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Comprehensive Lower Body Evaluation for Ankle and Leg Issues

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Explore bony, ligamentous, and muscular anatomy of lower limbs. Learn about ankle articulations, motions, compartments, sprains, fractures, and common pathologies such as Achilles tendon issues and stress fractures.

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Comprehensive Lower Body Evaluation for Ankle and Leg Issues

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  1. ATC 328 Lower Body Evaluation The Ankle and Leg Chapter 5

  2. Bony Anatomy • Tibia • Periosteum • Interosseous membrane • Fibula • Weight bearing??? • Distal 1/3 thinner

  3. Bony Anatomy • Talus • Anterior 1/3 wider • Steda’s process • Calcaneus • Calcaneal tubercle

  4. Ligamentous Anatomy • Anterior Talofibular Ligament (ATF) • Posterior Talofibular Ligament (PTF) • Calcaneofibular Ligament (CF) • Deltoid Ligament • Anterior Inferior Tibiofibular Ligament (AITF) • Interosseous membrane

  5. Articulations • Closed-packed position • Open-packed position • Syndesmosis

  6. Articulations Talocrual joint = (mortise and tenon) 1 degree of freedom of movement Dorsiflexion/plantarflexion Subtalar joint 1 degree of freedom of movement Inversion/eversion Distal tibiofibular Proximal tibiofibular

  7. Motions • Functional motion = multiplanar • Supination = PF, INV, ADD • Pronation = DF, EVER, ABD

  8. Muscular Anatomy • Triceps Surae • Gastrocnemius and soleus • Plantaris • Peroneal group • Posterior tibialis • Anterior tibialis • EHL, EDL • FDL, FHL

  9. Leg Compartments • Anterior • TA, EDL, EHL, PT, deep peroneal nerve • Lateral • PL, PB, superficial peroneal nerve • Superficial posterior • Triceps surae, plantaris, tibial nerve • Deep posterior • Tibialis posterior, FDL, FHL

  10. Bursae • Superficial calcaneal bursa • Deep retrocalcaneal bursa

  11. Range of Motion • 10 degrees DF for normal walk, 15 run • PF/DF = 20 degrees and 50 degrees • Inv/Ever = 20 degrees and 5 degrees

  12. Lateral Ankle Sprain

  13. Lateral Ankle Sprain • Etiology • Tension laterally, compression medially • S/S • Testing • Anterior drawer • Talar tilt • Complications

  14. Syndesmosis Sprains • Etiology • S/S • Testing • Kleiger’s test • Passive DF • Tibiofibular compression test • Maisonneuve fracture = proximal 1/3 of tibia

  15. Medial Ankle Sprain • Etiology • S/S • Testing • Talar tilt • External rotation • Complications

  16. Stress Fractures Signs and Symptoms Common sites Predisposing factors

  17. Os Trigonum Injury • Steida’s process – develops at age 8-13 • Fracture of Steida’s process • Acute, stress, or developmental non-union • Common with dancers, kickers, repetitive PF

  18. Os Trigonum Injury • S/S • Pain in posterior calcaneus • Swelling • Pain with PF

  19. Achilles Tendonitis • Limited blood supply to tendon • Common causes • Typical signs and symptoms

  20. Achilles Tendon Rupture • Males 30+ • Common etiology • PF MMT greater than 0/5 • Positive Thompson test

  21. Subluxating Peroneal Tendons • Causes • DF and Ever • PF and Inv • Biomechanical and structural abnormalities • Rupture of retinaculum • S/S • Audible and visible subluxation

  22. Anterior Compartment Syndrome • Traumatic or exertional • S/S • Pain • Paresthesia • Weakness • Decreased pulse/cap. Refill

  23. Deep Vein Thrombophlebitis • Common in post-surgery • S/S • Leg pain • Vascular changes • Positive Homan’s sign

  24. Acute Ankle Dislocations • OUCH!!!

  25. Acute Leg Fractures • Common sites

  26. Sever’s Syndrome • Etiology • S/S

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