Mrs. Marr

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Sports Medicine II
And the Lower Leg
Foot

• Mrs. Marr

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THE 4 BONES OF THE ANKLE JOINT
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ANKLE LIGAMENTS MEDIAL

• Deltoid Ligament Complex
• 4 ligaments
• Broad
• Flat
• Overlapping
• STRONG!

D
A
C
B
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ANKLE LIGAMENTS - LATERAL

• Lateral Collateral Ligaments
• ATF
• Anterior
• From Talus to Fibula
• Weakest of 3 ligaments
• PTF
• Posterior
• From Talus to Fibula
• Strongest/Deepest of 3 ligaments
• CF
• Anterior
• From Calcaneus to Fibula
• Largest Strong and Cord-like

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ANKLE MUSCLES ANTERIOR SIDE

• TIBIALIS ANTERIOR
• Muscle starts _at_ top of Tibia
• Tendon crosses over Ankle Joint _at_ Talus
• Attaches at the base of the 1st foot bone
• Cross over at joint allows for multiple motions
• Major Motion
• Dorsiflexion of the ankle joint
• Inversion of the foot
• Prevents the forefoot slapping AND scrapping the
  ground

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ANKLE MUSCLES LATERAL SIDE

• PERONEAL GROUP
• 3 muscles (peroneus brevis/longus/tertius)
• Muscle group starts _at_ top of Fibula
• Peroneal tendon hooks around the back of Lateral
  Malleolus
• Insertion of Peroneal Tendon is at the base of
  the 5th foot bone
• Major Motion
• Eversion of the Foot _at_ the Ankle

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ANKLE MUSCLES POSTERIOR

• GASTROCNEMIUS
• Muscle starts on distal femur
• 1 muscle with two points of origin
• Achilles Tendon is other attachment
• Crosses two joints
• Major Motion
• Plantarflexion _at_ the Ankle

• ACHILLES TENDON
• Large Tendon/Cord from Gastroc.
• Inserts firmly at Calcaneus
• Largest, Strongest Tendon in Body
• Combination of Gastroc and Soleus Tendons

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Compartments of the Leg

1. Anterior
2. Lateral (peroneal)
3. Deep posterior
4. Superficial posterior

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(No Transcript)
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Anterior Compartment Musculature

• Tibialis anterior
• Extensor digitorum longus
• Extensor hallucis longus
• Peroneus tertius

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Tibialis Anterior

• DF and inversion
• O lateral tibial condyle and shaft
• I medial/plantar 1st cuneiform and metatarsal
• N deep peroneal

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Extensor Digitorum Longus

• Extension of 2nd-5th MP joints, assists with
  eversion and DF
• O lateral tibial condyle, proximal ¾ of anterior
  fibula
• I via 4 tendons into distal phalanges of 2nd-5th
  toes
• N deep peroneal

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Extensor Hallucis Longus

• Extension of 1st MP and IP joints
• O middle 2/3 of anterior fibula
• I base of distal 1st phalanx
• N deep peroneal

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Peroneus Tertius

• Eversion of foot, assists in PF
• O distal 1/3 of anterior fibula
• I dorsal base of 5th metatarsal
• N deep peroneal

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Lateral Compartment Musculature

• Peroneus longus
• Peroneus brevis

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Peroneus Longus

• Eversion of the foot, assists with PF
• O lateral tibial condyle, fibular head, upper
  2/3 of lateral fibula
• I lateral base of 1st metatarsal, lateral and
  dorsal aspect of 1st cuneiform
• N superficial peroneal

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Peroneus Brevis

• Eversion of the foot, assists with PF
• O distal 2/3 of lateral fibula
• I styloid process at base of 5th metatarsal
• N superficial peroneal

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Superficial Posterior Compartment Muscles

• Gastrocnemius
• Soleus
• Plantaris

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Gastrocnemius

• Ankle PF, assists knee flexion
• O medial head posterior medial femoral
  condyle, lateral head posterior lateral femoral
  condyle
• I calcaneus via Achilles tendon
• N tibial

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Soleus

• Ankle PF
• O posterior fibular head, upper 1/3 of posterior
  fibular, soleal line on posterior tibial shaft,
  middle 1/3 of medial tibial border
• I calcaneus via Achilles tendon
• N tibial

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Plantaris

• Ankle PF, assists knee flexion
• O distal supracondylar line of lateral femoral
  condyle, femoral popliteal surface
• I calcaneus via Achilles tendon
• N tibial

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Deep Posterior Compartment Musculature

• Tom, Dick, AND Harry
• Tibialis posterior

• Flexor Hallucis Longus
• Flexor Digitorum Longus

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Tibialis Posterior

• Inversion of the foot, assists with PF
• O posterior/lateral tibia, upper 2/3 of medial
  fibula
• I navicular tuberosity, via slips into
  sustentaculum tali, cuneiforms, cuboid and bases
  of 2nd-4th metatarsals
• N tibial

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Flexor Digitorum Longus

• Flexion of 2nd-5th PIP/DIP/MP joints, assists
  with foot inversion and PF
• O posterior medial 2/3 of distal tibia
• I plantar surface of base of 2nd-5th distal
  phalanges
• N tibial

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Flexor Hallucis Longus

• Flexion of 1st IP joint, assists with flexion of
  1st MP joint, foot inversion and PF
• O posterior/distal 2/3 of fibula
• I plantar surface of 1st proximal phalanx
• N tibial

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Syndesmosis
Interosseous membrane (Syndesmosis) isn't a
compartment but ligamentous sheathe that holds
the tibia and the fibula together.
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Nerves and Blood Vessels

• Nerves
• Peroneal N.
• Tibialis Anterior/ Posterior N.
• Saphenous N.
• Blood Vessels
• Dorsal Pedal A.
• Posterior Tibial A.
• Greater/ Lesser Saphenous V.

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Neuroanatomy

• Anterior compartment
• Deep branch of Peroneal nerve
• Lateral compartment
• Superficial branch of Peroneal nerve
• Deep posterior compartment
• Tibial nerve
• Superficial posterior compartment
• Tibial nerve

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Deep Branch of Peroneal Nerve

• Branches from common Peroneal nerve near fibular
  head
• Dives into anterior compartment

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Superficial Branch of Peroneal Nerve

• Branches from common Peroneal nerve near fibular
  head
• Stays superficial and lateral in lateral
  compartment

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Tibial Nerve

• Runs in fascial sheath between deep and
  superficial posterior compartments
• Provides innervation to both, but not in either

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Vascular Anatomy

• Anterior compartment
• Anterior tibial artery
• Lateral compartment
• Peroneal artery
• Deep posterior compartment
• Posterior tibial artery
• Superficial posterior compartment
• Posterior tibial artery

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Anterior Tibial Artery

• Traverses similar path to deep Peroneal nerve
• Terminating as dorsal pedal artery

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Peroneal Artery

• Branches off of posterior tibial artery

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Posterior Tibial Artery

• Runs in fascial sheath between deep and
  superficial posterior compartments
• Provides vascular supply to both, but not in
  either

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Special TestsThe Squeeze Test

• Squeeze test
• check malleolus
• Check tibia and fibula
• May indicate FX
• Feel for any abnormalities
• Feeling for grinding or movement

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Special TestsAnterior Drawer/Tilt

• Anterior drawer tests should always be performed
  with the knee bent to eliminate the Achilles and
  Gastrocnemius muscles from providing any
  stability to the ankle.
• A lateral talar tilt test can be conducted at the
  same time.

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Anterior Drawer Test
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Tilt Test
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Special TestsFunctional Tests

• Functional tests
• (Return to play)
• a) walking - check gait
• b) toe raises
• 1) both feet
• 2) one foot
• c) jump and land on both feet and then on one foot