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The Ankle & Lower Leg
Lecture 10
Lower leg and ankle
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ankle injuries most
frequent in sports
tibia
is major weight bearing
bone of the lower leg
fibula
assists minimally with
weight bearing aprrox 2
% , serves as a site for
muscle attachment and
contributes to the stability
of the ankle
Crural Bones
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med / lat. malleolus and
talus
Talocrural Joint (ankle
joint)
is a uniaxial modified
hinge joint - (talus, tibia
and fibula)
plantar flexion and
dorsiflexion occur here
talus wider ant vs post stability
Lateral Ankle Support
ATF, PTF , CF (static)
(AITF)
b) peroneals (dynamic)
 the lateral ligaments of
the ankle joint are
relatively weaker than
the medial ligaments
 hence the larger
number of lateral ankle
sprains
a)
Medial Ankle
a) Deltoid ligament
(static)
b) Tom, Dick and Harry
(dynamic)
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Dynamic
TA
TP
Distal Tib-Fib Joint
a) ant & post tibiofibular
lig
b) interosseos
membrane
Muscles
4 compartments
 anterior , deep , superficial and lateral
i) anterior - tibialis anterior - extensor
digitorum longus - extensor hallucis longus
and peroneous tertius
ii) deep - tibialis posterior - flexor digitorum
longus - flexor hallicus longus
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iii) superficial - gastrocnemius - soleus,
plantaris
iv) lateral - peroneus brevis , peroneus
longus
Ankle Movements
Plantarflexion
 Dorsiflexion
 Inversion
 Eversion
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General Ligament Sprains
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1st, 2nd, 3rd degree
Common Lower Leg & Ankle
Injuries
Inversion Ankle Sprain
more common than eversion because of
ligament and bony support
 stress is applied to the lateral side of the
foot during plantar flexion and inversion
 most often injuring the Anterior
Talofibular ligament (ATF)
 if stress is continued the Calcaneal
Fibular Lig (CF) may be injured as well
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individual will report cracking or tearing
sound at time of injury
 swelling and ecchymosis will be rapid and
diffuse
 point tenderness over ATF may extend
over CF
 Rx - PIER, modalities -horseshoe pad
 Should probably xray to rule out any
possible fractures
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http://www.youtube.com/watch?v=SjprI020
XQ0&feature=related
Eversion Ankle Sprain
less common than lateral ankle sprains
because of strong deltoid ligament, thus
many are associated with fibular fractures
 mild to moderate pain with ankle eversion
 slower and less evident swelling
 point tenderness over deltoid ligament
 Rx – X-ray, PIER, modalities -horse shoe
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First Aid Care
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Immediately apply ice,
compression and elevate
Apply a horseshoe or
doughnut pad, keep it in
place with a elastic wrap.
Have athlete rest , use
crutches
If needed refer to
physician or hospital for
x-rays .
Syndesmotic ankle sprain
AKA: high ankle sprain
 Approximately 10 – 15% of all ankle
sprains involve the syndesmosis
 30 % for collision sports ( football etc)
 MOI – almost always involves a direct
blow to the lateral aspect of the leg with
foot planted in external rotation
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s/s
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Min lateral swelling
Possible med swelling
Pain in anterolateral lower leg
Point tenderness over the AITF lig , the
interosseus membrane
Pont tenderness over the ATF and possibly the
sup ATF lig
Disomfort /pain with DF ( AROM )
Loss of ankle function
First Aid Care
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Immediately apply ice, compression
and elevate
Apply a horseshoe or doughnut pad,
keep it in place with a elastic wrap.
Have athlete rest , use crutches , may
want to put in walking boot or cast for
short period of time
If needed refer to physician or hospital
for xrays .
Achilles Tendon Strain or
Rupture
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probably the most severe
acute muscular problem
in lower leg
75% seen in males
between 30 - 50 years
mechanism of injury usually pushing off of the
forefoot while knee is
extending (racquet
sports )
most ruptures occur 1 to 2 inches proximal
to the distal attachments of the tendon on
the calcaneus
 individual experiences sharp pain and
hears or feels a POP in the tendon region
- often described as a gun shot sound
 a common sensation is one of being hit in
the back of the leg
 visible defect in the tendon
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inability to actively extend the foot
(especially against resistance)
 swelling - bruising and a palpable defect in
the tendon
 immediate referral to physician
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http://www.youtube.com/watch?v=AmDi08
rlR3I&feature=fvw
First Aid Care
Immediately apply ice, compression and
elevate
 Immobilize the area in a splint or walking
boot.
 Have athlete rest , use crutches
 Send to hospital or nearest medical
facility.
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Achilles Tendinitis
most common in lower leg
 tight heel cord – hyper-pronation repetitive heel running - a recent change in
shoes or running surfaces - increase in
distance or intensity
 pain present during and after activity
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increases with passive dorsiflexion and
resisted plantar flexion
 point tenderness - diffuse or localized
swelling
 aching or burning in the posterior heel
 occasionally fine crepitation can be
palpated in the tendon with movement
 Rx - PIER, Modalities, NSAIDS-heel lifts reduced activity (rest) - especially running
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Lower Leg Contusion
usually gastroc
 results in immediate pain and weakness
and loss of function
 haemorrhage and muscle spasm quickly
lead to a tender firm mass that is easily
palpable
 ice on a mild stretch
 care must be taken for myositis ossificans
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Exercise Induced
Compartment Syndrome
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50-60% are anterior – characterised
by exercise induced pain and
swelling that is relieved by rest
exercise induced aching leg pain
and a sense of fullness, both over
the involved compartment
symptoms are almost always
relieved with rest, usually with in 20
minutes
exercise will produce swelling and
tenderness
 to confirm a intra-compartmental pressure
must be measured
 RX involves stretching and strengthening ,
PIER, and NSAIDS
 If symptoms persist , surgery is
recommended
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Muscle Spasms and Cramps
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fatigue , loss of fluids or
electrolyte,
acute treated with ice ,
pressure and slow static
stretch
prevention - adequate water
intake (electrolyte solution) regular stretching program
Lower Leg Strain
may be acute or chronic
 acute may be result of tearing followed by
the inability to walk without pain
 point tenderness, swelling and muscle
weakness will be present
 Rx - PIER, modalities, depends on
severity
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Medial Tibial Stress
Syndrome
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AKA : Shin splints
Microscopic tears in the muscle
attachment site on posterior
medial border
pain along the posterior-medial
tibial border
usually in the distal third
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Possible factors - excessive pronation ,
prolonged pronation , recent training changes
(speed, form , running surface , distance)
pain usually present at start of activity ,but
decreases with activity only to return after
activity, later stages pain present at all times may restrict activity
RX - PIER, NSAIDS, (modalities) activity
modification (rest) - low impact - non impact stretching and strengthening of intrinsic muscle
of the foot
Real key is to find cause ….
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http://www.youtube.com/watch?v=o5DXF
VI6mTA&feature=related