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THE ANKLE
Introduction to Athletic Training
NOTES QUIZ
1. What are the long bones of the foot called?
NOTES QUIZ
2. What are the three arches of the foot?
NOTES QUIZ
3. What is the ligament on the medial side
of the ankle?
NOTES QUIZ
4. What is a Jones fracture?
NOTES QUIZ
5. What is medial tibial stress syndrome in
layman’s terms?
NOTES QUIZ
6.
What is the most common ankle sprain?
Inversion
OR
Eversion
ANKLE 101

What motions occur at the ankle?

What type of joint is the ankle?
BONE ANATOMY

Lower Leg



Bones of the Foot

Talus (ankle bone)
Calcaneus

Medial side

Navicular bone
 Medial cuneiform

BONE ANATOMY

Bones of the foot

Lateral Side
Cuboid
 Lateral cuneiform


Deep

Lateral cuneiform
BONY PALPATIONS
Fibular head
Fibula
Lateral malleolus
Tibia
Medial malleolus
Dome of the talus
Calcaneus
Base of the 5th metatarsal
Phalanges
MUSCLE ANATOMY

Ankle Dorsiflexors

Anterior

Tibialis anterior
MUSCLE ANATOMY

Ankle Plantarflexors

Posterior
Gastrocnemius
 Soleus
 Achilles tendon


Medial

Tibialis Posterior
MUSCLE ANATOMY

Ankle Inverters

Anterior

Tibialis anterior
Medial/Posterior

Tibialis posterior
MUSCLE ANATOMY

Ankle Eversion

Lateral

Peroneal muscles
MAJOR LIGAMENTS

Lateral Side

Anterior Talofibular Ligament


Posterior Talofibular Ligament?


Connects??
Connects??
Calcaneofibular Ligament

Connects
MAJOR LIGAMENT

Medial Side

Deltoid Ligament
SOFT TISSUE PALPATIONS
Anterior tibialis
 Posterior tibialis
 Peroneals
 Extensor tendons
 Plantar fascia/flexor muscles
 Achilles tendon
 Gastrocnemius
 Ligaments

Deltoid ligament
 Anterior talofibular
 Calcaneofibular

ANKLE RANGE OF MOTION

What is being measured?

Plantarflexion

Dorsiflexion

Inversion

Eversion
ANKLE RANGE OF MOTION

Ankle begins at a 90 degree angle.

Measurement is taken from 90 degrees

For dorsiflexion and plantarflexion…

Fulcrum

Stationary Arm

Moving Arm
ANKLE RANGE OF MOTION

Ankle Inversion & Eversion

Ankle is in plantarflexion

Goniometer Set Up

Fulcrum

Stationary Arm

Moving Arm
ANKLE STRENGTH TESTS
ANKLE STRESS TESTS
ANKLE BONE INJURIES

Jones Fracture

__________________ of the 5th metatarsal

MOI
Forced inversion
 Forceful muscle contraction to stabilize ankle


Signs & Symptoms

Pain


Decreased ROM

Treatment?

http://www.youtube.com/watch?v=lHsrHf-ROo0
ANKLE BONE INJURIES

Epiphyseal Injury

Affects the __________ tibia and/or fibular epiphysis

MOI


Forced plantar flexion and inversion
S/S

Pain, swelling over epiphysis


Treatment?


Splint
Refer to physician

Complications?

http://www.youtube.com/watch?v=jMU3lUouIx4
ANKLE BONE INJURIES

Stress Fracture

Most common in ______________________________.

M.O.I.

Chronic injury


S/S
Pain that increases…
 Swelling over bone


Treatment


X-ray vs Bone Scan
Complications?
BONE X-RAY VS. BONE SCAN
ANKLE MUSCLE & TENDON INJURIES

Shin Splints


Medial muscles affected


Which are??
MOI


Aka?
Overuse
S/S



ANKLE MUSCLE & TISSUE INJURIES

Shin Splints

Treatment
PRICES
 Change of activity
 Taping for support



ANKLE MUSCLE & TISSUE INJURIES

Achilles Tendinitis

M.O.I.


Repetitive running, jumping, landing
S/S




Pain with palpation particularly with ________________.


Treatment?
ANKLE & MUSCLE TENDON INJURIES

Achilles Tendon Rupture

M.O.I.



S/S





Forced ____________________
Forced contraction of the gastroc
Athlete feels tearing
Inability to walk
Swelling
Obvious depression
Treatment?
David Beckham
http://www.youtube.com/watch?v=p7NiwYqNqlA
 Ryan Howard


http://mlb.mlb.com/news/article.jsp?ymd=20111008&content_id
=25565996&vkey=news_phi&c_id=phi
ANKLE LIGAMENT INJURIES

Great Toe Sprain

M.O.I.


Forced flexion or extension
S/S
Pain
 Swelling
 Discoloration
 Inability to walk normally


Treatment
PRICES
 Taping for support

ANKLE LIGAMENT INJURIES

Arch Sprain

MOI


Repetitive stress
S/S

Longitudinal arch


Tarsal arch

Swelling
 Possible discoloration


Treatment?
ANKLE LIGAMENT INJURIES

Plantar Faciitis

MOI


Repetitive Stress
S/S



Moves towards toes
Treatment
Stretching of…
 Rest
 Night splint
 Heel cup


Complications?
ANKLE LIGAMENT INJURIES

Inversion Ankle Sprain

Makes up _____% of all ankle sprains


Inversion injures lateral ligaments


Why?
Which are?
S/S
Swelling
 Discoloration
 Decreased ROM depending on severity


Treatment
Depends on severity
 Refer when…

ANKLE LIGAMENT INJURIES

Eversion Ankle Sprain

Significantly less common

Eversion injures medial ligament


Which is?
S/S
Swelling
 Discoloration
 Decreased ROM depending on severity


Treatment
Depends on severity
 Refer when…


http://www.youtube.com/watch?v=T5qCI0T4Fhs
ANKLE LIGAMENT INJURIES

Ankle Dislocation

Anterior Dislocation MOI


Posterior Dislocation MOI




Obvious deformity
Intense pain
Rapid, profuse swelling
Treatment





Blow to anterior ankle in plantar flexion
S/S


Heel of foot strikes ground forcefully
IMMEDIATE ACTION REQUIRED – 911
Splint
Ice
Remove athlete from field
http://www.youtube.com/watch?v=CGCpkEEita8
SCENARIO #1
A cross country runner comes into the athletic
training room complaining of pain in his shins.
You notice one pocket of minimal swelling over the
athlete’s distal medial tibia over which he is point
tender. He also wakes up through the night with
sharp, intense pain in his shin.
What is his injury?
How do you know?
SCENARIO #2
A basketball player enters the athletic training
room with pain in her heel. You don’t notice any
swelling, but she is tender along the plantar aspect
of the foot, especially over the medial aspect of the
calcaneus. She observes that most of her pain is in
the morning with her first few steps, but tends to
start to feel better once she’s up and moving. Some
pain is elicited with toe flexion.
What is her injury?
How do you know?
SCENARIO #3
You are covering a tennis match when one of the
participants goes down. During play she was
moving laterally to return a ball and tried to
quickly change directions. She says she felt her
ankle roll and felt a pop. She is in a moderate
amount of pain. You are able to remove her shoe
and sock and notice that she has a moderate
amount of swelling over the ATF and CF. There is
also some discoloration and she is hesitant to put
weight on the foot when she gets up.
What is her injury?
How do you know?