: The Ankle and Lower Leg joints
Chronic Compartment Syndrome
Activity related in that the symptoms arise rather consistently at a certain point of activity. Usually occurs during running and jumping activities, and symptoms cease when activity stops.
Achilles Tendinosis
Also known as Achilles tendinopathy, there is no evidence of inflammation, the injured areas of the Achilles tendon show that cells are disorganized, scarred, and degenerated. It is a soreness and stiffness that come on gradually and continue to worsen until treated.
Achilles Tendinitis
An inflammatory condition that involves the Achilles tendon.
MOI: Inversion
Area Injured: Calcaneofibular ligament (along with anterior or posterior talofibular ligament)
MOI: Eversion
Area Injured: Deltoid Ligament Tibiofibular ligament (severe injury) Interosseous membrane (as external rotation increases) Possible fibular fracture (proximal or distal)
MOI: Dorsiflexion
Area Injured: Tibiofibular Ligament
Compartment Syndrome
Conditions in which increased pressure within one of the four compartments of the lower leg causes compression of muscular and neurovascular structures within that compartment.
Subtalar Joint
Consists of the articulation between the talus and the calcaneus. Movements that occur: inversion, eversion, pronation, and supination.
Superifical Posterior Compartment
Contains the gastrocnemius msucle and the soleus muscle. These muscles plantar flex the ankle.
Lateral Compartment
Contains the peroneus longus and brevis, which evert the ankle; the peroneus tertius muscle, which assists in dorsiflexion; and the superficial branch of the peroneal nerve.
Popliteus
Deep Posterior Compartment Origin: Lateral condyle of the femur Insertion: Proximal portion of the tibia Action: Flexes and rotates the leg medially Nerve Root: Tibial Nerve (L5, S1)
Tonic Spasm
Identified by constant muscle contraction without an intervening period of relaxation.
Clonic Spasm
Identified by intermittent contraction and relaxation. Has a neurological basis and is seen less in sports.
Acute Compartment Syndrome
Occurs secondary to direct trauma to the area. This is considered to be a medical emergency because of the possibility of compression of the arterial and nerve supply, which could result in additional injury to structures distal to the compartment.
Deltoid Ligament
Prevents abduction and eversion of ankle and subtalar joint. Prevents eversion, pronation, and anterior displacement of talus.
Gastrocnemius
Superficial Posterior Compartment Origin: Medial and lateral condyles of the femur Insertion: Calcaneus via the Achilles tendon Action: Flexes the leg; plantar flexes the foot Nerve Root: Tibial Nerve (L5,S1)
Volkmann's Contracture
The result of internal tension caused by hemorrhage and swelling within closed fascial compartments, which inhibits the blood supply and results in muscle necrosis and contractures.
Kleiger's Test
This test is used primarily to determine injury to the deltoid ligament. it can also indicate injury to the structures that support the tibiofibular ligament, the posterior tibiofibular ligament, and the interosseous membrane.
Anterior Draw Test
This test is used to determine the extent of injury to the anterior talofibular ligament primarily and to the other lateral ligaments secondarily.
Anterior Tibialis Tendinitis
A common condition in individuals who run downhill for an extended period of time. There is point tenderness over the tendon. The patient complains of pain when the tendon is stretched or when the muscle is contracted.
Posterior Tibialis Tendinitis
A common overuse condition among runners with hypermobility or pronated feet. It is a repetitive microtrauma occurring during pronation in movements such as jumping, running, and cutting.
Achilles Tenosynovitis
An inflammatory condition that involves the Achilles tendon and it's sheath. Causes fibrosis and scarring that can restrict the Achilles tendon's motion within the tendon sheath.
Extensor Hallucis Longus
Anterior Compartment Origin: Anterior surface of the middle of the fibula and the interosseous membrane Insertion: Dorsal surface of the distal phalanx of the great toe Action: Dorsiflexes and inverts the foot; extends great toe Nerve Root: Deep Peroneal (L5, S1)
Peroneus Tertius
Anterior Compartment Origin: Distal third of the anterior surface of the fibula and the interosseous membrane Insertion: Dorsal surface of the fifth metatarsal Action: Dorsiflexes and everts the foot Nerve Root: Deep Peroneal (L5, S1)
Tibialis Anterior
Anterior Compartment Origin: Lateral condyle and proximal two-thirds of the shaft of the tibia and the interosseous membrane. Insertion: Medial surface of the first cuneiform and first metatarsal Action: Dorsiflexes and inverts the foot Nerve Root: Deep Peroneal (L5, S1)
Extenor Digitorum Longus
Anterior Compartment Origin: Lateral condyle of the tibia, proximal three-fourths of the anterior surface of the fibula, and the interosseous membrane Insertion: Dorsal surface of the phalanges of te second through fifth Action: Dorsiflexes and everts the foot; extends the toes Nerve Root: Deep Peroneal (L5, S1)
MOI: Plantar Flexion or Inversion
Area Injured: Anterior talofibular ligament Calcaneofibular ligament Posterior talofibular ligament Tibiofibular ligament (severe injury)
Deep Posterior Compartment
Contains the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles, which invert the ankle, and the posterior tibial artery.
Anterior Compartment
Contains those muscles that dorsiflex the ankle and extend the toes--tibialis anterior, extensor hallucis longus, and extensor digitorum longus muscles--and contains the anterior tibial nerve and the tibial artery.
Flexor Hallucis Longus
Deep Posterior Compartment Origin: Lower two-thirds of the fibula Insertion: Distal phalanx of the great toe Action: Plantar flexes and inverts the foot; flexes the great toe Nerve Root: Tibial Nerve (L5, S1)
Tibialis Posterior
Deep Posterior Compartment Origin: Posterior surface of the interosseous membrane, the tibia, and the fibula Insertion: Navicular, cuneiforms, cuboid; second through fourth metatarsals Action: Plantar flexes and inverts the foot Nerve Root: Tibial Nerve (L5, S1)
Flexor Digitorum Longus
Deep Posterior Compartment Origin: Posterior surface of the tibia Insertion: Distal phalanx of the second through fifth toes Action: Plantar flexes and inverts the foot; flexes the toes Nerve Root: Tibial Nerve (L5, S1)
Medial Tibial Stress Syndrome (MTSS)
In the past, this as been referred to as shinsplints, which is a catchall term that indicates pain in the anterior part of the shin. Conditions such as stress fractures, muscle strains, and chronic anterior compartment syndrome have all been termed shinsplints.
Peroneus Brevis
Lateral Compartment Origin: Distal two-thirds of the fibula Insertion: Lateral side of the fifth metatarsal Action: Plantar flexes and everts the foot Nerve Root: Superficial peroneal (L4, L5,S1)
Peroneus Longus
Lateral Compartment Origin: Proximal two-thirds of the lateral surface of the fibula Insertion: Ventral surface of the first metatarsal and the medial cuneiform Action: Plantar flexes and everts the foot Nerve Root: Superficial peroneal (L4, L5,S1)
MOI
Mechanism of Injury
Peroneal Tendinitis
Not particularly common, it can be a problem in individuals withs pes cavus. IN pes cavus, the foot tends to supinate excessively, which causes weight bearing on the of the foot, placing stress on the peroneal tendon.
Acute Exertional Comparment Syndrome
Occurs without any precipitating trauma and can evolve with minimal to moderate activity.
Anterior Talofibular Ligament
Restrains anterior displacement of talus
Calcaneofibular Ligament
Restrains inversion of the calcaneus
Posterior Talofibular Ligament
Restrains posterior displacement of the talus
Soleus
Superficial Posterior Compartment Origin: Posterior surface of the proximal third of the fibula and the middle third of the tibia Insertion: Calcaneus via the Achilles tendon Action: Plantar flexes the foot Nerve Root: Tibial Nerve (L5,S1)
Plantaris
Superifical Posterior Compartment Origin: Posterior surface of the femur above the lateral condyle Insertion: Calcaneus via the Achilles tendon Action: Flexes the leg; plantar flexes the foot Nerve Root: Tibial Nerve (L5,S1)
Ankle Mortise
Talocrural joint formed by the tibia, fibula, and talus.
Superior Tibiofibular Joint
This is a diarthrotic joint, allowing some gliding movements. Articulaton is formed by the tibia's lateral condyle and the head of the fibula. It is surrounded by a fibrous capsule reinforced with anterior and posterior ligaments.
Inferior Tibiofibular Joint
This is a fibrous articulation, the articulation is between the lateral malleolus and the distal end of the tibia. The joint is reinforced by the ankle ligaments.
Talocrural Joint
This is a hinge joint that is formed by the articular facet on the distal portion of the tibia, which articulates with the superior articular surface of the talus; the medial malleolus, which articulates with the medial surface of the trochlea of the talus; and the lateral malleolus, which articulates with the lateral surface of the trochlea. Movements that occur: plantar flexion and dorsiflexion
Homan's Sign
This test gives some indication of the presence of a deep vein thrombophelbitis. With the patient in a supine position with the knee fully extended, the ankle is passively dorsiflexed, so that the calf muscles are stretched. Pain the calf is a positive sign.
Medial Subtalar Glide Test
This test is done to determine the presence of excessive medial translation of the calcaneus on the talus in the transverse plane.
Talar Tilt Test
This test is used to determine the extent of inversion or eversion injuries. Excessive motion of the talus indicates injury to the calcaneofibular and possibly the anterior and posterior talofibular ligaments. The deltoid ligament can be tested in the same manner.
Thompson Test
Used to determine if there is a rupture of the Achilles tendon. Performed by squeezing the calf muscle while the leg is extended and the foot is hanging over the edge of a table (supine).