Ch 5- The Ankle and Lower leg
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| What forms the ankle mortise? | distal tibia, fibula, and talus
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| Where is the interosseous membrane lie? | off the length of the lateral tibial border and attaches to the length of the medial fibula
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| Where does the achilles tendon insert? | calcaneal tubercle
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| What type of joint is the talocrural joint? | synovial hinge joint
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| What is a synovial hinge joint? | A joint separated by a space filled with synovial fluid
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| What are the three ligaments that provide lateral support to the talocrural joint? | anterior talofibular (ATF), calcaneofibular (CF), posterior talofibular (PTF)
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| What four ligaments comprise the deltoid ligament? | anterior tibiotalar (ATT), tibiocalcaneal (TC), posterior tibiotalar (PTT) , and tibionavicular (TN)
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| What kind of support does the deltoid ligament provide? | medial support
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| What is a syndesmosis joint? | A relatively immobile joint in which two bones are bound together by ligaments
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| What 1 degree of freedom does the subtalar joint provide? | inversion and eversion
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| What are the four compartments of the lower leg? | anterior, lateral, superficial posterior, deep posterior
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| What muscles lie in the anterior compartment of the lower leg? | tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius
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| What action do the muscles of the anterior compartment contribute to? | dorsiflexion
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| What is the name of the pulse that can be found on the anterior aspect of the ankle? | dorsalis pedis
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| What muscles lie in the lateral compartment of the lower leg? | Peroneus longus and Peroneus brevis
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| What action do the muscles of the lateral compartment contribute to? | strong evertors of the foot and contribute to plantarflexion
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| What nerve does the lateral compartment contain? | superficial peroneal nerve
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| What muscles lie in the superficial posterior compartment of the lower leg? | gastroc, soleus, plantaris
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| What action do the muscles of the superficial posterior compartment contribute to? | plantarflexion
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| What muscle lies in the deep posterior compartment of the lower leg? | tibialis posterior
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| What action does the muscle of the deep posterior compartment of contribute to? | primary adductor of the forefoot while also assisting in plantarflexion and inversion
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| What are the two major bursae of the lower leg? | subtendinous calcaneal, subcutaneous calcaneal
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| Define proprioception. | The athlete's ability to sense the position of one or more joints
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| What structures should be inspected on the lateral side of the lower leg? | peroneal muscle group, distal one third of the fibula, lateral malleolus
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| What structures should be inspected on the anterior side of the lower leg? | appearance of the anterior lower leg, contour of the malleoli, talus, sinus tarsi
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| What structures should be inspected on the medial side of the lower leg? | medial malleolus, medial longitudinal arch
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| What structures should be inspected on the posterior side of the lower leg? | gastronemius-soleus complex, achilles tendon, bursae, calcaneus
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| What fibular structures should be palpated? | common peroneal nerve, peroneus longus and brevis, fibular shaft, anterior and posterior tibiofibular ligaments, interosseous membrane, superior peroneal retinaculum
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| What lateral ankle structures should be palpated? | lateral malleolus, calcaneofibular ligament, ATF, PTF, peroneal retinaculum, peroneal tubercle, cuboid, base of the fifth metatarsal, peroneus tertius
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| What anterior structures should be palpated? | anterior tibial shaft, tibialis anterior, extensor hallucis longus, extensor digitorum longus, dome of the talus, extensor retinacula, sinus tarsi
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| What medial structures should be palpated? | medial malleolus, deltoid ligament, sustentaculum tali, spring ligament, navicular and navicular tuberosity, tibialis posterior, flexor hallucis longus, flexor digitorum longus
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| What posterior structures should be palpated? | gastrocnemius-soleus complex, achilles tendon, subcutaneous calcaneal bursa, calcaneus, subtendinous calcaneal bursa
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| What is the range of active plantarflexion and dorsiflexion? | 70 degree range, 20 degrees of dorsiflexion and 50 degrees of plantar flexion
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| What is the range of active inversion and eversion? | 25 degrees of total range, 20 degrees of inversion and 5 degrees of eversion
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| Where should the fulcrum of the goniometer be placed to measure plantarflexion or dorsiflexion | centered on the lateral malleoulus
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| Where should the fulcrum of the goniometer be placed to measure inversion or eversion? | over the talocrural joint line, centered between the malleoli
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| What ligament does the anterior drawer test? | ATF
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| What ligament does the talar tilt test ? | CF ligament with inversion stress or deltoid ligament with eversion stress
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| What does a positive kleiger's test implicate? | Medial pain is indicative of trauma to the deltoid ligament. Pain the area of the anterolateral ankle should be considered syndesmosis pathology unless determined otherwise
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| What does a positive squeeze test implicate? | gross fracture or stress fracture of the fibula when pain is described along the fibluar shaft. syndesmosis sprain when pain is described at the distal tibiofibular joint
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| What are the pain characteristics of an inversion ankle sprain? | lateral aspect of the ankle around the area of the malleolus and sinus tarsi
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| What is the MOI of an inversion ankle sprain? | Inversion, plantarflexion, or talar rotation in any combination
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| What would you find on inspection of an inversion ankle sprain? | findings include swelling around the lateral joint capsule, which may spread to the dorsum of the foot and into the sinus tarsi. ecchymosis may be present around the lateral malleolus
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| What are the pain characteristics of a syndesmotic ankle sprain? | anterior portion of the distal tibiofibular ligaments
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| What is the MOI of a syndesmotic ankle sprain? | external rotation of the talus within the ankle mortise and/or dorsiflexion
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| What would you find on inspection of a syndesmotic ankle sprain? | swelling possibly present over the distal tibiofibular syndesmosis
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| What are the pain characteristics of an eversion ankle sprain? | medial border of the ankle and foot, radiating from the medial malleolus
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| What is the MOI of a eversion ankle sprain? | eversion and/or rotation
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| What would you find on inspection of a eversion ankle sprain? | swelling around the medial joint capsule
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| What are the pain characteristics of a lower leg stress fracture? | along the shaft of the tibia or fibula; localized during or after exercise; may be described as a localized "ache" while at rest
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| What is the MOI of a lower leg stress fracture? | no definitive origin of pain. the history possibly indicates a sudden increase in the duration, frequency, or intensity of exercise or a change in a playing surface or shoe wear
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| What would you find on inspection of a lower leg stress fracture? | normally unremarkable; however, localized swelling is possible in advance stages
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| What does a positive bump test implicate? | possible advanced stress fracture
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| What are the pain characteristics of os trigonum syndrome? | posterior aspect of the talus, anterior to the achilles tendon
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| What is the MOI of os trigonum syndrome? | Acute: forced hyperplantarflexion. Chronic or insidious: repetitive activity usually involving plantarflexion
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| What would you find on inspection of os trigonum syndrome? | swelling possibly observed anteromedial and anterolaterl to the achilles tendon.
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| What are the pain characteristics of an achilles tendinitis? | along the length of the achilles tendon
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| What is the MOI of an achilles tendinitis? | Overuse or secondary to acute trauma, such as a blow to the achilles tendon. improperly fitting shoe rubbing against the tendon may also activate the inflammatory response
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| What would you find on inspection of an achilles tendinitis? | Possible visible edema along the length of the tendon; the tendon on the involved leg may appear thicker than on the opposite leg
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| What are the pain characteristics of an achilles tendon rupture? | Achilles tendon and/or lower portion of the gastrocnemius, the patient often reports the sensation of being kicked
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| What is the MOI of an achilles tendon rupture? | Forceful plantarflexion with eccentric loading, usually the result of eccentric loading or plyometric contraction of the calf muscle
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| What would you find on inspection of an achilles tendon rupture? | A defect may be visible in the achilles tendon or at the musculotendinous junction, but rapid swelling may obscure this; discoloration may be present around the tendon. The patient is unable to bear weight on the involved extremity because of pain
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| What does a positive thompson's test indicate? | achilles tendon rupture
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| What are the pain characteristics of subluxating peroneal tendons? | Behind the lateral malleolus in the area of the superior peroneal retinaculum, across the lateral malleolus, length of the peroneal tendons, and, in some cases, at the site of the inferior peroneal retinaculum
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| What is the MOI of subluxating peroneal tendons? | forceful dorsiflexion and eversion or plantarflexion and inversion
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| What would you find on inspection of subluxating peroneal tendons? | swelling and ecchymosis may be isolated behind the lateral and inferior lateral malleolus
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| What are the pain characteristics of anterior compartment syndrome? | Numbness is possibly described in the dorsum of the foot, especially in the web space between the first and second toes. anterolateral portion of the lower leg, which is described as "achy", "sharp", or "dull". other complaints such as muscle tightness,
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| What is the MOI of anterior compartment syndrome? | Traumatic: direct blow to the anterolateral tibia. Exertional: symptoms reported during or after running or other prolonged activity
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| What would you find on inspection of anterior compartment syndrome? | The anterolateral compartment may appear shiny and swollen. In advanced cases, possible discoloration of the dorsum of the foot may be present.
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| What does a positive homan's sign implicate? | possible deep vein thrombophlebitis, this should be in agreement with other clinical findings of pain with deep palpation, swelling, heat, and dysfunction. ultrasonic imaging is used to make a definitive diagnosis of deep vein thrombosis
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