Chapter 19: The Ankle and Lower Leg



Chapter 19: The Ankle and Lower Leg

Overview

Ankle injuries, especially to the ligamentous tissue, are the most frequent injuries in sports. For the coach and the athletic trainer, understanding the complex nature of ankle injuries should be a major goal.

Many sports place demands on the ankle and lower leg that far exceed the normal daily requirements. Many ankle injuries could be prevented by Achilles tendon stretching, strengthening of key muscles, proprioceptive training, proper footwear, and, in some cases, proper taping. The leg is prone to a number of acute conditions, of which contusions and strains are most common. Although less common, fractures can occur because of direct trauma, such as being struck by a blow or through torsioned forces with the foot fixed to the ground.

A number of problems of the leg can also be attributed to repetitive stress and overuse, such as medial shin stress syndrome (shin splints), exercise-induced compartment compression syndromes (both acute and chronic), and stress fractures.

Repetitive use and overuse of the lower extremity, particularly when there are biomechanical and subsequent weight transmission discrepancies, can lead to problems in other regions of the body, particularly for the knee and hip. This is especially true for long distance runners.

The coach and athletic trainer should be capable of identifying, ameliorating, or preventing these problems whenever possible.

Learning Objectives

After completing this chapter, the student will be able to:

• Identify the major anatomical components of the ankle and lower leg that are commonly injured in sports.

• Accurately assess ankle and lower leg injuries.

• Discuss the etiology, symptoms and signs, and management of injuries occurring to the ankle and lower leg.

• Develop a rehabilitation plan for various injuries to the ankle and lower leg.

Visit connect.mcgraw- for further exercises:

• Clinical application scenarios covering assessment of the ankle and lower leg, etiology, symptoms and signs, and management of ankle and lower leg injuries, and rehabilitation for the ankle and lower leg

• Click and drag questions covering structural anatomy of the ankle and lower leg, assessment of ankle and lower leg injuries, and rehabilitation plan of the ankle and lower leg

• Multiple choice questions covering anatomy, assessment, etiology, management and rehabilitation of ankle and lower leg injuries

• Selection questions covering rehabilitation plan for various injuries to the ankle and lower leg

• Video identification of special tests for ankle and lower leg injuries, rehabilitation techniques for the ankle and lower leg, taping and wrapping for ankle and lower leg injuries

• Picture identification of major anatomical components of the ankle and lower leg, rehabilitation techniques of the ankle and lower leg, and therapeutic modalities for management

Key Terminology

Syndesmotic joint - An articulation in which the bones are united by a ligament

Ankle mortise - Talocrural joint formed by the tibia, fibula, and talus

Other Terms

Anterior compartment - contains those muscles that dorsiflex the ankle and extend the toes

Lateral compartment - contains the peroneus longus and brevis, the peroneus tertius muscle, and the superficial branch of the peroneal nerve.

Superficial posterior compartment - contains the gastrocnemius muscle and the soleus muscle.

Deep posterior compartment - contains the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles, and the posterior tibial artery.

Bimalleolar fracture - both the medial malleolus of the distal tibia and the lateral malleolus of the distal fibula are fractured.

Tendinitis is an inflammatory condition that involves the tendon

Tenosynovitis - an inflammatory condition that involves the tendon sheath (the paratenon)

Osteomyelitis - a serious condition that results in the destruction and deterioration of bone

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