Ankle LabelingSports Med 2

Chapter reading:

You will need a white board and pen

From teacher website read:◦ P 235-236

◦ P 239-240

Ankle/Foot Outline

Facts:

• Ankle injuries occur most in sports.

• Plantar flexion/ Inversion ankle sprains account for about 90% of all ankle sprains

Bones

• Distal end of tibia (medial malleolus) and fibula (lateral malleolus)

• Talus:

– 2nd largest tarsal

– Main weight bearing bone in foot

– Almost square shape

• Calcaneus

MovementsThe most stable position of the ankle is when it is in dorsiflexion

Place the muscle in the movement category:Gastrocnemius, anterior tibialis, peroneus longus and brevis,

soleus, posterior tibialis

Dorsiflexion

•Plantarflexion

Inversion

Eversion

Ankle MMTs

MMTs from video• Perform 25 single leg calf raises with the knee

straight and then with the knee bent

• Resist dorsiflexion (DF) and inversion– Start in PF and eversion

– Anterior tibialis

• Resist plantarflexion (PF) and eversion– Start in DF and inversion

– Peroneus longus and peroneus brevis

• Resist plantarflexion– Start in DF

– Gastrocnemius and soleus

Ligament SupportLa

tera

l • Anterior tibiofibular

• Posterior tibiofibular

• Anterior talofibular

• Posterior talofibular

• Calcaneofibular

med

ial • Deltoid

• Triangular

• Primary eversion resistor

H.O.Palpations.S.

• Palpation should start with bony sites.

• Purpose of palpation is to detect obvious defects, swellings, localized tenderness

H.O.Palpations.S.

Bony

• Medial:

• Medial malleolus

• Navicular

• Talus

• Cuneiforms

• Lateral

• Lateral malleolus

• Proximal base of the 5th

metatarsal

• cuboid

Soft

• Medial:

• Deltoid ligament

• Lateral

• Anterior talofibular ligament

• Calcaneofibular ligament

• Posterior talofibular

• Anterior tibiofibular

• Peroneal tendon

• Posterior

• Achilles tendon

Medial Palpations Quick video: You need a wet markerankle medial palpations quick video link

Lateral Palpations Quick Videoankle lateral palpations quick video link

Ankle wrap with horseshoe pad

• To help control immediate swelling

Lower leg Compartments

• Copy table 15-1 (p 237 on website)

• Review movements and MMT’s in LAB groups

Functions of Ankle Ligaments: add these to the back of flashcard

Ligament Primary FunctionPut on back of corresponding flashcard

Anterior Talofibular Restrains displacement of talus

Calcaneofibular Restrains of calcaneus

Posterior Talorfibular Restrains displacement of talus

Deltoid Ligaments (medial) Prevents and of ankle

Types and Grades of Ankle Sprain: Read pgs 240-242

Soft tissue Palpations Quick VideoSoft tissue palpations quick video link

SOAP Note Practice

• Pick an ankle injury MOI and grade of sprain– Come up with the type of pain you might be feeling,

pain scale, scenario of how it happened

– Understand what palpations will hurt and what motions you will not be able to do or will be painful.

• Your partner will fill in a SOAP note – Ask history questions

– Palpate ligaments

– Determine injury and grade of sprain

– Then switch with your partner

– Show instructor completed SOAP note when finished

– Cloth wrap/horseshoe practice when finished

Sports Med 2

The foot is critical in walking, running, jumping and changing direction

1) Shock absorber2) Lever that propels the body forward, backward

or to the side

Foot management is key for the athletic population

Label review

Arches support the body weight, shock absorb during weight bearing.

Write the bones that it supports

Write the bones that it supports

Please look these up in your own books.

Mortons Toe 2nd meta fx p 227

Plantar fasciitis p 226

Jones fracture p 226

Bunion p 229

A. Generally caused by sudden lateral or medial twist

B. Most common – Inversion (w/Plantar flexion)1. More bony stability on the lateral side

2. Tight heel cord

3. Graded by the ligaments involvedC. Eversion etiology:

A. Pronated, hypermobile or depressed arched

B. Represents about 10% of ankle sprains

C. More serious than lateral ankle sprains

MOI: Foot inversion, PF, with mild stretching of the ATF

S/S:- Mild pain and disability- Weight bearing is not impaired- Mild point tenderness- Mild/slight swelling over ligament- No joint laxity (looseness)TX:- PRICE- Progressive Resistance Exercises (PRE’s)

MOI:- Moderate force in inversion, PF - Complete tear of the ATF and stretch of the CFS/S:- c/o pop or snap- Moderate pain and disability- Weight bearing is difficult- Tenderness and edema w/blood in the joint- Ecchymosis- + talar tilt, + anterior drawer testsTX:- PRICE- x-ray, crutches- PF and DF exercises- ROM, PRE’s

MOI:- Severe force in inversion, PF - Involving ATF, CF and PTFS/S:- c/o pain in region of lateral malleolus- Swelling is diffused along w/ discoloration- No possible weight bearing- Major loss of function (LOF)- Severe swelling- + talar tilt, + anterior drawer testsTX:- PRICE- Crutches, refer for x-ray- ROM, PRE’s

Anterior Drawer Test

Procedure: stabilize the distal leg with one hand & grasps the patient's calcaneus and rear foot with other hand. Move the foot anteriorly.

Positive Test: laxity and pain indicates ATF ligament sprain

Talar (Calcaneal) tilt test

Procedure: Grasp the distal fibula and tibia. Grasp the calcaneus and move into inversion.

Positive Test: gapping or laxity, and pn = sprain of CF ligament

MOI:- Eversion, DF- Avulsion fx of the medial malleolus in 15% of casesS/S: - c/o pain over the foot and lower leg- Unable to bear weight on the foot- Ab/adduction causes painTX:- x-ray to rule out fx.- PRICE- NSAIDS- PRE’s for posteromedial ankle muscle and for arch,

could lead to pronation of the foot.

External rotation test (kleigers)

Procedure: Grasp the distal tibia and fibula. Grasp the distal end of the foot and externally rotate (eversion)

Positive Test: Pain and laxity indicates deltoid ligament sprain.

Bump Test

Procedure: The athlete should be sitting with their foot off the table. Bump the calcaneus with the heel of your hand.

Positive Test: Pain at the injury site is indicative of fracture

Relatively common in footballMOI:- Forceful external rotation of the ankle

- While lying on the field w/ ankle externally rotated, someone falls on the back of the leg and foot, forcing ER

- Lateral blow to knee/leg with foot planted, forcing ER

- External force can rupture ant. Tibiofibular lig., posterior tibiofibular lig., or fracture the posterior tibial tubercle.

S/S:- c/o severe pain, loss of function- When ankle is passively externally rotated,

major pain in lower leg- Pain along the antero-lateral leg

TX:- Out of competition- PRICE - NSAIDS- X-ray can reveal fracture or widening of the

ankle mortise

Squeeze Test

Procedure: compress the tibia and fibula together at mid-shaft.

Positive Test: pain indicates injury to the syndesmosis or fxat the site of pain

Weekend warrior injury quick acceleration/jumping-type sports MOI

forceful PF of foot while the knee is extended Unexpected rapid DF of the foot, stepping in a hole, stepping on a

curb violent dorsiflexion when jumping from a height and landing on a

plantar flexed foot S/S

report feeling a kick in the calf and severe sharp pn loud pop or snap sound and swelling. Limping, cant plantarflex

TX Immobilize PRICE, crutches Refer

ThompsonsTest

Procedure: Athlete is lying prone with feet hanging off the table. Examiner squeezes the gastrocnemius muscle belly.

Positive Test: No plantarflexion indicates Achilles tendon rupture.

Deep Vein Thrombosis (DVT) test

Procedure: athlete is supine with knee in extension. Examiner passively dorsiflexes the foot and squeezes the gastrocnemius.

Positive Test: Pain in the gastrocnemius indicates a DVT.

Please look up these injuries of foot and ankle on your own:

Severs Disease (apophysitis) p. 225

Achilles Tendinitis/Tendinosis p. 248

Medial tibial Stress Syndrome p. 246

Compartment Syndrome p. 248

Sports med 2

Phase 1 (immediate protocol) ABC’s

Upper and lower case

Towel scrunches Foam pick ups

Uses intrinsic muscles/tendons of foot

Balancing (floor) 3 x 30 sec

Calf stretch On incline board, 3 x 1 min

Passive ROM BAPS board

ICE 20 min. on 40 min off 72 hours minimum

Compression wrap w/horseshoe Crutches if limping

Phase 2 (harder than phase 1) ABC’s

Towel scrunches

Balancing (tramp or foam pad) Eyes open and closed

Calf stretch

Resisted ROM/bands

Calf raises Increase sets and reps, single leg?

ICE 20 min.

Compression wrap w/horseshoe

Bike

Phase 3 (increase sets/intensity/time)

ABC’s

Balancing (tramp) 1 leg, catch ball

Calf stretch

Resisted ROM/bands

Calf raises single leg

Functional activities

ICE 20 min.

Compression wrap w/horseshoe if swelling

Tape for limited practice

Release

Full Strength

Sport specific Testing

Pass Functional testing

Full ROM

Support usually required

tape

brace

Functional Testing examples Walks on toes, test plantar flexion

Walk on heels, test dorsiflexion

Walks on lateral border of feet, test inversion

Walks on medial border of feet, tests eversion

Hop on both feet 10 times

Run forward 70 -100%

Run backwards 70-100%

Zig zags down and back

Figure 8’s

Sports specific

10 sites of Palpation(memorize in order)

1. Squeeze the midshaft of calf2. Medial maleolus3. Lateral maleolus4. Base of the 5th metatarsal5. Calcaneous6. Achilles tendon7. Deltoid Ligament8. Syndesmosis (interosseous membrane)9. Posterior talofibular10. Anterior talofibular