Unit 3 Ankle - westada.org

AnkleUnit 3

Ankle LabelingSports Med 2

Tibia Fibula

1 Structure per card

Talus Calcaneus


Navicular 1st Cuneiform


1st Metatarsal 2nd Cuneiform


Sesamoid 1st Proximal Phalanx


1st distal phalanx


Metatarsals (5) Cuboid


1st cuneiformNavicular

2nd cuneiform

3rd cuneiform1 Structure per card

3 Structuresso 3 cards

Talus Calcaneus


FibulaTibia


Posterior Tibiofibular LigamentDeltoid Ligament

Posterior TalofibularLigament

Calcaneofibular LigamentAnterior TalofibularLigament

Anterior Tibiofibular Ligament

5 Structuresso 5 cards


GastrocnemiusSoleus


Posterior TibialisTendon

Flexor DigitorumLongus

Flexor Hallicus Longus


Gastrocnemius SoleusAnterior Tibialis

1 Structure per card2 Structures on 1 card

Peroneus Longus Peroneus BrevisExtensor DigitorumLongus


Peroneus Longus

Anterior Tibialis

Soleus

Gastrocnemius (muscle belly)

Extensor DigitorumLongus

Extensor HallicusLongus Achilles Tendon

4 Structuresso 4 cards 3 Structures

on 1 card


Lateral longitudinal arch

Medial longitudinal arch

A-B: Transverse archA-C: Medial longitudinal archB-C: Lateral longitudinal arch

Ankle/Foot Outline

Facts:

• Ankle injuries occur most in sports.

• Plantar flexion/ Inversion ankle sprains account for about 90% of all ankle sprains

Bones

• Distal end of tibia (medial malleolus) and fibula (lateral malleolus)

• Talus:• 2nd largest tarsal

• Main weight bearing bone in foot

• Almost square shape

• Calcaneus• largest

MovementsThe most stable position of the ankle is when it is in dorsiflexion

Place the muscles from flashcards in the movement category:

Dorsiflexion

Plantarflexion

Inversion

Eversion

MMT Scoring Chart: Start with the highest/hardest value. Change Right side of column first and fully; then work your way left. (fine in notes packet)

Score (5-0) ROM (Full, Some, None) Gravity? (Against, With) Resistance (Full, Some, None)

5

4

3

2

1

0

To test any joint, movement, or muscle:1. Start at a score of 32. If they can do 3, test a 4/5

• Remember to test bilaterally and the purpose of each of your two hands: stabilize and resistance.3. If they cannot do 3, test a 2-0

1. Eliminating gravity is the hardest part; doesn’t have to be fully with gravity either!

Ankle ROM Rubric & MMT’s

• Review with your partner:• The steps, IN ORDER, of the ankle ROM rubric

• No notes

• Perform the ankle ROM on your “athlete.”• “Athlete:” initial what column you are putting the score into (make them better)

• SAT: give the “athlete” an actual score from the MMT chart for each movement

Ankle MMTs:http://ahn.mnsu.edu/athletictraining/spata/footanklemodule/manualmuscle.html

http://ahn.mnsu.edu/athletictraining/spata/footanklemodule/manualmuscle.html

MMTs from video• Perform 25 single leg calf raises with the knee straight

and then with the knee bent

• Resist dorsiflexion (DF) and inversion• Start in PF and eversion

• Anterior tibialis

• Resist plantarflexion (PF) and eversion• Start in DF and inversion

• Peroneus longus and peroneus brevis

• Resist plantarflexion• Start in DF

• Gastrocnemius and soleus

Foot/Ankle Read with main conceptson shiny desk (keep)

• Foot: pgs. 221-3• Bones (3)

• Ligaments (10)

• Muscles (6)

• Ankle: pgs. 235-7• Bones (6)

• Ligaments (6)

• Muscles (4)

Ligament Support

Late

ral • Anterior

tibiofibular

• Posterior tibiofibular

• Anterior talofibular

• Posterior talofibular

• Calcaneofibular

med

ial • Deltoid

• Triangular

• Primary eversionresistor

H.O.Palpations.S.

• H =• Can you list the 10 questions?

• Can you list a specific ankle question?

• O =• What 6 things do we observe?

• Palpation should start with bony sites. Why?• Purpose of palpation is to detect obvious defects, swellings, localized

tenderness

H.O.Palpations.S.

Bony

• Medial:

• Medial malleolus

• Navicular

• Talus

• Cuneiforms

• Lateral

• Lateral malleolus

• Proximal base of the 5th metatarsal

• cuboid

Soft

• Medial:

• Deltoid ligament

• Lateral

• Anterior talofibular ligament

• Calcaneofibular ligament

• Posterior talofibular

• Anterior tibiofibular

• Peroneal tendon

• Posterior

• Achilles tendon

• Gastrocnemius

• Anterior

• Anterior tibialis

• Flexor tendons

10 sites of Palpation(memorize in order)

1. Squeeze the midshaft of calf2. Medial malleolus 3. Lateral malleolus4. Base of the 5th metatarsal5. Calcaneus6. Achilles tendon7. Deltoid Ligament8. Syndesmosis (interosseous membrane)9. Anterior talofibular10. Posterior talofibular

Functions of Ankle LigamentsLigament Primary Function

*Put on back of corresponding flashcard also*

Anterior Talofibular Restrains (directional term) displacement of talus

Calcaneofibular Restrains (movement term) of calcaneus

Posterior Talorfibular Restrains (directional term) displacement of talus

Deltoid Ligaments Prevents (movement term) of ankle

Types and Grades of Ankle Sprain• Read pg. 240-242

MOIMechanism of Injury

Grade 1 Grade 2 Grade 3

Inversion Calcaneofibular (CF) CF + CF + ATF +

Inversion + Plantarflexion

(most common)

Anteriotalofibular (ATF) ATF + ATF + CF +

Forced ER and hyper dorsiflextion

“SyndesmosisOr high ankle sprain”

Anteriotibiofibular (ATiF) + Posteriotibiofibular (PTiF)

ATiF + PTiF+ ATiF + PTiF+ Interosseous membrane +

Eversion Deltoid ligaments + possible avulsion fx or medial maleolus

Deltoid + joint instability+

Deltoid + joint instability+ interosseous membrane +

Foot/Ankle Injuries and Special Tests

Sports Med 2

Foot Functions• The foot is critical in walking, running, jumping and

changing direction

1) Shock absorber

2) Lever that propels the body forward, backward or to the side

Foot management is key for the athletic population

• Label review

Arches of the Foot

• Arches support the body weight, shock absorb during weight bearing.

Lateral Longitudinal Arch

• Write the bones that it supports

Medial longitudinal Arch

• Write the bones that it supports

Transverse Arch

Foot Injuries

Please look these up in your own books.

• Mortons Toe 2nd meta fx p 227

• Plantar fasciitis p 226

• Jones fracture p 226-228

• Bunion p 229-230

Ankle Injuries Etiology

A. Generally caused by sudden lateral or medial twist

B. Most common – Inversion (w/Plantar flexion)1. More bony stability on the lateral side

2. Tight heel cord

3. Graded by the ligaments involved

C. Eversion etiology:A. Pronated, hypermobile or depressed arched

B. Represents about 10% of ankle sprains

C. More serious than lateral ankle sprains

Grade I Inversion ankle sprain

MOI: Foot inversion, PF, with mild stretching of the ATF

S/S:

- Mild pain and disability

- Weight bearing is not impaired

- Mild point tenderness

- Mild/slight swelling over ligament

- No joint laxity (looseness)

TX:

- PRICE

- Progressive Resistance Exercises (PRE’s)

Grade II Inversion Ankle Sprain

MOI:

- Moderate force in inversion, PF

- Complete tear of the ATF and stretch of the CF

S/S:

- c/o pop or snap

- Moderate pain and disability

- Weight bearing is difficult

- Tenderness and edema w/blood in the joint

- Ecchymosis

- + talar tilt, + anterior drawer tests

TX:

- PRICE

- x-ray, crutches

- PF and DF exercises

- ROM, PRE’s

Grade III Inversion Ankle Sprain(relatively uncommon in sports)

MOI:

- Severe force in inversion, PF

- Involving ATF, CF and PTF

S/S:

- c/o pain in region of lateral malleolus

- Swelling is diffused along w/ discoloration

- No possible weight bearing

- Major loss of function (LOF)

- Severe swelling

- + talar tilt, + anterior drawer tests

TX:

- PRICE

- Crutches, refer for x-ray

- ROM, PRE’s

10 Palpations practice

• Need a washable marker from teacher

• Label each palpation site by placing the number over the site• Should go in order

• Just label one leg and then switch partners

REVIEW: Special test-a procedure to tests for certain injury.

• Ligament tests:• Look for laxity (L for laxity & ligament)

• Muscle tests:• Test for strength, decreased ROM, or pain

• Fracture tests:• Test for pain, discontinuity of bone,

crepitus

• Misc. Tests:• Impingement?

• Squeeze/pinch area

Ankle Anterior Drawer Special Test(notes packet & flashcards)

Picture Positive/Purpose Diagnosis

Look for laxity ATF and/or CF sprain

Inversion Talar Tilt Special Test


Look for laxity CF sprain

Eversion Ankle Sprain

MOI:

- Eversion, DF

- Avulsion fx of the medial malleolus in 15% of cases

S/S:

- c/o pain over the foot and lower leg

- Unable to bear weight on the foot

- Ab/adduction causes pain

TX:

- x-ray to rule out fx.

- PRICE

- NSAIDS

- PRE’s for posteromedial ankle muscle and for arch, could lead to pronation of the foot.

Eversion Talar Tilt Special Test


Look for laxity Deltoid ligament sprain

External Rotation (Kleiger’s) Special Test


Look for laxity Deltoid ligament sprain

Bump Special Test


Look for pain or crepitus

Fracture

Syndesmotic Ankle Sprain(high ankle sprain)Relatively common in football

MOI:

- Forceful external rotation of the ankle- While lying on the field w/ ankle externally rotated, someone falls on the back

of the leg and foot, forcing ER

- Lateral blow to knee/leg with foot planted, forcing ER

- External force can rupture ant. Tibiofibular lig., posterior tibiofibular lig., or fracture the posterior tibial tubercle.

Syndesmotic Ankle Sprain(high ankle sprain)S/S:

- c/o severe pain, loss of function

- When ankle is passively externally rotated, major pain in lower leg

- Pain along the antero-lateral leg

TX:

- Out of competition

- PRICE

- NSAIDS

- X-ray can reveal fracture or widening of the ankle mortise

Squeeze Special Test


Look for pain, crepitus, movement of fibula

Fracture or high ankle sprain

Achilles Tendon Rupture (Weekend Warrior)• quick acceleration/jumping-type sports

• MOI• forceful PF of foot while the knee is extended• Unexpected rapid DF of the foot, stepping in a hole, stepping on a

curb• violent dorsiflexion when jumping from a height and landing on a

plantar flexed foot

• S/S• report feeling a kick in the calf and severe sharp pn• loud pop or snap sound and swelling.• Limping, cant plantarflex

• TX• Immobilize• PRICE, crutches• Refer

Achilles Rupture and Fixture

Thompson’s Special Test


Look for no movement of plantarflexion

Achilles tendon rupture

Deep vein thrombosis (DVT) Special Test


Look for pain in gastrocnemius

Deep vein thrombosis

Other Injuries

• Please look up these injuries of foot and ankle on your own:• Severs Disease (apophysitis) p. 225

• Achilles Tendinitis/Tendinosis p. 248

• Medial tibial Stress Syndrome p. 246

• Compartment Syndrome p. 248

SOAP Note Practice

• Pick an ankle injury MOI and grade of sprain

• Your partner will fill in a SOAP note • Ask history questions

• Palpate ligaments

• Determine injury and grade of sprain

• Then switch with your partner

Ankle RehabSports med 2

REVIEW: Purpose of rehab

• What are the 5 goals of rehab:• Decreasing swelling

• Increasing ROM

• Increasing strength

• PNF

• Functional activities

Rehab progress

• Phase 1 (think the injury just happened; could last 5 days)• What would we see?

• Swelling (brainstorm)• Discoloration• Painful• Limited ROM• Limited strength

• Cryokinetics: making the part numb first and then exercises until they can feel again.• 5-7 mins in ice (need to be numb)• ABC’s, circles, P=D or I=E• Repeat 3-5 times• End in ice

Phase 1 (immediate protocol(?))• ABC’s (what do you think this does for the athlete?)

• Upper and lower case

• Towel scrunches (what do you think this does for the athlete?)

• Foam pick ups (what do you think this does for the athlete?)• Uses intrinsic muscles/tendons of foot

• Balancing (floor) (what do you think this does for the athlete?) • 3 x 30 sec

• Calf stretch (what do you think this does for the athlete?) • On incline board, 3 x 1 min

• Passive ROM (what do you think this does for the athlete?)• BAPS board

• ICE • 20 min. on 40 min off• 72 hours minimum

• Compression wrap w/horseshoe• Crutches if limping

Phase 2 (harder than phase 1; simple way to increase?)

• ABC’s (what do you think this does for the athlete?)

• Towel scrunches (what do you think this does for the athlete?)

• Balancing (tramp or foam pad) (what do you think this does for the athlete?) • Eyes open and closed

• Calf stretch (what do you think this does for the athlete?)

• Resisted ROM/bands (what do you think this does for the athlete?)

• Calf raises (what do you think this does for the athlete?)• Increase sets and reps, single leg?

• ICE 20 min.

• Compression wrap w/horseshoe

• Bike

Rehab equipment progression

• Bands:• Yellow

• Red

• Green

• Blue

• Black

• Weights:• See number on them

• Size also matters

• Balance• Always no shoes

• Start with eyes open, progress to eyes closed on each surface• Ground

• Pink foam

• Squishy (dyna disc)

• Bosu ball (half ball)

• Theraball

Phase 3 (increase sets/intensity/time)

• ABC’s (what do you think this does for the athlete?)

• Balancing (tramp) 1 leg, catch ball (what do you think this does for the athlete?)

• Calf stretch (what do you think this does for the athlete?)

• Resisted ROM/bands (what do you think this does for the athlete?)

• Calf raises single leg (what do you think this does for the athlete?)

• Functional activities (what do you think this does for the athlete?)

• ICE 20 min.

• Compression wrap w/horseshoe if swelling

• Tape for limited practice

Release

• Full Strength

• Sport specific Testing• Pass Functional testing

• Full ROM

• Support usually required• tape

• brace

Functional Testing examples

• Walks on toes, test plantar flexion

• Walk on heels, test dorsiflexion

• Walks on lateral border of feet, test inversion

• Walks on medial border of feet, tests eversion

• Hop on both feet 10 times

• Run forward 70 -100%

• Run backwards 70-100%

• Zig zags down and back

• Figure 8’s

• Sports specific

Rehab and Skills Stations

• Stations 1-8 around the room/hallway.• 5 minutes per slide

• USE TIME WISELY• This will be on the test and you will use it in the clinic

Unit 3: Ankle Test ReviewShiny Desk PRACTICE quizzes

Unit 2 Review

• Major questions missed in Unit 2

Ankle Outline

1. What MOI of ankle sprains account for about 90% of all ankle sprains?• Plantarflexion & inversion

2. List a muscle that does dorsiflexion?• Anterior tibialis, extensor hallicus longus, extensor digitorum

longus, & peroneus tertius

3.

4.

5.

Medial longitudinal arch

Gastrocnemius

Peroneus longus

Unit 3 Ankle - westada.org

Documents

Transcript of Unit 3 Ankle - westada.org