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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?
