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Sports Medicine II. And the Lower Leg. Mrs. Marr. Foot. TIBIA. FIBULA. TALUS. CALCANEUS. THE 4 BONES OF THE ANKLE JOINT. ANKLE LIGAMENTS – MEDIAL. Deltoid Ligament Complex 4 ligaments Broad Flat Overlapping = STRONG!. D. A. C. B. ANKLE LIGAMENTS - LATERAL.

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mrs marr

Sports Medicine II

And the Lower Leg

Mrs. Marr

Foot

ankle ligaments medial
ANKLE LIGAMENTS – MEDIAL
  • Deltoid Ligament Complex
    • 4 ligaments
    • Broad
    • Flat
    • Overlapping
    • = STRONG!

D

A

C

B

ankle ligaments lateral
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
ankle muscles anterior side
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
ankle muscles lateral side
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

ankle muscles posterior
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
compartments of the leg
Compartments of the Leg
  • Anterior
  • Lateral (peroneal)
  • Deep posterior
  • Superficial posterior
anterior compartment musculature
Anterior Compartment Musculature
  • Tibialis anterior
  • Extensor digitorum longus
  • Extensor hallucis longus
  • Peroneus tertius
tibialis anterior
Tibialis Anterior
  • DF and inversion
  • O: lateral tibial condyle and shaft
  • I: medial/plantar 1st cuneiform and metatarsal
  • N: deep peroneal
extensor digitorum longus
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
extensor hallucis longus
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
peroneus tertius
Peroneus Tertius
  • Eversion of foot, assists in PF
  • O: distal 1/3 of anterior fibula
  • I: dorsal base of 5th metatarsal
  • N: deep peroneal
lateral compartment musculature
Lateral Compartment Musculature
  • Peroneus longus
  • Peroneus brevis
peroneus longus
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
peroneus brevis
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
superficial posterior compartment muscles
Superficial Posterior Compartment Muscles
  • Gastrocnemius
  • Soleus
  • Plantaris
gastrocnemius
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
soleus
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
plantaris
Plantaris
  • Ankle PF, assists knee flexion
  • O: distal supracondylar line of lateral femoral condyle, femoral popliteal surface
  • I: calcaneus via Achilles tendon
  • N: tibial
deep posterior compartment musculature
Deep Posterior Compartment Musculature
  • Flexor Hallucis Longus
  • Flexor Digitorum Longus
  • “Tom, Dick, AND Harry”
  • Tibialis posterior
tibialis posterior
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
flexor digitorum longus
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
flexor hallucis longus
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
slide26

Syndesmosis

Interosseous membrane (Syndesmosis) isn\'t a compartment but ligamentous sheathe that holds the tibia and the fibula together.

nerves and blood vessels
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.
neuroanatomy
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
deep branch of peroneal nerve
Deep Branch of Peroneal Nerve
  • Branches from common Peroneal nerve near fibular head
  • “Dives” into anterior compartment
superficial branch of peroneal nerve
Superficial Branch of Peroneal Nerve
  • Branches from common Peroneal nerve near fibular head
  • Stays superficial and lateral in lateral compartment
tibial nerve
Tibial Nerve
  • Runs in fascial sheath between deep and superficial posterior compartments
  • Provides innervation to both, but not “in” either
vascular anatomy
Vascular Anatomy
  • Anterior compartment
    • Anterior tibial artery
  • Lateral compartment
    • Peroneal artery
  • Deep posterior compartment
    • Posterior tibial artery
  • Superficial posterior compartment
    • Posterior tibial artery
anterior tibial artery
Anterior Tibial Artery
  • Traverses similar path to deep Peroneal nerve
  • Terminating as dorsal pedal artery
peroneal artery
Peroneal Artery
  • Branches off of posterior tibial artery
posterior tibial artery
Posterior Tibial Artery
  • Runs in fascial sheath between deep and superficial posterior compartments
  • Provides vascular supply to both, but not “in” either
special tests the squeeze test
Special TestsThe Squeeze Test
  • Squeeze test
    • check malleolus
    • Check tibia and fibula
    • May indicate FX
      • Feel for any abnormalities
      • Feeling for grinding or movement
special tests anterior drawer tilt
Special TestsAnterior Drawer/Tilt

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 tests functional tests
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

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