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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


The 4 bones of the ankle joint

TIBIA

FIBULA

TALUS

CALCANEUS

THE 4 BONES OF THE ANKLE JOINT


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


    Mrs marr

    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.


    Anterior drawer test

    Anterior Drawer Test


    Tilt test

    Tilt Test


    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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