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a.n.k.l.e

This is the ankle page











These are all the bones in the foot.






Ligaments
The ligaments in the foot are named after the bones they connect.




Muscles of the Lower Leg



Muscle Motions

True Ankle Joint

Plantar flexion - toes down(Plantar means bottom, Flexion means movement)
Muscles Used= Soleus and the Gastroctnemius

Dorsi flexion - toes up(Dorsal meaning top)
Muscles Used= Anterior Tibialis, Extensor Halicus Longus, Extensor Digitorum Longus

SubTalar Joint

Eversion - toes to the lateral side
Muscles used= Peroneus Longus and the Peroneus Brevis
Inversion - toes to inside(medial plane) Muscles used= Posterior Tibialis, Flexor Halicus Longus, Flexor Digitorum Longus.



Flexion - Curling

Extension - Extending

Injuries/Conditions of the Lower Leg

1.Arches

A. Types 1. Longitudinal Arch
When you put weight on this arch, the long plantar ligament stretches, allowing the foot to become flat, absorbing shock.
a. pes planus-flat footed- no spring.
b. pes cavus-high, rigid arch- no spring
2. Metatarsal Arch


Your foot is like a tripod, there are three points of weight bearingness.

B. Sprains

1. Traumatic(all at once) arch sprain
could involve calcaneonavicular and calcaneo cuboid.
a. mechanism- how the injury happens
twisting or turning of the foot.
b. Signs and Symptoms (S+S)
Sign- evaluator can find this out themselves(vomit on the floor, blood)
Symptom- patient tells evaluator(pain/nausea)
Signs are objective/symptoms are subjective
Pain is not/rarely an indicator of injury severity
1)Pain
2)Swelling
3)Discoloration (Echymosis)
4)point tenderness
palpate- touch it
c. Treatment
1)R.I.C.E.
2)Support Arch
Padding/taping
3)Decrease Activity (weight bearing)
2-5 days (approximate)
Active Rest=Work without using injured bodypart
4)Gradual return to Activity.
2. Chronic(over a period of time) arch foot sprains
gradual onse over a period of time
a. Plantar Fascitis
1)Signs and Symptoms(S+S)
a) pain (especially in the morning
b) Pt. Tenderness
Plantar surface of calcaneus

2)Treatment
a) Doughnut Pad
b) anti-inflamatory
Over the Counter

IB profin
Asprin
Aleeve
c)Calf stretching -knee straight and bent
d)Active Rest
II. Big Toe Sprain (Turf Toe) or (Stubbed toe)
IP/MP Joint is affected
(any toe could be affected)

A. Mechanism -hyperflexion or extension
S+S
1)Pain
2)Swelling
3)Echymosis
4)Pt tenderness over Joint that's affected
5)"Pushing off" trouble

B. Treatment
1)R.I.C.E.
2)Taping
3)Wear firm soled shoe
4)Activity as tolorated
**Question**

-Is It Fractured??
Treatment for a fractured toe is the same as if it is sprained.

III. Fracture of the 5th Metatrasal
Fracture of the base of the 5th Metatarsal A.K.A. Jones Fracture
A. Mechanism - ankle inversion (foot twist)

B. S+S
1) Pain
2) Pt. Tenderness
3) Swelling
4) Confirmed by X-ray

C. Treatment
1) R.I.C.E
2) Dr. Referral
3) Immobilize
4) Active Rest
5) Possible Internal Fixation (screwed together)
6) When bone heals, (4-6 weeks) gradual return to actvity

IV. Ankle Sprain
A. Lateral Sprain (most common)
1. Mechanism
a. inversion
b. plantar flexion
When the foot is plantar flexed, it's less stable.
2. Ligaments Injured
a. Anterior Talofibular
b. Calcaneofibular
3. S+S
a. pain
b. swelling (lateral maleolus)
c. echymosis
d. pt tenderness distal to the lateral maleolus
e. laxity - looseness
only fond in 2 degree/3 degree sprains
1)Tests
A. Talar Tilt- this tests to see if the calcaneofibular ligament is sprained.

B. Anterior Drawer- this tests the Anterior Talofibular Ligament but only with 2/3 degree sprains

4. Treatment
a. R.I.C.E.
1. elastic wrap
2. horseshoe
b. Rule out fracture (Dr. Referral)
c. for 2-3 degree sprains, Immobilize
d. ROM Exercizes
e. Strength exercizes
f. Support (tape or brace)
g. Contrast Bath
this could begin as early as 2 days after injury
h. Active Rest (if needed)
i. Gradual Return to activity.

1 degree- 3-5days
2 degree- 2-3weeks
3 degree- 4-6weeks(or longer)

B. Medial Sprains
1. Mechanism
a. eversion
b. plantar flexion
2. Ligaments Injured-Deltoid
3. S+S (same as on Lateral Sprain)
4. Treatment (same as on Lateral Sprain)

**Rule out a fracture**

V. Shin Splints- garbage term used to describe any pain in the shin.
A. Anatomical Structures Involved
1. Inflamation of Interossious Membrane
2. Posterior Tibialis (where it attatches to tibia)
3. Periosteum- outer covering of bone(inflamed because of shock or stress)
4. Anterior Compartment
1)Extensor Hallicus/Digitorum Longus Anterior Tibialis.

B. Mechanism of Injury
1)Overuse

C. S+S
1. Pain-when it happens
2. Pt Tenderness - Anterior Medial Shin
No Swelling

No discoloration


D. Treatment
1. R.I.
2. Arch Support - less shock
3. Active Rest
4. Play as Able
5. Rule out Stress fracture
6. Anti-inflamatory

VI. Acute Anterior Compartment Syndrome
A. Direct Blow- not all make AACS maybe a contusion

B. S+S
1. Pain
2. Swelling
3. Pt. Tenderness
4. Numbness(Tingling)in foot
5. Drop Foot - unable to dorsi flex

C. Treatment
1. R.I.E. NO COMPRESSION!!!
2. Emergency referral
3. Possible Fasciotomy
4. Rest
5. Padding
6. Gradual Return to Activity

D. Prevention
-proper padding + care of original

VII. Achilles-Gastroc-Soleus-Strain
A. Achilles Tendonitis
1. Mechanism
-overuse

2. S+S
a. Pain
b. Pt Tenderness
c. Minor swelling(puffiness)

3. Treatment
a. R.I.
b. Calf Stretching
c. ice message
d. heel lifts
e. Active Rest
f. Anti-inflamatories
g. Gradual Return to play

B. Achilles Rupture
1. Usually found in Middle age people
2. Mechanism
-forced Dorsi Flexion

3. S+S
a. pain
b. "Felt a pop"
c. "Felt like someone shot the back of my leg"
d. Thompsons Test - against gravity plantar flex
4. Treatment
a. R.I.C.E.
b. immobilize it
c. Dr. Referral
d. Surgery
e. immobilize it
f. rehab
g. gradual return

C. Calf Strain (Musculo-tendonis-junction)
1. Mechanism- Forced Dorsi flexion
2. S+S
a. pain
b. swell
c. pt tender
d. wekness
3. Treatment
a. R.I.C.E.
b. stretch calf
c. active rest
d. anti-inflamatories
e. heel lift
f. taping
g. plantar flexion
h. gradual return

VIII. Fracture
A. Treatment
1. Immobilize
2. Dr. Referral
3. Cast



On to the Knee