Chapter 19: The Ankle and Lower Leg

Functional Anatomy

Ankle is a stable hinge joint

Medial and lateral displacement is prevented by the malleoli

Ligament arrangement limits inversion and eversion at the subtalar joint

Square shape of talus adds to stability of the ankle

Most stable during dorsiflexion, least stable in plantar flexion

Degrees of motion for the ankle range from 10 degrees of dorsiflexion to 50 degrees of plantar flexion

Achilles Tendon Stretching

A tight heel cord may limit dorsiflexion and may predispose athlete to ankle injury

Static and dynamic joint stability is critical in preventing injury

While maintaining normal ROM, muscles and tendons surrounding joint must be kept strong

Neuromuscular Control Training

However, improperly applied tape can disrupt normal biomechanical function and cause injury

Lace-up braces have even been found to be superior to taping relative to prevention

Assessing the Lower Leg and Ankle

Observations

Special Test - Lower Leg

Percussion and compression tests

Thompson test

Squeeze calf muscle, while foot is extended off table to test the integrity of the Achilles tendon

Positive tests results in no movement in the foot

Homanπs test

Ankle Stability Tests

Anterior drawer test

Talar tilt test

Kleigerπs test

Functional Tests

Ankle Injuries: Sprains

Single most common injury in athletics caused by sudden inversion or eversion moments

Inversion Sprains

Severity of sprains is graded (1-3)

Grade 1 Inversion Ankle Sprain

Grade 2 Inversion Ankle Sprain

Ankle Edema

Grade 3 Inversion Ankle Sprain

Syndesmotic Sprain: High Ankle Sprain

Ankle Fractures/Dislocations

Osteochondritis Dissecans

Acute Achilles Strain

Achilles Tendinitis

Achilles Tendon Rupture

Torn Achilles Tendon

Peroneal Tendon Subluxation/Dislocation

Peroneal Subluxation (continued)

Anterior Tibialis Tendinitis

Posterior Tibial Tendinitis

Peroneal Tendinitis

Shin Contusion

Muscle Contusions

Leg Cramps and Spasms

Gastrocnemius Strain

Shin Fracture while running

Acute Leg Fractures

Medial Tibial Stress Syndrome (Shin Splints)

Shin Splints (continued)

Signs and Symptoms

Four grades of pain

Pain after activity

Pain before and after activity and not affecting performance

Pain before, during and after activity, affecting performance

Pain so severe, performance is impossible

Stress Fracture of Tibia or Fibula

Strengthening

Taping and Bracing

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