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Anatomy and Injury of the Lateral Ankle

Lateral Ankle

Anatomy of the ankle compartment includes:

  • Tibia
  • Fibula

it also includes:

  • Tibialis anterior  tendon
  • Extensor hallucis longus tendon
  • Extensor digitorum longus tendons
  • Superior and inferior extensor retinaculum
    There are many structures present at the anterior aspect of it. These structures are often susceptible to injury.
Lateral Ankle

Common Injuries and Conditions Around the Anterior Ankle

  1. Anterolateral Impingement
    Painful limitation of the full range of ankle motion due to soft tissue or osseous(bony) pathology. Soft tissue thickening was commonly seen in athletes with prior trauma that extends into the ankle joint.
    Tibial bone spur impinging on the tailless can become a source of chronic ankle pain and limitation of ankle motion in athletes.
    Osseous (bony)
    .Spur on the anterior lip of the tibia contacting the talus during dorsiflexion.
  2.  Arthritis of the ankle joint
    .commonly the result of a prior injury or inflammation to the ankle joint.
    It can usually be diagnosed with an examination and x-ray.
  3.  Osteochondritis Dissecans of the Talus
    .chip-type fracture that usually occurs with severe ankle sprains.
    .causes pain, swelling, and stiffness of the ankle joint.
    .x-rays, CT scans or MRI are commonly used for diagnosis.
  4.  Tibialis Anterior Tendonitis
    .anterior tibialis tendonitis is an overuse condition common in runners.
    .a common injury that usually accompanies anterior shin splints.
    .if this tendon is strained, pain and tenderness will be felt upon active
    dorsiflexion or when the tendon is touched.
The cartilage of the knee is complex and is made

Anatomy and Injury of the Medial Ankle

Anatomy and injury of the medial ankle includes:

  • Tibia
  • Tibialis posterior tendon(TP)
  • Flexor digitorum longus tendon(FDL)
  • Flexor hallucis longus tendon(FHL)
  • Posterior tibial artery(PTA) and nerve(PTN)
  • Flexor retinaculum
  • Achilles tendon

Bursa
There are many structures present at the medial aspect of the ankle. These structures are often susceptible to injury.
Common Injuries and Conditions Around the Medial Ankle

1. Posterior tibial tendonitis or rupture
posterior tibial tendon problems can occur from:

  • overuse activities
  • degeneration
  • trauma

the posterior tibial tendon is one of the major supporting structures of the foot. The tendon helps to keep the arch of the foot in its normal position. When there’s insufficiency or rupture of the tendon, the arch begins to sag, and a flatfoot deformity can occur with associated tight Achilles tendon.
The posterior tibial tendon rupture occurs distal to the medial malleolus. This area is hypovascular.
Clinical Presentation
painful swelling on the posteromedial aspect of the ankle.

  • unable to perform a single leg toe raise
  • too many toes
  • flat foot
  • fixed deformity of the hindfoot

Four Stages of Posterior Tibial Tendon Rupture

Rupture of the posterior tibial tendon could be missed!

2. Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is compression of the tibial nerve in the
tarsal tunnel. The flexor retinaculum covers the nerve.
Tarsal tunnel syndrome is similar to compression of the median nerve in the carpal tunnel.
Causes include:

  • ganglia
  • accessory muscles
  • soft tissue mass
    Differential diagnoses

may include:

  • herniated disc
  • stress fracture or
  • plantar fasciitis

clinical findings of tarsal tunnel syndrome include:

  • pain on the medial side of the foot.
  • pain worse with dorsiflexion due to tension of the nerve.
  • parathesia and numbness of the foot.
  • positive tunnel’s sign behind the medial malleolus.
  • EMG is usually not helpful.


3.Flexor Hallucis Tendonitis
Pain, swelling, and weakness posterior to the medial malleolus. Dorsiflexion of the big toe may be reduced when the ankle is placed in dorsiflexion. Triggering and pain along the tendon sheath may also occur with toe flexion. Often occurs in activities such as ballet dancing, in which plantar flexion is necessary.

4. Rupture of the Deltoid Ligament
The deltoid ligaments are the primary stabilizers of the ankle
joint. The deltoid ligaments provide support to prevent the ankle from averting. An isolated version sprain with a tear of the deltoid ligaments is a rare injury.
There are many structures present at the posterior aspect of the ankle. These structures are often susceptible to injury.

Common Injuries and Conditions Around the Posterior Ankle

1. Posterior Ankle and Impingement (Os Trigonum).

  • posterior talar impingement of the os Trigonum or large process of the tailless(Stieda Syndrome).
  • non united piece of accessory bone seen posterior to the talus.
  • common among athletes such as ballet dancers.
  • tenderness in the posterolateral aspect of the posterior to the peroneal spacially with passive plantar flexion.
  • may be seen in association with flexor Hallucis Longus tenosynovitis.

2. Flexor Hallucis Longus Tenosynovitis

  • condition associated with ballet dancing in which extreme plantar flexion is necessary.
  • swelling and pain are posterior to the medial malleolus.
  • triggering with toe flexion.
  • dorsiflexion of the big toe is less big when it is dorsiflexed.

3. Achilles Tendonitis

  • irritation and inflammation due to overuse.
  • pain, swelling, and tears within the tendon.
  • usually treated with therapy and injection.
  • do not inject inside the tendon.
  • was rarely treated with surgery.

4. Achilles Tendon Rupture
Achilles tendon can become prone to rupture with age, lack of use, or aggressive exercises.
Achilles

  • rupture is diagnosed by the Thompson test and MRI
  • treatment may be conservative without surgery by using a cast or boot, however, the re-rupture rate is high.
  • surgery is done by approximation of the torn ends, however, there is a risk of infection, skin and wound complications with surgery.
    The bony structures of the ankle consist of the Tibia, Fibula, Talus and calcaneus. Ligaments of the ankle include the Syndesmosis, Anterior Tibiofibular Ligament and the Posterior TibioFibular Ligament.
  • ligaments Around the Ankle
  • Anterior talofibular Ligament
  • Calcaneo-Fibular Ligament
  • Posterior Talofibular Ligament

within the lateral compartment of the ankle, you can see the peroneus Brevis tendon. The peroneus Longus tendon and the Achilles tendon. air2 bursae are located near the insertion of the Achilles tendon into the calcaneus. The superior and inferior peroneal retinacula are two bands that would support the tendons of the peroneus Longus and Brevis muscles and finally, the sural nerve passes along the lateral ankle.
There are many structures present on the lateral side of the ankle. These are often susceptible to injury. Diagnosis of these injuries can
be confusing, and many of these injuries can be missed.
Diagnosis of a sprained ankle may be the wrong diagnosis!
Common Injuries and Conditions Around the lateral Ankle
1. Ankle Sprain
2. High Ankle Sprain or Syndesmotic Injury
3. Peroneal Tendon Subluxation
4.Rupture of the Peroneus Longus Tendon
5. Peroneal tendonitis
6.Anterior Process of the Calcaneus Fracture
7. Lateral Process of the Talus Fracture
8. Achilles Tendonitis
This is for educational purposes only. Please consult your doctor before you make any decision about your medical care you.

Leg Length Discrepancy
Physio knowledge

Leg Length Discrepancy

Leg length discrepancy is a common condition with diverse causes.

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