Chapter 15 The Ankle and Lower Leg

CHAPTER 15
The Ankle and Lower Leg
OVERVIEW
Many sports place demands on the ankle and lower leg that far exceed the
normal daily requirement of ankle injuries. Sprains in particular are among the most
common injuries in athletics. Many ankle injuries could be prevented by Achilles
tendon stretching, strengthening of key muscles, proprioceptive training, choosing
appropriate footwear, and in some cases, the application of tape or preventative
bracing. The leg is prone to a number of acute conditions such as contusions and
strains. Although fractures are less common, the mechanism can be direct trauma,
such as being struck by an implement, or through torsion forces with the foot fixed
to the ground.
A number of problems that occur in the lower leg can also be attributed to
repetitive stress and overuse. These problems include medial tibial stress syndrome
(shin splints), stress fractures, and compartment compression syndromes (including
acute, acute exertional, and chronic).
Repetitive use and overuse of the lower extremity can be contributed to
biomechanical and subsequent weight transmission discrepancies. These can lead
to problems in other regions of the body, particularly the knee and the hip. These
overuse injuries occur quite frequently in long distance runners.
Individuals working with athletes should be capable of preventing, identifying,
and treating these problems whenever possible.

LEARNING OBJECTIVES

After studying Chapter 15, the student will be able to:

Describe the bony, ligamentous, and muscular anatomy of the ankle and lower
leg.
List considerations for preventing injuries to the ankle and lower leg.
Describe the motions allowed at the talocrural joint and subtalar joint.
Identify the three types of ankle sprains and describe the mechanism of injury,
signs and symptoms, and treatment.
Describe special tests used to evaluate ankle sprains.
Explain how to assess common ankle and lower leg injuries.
Identify functional activities that can be used to assess an athlete's ability to
return to activity.
Identify the structures found within the four compartments of the lower leg.
Identify the possible causes and signs of various injuries that can occur in the
ankle and lower leg.
Explain the causes, signs of injury, and care for ankle fractures, tendinitis, stress
fractures, medial tibial stress syndrome, compartment syndrome, Achilles tendon
ruptures, and shin contusion.
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Chapter 15 The Ankle and Lower Leg

KEY TERMINOLOGY

Acute compartment syndrome - A medical emergency that occurs secondary to

direct trauma to the lower leg.
Acute exertional compartment syndrome - Occurs without trauma and can
evolve with moderate activity
Avulsion fracture - The tearing away of a bony prominence such as a tuberosity
from the rest of the bone by the forcible pull of its tendinous attachment
Chronic compartment syndrome Symptoms occur at a particular point within an
activity, and signs and symptoms cease when activity stops.
Dorsiflexion - Movement of the foot/ankle in an upward position bringing the toes
up.
Eversion - Movement of the foot outward. It is a relatively uncommon mechanism
of injury for the ankle
Inversion - Movement of the foot inward. It is the most common mechanism of
injury for the ankle.
Plantarflexion - Pointing the toes downward
Shin splints Anterior lower leg pain
Subtalar Joint The joint formed by the talus and calcaneous allowing for
inversion and eversion of the ankle
Talocrural Joint The joint formed by the lateral malleolus, medial malleolus, and
the talus. Allows for dorsiflexion and plantarflexion of the ankle

DISCUSSION QUESTIONS
1. Describe the anatomy of the ankle. What mechanisms of injury can cause
significant damage?
2. How can ankle injuries be prevented?
3. How do you manage acute injuries in the ankle region?
4. How do you manage chronic injuries in the ankle region?
5. Contrast the management of first-, second-, and third-degree ankle sprains.
6. How can the anterior and posterior tibiofibular ligament be torn?
7. Describe acute sports injuries to the Achilles tendon including etiology and
symptoms and signs.
8. Which conditions may occur to the lower leg? Can any of them be serious
enough to cause permanent damage?
9. Describe the four different compartments in the lower leg. Differentiate between
the three different types of compartment syndromes.

CLASS ACTIVITIES
1. Students should pair up and identify as well as palpate the bony landmarks,
ligamentous structures, and muscle tendons associated with the ankle and lower
leg as they are discussed in class.
2. Present the signs and symptoms of an injury or condition. Have the students
identify it and explain how to manage it.
3. In groups of four or five, have students interview one athlete who has
experienced an injury to the ankle or lower leg. From their interaction, the group
can submit a 3-to-5 page typewritten report that covers as many of the following
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Chapter 15 The Ankle and Lower Leg

evaluation procedures as possible:

a. History
b. Initial evaluation of injured structures
c. Observational data gathered immediately after the injury
d. Bony and soft tissue that were palpated
e. Extent of the athlete's range of motion (or lack of it)
f. Stress tests or special tests that were performed to determine the extent of
the injury
g. Any circulatory and neurological tests that were performed
h. Immediate management (i.e., compression, splinting, etc.)
i. Follow-up care (doctor's referral, surgery, etc.)
j. Planned rehabilitation program and various exercises used to prepare the
athlete for full participation

WORKSHEET ANSWERS
Matching
1.
2.
3.
4.

e
f
j
c

5.
6.
7.
8.

g
h
i
d

9. m
10. b
11. a
12. k

13. l
14. n

Short Answer
15.Anterior, lateral, superficial posterior, and deep posterior
16.Medial tibial stress syndrome
17.Inversion, eversion, and high ankle sprains
18.Limit or restrict activity, stretch the Achilles tendon aggressively, insert a heel lift
under the calcaneous, use taping techniques to provide support to the Achilles,
and use anti-inflammatory medication.
19.Have the athlete walk on toes, walk on heels, hop on affected foot without the
heel touching the ground, stopping and starting running activities, changing
directions rapidly, and run figure 8s.
20.Strain of the posterior tibialis muscle and its fascial sheath, faulty foot
mechanics, tightness in the heel cord, muscle weakness, improper footwear, and
training errors involving changes in running surfaces.
Listing
21.Deep aching pain
22.Tightness and swelling of the involved compartment
23.Pain with passive stretching of the involved muscles
24.Reduced circulation in the foot
25.Sensory changes in the foot
26.Achilles tendon complex stretching
27.Strength training
28.Neuromuscular control
29.Appropriate footwear
30.Preventative ankle taping and bracing
31.Extensor digitorum longus
32.Extensor hallucis longus
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Chapter 15 The Ankle and Lower Leg

33.Tibialis anterior
Essay
34-39.See page 243

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Chapter 15 The Ankle and Lower Leg

NAME ______________________________
SECTION__________

CHAPTER 15 WORKSHEET
The Ankle and Lower Leg
MATCHING: Match each item with the appropriate response.
_____ 1. Anterior
talofibular
ligament
_____ 2. Anterior
tibiofibular
ligament
_____ 3. Calcaneous
_____ 4. Calcaneofibular
ligament
_____ 5. Deltoid ligament
_____ 6. Fibula
_____ 7. Lateral malleolus
_____ 8. Lateral
talocalcaneal
ligament
_____ 9. Medial malleolus
_____ 10. Posterior
talofibular
ligament
_____ 11. Posterior
tibiofibular
ligament
_____ 12. Subtalar joint
_____ 13. Talus
_____ 14. Tibia
SHORT ANSWER: Answer the following with a brief response.
15.What are the four compartments in the lower leg?
16.Which condition can progress into a stress fracture if not properly treated?
17.What are the three types of ankle sprains?
18.How is Achilles tendinitis managed?
19.What activities must be included in a functional examination of the ankle?
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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 15 The Ankle and Lower Leg

20.What are the causes of medial tibial stress syndrome?

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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 15 The Ankle and Lower Leg

LISTING: List five characteristic signs of a compartment syndrome.

21.
22.
23.
24.
25.
Name five ways to prevent injuries to the lower leg and ankle.
26.
27.
28.
29.
30.
List the muscles responsible for dorsiflexion of the foot/ankle.
31.
32.
33.
ESSAY:
34-39.Describe the care for a lateral ankle sprain.

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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.