Ankle

and
Lower Leg
Chapter 17

Ankle Bony Anatomy

Talus (link between
lower leg & foot)
Tibia
Medial malleolus

Fibula
Lateral malleolus

Mortise
Tibial tuberosity
Tibial condyles

Bony Anatomy

Functional Anatomy
Ankle is a stable hinge joint
Medial/lateral dislocation is prevented by
malleoli
Square shape of talus adds stability of
ankle
Most stable during dorsiflexion, least
stable in plantar flexion

Ankle Motions

Plantar Flexion
Dorsiflexion
Inversion
Eversion
Pronation
Supination

Ankle Articulations
Talar Joint (Talocrural
joint)
Tibia & fibula with
talus
Dome of talus
articulates with
mortise formed by
tibia & fibula
Motions: dorsiflexion
& plantar flexion

Subtalar Joint
Articulation of talus
with calcaneus
Motions: inversion &
eversion

Soft Tissue

Gastrocnemius
Soleus
Tibialis posterior
Tibialis anterior
Peroneus longus
Peroneus brevis
Plantaris
Plantar fascia

Anterior talofibular
Anterior tibiofibular
Calcaneofibular
Posterior talofibular
Deltoid ligament

Tibionavicular
Calcaneotibial
Anterior talotibial
Posterior talotibial

Muscles of the Lower Leg

Flexor hallucis longus

Flexor digitorum
longus
Anterior tibialis

Muscles of the Lower Leg

Peroneus tertius
Peroneus longus
Peroneus brevis

Muscles of the Lower Leg

Gastrocnemius
Soleus

Muscles of the Lower Leg

Muscles of the Lower Leg

Compartments of the
Lower Leg
Anterior
Tibialias anterior
Extensor digitorum
longus
Peroneus tertius
Extensor hallucis
muscles

Peroneal
Peroneus longus
Peroneus brevis

Deep Posterior
Popliteus
Flexor digitorum
longus
Flexor hallucis longus
Tibialis posterior

Superficial Posterior
Gastrocnemius
Soleus
Plantaris

Compartments of the
Lower Leg

Compartments of the
Lower Leg

Ligaments
Lateral aspect
Anterior talofibular
(ATF)
Anterior tibiofibular
Calcaneofibular (CF)
Posterior talofibular

Medial aspect
Deltoid Ligament

Common Injuries
to the
Ankle & Lower Leg

Contusions
Occur most often on
tibia
Can be painful and
disabling
Complication
compartment syndrome

Muscle Strains
Most common in calf
Result from:
violent contraction
Overstretching
Continued overuse

Usually occur in area

of MTJ or insertion of
Achilles tendon
Result from:
Repetitive overuse
Single violent
contraction

Acute strain to
Achilles have
tendency to become
chronic

Cramps
A sudden, involuntary contraction of a
muscle
Contributing factors include:
Fatigue
Fractures
Dehydration
Lack of nutrients in diet
Poor flexibility
Improperly fitted equipment

CrampsTreatment
Passive stretching
Fluid replacement
Water
Sports drink
Massage
Rest
Ice

Achilles Tendonitis
Inflammation of
Achilles tendon
Tearing of tendon
tissues caused by
excessive stress
Occurs at point where
tendon attaches to
heel

Achilles Tendonitis
Symptoms develop gradually
Repeated or continued
overstress increases
inflammation
Pain, crepitus, redness
Treatment

Prevention
Stretching
Biomechanical problems?
Ice/Rest
NSAIDs
Heel lift/Achilles taping

Achilles Tendon Rupture

Rupture occurs w/in
tendon, approx 1-2
proximal to insertion
Eccentric force applied
to dorsiflexed foot
Poor conditioning
Overexertion

Direct trauma
Surgically repaired
Rehab = 1yr +
Thompson test

Medial Tibial Stress

Syndrome
aka shin splints
Catchall term for
pain that occurs
below knee
Anterior shin
Medial shin

Result of doing too

much too soon

Associated with:
repetitive activity on
hard surface
forcible excessive
use of leg muscles
(running, jumping)
tightness of gastroc
and/or soleus
muscles
improper footwear
running
biomechanics

MTSS Treatment

Ice
Reduce activity level
Gentle stretching
Biomechanical
assessment
Orthotics
NSAIDs
Strengthening and
flexibility program

Stress Fractures
Incomplete crack in
bone
Microscopic fractures
in bone that will
eventually lead to full
fracture if left
untreated
Repeated stress
placed on bone
greater than bodys
ability to heal it

Stress FracturesS/Sxs
hot spot of sharp,
intense pain upon
palpation
Shin-splint

Stress Fx

Pain more
generalized
Pain worse in
am

Pain worse
in pm

Compartment Syndrome
Swelling within one or more of the
compartments of the lower leg
Caused by:
Contusion
Fracture
Crush injury
Localized infection
Excessive exercise
Overstretching

Ankle Sprains
MOI: combo of excessive inversion and
PF
aka lateral ankle sprain

Anterior Talofibular Ligament (ATF)

Calcaneofibular (CF)
Posterior talofibular (PTF)

Eversion (medial) ankle

sprain less common
Deltoid ligament

Ankle Sprains
Injury to ligamentous
and capsular tissue
Traumatic joint twist
that results in
stretching of total
tearing of the
stabilizing connective
tissue
One of most common
& disabling sports
injuries

General Symptoms:
Joint swelling
Local temperature
increase
Pain
Point tenderness
Skin discoloration

Ankle Sprains

 Inversion
Anterior Talofibular
Calcaneofibular
Posterior Talofibular

Eversion
Deltoid Ligament

Syndesmotic
High ankle sprain

Ankle SprainS/SXS
Grade 1

Some pain
Minimum LOF
Mild point tenderness
Little or no swelling
No abnormal motion

Grade 2

Pain
Moderate LOF
Swelling
Slight to moderate
instability

Grade 3
Severe sprain
Extremely painful initially
LOF
Severe instability
Tenderness
Swelling
May represent
subluxation that
reduced
spontaneously

Ankle SprainTreatment

R.I.C.E.
Crutches
Boot
Splint, tape, brace
Compressive wrap
Horseshoe

Special Tests
&
Rehabilitation

Anterior Drawer

Talar Tilt

Tests integrity of anterior

talofibular ligament

Tests integrity of
calcaneofibular ligament

Squeeze Test
Squeezing the tibia and
fibula together
Can indicate fracture or
high ankle sprain

Bump Test/Tap Test

Bump calcaneus
Indicate fracture to
tibia/fibula
Indicate high ankle sprain

Tap mallelous
Indicate fracture of
particular bone

Ankle Rehab

4-way TheraBand
Heel walks/Toe walks
3-way heel raises
Unilateral Balance
3-way Tramp throw