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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. - PowerPoint PPT Presentation
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Ankle and Leg Injuries
ROP SPORTS MEDICINEStacy 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
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 inflammationor– 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.