The lower leg and ankle f09
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The lower leg and ankle f09






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The lower leg and ankle f09 The lower leg and ankle f09 Presentation Transcript

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