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Ankle Lower Leg Lab2

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					Ankle, Lower Leg Lab
BONY PALPATION:
Anterior Aspect
fibular head
fibular shaft
tibial plateau
tibial shaft
Posterior Aspect
medial malleolus
lateral malleolus
calcaneus
SOFT TISSUE PALPATION:
Lateral Aspect
lateral compartment (peroneals)
Note: B is peroneus brevis and C is peroneus tertius
anterior talofibular ligament
calcaneofibular ligament
posterior talofibular ligament
Medial Aspect
               deep posterior muscles
•   posterior tibialis muscle; flexor digitorum longus muscle; flexor hallucis muscle
deltoid ligament:
anterior tibiotalar
deltoid ligament:
 tibionavicular
deltoid ligament:
 tibiocalcaneal
 deltoid ligament
posterior tibiotalar
Anterior Aspect
       anterior compartment
• anterior tibialis muscle
• extensor hallucis longus muscle
• extensor digitorum longus muscle
anterior tibiofibular ligament
Posterior Aspect
          superficial posterior
             compartment
• gastrocnemius muscle
        superficial posterior
           compartment
• soleus muscle
Achilles tendon
posterior tibiofibular ligament
calcaneal bursa
retrocalcaneal bursa
SPECIAL TESTS
              Anterior Drawer Test
Positioning the Athlete:
   The athlete is seated on a table with the knee flexed to 90 degrees and the
   involved foot relaxed in slight plantar flexion. The examiner stabilizes the
   tibia and fibula with one hand and grasps the calcaneus with the other.
Action:
   While assuring stabilization of the distal tibia and fibula, the examiner
   applies an anterior force to the calcaneus and talus.
Positive Finding:
   Anterior translation of the talus away from the ankle mortise that is greater
   on the involved side, as opposed to the noninvolved side, indicates a
   positive sign for a possible anterior talofibular ligament sprain.
Anterior drawer test
         Talar Tilt Test- Inversion
Positioning the Athlete:
   The athlete lies on the uninvolved side on a table with the involved
   foot relaxed and the knee flexed to approximately 90 degrees. Make
   sure to stabilize the distal tibia with one hand with grasping the talus
   with the other.
Action:
   The examiner first places the foot in the neutral plantar flexion and
   dorsiflexion position (anatomical position). Then tilt the talus into an
   adducted position.
Positive Finding:
   Range of motion in the adducted position on the involved foot
   greater than that of the noninvolved foot reveals a positive test. This
   may be indicative of a tear of the calcaneofibular ligament of the
   ankle.
Talar tilt test-inversion
         Talar Tilt Test- Eversion
Positioning the Athlete:
   The athlete lies on the involved side on a table with the involved foot
   relaxed and the knee flexed to approximately 90 degrees. Make
   sure to stabilize the distal tibia with one hand with grasping the talus
   with the other.
Action:
   The examiner first places the foot in the neutral plantar flexion and
   dorsiflexion position (anatomical position). Then tilt the talus into an
   abducted position.
Positive Finding:
   Range of motion in the abducted position on the involved foot
   greater than that of the noninvolved foot reveals a positive test. This
   may be indicative of a tear of the deltoid ligament of the ankle.
Talar tilt test-eversion
              Kleiger Test-Deltoid
Positioning the Athlete:
   The athlete sits with the leg off of the table and the knee at
   approximately 90 degrees of flexion. The examiner stabilizes the
   distal tibia and fibula with one hand and the medial and inferior
   aspects of the calcaneus with the other. The ankle should be in a
   neutrally aligned position.
Action:
   The examiner applies an externally rotated force upon the
   calcaneus.
Positive Finding:
   Complaints of pain along the medial aspect of the ankle when an
   externally rotated force is applied in neutral dorsiflexion may indicate
   a deltoid ligament injury.
Kleiger test-deltoid
      Kleiger Test- Syndesmosis
Positioning the Athlete:
   The athlete sits with the leg off of the table and the knee at
   approximately 90 degrees of flexion. The examiner stabilizes the
   distal tibia and fibula with one hand and the medial and inferior
   aspects of the calcaneus with the other. The ankle should be in a
   dorsiflexed position.
Action:
   The examiner applies an externally rotated force upon the
   calcaneus.
Positive Finding:
   Pain may be present medially and slightly more proximally,
   indicating distal tibiofibular syndesmotic involvement.
Kleiger test-syndesmosis
                Compression Test
Positioning the Athlete:
   The athlete lies supine with the affected leg extended and the
   ankle/foot just off the examining table. The examiner stands next to
   the athlete’s leg and notes where the pain originates.
Action:
   The examiner squeezes the tibia and fibula together at some point
   away from the painful area.
Positive Finding:
   Pain at the site of injury my be indicative of a fracture. Compression
   of the two bones may exaggerate pain at the fracture site.
Compression test
Bump test
                 Homan’s Test
Positioning the Athlete:
  The athlete lies supine on a table.
Action:
  With the knee of the involved side fully extended, the
  examiner passively dorsiflexes the subject’s foot.
Positive Finding:
  A production of pain in the calf that is brought upon by
  the passive stretch of the foot into a dorsiflexed position
  is a positive sign for thrombophlebitis.
Homan’s test
                  Thompson Test
Positioning the Athlete:
   The athlete lies prone on a table with the heels placed over the edge
   of the table.
Action:
   With the gastrocnemius-soleus complex relaxed, the examiner
   squeezes the belly of these muscles.
Positive Finding:
   When squeezing the calf muscles, a normal response would be to
   have the foot plantar flex. Therefore, an absence of plantar flexion
   upon squeezing would be a positive test, indicating a possible
   rupture of the Achilles’ tendon.
Thompson test

				
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