Ankle and Leg Injuries

ROP SPORTS MEDICINE

Stacy Camou

Skeletal Anatomy• Talus• Tibia

– Medial aspect– Larger of the two leg bones– Second longest bone in body– Primary weight bearing bone in leg

• Fibula– Lateral aspect– Functions to provide muscle attachments– Non-weight bearing

Skeletal Anatomy

Articulations

• Talocrural joint = Ankle joint– Made up of the tibia, fibula, and talus– Talus is wedge shaped– Lateral malleolus extends more distally than the

medial malleolus

• Proximal to Distal tibiofibular joint is connected by– Syndesmosis Joint (HIGH ANKLE SPRAIN)

Articulations- Talocrural Joint

Articulations

Musculoskeletal Anatomy

• 4 Compartments of the leg– Anterior compartment (most commonly Injured)

• Tibialis anterior• Extensor hallicus longus• Extensor digitorum longus• Peroneus tertius• Anterior tibial artery and vein• Deep peroneal nerve

– Lateral compartment• Peroneus longus• Peroneus brevis• Superficial peroneal nerve

Musculoskeletal Anatomy• Compartments of the leg

– Deep posterior compartment• Tibialis posterior• Flexor hallucis longus• Flexor digitorum longus• Posterior tibial artery and vein• Tibial nerve

• Superficial posterior• Gastrocnemius• Soleus• Plantaris

Musculoskeletal Anatomy

Ligamentous Anatomy

• Ankle– Medial aspect

• Deltoid ligament• Thick and strong

– Lateral aspect• Anterior talofibular • Posterior talofibular • Calcaneofibular

• Leg– Proximal and distal anterior and posterior

tibiofibular ligaments

+ Interosseous membrane

=

Syndesmosis Ligaments

Ligamentous Anatomy

http://www.google.com/imgres?q=ankle+ligament+anatomy&hl=en&qscrl=1&nord=1&rlz=1T4ADFA_enUS403US452&biw=1600&bih=610&tbm=isch&tbnid=I_tl3fuCUPnsXM:&imgrefurl=http://www.hawaii.edu/medicine/pediatrics/pemxray/v3c03.html&docid=qlEMCdlJnVfjRM&imgurl=http://www.hawaii.edu/medicine/pediatrics/pemxray/v3c03b.jpg&w=453&h=423&ei=EnvEToHLMc7XiAL1jvHCBQ&zoom=1

Gastrocnemius

Soleus

Achilles Tendon

Tibialis Anterior

Peroneus Longus Peroneus Brevis

Fractures• Avulsions

– Piece of tibia/fibula is pulled off by ligament– Fairly common– X-rays for all ankle sprains

Fractures

Fractures

• Tibia– Traumatic fractures are serious due to size of bone– Stress fractures

• Medial tibial stress syndrome• “shin splints”

• Fibula– Fairly common– Non-weight bearing; competition possible– Stress fractures

• Reasonably common due to muscle attachments

• Both bones– Usually requires surgery to stabilize

Fractures

Strains

• Gastrocnemius/Soleus strain occurs:– Muscle belly– Musculotendinous junction

• Anterior extensors strain– Often called “shin splints” (lateral to tibial ridge)– M.O.I = Hill, climbing, or speed work– May lead to chronic compartment syndrome

• Toe flexors– Often called “shin splints” (medial to tibial ridge)– M.O.I = Pronation increases odds

• Achilles tendon– Strain vs tendonitis ( can lead to rupture )

Strains

• Achilles tendon rupture– Most common over 30 years old– Chronic history of inflammation

or– Acute Sudden push off– Signs and symptoms

• “I was kicked in the back of the leg!!”• Immediate pain• Palpable defect• Positive Thompson’s test

STRAINS

Thompson’s Test

Sprains• Lateral ankle sprains

– M.O.I = Inversion/plantar flexion mechanism– Most common injury in body– 90-95% of all ankle sprains occur to lateral

ligaments…..Why?• Strong medial ligaments• Fibular block

– Ligaments involved• Anterior talofibular or ATFL• Calcaneofibular or CFL• Posterior talofibular or PTFL

– Mild to severe grades (1°-3°)

Lateral Ankle Sprain

Sprains• Medial ankle sprains

– M.O.I = Eversion mechanism– Rare (5%) occur medially….WHY????

• Strong deltoid ligament• Fibular block

– Deltoid ligaments Injured– Graded Mild to severe (1°-3°)

• Syndesmosis sprain– M.O.I = Forced dorsiflexion and/or eversion– “High ankle sprain”– Slow to heal– Anterior tibiofibular (ATFL) ligament and interosseous

membrane are the ligaments injured

Medial Ankle Sprain

Other Conditions

• Achilles tendonitis/tenosynovitis– Inflammation of the tendon or sheath

surrounding the tendon– Causes hypertrophic scarring

Achilles Tendon Rupture

Achilles Tendonitis

ACHILlES TENDON RUPTURE

Other Conditions• Compartment syndrome

– Typically anterior or deep posterior compartments– Acute

• Caused by direct blow or injury within fascial compartment• Medical emergency• Taut, shiny appearance of skin• Foot drop if advanced• Requires surgical decompression

– Chronic• Muscle hypertrophy during exercise

– Decreased space in compartment• Slow, continual rise in temperature

– Treatment???

If pressure is too high surgery will be required.