Module 05
Extensor Digitorum Longus (EDL) Origin and Insertion
Origin: Lateral Condyle of the tibia, proximal two-thirds of the medial surface of the fibula, and adjacent interosseous membrane Insertion: Splits into four tendons that attach to the proximal base of the dorsal surface of the middle distal phalanges
Fibularis Longus Origin and Insertion
Origin: Lateral Condyle of the tibia; head and proximal two-thirds of the lateral surface of the fibula Insertion: Lateral surface of the medial cuneiform and plantar base of the first metatarsal
Gastrocnemius Origin and Insertion
Origin: Medial Head - the posterior aspect of the medial femoral condyle Lateral Head - the posterior aspect of the lateral femoral condyle Insertion: Calcaneal tuberosity via the Achilles tendon
Flexor Digitorum Longus (FDL) Origin and Insertion
Origin: Posterior surface of the middle one-third of the tibia Insertion: By four separate tendons to the base of the distal phalanx of the four lesser toes
Anterior Tibialis Origin and Insertion
Origin: Proximal two-thirds of the lateral surface of the tibia and the interosseous membrane Insertion: Medial plantar aspects of the medial cuneiform and the base of the first metatarsal
Posterior Tibialis Origin and Insertion
Origin: Proximal two-thirds of the posterior aspect of the tibia, fibula, and interosseous membrane Insertion: Multiple attachments to every tarsal bone except the talus; also attaches to the bases of the second, third, and fourth metatarsals. The most prominent insertion is on the navicular tuberosity
Extensory Hallucis Longus (EHL) Origin and Insertion
Origin: middle section of the fibula and adjacent interosseous membrane Insertion: Dorsal base of the distal phalanx of the great toe
Soleus Origin and Insertion
Origin: proximal one third of posterior fibula and fibular head and posterior aspect of the tibia Insertion: calcaneal tuberosity via the Achilles tendon
Ankle Instability - Functional
Poor proprioception- they think the ankle will give out Interventions: closed chain, proprioception, taping
Ligament Injury Intervention Phase 3
Sport Specific Stabilization
Joints for Supination and Pronation
Subtalor and Transverse
Achilles Rupture MOI
Sudden eccentric and concentric contraction Raquetball/Tennis Most common in Males 20-50 y/o
Subtalor Joint
Talus/Calcaneus Combined Movements Inversion/Adduction
talocrural joint
a. Ankle jt b. Saddle or hinge jt c. Sagittal plane d. AKA known as carpenter's mortise jt
Sagittal Plane of the ankle
dorsiflexion and plantarflexion
Metatarsals and phalanges:
forefoot bones
Tarsals:
include the talus, calcaneus, navicular, cuboid, and the cuneiforms
Frontal Plane of the ankle
inversion and eversion
midfoot bones
navicular, cuboid, cuneiforms
Plantar Fasciitis MOI
repetitive microtrauma Chronic inflammation
Ligament Injury Intervention Phase 1
Avoid what causes pain High Volt EMS is good for swelling isometrics for opposite side
Flexor Hallucis Longus (FHL) Origin and Insertion
Origin: Distal two-thirds of the posterior fibula Insertion: Plantar surface of the base of the distal phalanx of the great toe
3 Fibers of Deltoid Ligament
1. Tibionavicular fibers2. Tibiocalcaneal fibers 3. Tibiotalar fibers
Anterior talofibular ligament:
1. weakest & most commonly injured (excessive inversion and plantar flexion) 2. Spans from the anterior surface of the lateral malleolus to the lateral side of the talus' neck
Lateral Ligament Injuries (Inversion)
25% of sports injuries Forced Plantarflexion Very common
Most common location for achilles tendon rupture
3-4 CM proximal to insertion
Deltoid Ligament
Considered medial collateral ligament of ankle a. Limits eversion b. Very strong: not sprained very often c. Triangular-shaped ligament originating off of the medial malleolus and attach at the talus, sustentaculum tali and navicular
Medial Ligement Injury
Easy on Dorsi and Eversion
General Intervention for Lateral Ligament Injury
Easy on Plantar and Inversion
What causes shin splints
Excessive Pronation Female High BMI Reduced Hip ER/IR Decreased Dorsiflexion
Interventions for Achilles Tendinopathy
ICE pack (15-20 min) 3-5X NSAIDS Small Heel lift US before exercise Eccentric control of Plantar flexion
Anterior Tibialis Innervation and Action
Innervation: Deep Branch of the fibular nerve Action: Dorsiflexion and inversion
Extensory Hallucis Longus (EHL) Innervation and Action
Innervation: Deep branch of the fibular nerve Action: Extension of the great toe, Dorsiflexion
Extensor Digitorum Longus (EDL) Innervation and Action
Innervation: Deep branch of the fibular nerve Action: Extension of toes 2-5 (MTP, PIP, and DIP joints), Dorsiflexion, Eversion
Fibularis Longus Innervation and Action
Innervation: Superficial branch of the fibular nerve Action: Eversion and Plantar Flexion
Flexor Hallucis Longus (FHL) Innervation and Action
Innervation: Tibial Nerve Action: Flexion of the great toe, Plantar flexion, inversion/adduction
Gastrocnemius Innervation and Action
Innervation: Tibial Nerve Action: Plantar Flexion, Flexion of the knee
Posterior Tibialis Innervation and Action
Innervation: Tibial Nerve Action: Plantarflexion
Flexor Digitorum Longus (FDL) Innervation and Action
Innervation: Tibial nerve Action: Flexion of toes 2-5, Plantar Flexion, Inversion, Adduction
Soleus Innervation and Action
Innervation: tibial nerve Action: plantar flexion
Interventions for Plantar Fasciitis
Iontophoresis Orthotics Intrinsic Muscle training (marble/towel) Gastroc/Soleus stretching
High Ankle Sprain MOI
Jumping, Skiing, Football, Soccer, Basketball, Talus pushes up into syndesmosis (between tibia and fibula)
Ankle Instability - Mechanical
Laxity in ligaments May re-route ligaments and muscle to 'pick up slack'
Deltoid/Medial Ligament Sprain
Less Common Typically occur with a fracture MOI: Fracture, trauma, fall, accident
Ligament Injury Interventions Phase 2
More weight bearing Increase to Eccentric and Concentric AROM (as pain allows) Stationary Bike (with neutral foot) SLS/BAPS Board/Wobble board/heel raises
Transverse plane of the ankle
abduction and adduction
Hindfoot bones
calcaneus and talus