The lower leg and ankle f09


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The lower leg and ankle f09

  1. 1. The Lower Leg and Ankle
  2. 2. Anatomy of Lower Leg <ul><li>Comprised of two long bones . </li></ul><ul><ul><li>Tibia is the larger of the two, and is located toward the middle of the lower leg (medially). </li></ul></ul><ul><ul><li>Fibula is the smaller bone and it is located on the outside of the lower leg (laterally). </li></ul></ul>
  3. 3. Bone Structure <ul><li>A. Lateral Malleolus </li></ul><ul><li>C. Fibula </li></ul><ul><li>D. Interosseous Membrane </li></ul><ul><li>I. Medial Condyle </li></ul><ul><li>J. Tibial Tuberosity </li></ul><ul><li>L. Tibia </li></ul><ul><li>M. Medial Malleolus </li></ul>
  4. 4. Muscles in the Lower Leg <ul><li>Divided into four compartments </li></ul><ul><li>Anterior compartment (the front of the shin) </li></ul><ul><ul><li>Has 4 muscles: tibilais anterior, the extensor digitorum longus, the extensor hallucus longus and the peroneus tertius muscles. </li></ul></ul><ul><ul><li>These muscles dorsiflex the foot and toes. </li></ul></ul><ul><ul><li>The tibialis anterior also assists turning the foot inward. </li></ul></ul><ul><li>Lateral compartment: (outside). </li></ul><ul><ul><li>Has 2 muscles: peroneus longus and peroneus brevis muscles. </li></ul></ul><ul><ul><li>Pull the foot outward. </li></ul></ul><ul><ul><li>They also help with plantarflexion </li></ul></ul><ul><li>Posterior compartment </li></ul><ul><ul><li>Ha s 2 large muscles: </li></ul></ul><ul><ul><ul><li>gastrocnemius shorter, thicker and has two attachments and most visible </li></ul></ul></ul><ul><ul><ul><li>soleus lies underneath </li></ul></ul></ul><ul><ul><li>Also contains plantaris muscle. </li></ul></ul><ul><ul><li>These three muscles attach to the achilles tendon. </li></ul></ul><ul><ul><li>They all aid with plantarflexion. </li></ul></ul><ul><li>Deep posterior compartment (deep within the back) </li></ul><ul><ul><li>Has 3 muscles: tibialis posterior, flexor digitorum longus, and flexor hallucus longus. </li></ul></ul><ul><ul><li>All three aide in plantarflexion. </li></ul></ul>
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  6. 6. Understanding the Gait . <ul><ul><li>OBSSERVING THE FOLLOWING: </li></ul></ul><ul><ul><ul><li>Mechanics of foot-strike while walking/running. </li></ul></ul></ul><ul><ul><ul><li>Loading/energy transfer phase. </li></ul></ul></ul><ul><ul><ul><li>The push off (“toe-off”) with the forefoot. </li></ul></ul></ul><ul><ul><li>Each foot-strike delivers a shockwave that travels up the leg. </li></ul></ul><ul><ul><li>This energy must be absorbed by the musculoskeletal system. </li></ul></ul><ul><ul><li>The harder the running surface the greater the shockwave. </li></ul></ul><ul><ul><ul><li>Soft grass, smooth dirt, asphalt, and concrete. </li></ul></ul></ul><ul><ul><ul><li>Basketball court, track, baseball field, tennis court </li></ul></ul></ul><ul><ul><li>M.S.T.T. </li></ul></ul><ul><ul><ul><li>Miles </li></ul></ul></ul><ul><ul><ul><li>Shoes </li></ul></ul></ul><ul><ul><ul><li>Technique </li></ul></ul></ul><ul><ul><ul><li>Terrain </li></ul></ul></ul>
  7. 7. Calf Strain <ul><li>Most commonly injured is at the musculotendinous junction of the Gastrocnemius (half way between the knee and the heel). </li></ul><ul><li>Soleus muscle damage pain lower in the leg </li></ul><ul><ul><li>pain when you contract the muscle against resistance with the knee bent </li></ul></ul><ul><li>Symptoms of calf strain include: </li></ul><ul><ul><ul><li>A sudden pain at the back of the leg, particularly at the musculotendinous junction. </li></ul></ul></ul><ul><ul><ul><li>Difficulty in contracting the muscle or standing on tip toes </li></ul></ul></ul><ul><ul><ul><li>Pain and swelling or bruising in the calf muscle </li></ul></ul></ul><ul><ul><ul><li>Pain on resisted plantar flexion (pointing the toes away from you) or contracting the muscles against resistance, </li></ul></ul></ul>
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  9. 9. What are Shin Splints? <ul><li>General name given to pain at the front of the lower leg. </li></ul><ul><li>Shin splints is not a diagnosis in itself but a description of symptoms of which there could be a number of causes. </li></ul><ul><li>The most common cause is inflammation of the periostium of the tibia sheath surrounding the bone). </li></ul><ul><ul><li>Traction forces occur from the muscles of the lower leg on the periostium causing shin pain and inflammation </li></ul></ul><ul><li>Symptoms of shin splints: </li></ul><ul><ul><li>Tenderness over the inside of the shin. </li></ul></ul><ul><ul><li>Lower leg pain which goes after a period of rest but comes back when running starts again. </li></ul></ul><ul><ul><li>Sometimes some swelling. </li></ul></ul><ul><ul><li>Lumps and bumps may be felt when feeling the inside of the shin bone. </li></ul></ul><ul><ul><li>Pain when the toes or foot are bent downwards. </li></ul></ul><ul><ul><li>A redness over the inside of the shin. </li></ul></ul>
  10. 10. Shin Splints Medial Tibial Stress Syndrome (MTSS) <ul><li>Four basic grades you can follow: </li></ul><ul><ul><li>Grade 1 - Shin pain 2-3 hours after exercise.  </li></ul></ul><ul><ul><ul><li>Dull soreness; low impact activity can reduce pain. </li></ul></ul></ul><ul><ul><li>Grade 2 - Shin pain before and after exercise </li></ul></ul><ul><ul><ul><li>but doesn’t affect performance. </li></ul></ul></ul><ul><ul><li>Grade 3 - Shin pain before, during, and after, exercise </li></ul></ul><ul><ul><ul><li>affects performance. </li></ul></ul></ul><ul><ul><li>Grade 4 - Severe pain, cannot perform activity.  </li></ul></ul><ul><ul><ul><li>Should be referred to a physician or physiotherapist if pain persists after one week. </li></ul></ul></ul>
  11. 11. Two types of muscular shin splints (different problems) <ul><li>Tibialis posterior </li></ul><ul><li>Most common of shin splints </li></ul><ul><li>Inflammation of the muscle attachments and interosseous  membranes to the tibia (shin bone) on the inside of the front of the lower leg. </li></ul><ul><li>Affecting the inner part of the lower leg at the insertion of a major decelerator muscle of the foot, namely tibialis posterior. </li></ul><ul><li>Pain is felt on palpation or when walking/running approximately half way up the inner shin. </li></ul><ul><li>Pain is only felt in the muscular region right next to the tibia (shin bone) and not when touching the bone itself </li></ul><ul><li>Tibilas anterior </li></ul><ul><li>These are known as anterior shin splints and are almost as common as the posterior shin splints. </li></ul><ul><li>These are caused by inflammation of the insertion of the  second decelerator of the foot: </li></ul><ul><ul><li>namely tibialis anterior. </li></ul></ul><ul><li>Pain is felt on the other side of the shin bone (on the outer part of the leg). </li></ul><ul><li>Again pain will not be felt when touching the bone itself </li></ul>
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  13. 13. Achilles Tendon Injury <ul><li>The Achilles tendon, or tendon calcaneus </li></ul><ul><ul><li>Large ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus). </li></ul></ul><ul><ul><li>It is the largest tendon in the human body </li></ul></ul><ul><li>Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. </li></ul><ul><ul><li>Most often these are tennis, racquetball, basketball, and badminton. </li></ul></ul>
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  15. 15. Retrocalcaneal Bursitis <ul><li>An inflammation in the bursa behind the heel bone. Pain at the back of the heels especially when running uphill or on soft surfaces. </li></ul><ul><li>Tenderness and swelling which might make it difficult to wear certain shoes on the feet. </li></ul><ul><li>When pressing fingers in both sides of the heel a spongy resistance may be felt. </li></ul>
  16. 16. The Ankle <ul><li>The ankle is a joint which is formed </li></ul><ul><ul><li>tibia and fibula and the talus (below the ankle joint). </li></ul></ul><ul><li>The ankle joint allows for: </li></ul><ul><ul><li>upwards (dorsiflexion) and </li></ul></ul><ul><ul><li>downwards (plantarflexion) motion. </li></ul></ul><ul><li>The end of the shin bone (tibia) forms the inner bony prominence of the ankle called the medial malleolus. </li></ul><ul><li>The outer bony prominence is called the lateral malleolus and is formed by the small outer bone in the foreleg called the fibula. </li></ul><ul><li>Stability of the joint comes from several factors: </li></ul><ul><ul><li>the unique structural arrangement of the bones forming the joint </li></ul></ul><ul><ul><li>the surrounding ligaments </li></ul></ul>
  17. 17. <ul><li>On the lateral (outside) of the ankle is a complex of three ligaments. </li></ul><ul><li>These three ligaments provide stability by attaching the lateral malleolus to the bones below the ankle joint (talus and calcaneus). </li></ul><ul><li>They are the: (Inversion sprain) </li></ul><ul><ul><li>anterior talo-fibular ligament (goes from the talus to the fibula) </li></ul></ul><ul><ul><li>calcaneo-fibular ligament (goes from the calcaneus to the fibula) </li></ul></ul><ul><ul><li>posterior talo-fibular ligament (goes from the talus to the fibula). </li></ul></ul><ul><li>Medial (inside) of the ankle: (Eversion sprain) </li></ul><ul><ul><li>The deltoid ligament is a wide complex ligament over the inner part of the ankle. </li></ul></ul><ul><ul><li>deltoid ligament sprain coupled with an ATFL sprain takes longer to heal. </li></ul></ul>
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  19. 19.
  20. 20. Ankle Sprains
  21. 21. Common Injuries to the Foot <ul><li>Turf toe : </li></ul><ul><ul><li>Turf toe is an injury to the base of the big toe, in which you actually tear the capsule that surrounds the joint at the base of the toe. </li></ul></ul><ul><ul><li>The toe is jammed into the ground and bent too far back (hyperextended). </li></ul></ul><ul><ul><li>This injury occurs most often in sports that require quick direction changes: </li></ul></ul><ul><ul><ul><li>football, soccer or rugby. </li></ul></ul></ul><ul><li>Plantar Fasciitis: </li></ul><ul><ul><li>Ligament band running from your heel to the ball of your foot. </li></ul></ul><ul><ul><li>This band pulls on the heel bone, raising the arch of your foot as it pushes off the ground. </li></ul></ul><ul><ul><li>The fascia may swell and its tiny fibers may begin to fray, causing plantar fasciitis. </li></ul></ul><ul><ul><li>Caused by poor foot mechanics </li></ul></ul><ul><li>Morton's syndrome : </li></ul><ul><ul><li>An enlarged nerve that usually occurs in the third interspace, which is between the third and fourth toes </li></ul></ul><ul><ul><li>localized pain in the inter space </li></ul></ul>
  22. 22. <ul><li>Turf Toe </li></ul><ul><li>Morton’s Neuroma </li></ul><ul><li>Plantar Fascitis </li></ul>
  23. 23. <ul><li>Peroneal Tendinitis </li></ul><ul><ul><li>Caused by pes cavus </li></ul></ul><ul><ul><ul><li>Foot excessively supinates </li></ul></ul></ul><ul><ul><ul><li>Causes weight bearing on the outside of foot </li></ul></ul></ul><ul><ul><li>Mistaken for ankle sprains </li></ul></ul><ul><li>Leg Cramps and Spasms </li></ul><ul><ul><li>Sudden, violent, involuntary contractions </li></ul></ul><ul><ul><ul><li>Clonic spasm = intermittent contraction and relaxation (neurological) </li></ul></ul></ul><ul><ul><ul><li>Tonic spasm = constant contraction without relaxation </li></ul></ul></ul>
  24. 24. Peroneal & Spasms
  25. 25. Fracture Normal Ankle X-ray Fractured Ankle X-ray Surgery with Plate and Screws
  26. 26. Ankle Fracture Dislocation
  27. 27.
  28. 28. Taping <ul><li>Arches </li></ul><ul><ul><li>Longitudinal </li></ul></ul><ul><ul><li>Transverse </li></ul></ul><ul><li>Barber Poll </li></ul><ul><li>Shins </li></ul><ul><li>Great Toe </li></ul><ul><ul><li>Turf toe </li></ul></ul><ul><li>Ankle </li></ul><ul><ul><li>prevention </li></ul></ul>