踝關(guān)節(jié)生物力學教學課件教學課件

1、AnkleAnatomical StructuresTibiaFibularTalusTibia脛骨This is the strongest largest bone of the lower leg. It bears weight and the bone creates the medial malleoli (the bump on the inside of your ankle) which is the medial aspect of the mortise or the (hole) that the talus lies within.這是最強壯的小腿骨。它具有承重和形成

2、了內(nèi)側(cè)支撐面(組成腳踝的凹面)，能與距骨相契合The Tibia is the medial bone and largest bone of the lower leg.Tibia脛骨是小腿的最大和支撐骨的骨頭。 Fibula腓骨This is a smaller lateral bone of the lower leg. It is not vital for weight bearing yet it comprises the lateral (outside) aspect of the malleoli and makes up the lateral aspect of the

3、 mortise. 這是小腿的一根更小的外側(cè)骨頭。 它不承重，它是踝關(guān)節(jié)的外側(cè)支撐面。 Fibula-The fibula is longer and non weight bearing. It makes up the lateral aspect of the mortise. The lateral malleoli lies inferior (below) the medial malleoli它比較長和不承重。并組成踝關(guān)節(jié)外側(cè)面。 并低于內(nèi)側(cè)面_Talus This bone transmits the forces from the calcaneus up into the

4、tibia and also allows the articulations of Plantar Flexion (pointing the foot downward) Dorsiflexion or pulling the foot upward and Inversion (rolling the foot inward) and Eversion (rolling the foot outward)- TalusTalocrural JointThe formation of the mortise (a hole) by the medial malleoli (Tibia) a

5、nd lateral malleoli (fibula) with the talus lying in between them makes up the talocrural joint. This is a hinge joint and allows most of the motion with plantarflexion and dorsiflexion._Talocrural Jt.Subtalar JointThe articulation between the talus and the calcaneus is referred to as the subtalar j

6、oint. Motion allowed by this joint is inversion (roll inward)/eversion (roll outward) as well as rear foot pronation (inward tilt of the calcaneus) and supination (outward tilt of the calcaneus) .calcaneusTalus-Subtalar JointMedial aspect of footAnkle LigamentsThere are three lateral ligaments predo

7、minantly responsible for the support and maintenance of bone apposition (best possible fit). These ligaments prevent inversion of the foot.These ligaments are:Anterior talofibular ligamentCalcaneofibular ligamentPosterior talofibular ligamentTalusFibulaTibiaAnt. Talofibular LigamentAnt.Tibiofibular

8、Lig.Post. Tibiofibular Lig.- Fibula- Ant. Talofibular Lig- TalusPeroneal TendonsCalcaneofibular LigamentCalcaneus Subtalar Joint SpaceCuboidcalcaneus-Fibular headPosterior tibiofibular LigamentAchilles TendonTalusPosterior talofibular lig.Peroneal tendonsThe deltoid ligamentThis is located on the me

9、dial aspect of the foot. It is the largest ligament but is actually comprised of several sections all fused together. This ligament prevents (eversion) of the ankle. The deltoid ligament is triangular in shape and has superficial and deep layers. It is the most difficult ligament in the foot to spra

10、in.TibiaXXXNavicular - TalusTibialis Posterior TendonTibialis Ant. TendonDeltoid LigamentXMuscles of the lower leg/ankleThere are 4 compartments that make up the lower leg that operate the motions of the ankle.Injury can cause swelling inside these compartments that can lead to tissue death or nerve

11、 damage.Anterior CompartmentAnt. TibialisExt. Hallicus LongusExtensor Digitorum LongusContains Ant. Tibial NerveContains Anterior Tibial ArteryDorsiflexors of the foot (lifts foot up)-Ant. CompLateral Compartment Everters of the foot (turns foot outward)Peroneus LongusPeroneus BrevisPeroneus Tertius

12、Contains the superficial peroneal nerve-Lat. Comp.Posterior Superficial GroupPlantar flexors (pushes foot downwards)Gastrocnemius SoleusSuperficialPosterior Posterior DeepAssists with PlantarflexionTibialis PosteriorFlexor Hallicus LongusFlexor Digitorum LongusPosterior tibial arteryPost. Deep-Asses

13、sing the Lower Leg and AnkleHistoryPast historyMechanism of injuryWhen does it hurt?Type of, quality of, duration of pain?Sounds or feelings?How long were you disabled?Swelling?Previous treatments?ObservationsPostural deviations?Is there difficulty with walking?Deformities, asymmetries or swelling?C

14、olor and texture of skin, heat, redness?Patient in obvious pain?Is range of motion normal?Percussion and compression testsUsed when fracture is suspectedPercussion test is a blow to the tibia, fibula or heel to create vibratory force that resonates w/in fracture causing painCompression test involves

15、 compression of tibia and fibula either above or below site of concernThompson testSqueeze calf muscle, while foot is extended off table to test the integrity of the Achilles tendonPositive tests results in no movement in the footHomans testTest for deep vein thrombophlebitisWith knee extended and f

16、oot off table, ankle is moved into dorsiflexionPain in calf is a positive sign and should be referred Compression TestPercussion TestHomans TestThompson TestAnkle Stability TestsAnterior drawer testUsed to determine damage to anterior talofibular ligament primarily and other lateral ligament seconda

17、rilyA positive test occurs when foot slides forward and/or makes a clunking sound as it reaches the end pointTalar tilt testPerformed to determine extent of inversion or eversion injuriesWith foot at 90 degrees calcaneus is inverted and excessive motion indicates injury to calcaneofibular ligament a

18、nd possibly the anterior and posterior talofibular ligamentsIf the calcaneus is everted, the deltoid ligament is testedAnterior Drawer TestTalar Tilt TestKleigers testUsed primarily to determine extent of damage to the deltoid ligament and may be used to evaluate distal ankle syndesmosis, anterior/p

19、osterior tibiofibular ligaments and the interosseus membraneWith lower leg stabilized, foot is rotated laterally to stress the deltoidMedial Subtalar Glide TestPerformed to determine presence of excessive medial translation of the calcaneus on the talusTalus is stabilized in subtalar neutral, while

20、other hand glides the calcaneus, mediallyA positive test presents with excessive movement, indicating injury to the lateral ligamentsKleigers TestMedial Subtalar Glide Test Functional TestsWhile weight bearing the following should be performedWalk on toes (plantar flexion)Walk on heels (dorsiflexion

21、)Walk on lateral borders of feet (inversion)Walk on medial borders of feet (eversion)Hops on injured anklePassive, active and resistive movements should be manually applied to determine joint integrity and muscle functionIf any of these are painful they should be avoidedPrevention of Injury to the A

22、nkleStretching of the Achilles tendonStrengthening of the surrounding musclesProprioceptive training: balance exercises and agilityWearing proper footwear and or tape when appropriateSpecific InjuriesAnkle Injuries: SprainsSingle most common injury in athletics caused by sudden inversion or eversion

23、 momentsInversion SprainsMost common and result in injury to the lateral ligamentsAnterior talofibular ligament is injured with inversion, plantar flexion and internal rotationOccasionally the force is great enough for an avulsion fracture to occur w/ the lateral malleolusSeverity of sprains is grad

24、ed (1-3)With inversion sprains the foot is forcefully inverted or occurs when the foot comes into contact w/ uneven surfacesGrade 1 Inversion Ankle SprainEtiologyOccurs with inversion plantar flexion and adductionCauses stretching of the anterior talofibular ligamentSigns and SymptomsMild pain and d

25、isability; weight bearing is minimally impaired; point tenderness over ligaments and no laxityManagementRICE for 1-2 days; limited weight bearing initially and then aggressive rehabTape may provide some additional supportReturn to activity in 7-10 daysGrade 2 Inversion Ankle SprainEtiologyModerate i

26、nversion force causing great deal of disability with many days of lost timeSigns and SymptomsFeel or hear pop or snap; moderate pain w/ difficulty bearing weight; tenderness and edemaPositive talar tilt and anterior drawer testsPossible tearing of the anterior talofibular and calcaneofibular ligamen

27、tsManagementRICE for at least first 72 hours; X-ray exam to rule out fx; crutches 5-10 days, progressing to weight bearingManagement (continued)Will require protective immobilization but begin ROM exercises early to aid in maintenance of motion and proprioceptionTaping will provide support during ea

28、rly stages of walking and runningLong term disability will include chronic instability with injury recurrence potentially leading to joint degenerationMust continue to engage in rehab to prevent against re-injury Grade 3 Inversion Ankle SprainEtiologyRelatively uncommon but is extremely disablingCau

29、sed by significant force (inversion) resulting in spontaneous subluxation and reductionCauses damage to the anterior/posterior talofibular and calcaneofibular ligaments as well as the capsuleSigns and SymptomsSevere pain, swelling, hemarthrosis, discolorationUnable to bear weightPositive talar tilt

30、and anterior drawerManagementRICE, X-ray (physician may apply dorsiflexion splint for 3-6 weeks)Crutches are provided after cast removalIsometrics in cast; ROM, PRE and balance exercise once outSurgery may be warranted to stabilize ankle due to increased laxity and instabilityEversion Ankle Sprains-

31、(Represent 5-10% of all ankle sprains)Etiology Bony protection and ligament strength decreases likelihood of injuryEversion force results in damage to deltoid ligament and possibly fx of the fibulaDeltoid can also be impinged and contused with inversion sprainsInjury PreventionStrength training allo

32、ws the supporting musculature to stabilize where ligaments may no longer be capable of holding the original tension between bones of the joint. This will also help prevent reinjury.Chronic Ankle Injury “the vicious cycle”Why are some people prone to ankle re-injury over and over?Most commonly due to

33、 lack of rehabilitation, but more importantly lack of neuromuscular training.This means the person has not retrained the body to recognize where the ankle and foot are during motion.This sets up the body part to be re-injured due to improper feedback to the brain about body position.Injury Preventio

34、nNeuromuscular Control is the ability to compensate for uneven surfaces or sudden change in surfaces. It is retrained by using balance and agility exercises such as a BAPS board or standing on one leg with eyes closed as well as using a single leg on a mini trampoline.Neuromuscular Control TrainingCan be enhanced by training in controlled activitiesUneven surfaces, BAPS boards, rocker boards, or Dynadisc