ATC 328 Lower Body Evaluation

The Ankle and Leg

Chapter 5

Bony Anatomy

• Tibia– Periosteum– Interosseous membrane

• Fibula– Weight bearing???– Distal 1/3 thinner

Bony Anatomy

• Talus– Anterior 1/3 wider– Steda’s process

• Calcaneus– Calcaneal tubercle

Ligamentous Anatomy

• Anterior Talofibular Ligament (ATF)

• Posterior Talofibular Ligament (PTF)

• Calcaneofibular Ligament (CF)

• Deltoid Ligament

• Anterior Inferior Tibiofibular Ligament (AITF)

• Interosseous membrane

Articulations

• Closed-packed position

• Open-packed position

• Syndesmosis

Articulations

•Talocrual joint = (mortise and tenon)• 1 degree of freedom of movement

•Dorsiflexion/plantarflexion

•Subtalar joint–1 degree of freedom of movement

•Inversion/eversion

•Distal tibiofibular

•Proximal tibiofibular

Motions

• Functional motion = multiplanar

• Supination = PF, INV, ADD

• Pronation = DF, EVER, ABD

Muscular Anatomy

• Triceps Surae– Gastrocnemius and soleus

• Plantaris

• Peroneal group

• Posterior tibialis

• Anterior tibialis

• EHL, EDL

• FDL, FHL

Leg Compartments• Anterior

– TA, EDL, EHL, PT, deep peroneal nerve

• Lateral– PL, PB, superficial peroneal nerve

• Superficial posterior– Triceps surae, plantaris, tibial nerve

• Deep posterior– Tibialis posterior, FDL, FHL

Bursae

• Superficial calcaneal bursa

• Deep retrocalcaneal bursa

Range of Motion

• 10 degrees DF for normal walk, 15 run

• PF/DF = 20 degrees and 50 degrees

• Inv/Ever = 20 degrees and 5 degrees

Lateral Ankle Sprain

Lateral Ankle Sprain

• Etiology– Tension laterally, compression medially

• S/S

• Testing– Anterior drawer– Talar tilt

• Complications

Syndesmosis Sprains

• Etiology

• S/S

• Testing– Kleiger’s test– Passive DF– Tibiofibular compression test

• Maisonneuve fracture = proximal 1/3 of tibia

Medial Ankle Sprain

• Etiology

• S/S

• Testing– Talar tilt– External rotation

• Complications

Stress Fractures

Signs and Symptoms

Common sites

Predisposing factors

Os Trigonum Injury

• Steida’s process – develops at age 8-13

• Fracture of Steida’s process– Acute, stress, or developmental non-union

• Common with dancers, kickers, repetitive PF

Os Trigonum Injury

• S/S– Pain in posterior calcaneus– Swelling– Pain with PF

Achilles Tendonitis

• Limited blood supply to tendon

• Common causes

• Typical signs and symptoms

Achilles Tendon Rupture

• Males 30+

• Common etiology

• PF MMT greater than 0/5

• Positive Thompson test

Subluxating Peroneal Tendons

• Causes– DF and Ever– PF and Inv– Biomechanical and structural abnormalities– Rupture of retinaculum

• S/S– Audible and visible subluxation

Anterior Compartment Syndrome

• Traumatic or exertional

• S/S– Pain– Paresthesia– Weakness– Decreased pulse/cap. Refill

Deep Vein Thrombophlebitis

• Common in post-surgery

• S/S– Leg pain– Vascular changes– Positive Homan’s sign

Acute Ankle Dislocations

• OUCH!!!

Acute Leg Fractures

• Common sites

Sever’s Syndrome

• Etiology• S/S