Ankle and Lower Leg - PowerPoint PPT Presentation

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Ankle and Lower Leg

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Ice/Rest NSAIDs Heel lift/Achilles taping Achilles Tendon Rupture Rupture occurs w/in tendon, ... running biomechanics MTSS Treatment Ice Reduce activity ... – PowerPoint PPT presentation

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Date added: 26 March 2020
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Title: Ankle and Lower Leg


1
Ankle and Lower Leg
2
Do Now
  • What do you predict are some of the most common
    injuries of the foot and ankle?
  • Have you ever injured your ankle?

3
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

4
Ankle Motions
  • Plantar Flexion
  • Dorsiflexion
  • Inversion
  • Eversion
  • Pronation
  • Supination

5
Ankle Articulations
  • Talar Joint (Talocrural joint)
  • Tibia fibula with talus
  • Dome of talus articulates with mortise formed by
    tibia fibula
  • Motions dorsiflexion plantar flexion
  • Subtalar Joint
  • Articulation of talus with calcaneus
  • Motions inversion eversion

6
Ligaments
  • Lateral aspect
  • Anterior talofibular (ATF)
  • Anterior tibiofibular
  • Calcaneofibular (CF)
  • Posterior talofibular
  • Medial aspect
  • Deltoid Ligament

7
Common Injuries to theAnkle Lower Leg
8
Contusions
  • Occur most often on tibia
  • Can be painful and disabling
  • Complication?
  • compartment syndrome

9
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

10
Cramps
  • A sudden, involuntary contraction of a muscle
  • Contributing factors include
  • Fatigue
  • Fractures
  • Dehydration
  • Lack of nutrients in diet
  • Poor flexibility
  • Improperly fitted equipment

11
CrampsTreatment
  • Passive stretching
  • Fluid replacement
  • Water
  • Sports drink
  • Massage
  • Rest
  • Ice

12
Achilles Tendonitis
  • Inflammation of Achilles tendon
  • Tearing of tendon tissues caused by excessive
    stress
  • Occurs at point where tendon attaches to heel

13
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

14
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

15
(No Transcript)
16
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

17
MTSS Treatment
  • Ice
  • Reduce activity level
  • Gentle stretching
  • Biomechanical assessment
  • Orthotics
  • NSAIDs
  • Strengthening and flexibility program

18
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
    bodys ability to heal it

19
Stress FracturesS/Sxs
  • hot spot of sharp, intense pain upon palpation
  • Shin-splint
  • Pain more generalized
  • Pain worse in am
  • Stress Fx
  • Pain worse in pm

20
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

21
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

22
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

23
Ankle Sprains
24
  • Inversion
  • Anterior Talofibular
  • Calcaneofibular
  • Posterior Talofibular
  • Eversion
  • Deltoid Ligament
  • Syndesmotic
  • High ankle sprain

25
Ankle SprainS/SXS
  • Grade 1
  • Some pain
  • 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

26
Ankle SprainTreatment
  • R.I.C.E.
  • Crutches
  • Boot
  • Splint, tape, brace
  • Compressive wrap
  • Horseshoe

27
Special TestsRehabilitation
28
  • Anterior Drawer
  • Talar Tilt
  • Tests integrity of anterior talofibular ligament
  • Tests integrity of calcaneofibular ligament

29
  • 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

30
Ankle Rehab
  • 4-way TheraBand
  • Heel walks/Toe walks
  • 3-way heel raises
  • Unilateral Balance
  • 3-way Tramp throw
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