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ATC 328 Lower Body Evaluation. The Ankle and Leg Chapter 5. Bony Anatomy. Tibia Periosteum Interosseous membrane Fibula Weight bearing??? Distal 1/3 thinner. Bony Anatomy. Talus Anterior 1/3 wider Steda’s process Calcaneus Calcaneal tubercle. Ligamentous Anatomy.

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atc 328 lower body evaluation

ATC 328 Lower Body Evaluation

The Ankle and Leg

Chapter 5

bony anatomy
Bony Anatomy
  • Tibia
    • Periosteum
    • Interosseous membrane
  • Fibula
    • Weight bearing???
    • Distal 1/3 thinner
bony anatomy3
Bony Anatomy
  • Talus
    • Anterior 1/3 wider
    • Steda’s process
  • Calcaneus
    • Calcaneal tubercle
ligamentous anatomy
Ligamentous Anatomy
  • Anterior Talofibular Ligament (ATF)
  • Posterior Talofibular Ligament (PTF)
  • Calcaneofibular Ligament (CF)
  • Deltoid Ligament
  • Anterior Inferior Tibiofibular Ligament (AITF)
  • Interosseous membrane
articulations
Articulations
  • Closed-packed position
  • Open-packed position
  • Syndesmosis
articulations6

Articulations

Talocrual joint = (mortise and tenon)

1 degree of freedom of movement

Dorsiflexion/plantarflexion

Subtalar joint

1 degree of freedom of movement

Inversion/eversion

Distal tibiofibular

Proximal tibiofibular

motions
Motions
  • Functional motion = multiplanar
  • Supination = PF, INV, ADD
  • Pronation = DF, EVER, ABD
muscular anatomy
Muscular Anatomy
  • Triceps Surae
    • Gastrocnemius and soleus
  • Plantaris
  • Peroneal group
  • Posterior tibialis
  • Anterior tibialis
  • EHL, EDL
  • FDL, FHL
leg compartments
Leg Compartments
  • Anterior
    • TA, EDL, EHL, PT, deep peroneal nerve
  • Lateral
    • PL, PB, superficial peroneal nerve
  • Superficial posterior
    • Triceps surae, plantaris, tibial nerve
  • Deep posterior
    • Tibialis posterior, FDL, FHL
bursae
Bursae
  • Superficial calcaneal bursa
  • Deep retrocalcaneal bursa
range of motion
Range of Motion
  • 10 degrees DF for normal walk, 15 run
  • PF/DF = 20 degrees and 50 degrees
  • Inv/Ever = 20 degrees and 5 degrees
lateral ankle sprain13
Lateral Ankle Sprain
  • Etiology
    • Tension laterally, compression medially
  • S/S
  • Testing
    • Anterior drawer
    • Talar tilt
  • Complications
syndesmosis sprains
Syndesmosis Sprains
  • Etiology
  • S/S
  • Testing
    • Kleiger’s test
    • Passive DF
    • Tibiofibular compression test
  • Maisonneuve fracture = proximal 1/3 of tibia
medial ankle sprain
Medial Ankle Sprain
  • Etiology
  • S/S
  • Testing
    • Talar tilt
    • External rotation
  • Complications
stress fractures
Stress Fractures

Signs and Symptoms

Common sites

Predisposing

factors

os trigonum injury
Os Trigonum Injury
  • Steida’s process – develops at age 8-13
  • Fracture of Steida’s process
    • Acute, stress, or developmental non-union
  • Common with dancers, kickers, repetitive PF
os trigonum injury18
Os Trigonum Injury
  • S/S
    • Pain in posterior calcaneus
    • Swelling
    • Pain with PF
achilles tendonitis
Achilles Tendonitis
  • Limited blood supply to tendon
  • Common causes
  • Typical signs and symptoms
achilles tendon rupture
Achilles Tendon Rupture
  • Males 30+
  • Common etiology
  • PF MMT greater than 0/5
  • Positive Thompson test
subluxating peroneal tendons
Subluxating Peroneal Tendons
  • Causes
    • DF and Ever
    • PF and Inv
    • Biomechanical and structural abnormalities
    • Rupture of retinaculum
  • S/S
    • Audible and visible subluxation
anterior compartment syndrome
Anterior Compartment Syndrome
  • Traumatic or exertional
  • S/S
    • Pain
    • Paresthesia
    • Weakness
    • Decreased pulse/cap. Refill
deep vein thrombophlebitis
Deep Vein Thrombophlebitis
  • Common in post-surgery
  • S/S
    • Leg pain
    • Vascular changes
    • Positive Homan’s sign