Ankle joint Flashcards
What is the ankle joint
Between Tibia , fibula and Talus
Medial malleolus of Tibia & lateral one of fibula either side of Talus.
0 medial wall - medial mallelous
0 inferior surface- inferior surface of Tibia
Synovial hinge joint
Involved in Dorsi and plantarflexion
(plantarlexion - if you want to squash plant you press down - increase angle.
(* Dorsiflexion will be the opposite )
Ligaments of the Ankle joint ?
LATERAL LIGAMENTS
0 Anterior (most commonly sprained) and posterior talofibular ligaments - connect talus and fibula
0 Calceneofibular ligament- connects fibula to calceneous
MEDIAL LIGAMENTS
Medial (deltoid ) ligaments - triangular in shape (make a triangle shape)
Made up of 4 ligaments - top end of complex attach to medial malleolus - bottom end attach to navicular , calcaneus and medial malleolus.
1. 2/ 4 ligaments attach the Tibia to talus - Anterior & Posterior tibiatalar parts
2. Tibionavicular part - btw tibia & navicular.
3. Tibiocalcaneal part - connetcts Tibia & calcenous
BTW TIBIA AND FIBULAR
anterior tibiofibular* Ligaments - btw tibia and fibula)
Posterior tibiofibular
Transverse tibiofibular
Most common mechanisms of ankle injury ?
Inversion & eversion can cause ankle fractures.
Inversion ( foot moves inwards ) - 80% - damage will be on lateral side (where most tension is during inversion)
Eversion ( foot moves outwards ) - 20 %
What is a bimalleolar fracture ?
Fracture involves both lateral and medial malleolar.
Inversion ( foot moves inwards ) - 80% - damage will be on lateral side (where most tension is during inversion)
* lateral ligaments are less strong and smaller than medial so more likely to suffer injury - not strong enough to oppose excessive inversion movement,
Inversion - push off fracture - talus pushed against lateral malleolus and caused oblique / vertical fracture .
Eversion ( foot moves inwards ) - 20% - damage will be on medial side (where most tension is during eversion)
Eversion - pull off - horizontal fracture - medial mallelos pulled off talus as ligament pulls off causinf fracture.
What are the Ottawa ankle rules ?
Rules to make a clinical decison on whether a person with ankle & midfoot injuries need radiographic imaging e.g x- ray etc.
0 point tenderness at posterior edge (of distal 6 cm of fibula) or tip lateral malleolus
0 point tenderness at posterior edge (of distal 6 cm of tibia) or tip medial malleolus
0 inability to weight bear (four steps) immediately after the injury and in emergency departmen (if they can transfer weight 4 times from foot to foot )
0 point tenderness at the base of the fifth metatarsal
0 point tenderness at the navicular
0 inability to weight bear (four steps) immediately after the injury and in emergency department
injury within last 10 days
alert and cooperative
be cautious if patient under 18.
different parts of foot :
0 Malleolar zone
0 Midfoot zone - navicular - 5th metatarsal
Common Eversion ankle injuries?
Most common - blow to the lateral aspect of ankle when foot planted - cause eversion foot
Possible consquences
0 * Strong medial deltoid ligaments avulse medial malleolus rather than tearing .
Avulse - forced dettachment.
0 Fractured fibula ( superior to anterior talofibular L ) due everted calcaneous impact on inferior aspect of fibula.
0 sheared lateral malleolus ?
What are the 3 arches of the foot ?
Importance
0 Anterior Transverse Arch
0 Lateral Longitudinal Arch
0Medial Longitudinal Arch
-
What are the 3 arches of the foot ?
Importance
0 Anterior Transverse Arch
0 Lateral Longitudinal Arch
0Medial Longitudinal Arch
- distribute weight from talus back to calcenous forward to metatarsals.
also adapts foot shape to rough terrain & walking , jumping etc.
acts as elastic shock absorber.
Ligaments on the plantar surface of foot ?
Plantar calcneonavicular Ligament - btw calcaneous & navicular (Spring ligament ) - ligament most likey to affected in those affected by flat feet.
What is Flat foot ?
Fallen arches - no arches of the foot.
not usally a problem
occurs in children - usally disappears within 2 -3 yeards when tendons tighten.
- flat foot deformity - foot & ankle subjected to constant load bearing during walking and standing.
What is the Tarsal Tunnel ?
Channel btw Talus , Tibia and calcaneous.
Tendons of deep posterior compartent pass through.
Structures that pass through :
0 Tendons of deep posterior compartent of leg
Flexor Digatorium Longus
Flexor Hallicus Longus
Tibalis Posterior
0 Posterior tibial artery
0 Tibial nerve.
- Odema , space occupying lesions/cysts and scarring can cause compression of the tibial nerve in this tunnel, resulting in pain or numbness radiating up the leg or along the foot.
What is Aponeurosis and Plantar fascitis ?
Aponeurosis - A type of connective tissue for muscles to attach to a bone or cartilage. (all over body )
Plantar Fasciitis -inflammation & thickening of the aponeurosis on the plantar surface of the foot. ( becomes IRRITATED & INFLAMED )
* usually feel pain the heal or arch of bottom of foot.
most common form of pain at the bottom of the heel.
NICE defintion - persistent pain associated with degeneration of the plantar fascia as a result of repetitive microtears in the contracted fascia.
Common characteristic
0 intense pain during first steps walking or after period of inactivity.
0 Pain reduction with moderate activity , worsens with long periods of walking , standing etc.
SIGNS
0 Tenderness on palpation of the plantar heel area (particularly, but not always, localized around the medial calcaneal tuberosity).
0 Limited ankle dorsiflexion range (with the knee in extension).
0 Positive ‘Windlass test’ (reproduction of pain by extension of the first metatarsophalangeal joint).
0 Tightness of the Achilles tendon.
0 An antalgic gait (abnormal walking to avoid pain) or limping.
Mangement of Plantar fasculitis ?
usually solves within a year
0 advise on conservative measure to aid healing - foot resting . supportive shoes , no barefoot walking , weight loss if obese etc.
0 Symptom relief - pain relief , ice pack
0 Severe - refer to podiatrist or physiotherapy
0 consider short term relif with corticosteriod injection, - guided with ultasound. - if signifcant impact on life.
- injection is painful and pain can last for days after.
- if symptom relief achieved but comes back - give another injection 6 months apart from first.
0 consider surgery if not going away after treatment by podiatrist or physi0therpay.
