Ankle Notes 1

walking an running require the foot to be what

pliable to absorb impact, conform to countless spatial configurations, rigid to transfer potentially large propulsive forces

what joint is the true ankle jonit

the talocrural joint

which side of the lower leg is longer and what does it do

the fibula on the lateral side is longer and is one of the primary preventors of eversion ankle sprains

the trochlear surface of the talus is surrounded by what

articular cartilage

t/f: the talus is larger anteriorly

true

t/f: the talus is convex ant-post and slightly concave med-lat

true

how does the head of the talus project

forward and slightly medial toward navicular

what does the talus articulate with the form the subtalar joint

calcaneus

is the talus concave or convex in order to fit into the talocrural mortise

convex

what structure on the calcaneus recieves the achilles tendon

calcaneal tuberosity

what surface of the calcaneus articulates with the cuboid forming what joint

anterior surface forms the calcaneocuboid joint

what do the superior facets of the calcaneus articulate with

inferior talus

what forms the sinus tarsi

the superior facets create a sulcus for ligamentous attachments that bind the subtalar joint

what structure on the calcaneus acts as a shelf for the talus

sustentaculum tali

what ligaments strengthen the proximal tibiofibular joint

anterior and posterior ligaments, tendon of the biceps femoris and popliteus

what structure does the common peroneal nerve wrap around

head of the fibula

the proximal tibiofibular joint is formed by

head of the fibula and post-lat aspect of the lateral tibial condyle

what distal tibiofibular joint is formed by what structures

medial surface of the distal fibula and fibular notch of the tibia

a syndesmosis has how much movement

no movement

what are the syndesmosis/interosseous ligaments of the distal tib-fib joint

anterior and posterior tibiofibular ligament

what do the anterior and posterior tibiofibular ligament do

stabilize the distal tibiofibular joint

what forms the talocrural joint

articulation between the done and sides of talus with the rectangular concavity formed by distal end of tibia and both malleoli

what does the mortise at the talocrural joint provide

stability

how much of the bodies compression forces pass through the talus and tibia

90 to 95%

what protects the intra-articular subchondral bone from damaging stress at the talocrural joint

articular cartilage

what is the anterior capsule of the ankle reinforced by

collateral ligaments

what is the function of mechanoreceptors within ligaments

enhance stability by detecting overall stretch in the region

what are the medial ligaments of the ankle

deltoid ligament

what are the superficial fibers of the deltoid ligament

tibionavicular, tibiospring, tibiocalcaneal, tibiotalar

what are the deep fibers of the deltoid ligament

anterior and posterior tibiotalar

where do the anterior and posterior tibiotalar fibers attach to

medial surface of the talus

if the navicular is hypermobile, what is a possible differential diagnosis

deltoid ligament sprain

what happens to the rearfoot when the tibial tuberosity rotates

the foot pronates putting the foot in rearfoot valgus

what is the primary function of the deltoid ligament

reinforce the medial side, protect against extreme eversion across the talocrural, subtalar, and talonavicular joints

why is injury to the deltoid ligaments not common

ligament is strong and the lateral malleolus serves as an anatomical bony block to eversionh

how can the deltoid ligament be damaged

weight bearing during tibial internal rotation

what two actions does the talocrural joint perform

plantar flexion and dorsiflexion

what ligaments are affected during plantarflexion and eversion

anterior ligaments

what ligaments are affected during dorsiflexion and eversion

posterior ligaments

what are the lateral ligaments of the ankle

anterior talofibular, posterior talofibular, and calcaneofibular

what motion causes injury to the lateral ligaments

primarily inversion

the anterior talofibular ligament is affected by what motions

inversions, horizontal plane adduction and plantarflexion

the calcaneofibular ligament is affected by what motions

inversion and dorsiflexion

the posterior talofibular ligament is effected by what motions

inversion, excessive abduction and in full dorsiflexion

the distal tibofibular syndesmosis is made up of what ligaments

anterior and posterior tibiofibular, crural interosseous, inferior transverse ligament, and interosseous membrane

what ligaments are damaged during a high ankle sprain

anterior and posterior tibiofibular

how many degrees of freedom does the talocrural joint have

1

dorsiflexion of the talocrural joint is associated with

abduction and eversion (pronation)

plantarflexion at the talocrural joint is associated with

adduction and inversion (supination)

what is neutral defined as at the talocrural joint

90 degrees to the leg

how much dorsiflexion does the talocrural joint allow

15 to 25 degrees

how much plantarflexion does the talocrural joint allow

40 to 55 degrees

what is the arthrokinematics of the talus-on-tib/fin dorsiflexion

roll superior slide posterior

what is the arthrokinematics of the talus-on-tib/fib plantarflexion

roll inferior slide anterior

what is the arthrokinematics of tib/fib-on-talus dorsiflexion

roll and slide anterior

what is the arthrokinematics on tib/fib-on-talus plantarflexion

roll and slide posterior

when twisting the calcaneus during NWB, the talus

stays stationary within the mortise

what are the three articulations of the subtalar joint

posterior, middle, and anterior facets of the calcaneus and talus forming the sinus tarsi

what motion of the CF ligament limit

excessive inversion

what motion do the tibiocalcaneal fibers of the deltoid ligament limit

excessive inversion

the interosseous (talocalcaneal) and cervical ligaments bind the talus with the calcaneus and limits what motions

extremes of all motions especially inversion

the AoR of the subtalar pierces

lateral to posterior heel and anterior, medial, and superior

what motions make up pronation at the subtalar joint

eversion and abduction

what motions make up supination at the subtalar joint

inversion and adduction

t/f: at the talocrural joint, supination and pronation are DF/PF, ABD/ADD, and EV/INV while at the subtalar joint, they are EV/INV and ADD/ABD only

true

what degree of inversion is permitted at the subtalar joint

22 degree

what degree of eversion is permitted at the subtalar joint

12\.5 degrees

what muscles are within the anterior compartment of the leg

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

what muscles are within the lateral compartment of the leg

fibularis longus, os peroneum, fibularis brevis, fibularis quartus

what muscles are within the superficial posterior compartment of the leeg

gastrocnemius, soleus, plantaris

what muscles are within the deep posterior compartment of the leg

tibialis posterior, flexor digitorum longus, flexor hallucis longus

what are the two bursa located around the achilles

subtendinous calcaneal bursa (retrocalcaneal bursa) and subcutaneous calcanal bursa

what is a synovium

a bursa flattened out and surrounding the tendon

what compartment does the deep peroneal nerve innervate

anterior

what compartment does the sural nerve innervate

lateral

what does the sural nerve innervate

posterior and lateral leg and lateral foot

what does the saphenous nerve innervate

skin on medial ankle and foot

what veins empty into the femoral vein

great and small saphenous veinsw

what moves blood toward the heart

musculare contraction

a lateral ankle sprain affects what possible ligaments

ATF, CF, PTF

a syndesmosis sprain effects what ligaments

ANT + POST tib-fib

a medial ankle sprain affects what ligaments

deltoid ligament

what special tests affect the lateral ankle

cotton test, anterior drawer, inversion talar tilt test

what special tests affect the medial ankle

eversion talar tilt, kleigers test

what special tests affect the syndesmosis

kleigers, squeeze test

achilles tendon pathology includes

tendinopathy, rupture, or sever’s disease

what is the MOI for achilles tendinopathy

could develop due to acute trauma, running mechanism, increased duration or intensity, changes in shoes, weak musculature, repetitive load

what is the MOI of the achilles rupture

sudden, forceful, eccentric contraction (stepping in a hole, explosive push off)

what are the two theories for achilles rupture

chronic degeneration (microtrauma) and failure of inhibitory mechanism, most rupture occur in avascular zone

what is sever’s disease

inflammation of apophysis (growth-plate) calcaneal apophysitis

t/f: peroneal dislocations can be classified into four groups

true

what is the first group of peroneal dislocation

superior peroneal retinaculum is torn from its fibular insertion

what is the second group of peroneal dislocation

superior retinaculum and fibrocartilaginous ridge are avulsed from the lateral fibula

what is the third group of peroneal dislocation

superior retinaculum is torn form the lateral fibula, the fibrocartilaginous ridge is avulsed, and flake fractures occur on lateral malleolus

what is the fourth group of peroneal dislocation

superior retinaculum is torn from its calcaneal insertion

medial tibial stress syndrome is due to

inflammation of the tibialis posterior periosteum

medial tibial stress syndrome can be caused by

repetitive use, training errors, training on a hard surface, increased load too quickly, incorrect shoe wear, muscle fatigue, biomechanical abnormalities

what is a maisoneuve fracture

fracture of the proximal fibula along with some form of a ligamentous injury

what is a hugier fracture

fracture of the distal fibula and fixed posterior dislocation

what are the ottowa ankle rules

if the patient is unable to work four steps immediately following the injury and at the time of examination, if pain is elicited during palpation of zone A or B, if pain is elicited during palpation of zone C or D