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The Ankle Joint

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on 5 January 2013

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Transcript of The Ankle Joint

The Ankle Joint . . Ankle Bones The bones responsible for the ankle joint are:
-Fibula
-Tibia
-Calcaneus
-Talus Muscle Action Dorsiflexsion (sagittal plane) -Tibialis Anterior (prime mover): This muscle is the strongest dorsiflexor and also assists in the inversion of the foot. When the foot is on the ground, tibialis anterior is helpful in accommodating to uneven ground by adjusting the position of the leg.

-Extensor Hallucis Longus: As its name suggests, this muscle extends (= raises) the big toe or hallux. The muscle has an extensive origin from the fibula and the interosseous membrane between fibula and tibia. The muscle extends the big toe and also dorsiflexes the whole foot at the ankle joint.

-Extensor Digitorum Longus: This muscle extends (raises) all the toes with the exception of the big toe (hallux). The muscle also assists in dorisiflexes the whole foot at the ankle joint. Plantar Flexion (sagittal plane) -Gastrocnemius (antagonist of tibialis anterior):
Gastrocnemius is calf muscle which plantar flexes the ankle, and gives power at the "push off" phase of walking.

-Soleus
The soleus is another superficial calf muscle which powerfully plantar flexes the ankle(e.g. as in standing on tip-toe) and assists in plantar flexion during walking. The soleus also resists the tendency to fall forwards at the ankle when standing upright. Plantar Flexion (sagittal plane) Continued -Tibialis posterior: This muscle is in the posterior compartment of the leg and originates from both the tibia and fibula and the interosseous membrane. Its tendon passes into the foot behind the medial malleolus. It is an invertor and a plantar flexor of the foot.

-Flexor digitorum longus: As its name suggests, this muscle flexes the toes (with the exception of the big toe) i.e. it makes them point down.

-Flexor hallucis longus: flexes distal phalanx of big toe and assists in plantar flexion.
The tendon of peroneus longus and brevis evert the ankle and assists in plantar flexion. Eversion (coronal plane):
-Peroneus longus and peroneus brevis

Inversion (coronal plane):
-Tibialis posterior Ankle Injury Ankle injuries can happen to anyone at any age.

The most common ankle injures are sprains (more common) and fractures.

Ankle sprains and fractures are common sports injuries. Ankle Sprain A sprain is an injury to the ligaments when they are stretched beyond their normal range of motion. It may take a few weeks to many months to heal completely.
There are two types of sprain:

Inversion sprains:
Inversion sprains, commonly called “rolling over on your ankle” are sprains of the lateral ligaments of the ankle. When the ankle is plantar flexed, it is most unstable. As a result, sometimes when the ankle is plantar flexed (such as jumping) it does not return to neutral position causing the ankle to invert and lead to inversion sprain. This type of sprain is the most common especially in sports that involve jumping and quick changes of direction (e.g. basketball, soccer).

Eversion sprains:
This type of sprain is very rare due to the strength of the ligament that is responsible for this movement. The most severe eversion sprain is the Pott’s Fracture which is the break of the tip of the medial malleolus and the break of the fibula. Ankle Fracture X-ray of medial malleolus fracture and its surgical repair. -Infection:
Infections can occur at a joint and lead to the damage of the cartilage cells. The cartilage cells at a joint cannot grow back and the damage is permanent.



-Arthritis:
Ankle arthritis occurs when the cartilage at the joint between the tibia and the talus becomes worn out (tibiotalar joint). Ankle arthritis is most commonly the result of a prior injury to the ankle joint. It can also be caused by heavy body weight and prior infection at the joint. Resistance Training Exercises It improves the strength of the ankle muscles as well as ligaments and therefore helps prevent injuries and improve performance.

Each of the following exercises can begin with one set of ten repetitions (unless doctor has told otherwise) and gradually built to three sets of ten repetitions. Plantar and Dorsiflextion To perform the plantar flexion stretch, sit with knee straight and point toes toward the floor. Stretch until it starts to feel uncomfortable. Hold for 15 seconds, then release. This stretch also can be performed while standing up, moving between having your feet flat on the ground and standing on tip toes. The reverse of this stretch (dorsiflexion) can be done by pulling the toes up toward the tibia which stretches the back side of the ankle. Dorsiflexion Stretch with Band This exercise can be done by using a rigid band or a towel to bring toes towards the head as demonstrated. The exercise stretches the back of the calf (gastrocnemius and soleus) and the Achilles tendon and contracts the tibialis anterior. Inversion and Eversion of the Ankle Move the foot and ankle in and out as far as possible and comfortable without pain. Ankle Rotations Ankle rotations can help with ankle flexibility. Sitting on a bench or chair, raise foot off the floor and point toe. Continue pointing toes while rotating foot in a circle to the right. Repeat the rotation in the opposite direction as well. A fun variation on this exercise is to point your toes and trace each letter of the alphabet (lower case and upper case) in the air. Tibia Fibula Talus The P.I.E.R principle (Pressure, Ice, Elevation, Restriction) can be used for any type of ankle injury; it reduces swelling and leads to early diagnosis and quick recovery. Treatment: Different levels of lateral malleolus fracture. The lateral malleolus is the bump on the outer part of the ankle and is made up of the fibula bone. A fracture is a break in a bone. The decrease in stability of the ankle when the foot is plantarflexed is one reason why high heels are unstable, and also why you are less stable when walking down hill than walking up hill. The tendon of soleus merges with that of gastrocnemius as the Achilles tendon to attach to the posterior surface of the calcaneus . Infection and arthritis are other possible ankle injuries. Ligaments of the ankle joint The ligaments of the ankle joint are comprised mainly of the collateral ligaments, both medial (inner) and lateral (outer). These are extremely important in the stability of the ankle itself:

A. Lateral Collateral Ligament:

The lateral collateral ligament prevents excessive inversion. It is weaker than the deltoid ligament. Sprains to the lateral ligament are much more common. It is made up of 3 individual bands:

-Anterior talofibular ligament (AFTL)
-Calcaneofibular ligament (CFL)
-Posterior talofibular Ligament (PTFL)

B. Medial Collateral Ligament:

The medial ligament also known as the deltoid ligament is considerably thicker than the lateral ligament. Ankle Sprain . Ankle Fracture .
-The ankle joint consists of the true ankle joint and the subtalar joint.
- The true ankle joint is a modified synovial hinge joint. It is composed of the distal ends of the tibia and fibula resting on the talus to form the ankle joint.
- The subtalar joint is formed from the talus and calcaneus.
-The inside part of the tibia located at the medial side of the talus is called medial malleolus
-End part of the fibula located at the lateral side of the talus is called the lateral malleolus -The true ankle joint allows dorsiflexion and plantar flexion -The subtalar joint allows eversion and inversion. Ankle Muscle Bibliography Hoagland,T.(2011, June 29). Ankle joint anatomy. Retrieved from
http://emedicine.medscape.com/article/1946201-overview

Walden, M. (n.d.). http://www.sportsinjuryclinic.net/anatomy/ankle-anatomy. Retrieved from http://www.sportsinjuryclinic.net/anatomy/ankle-anatomy

Grana MD MPH, W. A. (2011, September 6). Orthoinfo. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00209

Cunha, J. (2012, March 09). Emedicinehealth. Retrieved from http://www.emedicinehealth.com/ankle_sprain/article_em.htm

orthoinfo.org. (2012, September). Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00150

American Academy of Orthopaedic Surgeons. (2011, Sept). Orthoinfo. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00391

Bernier, M. (2011, Oct). Exercises for ankle strengthening. Retrieved from http://www.physioroom.com/experts/asktheexperts/answers/qa_mb_20040315.php
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