mrs. marr and the lower leg foot sports medicine ii
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Mrs. Marr
And the And the
Lower Lower
LegLegFooFoo
tt
Sports Medicine IISports Medicine II
THE 4 BONES OF THE ANKLE JOINT
TIBIA
FIBULA
CALCANEUS
TALUS
ANKLE LIGAMENTS – MEDIAL
• Deltoid Ligament Complex – 4 ligaments– Broad– Flat– Overlapping– = STRONG!
A
BC
D
ANKLE LIGAMENTS - LATERAL
• Lateral Collateral Ligaments– ATF
• Anterior• From Talus to Fibula• Weakest of 3 ligaments
– PTF• Posterior• From Talus to Fibula• Strongest/Deepest of 3
ligaments
– CF• Anterior• From Calcaneus to Fibula• Largest; Strong and Cord-like
ANKLE MUSCLES: ANTERIOR SIDE
• TIBIALIS ANTERIOR– Muscle starts @ top of Tibia– Tendon crosses over Ankle Joint @ Talus– Attaches at the base of the 1st foot
bone– Cross over at joint allows for multiple
motions
• Major Motion:– Dorsiflexion of the ankle joint– Inversion of the foot – Prevents the forefoot slapping AND
scrapping the ground
ANKLE MUSCLES: LATERAL SIDE
• PERONEAL GROUP– 3 muscles (peroneus
brevis/longus/tertius)– Muscle group starts @ top of Fibula– Peroneal tendon hooks around the back
of Lateral Malleolus– Insertion of Peroneal Tendon is at the
base of the 5th foot bone
• Major Motion:Eversion of the Foot @ the Ankle
ANKLE MUSCLES: POSTERIOR
• GASTROCNEMIUS– Muscle starts on distal femur– 1 muscle with two points of origin– Achilles Tendon is other attachment– Crosses two joints
Major Motion:Plantarflexion @ the Ankle
•ACHILLES TENDON Large Tendon/Cord from Gastroc.
Inserts firmly at Calcaneus Largest, Strongest Tendon in Body Combination of Gastroc and Soleus Tendons
Compartments of the Leg1. Anterior
2. Lateral (peroneal)
3. Deep posterior
4. Superficial posterior
Anterior Compartment Musculature
• Tibialis anterior• Extensor digitorum
longus• Extensor hallucis
longus• Peroneus tertius
Tibialis Anterior
• DF and inversion• O: lateral tibial condyle
and shaft• I: medial/plantar 1st
cuneiform and metatarsal• N: deep peroneal
Extensor Digitorum
Longus• Extension of 2nd-5th MP joints,
assists with eversion and DF
• O: lateral tibial condyle, proximal ¾ of anterior fibula
• I: via 4 tendons into distal phalanges of 2nd-5th toes
• N: deep peroneal
Extensor Hallucis Longus
• Extension of 1st MP and IP joints
• O: middle 2/3 of anterior fibula
• I: base of distal 1st phalanx• N: deep peroneal
Peroneus Tertius
• Eversion of foot, assists in PF
• O: distal 1/3 of anterior fibula
• I: dorsal base of 5th metatarsal
• N: deep peroneal
Lateral Compartment Musculature
• Peroneus longus• Peroneus brevis
Peroneus Longus
• Eversion of the foot, assists with PF
• O: lateral tibial condyle, fibular head, upper 2/3 of lateral fibula
• I: lateral base of 1st metatarsal, lateral and dorsal aspect of 1st cuneiform
• N: superficial peroneal
Peroneus Brevis
• Eversion of the foot, assists with PF
• O: distal 2/3 of lateral fibula
• I: styloid process at base of 5th metatarsal
• N: superficial peroneal
Superficial Posterior Compartment Muscles
• Gastrocnemius• Soleus• Plantaris
Gastrocnemius
• Ankle PF, assists knee flexion• O: medial head – posterior
medial femoral condyle, lateral head – posterior lateral femoral condyle
• I: calcaneus via Achilles tendon
• N: tibial
Soleus• Ankle PF• O: posterior fibular head, upper 1/3
of posterior fibular, soleal line on posterior tibial shaft, middle 1/3 of medial tibial border
• I: calcaneus via Achilles tendon• N: tibial
Plantaris• Ankle PF, assists knee
flexion
• O: distal supracondylar line of lateral femoral condyle, femoral popliteal surface
• I: calcaneus via Achilles tendon
• N: tibial
Deep Posterior Compartment Musculature
• “Tom, Dick, AND Harry”• Tibialis posterior
•Flexor Hallucis Longus •Flexor Digitorum Longus
Tibialis Posterior
• Inversion of the foot, assists with PF
• O: posterior/lateral tibia, upper 2/3 of medial fibula
• I: navicular tuberosity, via slips into sustentaculum tali, cuneiforms, cuboid and bases of 2nd-4th metatarsals
• N: tibial
Flexor Digitorum
Longus
• Flexion of 2nd-5th PIP/DIP/MP joints, assists with foot inversion and PF
• O: posterior medial 2/3 of distal tibia
• I: plantar surface of base of 2nd-5th distal phalanges
• N: tibial
Flexor Hallucis Longus
• Flexion of 1st IP joint, assists with flexion of 1st MP joint, foot inversion and PF
• O: posterior/distal 2/3 of fibula• I: plantar surface of 1st proximal
phalanx• N: tibial
Interosseous membrane (Syndesmosis) isn't a compartment but ligamentous sheathe that holds the tibia and the fibula together.
Syndesmosis
Nerves and Blood Vessels• Nerves:
– Peroneal N.– Tibialis Anterior/ Posterior N.– Saphenous N.
• Blood Vessels– Dorsal Pedal A.– Posterior Tibial A.– Greater/ Lesser Saphenous V.
Neuroanatomy• Anterior compartment
– Deep branch of Peroneal nerve• Lateral compartment
– Superficial branch of Peroneal nerve• Deep posterior compartment
– Tibial nerve• Superficial posterior compartment
– Tibial nerve
Deep Branch of Peroneal
Nerve• Branches from
common Peroneal nerve near fibular head
• “Dives” into anterior compartment
Superficial Branch of Peroneal Nerve
• Branches from common Peroneal nerve near fibular head
• Stays superficial and lateral in lateral compartment
Tibial Nerve• Runs in fascial
sheath between deep and superficial posterior compartments
• Provides innervation to both, but not “in” either
Vascular Anatomy
• Anterior compartment– Anterior tibial artery
• Lateral compartment– Peroneal artery
• Deep posterior compartment– Posterior tibial artery
• Superficial posterior compartment– Posterior tibial artery
Anterior Tibial Artery
• Traverses similar path to deep Peroneal nerve
• Terminating as dorsal pedal artery
Peroneal
Artery• Branches off of
posterior tibial artery
Posterior Tibial Artery
• Runs in fascial sheath between deep and superficial posterior compartments
• Provides vascular supply to both, but not “in” either
Special TestsThe Squeeze Test
• Squeeze test – check malleolus – Check tibia and fibula– May indicate FX
• Feel for any abnormalities• Feeling for grinding or
movement
Anterior drawer tests should always be performed with the knee bent to eliminate the Achilles and Gastrocnemius muscles from providing any stability to the ankle.
A lateral talar tilt test can be conducted at the same time.
Special TestsAnterior Drawer/Tilt
Anterior Drawer Test
Tilt Test
Special TestsFunctional Tests
• Functional tests(Return to play)
a) walking - check gait
b) toe raises
1) both feet
2) one foot
c) jump and land on both feet and then on one foot
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