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The Ankle and Lower Leg

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Site of muscular attachment and origin. Site of ligamentous attachment ... Add crural interosseous lig. Extension of interosseous membrane ... – PowerPoint PPT presentation

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Title: The Ankle and Lower Leg


1
The Ankle and Lower Leg
  • Chapter 5

2
Ankle
  • What bones make up the ankle joint?

3
Lower leg
  • Periosteum
  • What is inflammation of the periosteum called?
  • What would cause this injury?

4
Fibula
  • Non-weight bearing
  • 12 of weight
  • Serves 4 functions (?)
  • Site of muscular attachment and origin
  • Site of ligamentous attachment
  • Provides lateral stability
  • Serves as a pulley to increase muscular
    efficiency of muscles which lie posterior (?)

5
Fibula Cont.
  • Superiorly
  • Common peroneal N splits into the Superficial
    peroneal nerve and Deep peroneal nerve (Fig 5-3)

6
Lateral Malleolus
  • Why is the lateral malleolus better at preventing
    ankle sprains than medial?
  • Mechanically superior

7
Talus
  • What structural feature allows the closed pack
    position to be dorsiflexion?

8
Talocrural Joint
  • Name the bones that make up this joint?
  • Closed-pack position??
  • Ligamentous support
  • Medially?
  • Laterally?

9
Injury
  • Most common injury?
  • Most common mechanism?
  • Must have ability to rationalize why mechanism
    cause certain injury
  • Anterior talotibial and Tibionavicular PF
  • Posterior talotibial and Tibiocalcaneal - DF

10
Tib-Fib Joint
  • Integrity is maintained by what ligaments?
  • Add crural interosseous lig
  • Extension of interosseous membrane
  • Common mechanism of injury for TibFib joint?

11
Muscles
  • Anterior Compartment
  • Posterior Compartment
  • Deep Posterior Compartment
  • Lateral Compartment

12
Retinaculum
  • A structure that retains and organ or tissue in
    place
  • Superior and Inferior Extensor Retinaculum
  • Superior and Inferior Peroneal Retinaculum

13
Nerves and Vessels
  • Anterior compartment
  • Deep Peroneal N and Anterior Tibial Artery and
    Vein
  • Posterior Compartment
  • Tibial N and Posterior Tibial Artery and Vein
  • Lateral Compartment
  • Peroneal Artery and Vein
  • Superficial Peroneal Artery
  • Which is nerve is most prone to injury?
  • What are examples of injury?

14
Bursae
  • Retrocalcaneal bursae (subtendinous)
  • Subcutaneous Calcaneal bursae

15
History
  • Prior history
  • May lead to decreased proprioception
  • Why is this important?
  • Injury Mechanism (Table 5-3)
  • Dont forget opposite side due to compressive
    forces that will exist

16
Inspection
  • Sinus Tarsi (Fig 5-16)

17
Palpation
  • ???????????????????????????

18
Pulses
  • What are the two pulses in the LE?

19
Active and Passive ROM
  • What is neutral?
  • 20 0 50 degrees (Dorsi/Plantarflexion)
  • Evaluation of Dorsi/Plantarflexion should occur
    with knee flexed and extended
  • Why?
  • Firm endfeel in both directions
  • 20 0 5 degrees (Inversion/Eversion)
  • Pt. should lie supine for most reliable
    measurement
  • Firm endfeel in inversion
  • Hard endfeel in eversion
  • Why?

20
Resistive ROM
  • Due to large posterior muscle group, MMT may be
    inadequate for testing
  • Use 10 rep unilateral heel raise

21
Ligamentous Testing
  • Anterior Drawer?
  • Posterior Drawer?
  • Talar tilt for inversion?
  • Talar tilt for eversion?
  • Kleiger Test?
  • Box 5-7, pg 161
  • Maximal dorsiflexion test
  • Squeeze test
  • What other purposes are there for this test?

22
Neurologic Testing
  • Figure 5-20
  • Table 5-5
  • Lower quarter screening
  • L4, L5, S1, S2

23
Ankle Sprains
  • Most common ligament injured?
  • Mechanism??
  • Capsular structures so result in more effusion
    than CF, which is extracapsular
  • If moderate to severe, gt70 reincidence rate
  • Why?
  • Pg 163
  • Possible pain over fibula indicates?

24
Syndesmosis
  • Mechanism (s) ??
  • Typically associated with deltoid lig sprain
  • Heterotopic ossification?
  • Synostosis?

25
Injuries
26
Injuries
27
Injuries
  • Fig 5-21
  • Fig 5-22

28
Medial Ankle Sprains
  • Asses Spring Lig when dealing with medial ankle
    sprain
  • Why?

29
Stress Fx
  • Where is the most common site of stress fx in the
    leg?
  • Test used to assess?
  • Table 5-10

30
Os Trigonum
  • Fracture of Steidas Process
  • Ossification occurs around 13 y.o.
  • Can occur due to non-union or stress fx
  • Also can occur through trauma known as a
    traumatic os trigonum

31
Achilles Tendon
  • An avascular zone is present 2 6 cm proximal to
    the insertion on the calcaneus
  • This is the most common site of tendon pathology
  • Succumbs to a continuous breakdown.
  • Pg 173
  • Age and gender most common predictors

32
Achilles Tendon Rupture
  • Two theories exist as to why it occurs
  • Chronic degeneration
  • Failure of the inhibitory mechanism
  • Increased risk with corticosteroids (Cortisone)

33
Subluxing peroneal tendons
  • Sudden dorsiflexion may rupture superior peroneal
    retinaculum
  • Changes line of pull
  • Technique used for treatment

34
On-field management
  • Fig 5-32
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