Unit 4 Part I The Ankle and Lower Leg
Anatomy of the Lower Leg and Ankle
 Bones
o Tibia: 2nd longest bone in the body, the “____________” bone
 Medial side, triangular in upper 2/3rds and rounded and constricted in the
lower third
o Fibula: ______________________ aspect of lower leg
 Proximal end is under the tibia
 Distal end articulates with tibia as a syndesmotic joint (bones are united by
a ligament)
New Vocab Word
 Syndesmotic Joint
o An articulation in which the bones are united by a ligament
Anatomy of the Lower Leg and Ankle
 Bones
o Tibial and fibular malleoli: medial and lateral malleoli
 Distal ends of the tibia and fibula
 Lateral side is ____________________ thus more stable
o Talus: _________________________________ bearing bone
 Rests on the calcaneus and articulates with the medial and lateral malleoli
o Calcaneus: ___________________ bone
 Many ligament attachments of the ankle and attachment of the Achilles
tendon
Articulations
 Superior and Inferior Tibiofibular Joint:
o Superior: diarthrotic (________________) joint, tibia’s lateral condyle and head
of fibula
o Inferior: Lateral malleolus and distal end of the tibia
 Talocrural Joint: Hinge joint aka the ankle mortise
o ___________________________________ flexion
 Subtalar Joint: Talus and calcaneus
o Inversion, eversion, pronation and supination
New Vocab Word
 Ankle Mortise
o Talocrural joint formed by the tibia, fibula and talus
Stabilizing Ligaments
 Tibiofibular Ligament:
o Strong interosseous membrane; helps diffuse the forces on the lower leg
o Distal sometimes referred as the _______________________________ ligaments
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
Lateral Ligaments:
o Anterior Talofibular
o Posterior Talofibular
o Calcaneofibular
Medial Ligaments: Deltoid ligament
o Resists ____________________________
Function of Key Ankle Ligaments
Ligament
Primary Function
Anterior talofibular
(ATF)
Restrains _______________________ displacement of talus
Calcaneofibular
(CF)
Restrains __________________________ of calcaneus
Posterior talofibular
(PTF)
Restrains _________________________ displacement of talus
Deltoid
Prevents ______________________________________________ of
ankle and subtalar joint
Prevents eversion, pronation, and anterior displacement of talus
Joint Capsule
 Thin articular capsule that encases the joint and borders the bone
Question
What is are the lateral ligaments of the ankle?
______________________________________________________________________________
What is the medial ligament of the ankle?
______________________________________________________________________________
Ankle Musculature
 Movements include:
o Dorsiflexion: muscles on the ____________________ side
o Plantarflexion: muscles on the posterior side
o Inversion: muscle cross _________________________
o Eversion: muscles cross laterally
Muscle Compartments
 The lower leg contains _________ distinct compartments bounded by a heavy fascia




Anterior Compartment:
o ___________________________ the ankle and extend the toes
o Muscles Include:
 Tibialis anterior, extensor hallucis longus, extensor digitorum longus and
peroneus tertius
Lateral Compartment:
o _________________ the ankle and assist with dorsiflexion
o Muscles:
 Peroneus longus and brevis and Peroneus tertius
Superficial Posterior Compartment:
o _________________ flexion
o Muscles:
 Gastrocnemius, soleus and plantaris
Deep Posterior Compartment:
o Invert the ankle
o Muscles:
 Tibialis posterior, flexor digitorum longus and flexor hallucis longus
Nerve Supple
 Anteriorly: Common _______________________ nerve
 Posterior: Tibial nerve
Blood Supply
 Arteries: Anterior tibial and posterior tibial
 Veins: Peroneal, Posterior tibial and Anterior Tibial
Functional Anatomy
 Ankle is a stable hinge joint
 Medial and lateral displacement is prevented by the malleoli
o Lateral malleolus _____________________ thus less degree of eversion
o Ligament arrangement limits inversion and eversion at the subtalar joint
 Square shape of talus adds to stability of the ankle
o Most stable during _______________________, least stable in plantar flexion
 Degrees of motion for the ankle range
o ________ degrees of dorsiflexion
o ________ degrees of plantar flexion
 Normal gait requires
o 10 degrees of dorsiflexion
o 20 degrees of plantar flexion with the knee fully extended
Preventing Injury in the Lower Leg and Ankle
 Achilles Tendon _________________________
o A tight heel cord may limit dorsiflexion
 May predispose individual to ankle injury
o Stretch before and after practice
o Stretching should be performed with knee ______________ and flexed
_____________ degrees (gastroc and soleus)
 Strength Training
o Static and dynamic joint stability is critical in preventing injury
o Muscles and tendons surrounding joint must be kept strong
New Vocab Word
 Neuromuscular Control
o Involves adapting to uneven surfaces at controlling motion at the ankle joint
Preventing Injury in the Lower Leg and Ankle
 Neuromuscular Control Training
o Can be enhanced by training in _____________________ activities
o Uneven surfaces, BAPS boards, rocker boards, or Dynadiscs can also be utilized
to challenge athlete
 Footwear
o Can be an important factor in reducing injury
o Shoes should not be used in activities they were _______________________
 Preventive Taping and Orthoses
o Tape can provide some prophylactic protection
o Improperly applied tape can disrupt normal biomechanical function and cause
injury
o ____________________________ have even been found to be superior to taping
relative to prevention
Assessing the Lower Leg and Ankle HOPS
History Past history
 Mechanism of injury
 When does it hurt?
 Type of, quality of, duration of pain?
 Sounds or feelings?
 How long were you disabled?
 Swelling?
 Previous treatments?
Observations- Bilateral
 Postural deviations? (toe in, pronation)
 Genu valgum or varum? (knocked knee, bow legged)
 Is there difficulty with walking?
 Deformities, asymmetries or swelling?
 Color and texture of skin, heat, redness?
 Patient in obvious pain?
 Is range of motion normal?
Palpation: Bony Landmarks
Fibular head and shaft
Lateral malleolus
Tibial plateau
Tibial shaft
Medial malleolus
Dome of talus
Calcaneus
Sustentaculum tali
Palpation: Soft Tissue
Peroneus longus
Peroneus brevis
Peroneus tertius
Flexor digitorum longus
Flexor hallucis
Posterior tibialis
Anterior tibialis
Extensor hallucis longus
Extensor digitorum longus
Gastrocnemius
Soleus
Achilles tendon
Palpation: Soft Tissue (Ligament)
 Anterior talofibular ligament (ATF)
 Posterior talofibular ligament (PTF)
 Calcaneofibular ligament (CF)
 Deltoid ligament
Special Tests
 Lower Leg Alignment
o Anteriorly
 A straight line can be drawn from ASIS, through patella and between 1st
and 2nd toes
o Laterally
 A straight line can go from greater trochanter through center of patella and
just behind the lateral malleolus
o Posteriorly
 A line can be drawn through the center of the lower leg, midline to the
Achilles and calcaneus
o Internal or external tibial torsion is also a common mal-alignment
Lower Leg
 Percussion and compression tests for fracture
o Percussion test is a blow to the tibia, fibula or heel to create vibratory force that
________________________________________
o Compression test involves compression of tibia and fibula either above or below
site of concern
o Tuning forks can also be used to create vibration at point of injury

Thompson test
o Squeeze calf muscle, while foot is extended off table to test the integrity of the
_______________________________ tendon
 Positive tests results in __________________________ in the foot

Homan’s test
o Test for ___________________________________________________________
o With knee extended and foot off table, ankle is moved into dorsiflexion
o Pain in calf is a positive sign and should be referred
Ankle Stability Tests
 Anterior drawer test: _________________ primarily and other lateral ligaments
secondarily
o Tibia is pushed backward as calcaneus is drawn forward
o A positive test occurs when foot slides forward and /or makes a clunking sound as
it reaches the end point
 Talar tilt test: Inversion or eversion
o With foot at 90 degrees calcaneus is inverted
 Excessive motion indicates injury to ______________________________
ligament and possibly the anterior and posterior talofibular ligaments
o If the calcaneus is everted, the _________________________ ligament is tested
 Kleiger’s test
o Extent of damage to the deltoid ligament and may be used to evaluate distal ankle
_________________________________
o With lower leg stabilized, foot is rotated laterally to stress the deltoid
Functional Tests
 While weight bearing the following should be performed
o Walk on toes (__________________ flexion)
o Walk on heels (dorsiflexion)
o Walk on lateral borders of feet (inversion)
o Walk on medial borders of feet (__________________)
 Hops on injured ankle
 Passive, active and resistive movements should be manually applied to determine joint
integrity and muscle function