mrs. marr and the lower leg foot sports medicine ii
TRANSCRIPT
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Mrs. Marr
And the And the
Lower Lower
LegLegFooFoo
tt
Sports Medicine IISports Medicine II
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THE 4 BONES OF THE ANKLE JOINT
TIBIA
FIBULA
CALCANEUS
TALUS
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ANKLE LIGAMENTS – MEDIAL
• Deltoid Ligament Complex – 4 ligaments– Broad– Flat– Overlapping– = STRONG!
A
BC
D
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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
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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
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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
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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
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Compartments of the Leg1. Anterior
2. Lateral (peroneal)
3. Deep posterior
4. Superficial posterior
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Anterior Compartment Musculature
• Tibialis anterior• Extensor digitorum
longus• Extensor hallucis
longus• Peroneus tertius
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Tibialis Anterior
• DF and inversion• O: lateral tibial condyle
and shaft• I: medial/plantar 1st
cuneiform and metatarsal• N: deep peroneal
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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
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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
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Peroneus Tertius
• Eversion of foot, assists in PF
• O: distal 1/3 of anterior fibula
• I: dorsal base of 5th metatarsal
• N: deep peroneal
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Lateral Compartment Musculature
• Peroneus longus• Peroneus brevis
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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
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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
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Superficial Posterior Compartment Muscles
• Gastrocnemius• Soleus• Plantaris
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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
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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
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Plantaris• Ankle PF, assists knee
flexion
• O: distal supracondylar line of lateral femoral condyle, femoral popliteal surface
• I: calcaneus via Achilles tendon
• N: tibial
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Deep Posterior Compartment Musculature
• “Tom, Dick, AND Harry”• Tibialis posterior
•Flexor Hallucis Longus •Flexor Digitorum Longus
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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
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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
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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
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Interosseous membrane (Syndesmosis) isn't a compartment but ligamentous sheathe that holds the tibia and the fibula together.
Syndesmosis
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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.
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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
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Deep Branch of Peroneal
Nerve• Branches from
common Peroneal nerve near fibular head
• “Dives” into anterior compartment
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Superficial Branch of Peroneal Nerve
• Branches from common Peroneal nerve near fibular head
• Stays superficial and lateral in lateral compartment
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Tibial Nerve• Runs in fascial
sheath between deep and superficial posterior compartments
• Provides innervation to both, but not “in” either
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Vascular Anatomy
• Anterior compartment– Anterior tibial artery
• Lateral compartment– Peroneal artery
• Deep posterior compartment– Posterior tibial artery
• Superficial posterior compartment– Posterior tibial artery
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Anterior Tibial Artery
• Traverses similar path to deep Peroneal nerve
• Terminating as dorsal pedal artery
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Peroneal
Artery• Branches off of
posterior tibial artery
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Posterior Tibial Artery
• Runs in fascial sheath between deep and superficial posterior compartments
• Provides vascular supply to both, but not “in” either
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Special TestsThe Squeeze Test
• Squeeze test – check malleolus – Check tibia and fibula– May indicate FX
• Feel for any abnormalities• Feeling for grinding or
movement
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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
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Anterior Drawer Test
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Tilt Test
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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