ankle ch review

• PNF patterns for ankle

  • D1 flexion: dorsiflexion
  • D1 Extension: plantarflexion
  • D2 flexion: dorsiflexion
  • D2 Extension: plantarflexion
• healing time for ligaments:

  3 months
• achilles tendon

  • no plantar flexion
  • no active walking
  • casted for 6-8 weeks recovery
  • can walk in boot, bc boot is doing natural walk of the foot
• DON'T MAKE IT DO ITS JOB, FUNCTION & HEALING TIMES = IMPORTANT
• foot has 3 main parts

  • hindfoot (talus & calcaneus)
  • midfoot (navicular, cuboid, 3 cuneiforms)
  • forefoot (14 bones of foot, metatarsals,)
  • Great toe (most significant bone of forefoot)
  • tendons & mms work together to control balance, propel gait, & stiffen food in response to external forces
• • Plantar flexion: downward
  • dorsiflexion: upward
  • inversion: medially
  • eversion: laterally
• talocrural joint

  • btwn talus & distal tibia
  • saddle-shaped talus = keystone of ankle bc distributes BW backward toward heel & forward to midfoot
• MM compartments of the lower leg

  • ANTERIOR: tib artery & vein, deep fibular N, Extensor hallucis, extensor digitorum longus, tibialis anterior
  • LATERAL: superficial fibular N, fibularis longus & brevis
  • SUPERFICIAL POSTERIOR: solus mm, tendons of plantaris & gastroc
  • DEEP POSTERIOR: flexor digitorum, tibialis post, tib N, flexor hallucis longus, fibular & posterior tib artery & vein
• strength of ankle ligaments weakest to strongest

  • ATFL, CFL, PTFL, and deltoid complex
• lateral ankle (inversion) sprain

  • least elastic of lat ligs.
  • risk factors: BMI, ROM, MM strength, Postural stability, proprioception
  • grade 1 sprain: min to no swelling, tenderness over ATFL, 2 week recovery
  • grade 2 sprain: localized swelling, lat tenderness. 2-6 week recovery
  • grade 3 sprain: significant swelling, pain, ecchymosis & referred to specialist. more than 6 week recovery
  • INTERVENTION: time required to return to full function = increase as severity of injury increases. Max dorsiflexion places jt in close packed position
• medial ankle (eversion) sprain

  • deltoid ligament complex, form a broad, strong, thick ligamentous structure
  • INTERVENTION: recovery can take as long. for all recurrent ankle sprains 2-3 months. Lateral heel wedge, fibularis mm strengthening, short leg brace
• turf toe

  • sprain of first MTP jt.
  • result in hypermobility of the first ray, can lead to biomechanical problems
  • Grade 1 sprain: little pain, swelling, or disability
  • grade 2 sprain: partial tear with mod pain, swelling, ecchymosis & disability
  • grade 3 sprain: complete tear of plantar plate with severe swelling, pain, inability to bear weight normally
  • INTERVENTION: rest, ice, compressive dressing, & elevation
• Claw toe

  • results from altered anatomy or neurological deficit, resulting in an imbalance btwn intrinsic & extrinsic musculature of the toes
  • INTERVENTION: avoid wearing high heeled or narrow toed shoes, cushioning sleeves with silicon linings can relieve pressure points at PIP jt & tip of toe.
• hammer toe

  • comprises flexion deformity of PIP jt of the toe, with hyperextension, of MTP & DIP jts
• fibularis (peroneal) tendon tendinopathy

  • repeated inversion strain, sheaths of fibularis longus & brevis tendons may be stretched & inflamed.
  • instability btwn 4th & 5th metatarsals
  • INTERVENTION: stretching, strengthening, icing, sometimes ankle bracing
• achilles tendiopathy

  • based on pts history & findings of physical exam
  • symptoms: pain & swelling in achilles tendon
  • INTERVENTION: 12 week eccentric program.
• plantar heel pain

  • pain arising from insertion of plantar fascia with or without heel spur
  • factors: obesity, prolonged standing/walking, acute injury to heel, loss of elasticity of heel pad, biomechanics, shortening of calf mms & achilles tendon, type of shoewear
  • history of pain & tenderness on plantar medial aspect of heel
  • heel pain decreases during day, worsens with increased activity
  • INTERVENTION: rest, shoes with good shock absorption, strengthening exercises (marble pick up, towel curls)
• tarsal tunnel syndrome

  • entrapment neuropathy of tibial N, passes through tunnel btwn flexor retinaculum & medial malleolus
  • orthotics to correct biomechanical gait abnormalities
• acute compartment syndrome

  • pain associated with sudden compression of nerves, blood vessels, mm inside closed space
  • CAUSES: tib fractures, hemorrhage, casts, prolonged limb compression, crush injuries,
  • (Pain, Paralysis, Paresthesia, Pallor, Pulses)
• stress fractures

  break that develops in bone after cyclical, submaximal loading.

  extrinsic factors: result of leg & foot running on hard surfaces, improper running shoes, sudden increases in jogging/running distance.

  Intrinsic factors: malalignment of L.E., excessive pronation