ANKLE Flashcards
Motions
DF/PF
Inversion/Eversion
Tibia and Fibula bound together by
interossous membrane
Hind foot
talus and calcaneus
mid foot
navicular
cuboid
3 cuniforms
forefoot
5 metatarsals
14 phalanges
Distal tibiofibular Joint
CONVEX fibular head with CONCAVE fibular notch on TIBIA
fibrous joint
small amount of gliding occurs with ankle motions
**W/ full ankle DF there is gliding with this joint
Talcrural Joint-Ankle Mortise
Distal tibia, distal fibula and talus
Hinge Joint
DF/PF motion
Open/Closed pack of Talocural joint
Open: 10 degrees of PF
Closed=full DF
End feels: FIRM
Open and Closed Chain movement of Talocrural Joint
CONVEX talus on CONCAVE tibia/fibula
OPEN: Talus on Tib/Fib
PF: anterior
DF-posterior
CLOSED: Tib/Fib on Talus
DF:anteriorly
PF: Posteriorly
Deltoid ligament
Talocrural joint ligament
medial malleolus to navicular, talus and calcaneus
Mantains medial stability and prevents eversion injuries
Lateral ligaments of Talocrural joint
-Mantains lateral stabiliity, prevents inversion injuries
- anterior talofibular lig=from tibia to fibula
- ant. side
- lateral malleolus to ant. talus - posterior talofibular lig.= tibia to fibula
- post. side
- lateral malleolus to pos. talus
3.calcaneofibular lig.= from lateral malleolus to calcaneus
subtalar joint
supination/pronation=standing position= CK
eversion/inversion=open chain
- planar joint
- calcaneus articulates with Talus
- pronation/supination
- eversion/inversion
OPEN/CLOSED PACK
O: Neutral
C: Full Supination
**CONVEX calcaneus on CONCAVE talus
Transverse Tarsal Joint
Planar Joint
Between talus and: Navicular, calacneous and cuboid
Transverse Arch= Cuboid-> cuneiform 3-> cuneiform 2 -> cuneiform 1
Position:
Pronation/supination
P: transverse arch flattens
S: transverse arch raises
MTP JOINTS
condyloid joint
CONVEX distal metatarsal head on CONCAVE proximal portion of proximal phalanx
Flex/ext
Abd/add
IP PIP DIP joints
Hinge joint
Medial Longitudinal arch
longer and higher arch
RUNS FROM: medial metatarsals to: -cuneiforms -navicular - talus -calcaneus
Supported by spring lig., plantar aponeurosis and long/short plantar lig.
Lateral Longitudinal arch
Lateral Metatarsals to:
cuboid
calcaneus
Transverse longitudinal arch
cuboid to cunieform 3
to Cunieform 2—-which is HIGHEST
to cuneiform 1
Lateral to medial
supported by spring ligament
windlass effect
during heel off in gait::
MTPs extend
- increases tension on plantar aponeurosis
- helps increase the arch
- provides more rigid foot during push-off as foot Plantarflexes and supinates
Prontation
foot/heel ABDUCTED
Foot EVERSION
flexible foot to accommodate to ground surfaces during foot flat-> midstance
overpronation effect:
internally rotates leg with flexion
SHORTENS LIMB
-everything drops down and in
Supination
Foot/hee ADDUCTIONs
Foot INVERSION
rigid foot to develop force for push-off
Oversupination effect:
Externally rotates leg with extension
everything goes up and out
Gait: SWING PHASE
when foot is not in contact with the ground “swing through”
3 stages:
acceleration, midswing and deceleration-> opp. muscles are working to slow everything down
Gait: Stance phase
when foot is in contact with the ground
heel strike
when heel contacts the ground and foot is slowly lowered to the ground
eccentric control
foot flat
when entire foot is in contact with the ground
midstance
body passes over WB foot
heel off
heel raises off the ground
toe off
period just before and after toes leave the ground
DF muscles
anterior tibialis
extensor digitorum longus and brevis needed for pure DF
Gait Function:
-controls food as it lowers to the ground after heel strike–eccentric
-keeps foot from dragging during swing phase–concentric
Plantarflexor muscles
attach to calcaneus by way of achilles tendon
Gastrocnemeus-2 joint muscle
soleus-1 joint muscle
GAIT FUNCTION:
- Heel-off : raise heel before push off—concentric
- powerful concentric contraction for PUSH OFF-concentric
Evertors
evert the foot and support the arches
peroneus longus-EV//PF
Peoneus bevis-EV
Invertors
anterior tibialis
posterior tibialis-slows down foot so when we heel strike the foot doesnt roll into eversion
GAIT FUNCTION
heel strike to midstance
controls movement of foot into pronation-eccentric
Anterior Drawer sign
identifies tear in anterior talofibular ligament
pt. supine with leg relazed and ankle in 10-20 degrees plantarflexion
therapist stabilizes distal tib& fib and draws the talus anterior on the mortise
+= anterior translation is greater than univolved side
Talar tilt test
identifies tear in calcanofibular ligament
pt. supine w/ leg relazed and ankle in neutral
therapist tilts the talus medially while palpating the calcanofibular lig.
+= excessive inversion compared to uninvolved side
Thompson test
identifies rupture of achilles tendon
pt. prone with knee extended and feet over the edge of plinth
therapist squeezes the middle 1/3 of gastroc muscle belly
+= normal plantar flexion response is not elicited
Homan’s sign
identifies DVT
signes of DVT= calf swelling, erythema, warmth
therapist passively DF ankle while squeezing pts. calf
+= pt. c/o sudden increase in pain
Lateral ankle complex
anterior talofibular lig
calcaneal fibular lig
posterior talofibular lig
most common ankle sprain
Lateral ankle complex causes
inversion with PF-stepping off curb, stepping on another persons foot
medial malleolus is not able to stop inversion because it does not extend distally
Clinical signs of lateral ankle complex injury
tenderness over ligaments
swelling of lateral ankle/bruising
painful gait
weakness
tests for lateral ankle complex injury
anterior drawer
talar tilt
Phase 1 : inversion sprain rehab
Max protextion RICE modalities joint protextion-bracing AROM isometrics general fitness
Phase 2: inversion sprain rehab
Moderate Protection RICE PREs bands, weights joint protection achilles/calf stretching proprioception exercises general fitness/cycling avoid inversion/PF
**Need to reteach muscles how to properly fire in correct sequence
Phase 3: inversion rehab
minimal protection
joint protection during activities advanced proprioception exercsies functional progression running, jumping plyometrics
Medial Ankle Complex
Deltoid ligament injury
less common
CAUSE:
eversion with DF
**deltoid ligament can avulse-tearing off a piece of tibia due to the strength of tendon
distal fibula may fracture from eversion force
achilles tendonITIS
inflammation of tendon
CAUSE:
oceruse-increase in training/running
changes in running surfaces
decreased flexibility of gastrocnemius/soleus–>possibly hamstrings too
**acute and located where achilles inserts
Achilles tendinOSIS
fibrotic changes of tendon–>pain and issue more along muscle portion of achilles
CAUSES:
impairment of blood supply to tendon with resultant tendon degeneration
achilles tendon does not normally have good circulation
Clinical signs of achilles tendinopathy
pain with resisted PF
pain with stretch of gastrocnemues, soleus
tendon site tender to palpation
antalgic gait with poor heel rise/push-off
achilles tendon rupture
occurs as sudden DF injury
*often due to recreational sport
tear typically occurs 2 inches above instertion
most common in men from 20-50 y.o
clinical signs of achilles rupture
audible pop when rupture occurs
severe pain when rupture occurs
gait changes-no heel up or push off
TEST:
Thompson test
surgical management of achilles rupture
open surgical repair by non essential muscle-plantaris
s/p surgery ankle will be casted or put in boot
different MDs and procedures will determine exercise progression
cast will be in PF to keep plantarflexors on slack
slow return to DF and PF ROM
start with isometrics
Plantar fasciiitis
longitudinal arch flattens, pulling and inflaming on the plantar fascia
chronic inflammation of the plantar fascia/aponeurosis results
causes of plantar fasciitis
repetitive microtrauma to plantar fascia-jumping, running etc
can include heel spur obesity age-40-60 occupational-standing long periods of time poor arch support
clinical signs of plantar fasciitis
pain at heel
pain along longitudinal arch
antalgic gait: pain with push off pain with WB pain worse in morning, especially first few steps heel spur-point tenderness
Hallux Valgus and Bunion deformity
transverse arch has flattened
distal portion of metatarsals have moved away from each other
proximal phalanx of great tos is held in place by adductor hallucis
can be exacerbated by improper footware
surgical management: Bunionectomy=surgical relocation of phalanx with pin/screws
more common in women
Shin Splints
inflammation and micro damage to the periosteum of the tibia near origin of posterior or anterior tibialis muscle
caused by muscles trying to slow down the foot at heel strike*
Outside of leg pain= ant. tib
inside of leg pain= post. tib
Clinical signs of shin spints
pain along medial or lateral lower leg pain with acitivity/ running pain with resisted : DF= ant. tib Inversion=post. tib
Overprontation issue with shin splints
tight PF and weak Ant. tib
Stress fracture
overuse and unrelenting stress to tibia, fibula and metatarsals
usually due to running
*can be caused by shin splints
Pylon fracture
distal tibia compression fracture when forced into talus
usually fibula breaks too
CAUSES:
- auto accident
- fall from a height
- skiing accident
**Extensive surgical management
Malleolar fractures
Lateral Malleolar-distal fib fracture
medial malleolar-distal tib fracture
bimalleolar-both distal tib/fib fracture
trimalleolar-distal fib/tib and posterior margin of distal tibia fractured
protection phase rehab
follw MD protocol alter activity to protect motion braces/splinting/taping decrease stress on area with altering WB -AD if needed well joint mobility strength&flexibility pain free ROM multi-angle isometrics supportive modalities
Controlled motion phase rehab
CRITERIA
- decreased edema
- full pain-free WB
Maximize ROM Maximie strength-OKC,CKC resolve gait deviations maximize flexibility of entire chain balance return to functional acitiivities
Return to function phase
Criteria:
- full pain free ROM
- good strength&balance
- no gait deviations
Functional training
adapt return to function to prevent reinjury
If appropriate:
-plyometrics
speed drills
