluation of the Ankle Low Leg
  • Palpation
  • Start away from the point of pain
  • Medial structures
  • Lateral structures
  • Dorsal structures
  • Plantar structures
  • Crepitus
  • Heat
  • Swelling
  • Rigidity
  • Deformities
  • Stress/ Special Tests
  • ROM tests (AROM, PROM, RROM-strength)
  • Special Tests
  • Fracture tests
  • Ligament/Capsular tests
  • Neurologic tests
  • Other

Which stress/special test do you perform first?
How do you make the correct decision?
27
Stress/ Special Tests
When do you perform all of these tests?
  • Lower Leg Fractures
  • Compression (Squeeze) test (fracture)
  • Bump (Tap or Percussion) test (stress fracture)
  • ROM AROM, PROM, RROM
  • Talar Tilt (Inversion Eversion Stress) tests
    (calcaneofibular ligament or deltoid ligament
    instability)
  • Anterior Drawer test (ATF ligament instability)
  • Kleigers Test (syndesmosis instability)
  • Homans Sign (deep vein thrombophlebitis
    neurovascular pathology)
  • Thompson test (achilles tendon pathology)

28
Whats your Diagnosis?
  • What is the MOI?
  • Where is the pain elicited?
  • Which tests elicit positive findings?
  • What are your observations?
  • How is the ROM strength?
  • Are there any neurovascular symptoms?
  • What do you think the injury is?

29
What Do You Do Next?
  • Is referral needed?
  • RICES
  • Are any home instructions
  • needed?

30
Conclusion
  • Questions?????
  • Case Study
  • Trivia
  • What is the os calcis?
  • What is an os trigonum injury?
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