Lower Leg

Question 1

What are the muscles responsible for dorsiflexion?

Answer 1

anterior tibialis, extensor digitorum longus, extensor hallucis longus, peroneus tertius

Question 2

What are the muscles used for plantar flexion?

Answer 2

gastrocnemius, soleus, peroneus longus/brevis, flexor digitorum longus, flexor hallucis longus, plantaris

Question 3

What muscles are used for inversion?

Answer 3

tibialis anterior/posterior, extensor hallucis longus, extensor digitorum longus, flexor hallucis longus

Question 4

what muscles are used for eversion?

Answer 4

peroneus longus, peroneus brevis, peroneus tertius, extensor digitorum longus.

Question 5

What muscles make up the anterior compartment of the lower leg?

Answer 5

tibialis anterior, peroneus tertius, extensor digitorum longus, extensor hallicus

Question 6

What muscles makes up the lateral compartment of the lower leg?

Answer 6

peroneus longus and brevis.

Question 7

What muscles make up the superficial posterior compartment of the lower leg?

Answer 7

gastrocnemius, soleus, plantaris

Question 8

What muscles make up the deep posterior lower leg compartment?

Answer 8

flexor digitorum longus, flexor hallucis longus, tibialis posterior.

Question 9

What is the largest and strongest tendon in the body?

Answer 9

achilles

Question 10

how much force can the achilles withstand?

Answer 10

~1000lbs

Question 11

what is the etiology of an acute achilles strain?

Answer 11

common in sports, occurs alongside sprains or excessive dorsiflexion.
pain may be mild to severe.
severe injury is caused by partial/complete avulsion or rupture.

Question 12

Management of Achilles strain?

Answer 12

RICE
after hemorrhaging subsides elastic wrap should be applied
conservative treatment, achilles issues may become chronic
heel lift, stretching/strengthening asap.

Question 13

What is achilles tendinitis?

Answer 13

inflammatory condition involving tendon, sheath or paratenon.

• referred to as tenosynovitis
• causes fibrosis/scar tissue that restricts motion in sheath
• can lead to tendinosis

Question 14

What is achilles tendinosis?

Answer 14

does not present inflammation, area loses normal appearance, cell disorganization, scarring and degeneration present.

Question 15

Signs and symptoms of achilles tendinitis?

Answer 15

generalized pain, stiffness, localized proximal to calcaneal insertion.
warm and painful with palpation, thickening of tendon
limited strength
crepitus with plantar flexion/dorsiflexion.

Question 16

Management for achilles tendinitis/tendinosis:

Answer 16

slow healing
reduce stress on tendon, address structural faults
use anti-inflammatory modalities/medications
cross friction massage
slow progressive strengthening.

Question 17

Etiology of an achilles tendon rupture:

Answer 17

sudden stop and go; forceful plantar flexion w knee moving into full extension.
generally history of chronic inflammation

Question 18

signs and symptoms of achilles rupture:

Answer 18

sudden snap with immediate pain that subsides
point tenderness, swelling, discoloration, decreased ROM
obvious indentation
occurs 2-6cm proximal to calcaneal insertion.

Question 19

What is the special test for achilles rupture?

Answer 19

thompson test

Question 20

What is management for achilles rupture?

Answer 20

surgical repair for serious injuries; return to 75-80% function
non-operative consists of RICE, NSAIDs, analgesics, non weight bearing cast for 6 weeks, walking cast 2 weeks (75-90% normal function)
rehab -6 months ROM, Progressive Resistive Exercise (PRE), wearing 2cm heel lift in both shoes.

Question 21

What is the etiology, signs and symptoms and management of the gastrocnemius strain?

Answer 21

strain occurs near musculotendinous attachment caused by quick start/stop, jumping.
depending on grade: variable swelling, pain, muscle disability
may feel like being “hit with a stick”
edema, point tenderness and functional loss of strength
RICE, NSAIDs, analgesics. grade 1- gentle stretching, weight bearing as tolerated.

Question 22

where are acute leg fractures common?

Answer 22

fibula in primarily middle third

tibia primarily lower third.

Question 23

What is Medial tibial stress syndrome?

Answer 23

MTSS- also known as shin splints

Question 24

What is the etiology of MTSS?

Answer 24

pain in anterior shin
catch all for stress fracture, muscle strain, chronic anterior compartment syndrome.
10-15% all running injuries, 60% all leg pain in athletes.
Repetitive microtrauma
can be from weak muscles, improper footwear, training errors, varus foot, tight heel cord, hypermobile/pronated feet, forefoot supination.

Question 25

What are 4 grades of pain for MTSS?

Answer 25

1. pain after activity
2. pain before activity/after not affecting performance
3. pain before, during, after, affecting performance
4. pain so severe performance is impossible.

Question 26

Management for MTSS?

Answer 26

x-ray/ bone scan
activity modification
correction of abnormal biomechanics
ice massage
flexibility program for gastroc-soleus complex
arch taping/orthotics.

Question 27

What bony landmarks do you palpate during a lower leg assessment?

Answer 27

tibia, fibula, medial and lateral malleolus

Question 28

What muscles and tendons do you palpate during lower leg assessment?

Answer 28

gastrocnemius, achilles tendon, peroneals, tibialis anterior.