踝關節(jié)生物力學ppt課件

1、Ankle,Anatomical StructuresTibiaFibularTalus,Tibia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 m

2、edial aspect of the mortise or the (hole) that the talus lies within.這是最強壯的小腿骨。它具有承重和形成了內側支撐面(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 sm

3、aller 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 mortise. 這是小腿的一根更小的外側骨頭。 它不承重，它是踝關節(jié)的外側支撐面。,Fi

4、bula--->,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。并組成踝關節(jié)外側面。 并低于內側面,_______________________

5、,,,Talus,This bone transmits the forces from the calcaneus up into the tibia and also allows the articulations of Plantar Flexion (pointing the foot downward) Dorsiflexion or pulling the foot upward and Inversion (rollin

6、g the foot inward) and Eversion (rolling the foot outward),?------ Talus,Talocrural Joint,The formation of the mortise (a hole) by the medial malleoli (Tibia) and lateral malleoli (fibula) with the talus lying in betw

7、een them makes up the talocrural joint. This is a hinge joint and allows most of the motion with plantarflexion and dorsiflexion.,________________________________,Talocrural Jt.,Subtalar Joint,The articulation between

8、 the talus and the calcaneus is referred to as the subtalar joint. Motion allowed by this joint is inversion (roll inward)/eversion (roll outward) as well as rear foot pronation (inward tilt of the calcaneus) and supina

9、tion (outward tilt of the calcaneus) .,calcaneus,Talus,?---Subtalar Joint,Medial aspect of foot,Ankle Ligaments,There are three lateral ligaments predominantly responsible for the support and maintenance of bone appositi

10、on (best possible fit). These ligaments prevent inversion of the foot.These ligaments are:Anterior talofibular ligamentCalcaneofibular ligamentPosterior talofibular ligament,Talus,Fibula,Tibia,Ant. Talofibular Ligam

11、ent,Ant.Tibiofibular Lig.,Post. Tibiofibular Lig.,<- Fibula,<- Ant. Talofibular Lig,<- Talus,Peroneal Tendons,Calcaneofibular Ligament,Calcaneus,? Subtalar Joint Space,Cuboid,calcaneus,<-Fibular head,Posteri

12、or tibiofibular Ligament,Achilles Tendon,Talus,Posterior talofibular lig.,Peroneal tendons,The deltoid ligament,This is located on the medial aspect of the foot. It is the largest ligament but is actually comprised of s

13、everal 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 spr

14、ain.,Tibia,X,X,X,Navicular ---?,?-- Talus,Tibialis Posterior Tendon,Tibialis Ant. Tendon,Deltoid Ligament,X,,,,,Muscles of the lower leg/ankle,There are 4 compartments that make up the lower leg that operate the motions

15、 of the ankle.Injury can cause swelling inside these compartments that can lead to tissue death or nerve damage.,Anterior Compartment,Ant. TibialisExt. Hallicus LongusExtensor Digitorum LongusContains Ant. Tibial Ner

16、veContains Anterior Tibial ArteryDorsiflexors of the foot (lifts foot up),<-Ant. Comp,Lateral Compartment,Everters of the foot (turns foot outward)Peroneus LongusPeroneus BrevisPeroneus TertiusContains the super

17、ficial peroneal nerve,<-Lat. Comp.,Posterior Superficial Group,Plantar flexors (pushes foot downwards)Gastrocnemius Soleus,SuperficialPosterior?,Posterior Deep,Assists with PlantarflexionTibialis PosteriorFlexor

18、Hallicus LongusFlexor Digitorum LongusPosterior tibial artery,Post. Deep---?,Assessing the Lower Leg and Ankle,HistoryPast historyMechanism of injuryWhen does it hurt?Type of, quality of, duration of pain?Sounds o

19、r feelings?How long were you disabled?Swelling?Previous treatments?,ObservationsPostural deviations?Is there difficulty with walking?Deformities, asymmetries or swelling?Color and texture of skin, heat, redness?P

20、atient 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 fra

21、cture causing painCompression test involves 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

22、 tendonPositive tests results in no movement in the footHoman’s testTest for deep vein thrombophlebitisWith knee extended and foot off table, ankle is moved into dorsiflexionPain in calf is a positive sign and shoul

23、d be referred,Compression Test,Percussion Test,Homan’s Test,Thompson Test,Ankle Stability TestsAnterior drawer testUsed to determine damage to anterior talofibular ligament primarily and other lateral ligament secondar

24、ilyA 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 calca

25、neus is inverted and excessive motion indicates injury to calcaneofibular ligament and possibly the anterior and posterior talofibular ligamentsIf the calcaneus is everted, the deltoid ligament is tested,Anterior Drawer

26、 Test,Talar Tilt Test,Kleiger’s testUsed primarily to determine extent of damage to the deltoid ligament and may be used to evaluate distal ankle syndesmosis, anterior/posterior tibiofibular ligaments and the interosseu

27、s 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 stab

28、ilized in subtalar neutral, while other hand glides the calcaneus, mediallyA positive test presents with excessive movement, indicating injury to the lateral ligaments,Kleiger’s Test,Medial Subtalar Glide Test,,Function

29、al TestsWhile weight bearing the following should be performedWalk on toes (plantar flexion)Walk on heels (dorsiflexion)Walk on lateral borders of feet (inversion)Walk on medial borders of feet (eversion)Hops on in

30、jured anklePassive, active and resistive movements should be manually applied to determine joint integrity and muscle functionIf any of these are painful they should be avoided,Prevention of Injury to the Ankle,Stretch

31、ing of the Achilles tendonStrengthening of the surrounding musclesProprioceptive training: balance exercises and agilityWearing proper footwear and or tape when appropriate,Specific Injuries,Ankle Injuries: SprainsSi

32、ngle most common injury in athletics caused by sudden inversion or eversion momentsInversion SprainsMost common and result in injury to the lateral ligamentsAnterior talofibular ligament is injured with inversion, pla

33、ntar flexion and internal rotationOccasionally the force is great enough for an avulsion fracture to occur w/ the lateral malleolus,Severity of sprains is graded (1-3)With inversion sprains the foot is forcefully inver

34、ted or occurs when the foot comes into contact w/ uneven surfaces,Grade 1 Inversion Ankle SprainEtiologyOccurs with inversion plantar flexion and adductionCauses stretching of the anterior talofibular ligamentSigns a

35、nd SymptomsMild pain and disability; 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

36、provide some additional supportReturn to activity in 7-10 days,Grade 2 Inversion Ankle SprainEtiologyModerate inversion force causing great deal of disability with many days of lost timeSigns and SymptomsFeel or hea

37、r 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 ligamentsManagementRICE for

38、 at least first 72 hours; X-ray exam to rule out fx; crutches 5-10 days, progressing to weight bearing,Management (continued)Will require protective immobilization but begin ROM exercises early to aid in maintenance of

39、motion and proprioceptionTaping will provide support during early stages of walking and runningLong term disability will include chronic instability with injury recurrence potentially leading to joint degenerationMust

40、 continue to engage in rehab to prevent against re-injury,Grade 3 Inversion Ankle SprainEtiologyRelatively uncommon but is extremely disablingCaused by significant force (inversion) resulting in spontaneous subluxati

41、on and reductionCauses damage to the anterior/posterior talofibular and calcaneofibular ligaments as well as the capsuleSigns and SymptomsSevere pain, swelling, hemarthrosis, discolorationUnable to bear weightPositi

42、ve talar tilt and anterior drawer,ManagementRICE, 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

43、 may be warranted to stabilize ankle due to increased laxity and instability,Eversion Ankle Sprains-(Represent 5-10% of all ankle sprains),Etiology Bony protection and ligament strength decreases likelihood of injury

44、Eversion force results in damage to deltoid ligament and possibly fx of the fibulaDeltoid can also be impinged and contused with inversion sprains,,,,Injury Prevention,Strength training allows the supporting musculature

45、 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

46、 to ankle re-injury over and over?Most commonly due to 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

47、are during motion.This sets up the body part to be re-injured due to improper feedback to the brain about body position.,Injury Prevention,Neuromuscular Control is the ability to compensate for uneven surfaces or sudden

48、 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 Training

49、Can be enhanced by training in controlled activitiesUneven surfaces, BAPS boards, rocker boards, or Dynadiscs can also be utilized to challenge athlete,Injury prevention,Tight Achilles tendons can predispose someone to