踝關(guān)節(jié)生物力學(xué)

關(guān)于踝關(guān)節(jié)生物力學(xué)AnkleAnatomicalStructuresTibiaFibularTalus第2頁,共55頁，星期六，2024年，5月Tibia脛骨Thisisthestrongestlargestboneofthelowerleg.Itbearsweightandthebonecreatesthemedialmalleoli(thebumpontheinsideofyourankle)whichisthemedialaspectofthemortiseorthe(hole)thatthetaluslieswithin.這是最強(qiáng)壯的小腿骨。它具有承重和形成了內(nèi)側(cè)支撐面(組成腳踝的凹面)，能與距骨相契合第3頁,共55頁，星期六，2024年，5月TheTibiaisthemedialboneandlargestboneofthelowerleg.Tibia脛骨是小腿的最大和支撐骨的骨頭。第4頁,共55頁，星期六，2024年，5月Fibula腓骨Thisisasmallerlateralboneofthelowerleg.Itisnotvitalforweightbearingyetitcomprisesthelateral(outside)aspectofthemalleoliandmakesupthelateralaspectofthemortise.這是小腿的一根更小的外側(cè)骨頭。它不承重，它是踝關(guān)節(jié)的外側(cè)支撐面。第5頁,共55頁，星期六，2024年，5月Fibula--->Thefibulaislongerandnonweightbearing.Itmakesupthelateralaspectofthemortise.Thelateralmalleoliliesinferior(below)themedialmalleoli它比較長和不承重。并組成踝關(guān)節(jié)外側(cè)面。并低于內(nèi)側(cè)面_______________________第6頁,共55頁，星期六，2024年，5月TalusThisbonetransmitstheforcesfromthecalcaneusupintothetibiaandalsoallowsthearticulationsofPlantarFlexion(pointingthefootdownward)DorsiflexionorpullingthefootupwardandInversion(rollingthefootinward)andEversion(rollingthefootoutward)第7頁,共55頁，星期六，2024年，5月------Talus第8頁,共55頁，星期六，2024年，5月TalocruralJointTheformationofthemortise(ahole)bythemedialmalleoli(Tibia)andlateralmalleoli(fibula)withthetaluslyinginbetweenthemmakesupthetalocruraljoint.Thisisahingejointandallowsmostofthemotionwithplantarflexionanddorsiflexion.第9頁,共55頁，星期六，2024年，5月________________________________TalocruralJt.第10頁,共55頁，星期六，2024年，5月SubtalarJointThearticulationbetweenthetalusandthecalcaneusisreferredtoasthesubtalarjoint.Motionallowedbythisjointisinversion(rollinward)/eversion(rolloutward)aswellasrearfootpronation(inwardtiltofthecalcaneus)andsupination(outwardtiltofthecalcaneus).第11頁,共55頁，星期六，2024年，5月calcaneusTalus---SubtalarJointMedialaspectoffoot第12頁,共55頁，星期六，2024年，5月AnkleLigamentsTherearethreelateralligamentspredominantlyresponsibleforthesupportandmaintenanceofboneapposition(bestpossiblefit).Theseligamentspreventinversionofthefoot.Theseligamentsare:AnteriortalofibularligamentCalcaneofibularligamentPosteriortalofibularligament第13頁,共55頁，星期六，2024年，5月TalusFibulaTibiaAnt.TalofibularLigamentAnt.TibiofibularLig.第14頁,共55頁，星期六，2024年，5月Post.TibiofibularLig.<-Fibula<-Ant.TalofibularLig<-TalusPeronealTendonsCalcaneofibularLigamentCalcaneus

SubtalarJoint SpaceCuboid第15頁,共55頁，星期六，2024年，5月calcaneus<-FibularheadPosteriortibiofibularLigamentAchillesTendonTalusPosteriortalofibularlig.Peronealtendons第16頁,共55頁，星期六，2024年，5月ThedeltoidligamentThisislocatedonthemedialaspectofthefoot.Itisthelargestligamentbutisactuallycomprisedofseveralsectionsallfusedtogether.Thisligamentprevents(eversion)oftheankle.Thedeltoidligamentistriangularinshapeandhassuperficialanddeeplayers.Itisthemostdifficultligamentinthefoottosprain.第17頁,共55頁，星期六，2024年，5月TibiaXXXNavicular---

--TalusTibialisPosteriorTendonTibialisAnt.TendonDeltoidLigamentX第18頁,共55頁，星期六，2024年，5月Musclesofthelowerleg/ankleThereare4compartmentsthatmakeupthelowerlegthatoperatethemotionsoftheankle.Injurycancauseswellinginsidethesecompartmentsthatcanleadtotissuedeathornervedamage.第19頁,共55頁，星期六，2024年，5月第20頁,共55頁，星期六，2024年，5月AnteriorCompartmentAnt.TibialisExt.HallicusLongusExtensorDigitorumLongusContainsAnt.TibialNerveContainsAnteriorTibialArteryDorsiflexorsofthefoot(liftsfootup)<-Ant.Comp第21頁,共55頁，星期六，2024年，5月LateralCompartmentEvertersofthefoot(turnsfootoutward)PeroneusLongusPeroneusBrevisPeroneusTertiusContainsthesuperficialperonealnerve<-Lat.Comp.第22頁,共55頁，星期六，2024年，5月PosteriorSuperficialGroupPlantarflexors(pushesfootdownwards)GastrocnemiusSoleusSuperficialPosterior

第23頁,共55頁，星期六，2024年，5月PosteriorDeepAssistswithPlantarflexionTibialisPosteriorFlexorHallicusLongusFlexorDigitorumLongusPosteriortibialarteryPost.Deep---

第24頁,共55頁，星期六，2024年，5月AssessingtheLowerLegandAnkleHistoryPasthistoryMechanismofinjuryWhendoesithurt?Typeof,qualityof,durationofpain?Soundsorfeelings?Howlongwereyoudisabled?Swelling?Previoustreatments?第25頁,共55頁，星期六，2024年，5月ObservationsPosturaldeviations?Istheredifficultywithwalking?Deformities,asymmetriesorswelling?Colorandtextureofskin,heat,redness?Patientinobviouspain?Israngeofmotionnormal?第26頁,共55頁，星期六，2024年，5月PercussionandcompressiontestsUsedwhenfractureissuspectedPercussiontestisablowtothetibia,fibulaorheeltocreatevibratoryforcethatresonatesw/infracturecausingpainCompressiontestinvolvescompressionoftibiaandfibulaeitheraboveorbelowsiteofconcernThompsontestSqueezecalfmuscle,whilefootisextendedofftabletotesttheintegrityoftheAchillestendonPositivetestsresultsinnomovementinthefootHoman’stestTestfordeepveinthrombophlebitisWithkneeextendedandfootofftable,ankleismovedintodorsiflexionPainincalfisapositivesignandshouldbereferred第27頁,共55頁，星期六，2024年，5月CompressionTestPercussionTestHoman’sTestThompsonTest第28頁,共55頁，星期六，2024年，5月AnkleStabilityTestsAnteriordrawertestUsedtodeterminedamagetoanteriortalofibularligamentprimarilyandotherlateralligamentsecondarilyApositivetestoccurswhenfootslidesforwardand/ormakesaclunkingsoundasitreachestheendpointTalartilttestPerformedtodetermineextentofinversionoreversioninjuriesWithfootat90degreescalcaneusisinvertedandexcessivemotionindicatesinjurytocalcaneofibularligamentandpossiblytheanteriorandposteriortalofibularligamentsIfthecalcaneusiseverted,thedeltoidligamentistested第29頁,共55頁，星期六，2024年，5月AnteriorDrawerTestTalarTiltTest第30頁,共55頁，星期六，2024年，5月Kleiger’stestUsedprimarilytodetermineextentofdamagetothedeltoidligamentandmaybeusedtoevaluatedistalanklesyndesmosis,anterior/posteriortibiofibularligamentsandtheinterosseusmembraneWithlowerlegstabilized,footisrotatedlaterallytostressthedeltoidMedialSubtalarGlideTestPerformedtodeterminepresenceofexcessivemedialtranslationofthecalcaneusonthetalusTalusisstabilizedinsubtalarneutral,whileotherhandglidesthecalcaneus,mediallyApositivetestpresentswithexcessivemovement,indicatinginjurytothelateralligaments第31頁,共55頁，星期六，2024年，5月Kleiger’sTestMedialSubtalarGlideTest第32頁,共55頁，星期六，2024年，5月

FunctionalTestsWhileweightbearingthefollowingshouldbeperformedWalkontoes(plantarflexion)Walkonheels(dorsiflexion)Walkonlateralbordersoffeet(inversion)Walkonmedialbordersoffeet(eversion)HopsoninjuredanklePassive,activeandresistivemovementsshouldbemanuallyappliedtodeterminejointintegrityandmusclefunctionIfanyofthesearepainfultheyshouldbeavoided第33頁,共55頁，星期六，2024年，5月PreventionofInjurytotheAnkleStretchingoftheAchillestendonStrengtheningofthesurroundingmusclesProprioceptivetraining:balanceexercisesandagilityWearingproperfootwearandortapewhenappropriate第34頁,共55頁，星期六，2024年，5月SpecificInjuriesAnkleInjuries:SprainsSinglemostcommoninjuryinathleticscausedbysuddeninversionoreversionmomentsInversionSprainsMostcommonandresultininjurytothelateralligamentsAnteriortalofibularligamentisinjuredwithinversion,plantarflexionandinternalrotationOccasionallytheforceisgreatenoughforanavulsionfracturetooccurw/thelateralmalleolus第35頁,共55頁，星期六，2024年，5月Severityofsprainsisgraded(1-3)Withinversionsprainsthefootisforcefullyinvertedoroccurswhenthefootcomesintocontactw/unevensurfaces第36頁,共55頁，星期六，2024年，5月第37頁,共55頁，星期六，2024年，5月Grade1InversionAnkleSprainEtiologyOccurswithinversionplantarflexionandadductionCausesstretchingoftheanteriortalofibularligamentSignsandSymptomsMildpainanddisability;weightbearingisminimallyimpaired;pointtendernessoverligamentsandnolaxityManagementRICEfor1-2days;limitedweightbearinginitiallyandthenaggressiverehabTapemayprovidesomeadditionalsupportReturntoactivityin7-10days第38頁,共55頁，星期六，2024年，5月Grade2InversionAnkleSprainEtiologyModerateinversionforcecausinggreatdealofdisabilitywithmanydaysoflosttimeSignsandSymptomsFeelorhearpoporsnap;moderatepainw/difficultybearingweight;tendernessandedemaPositivetalartiltandanteriordrawertestsPossibletearingoftheanteriortalofibularandcalcaneofibularligamentsManagementRICEforatleastfirst72hours;X-rayexamtoruleoutfx;crutches5-10days,progressingtoweightbearing第39頁,共55頁，星期六，2024年，5月Management(continued)WillrequireprotectiveimmobilizationbutbeginROMexercisesearlytoaidinmaintenanceofmotionandproprioceptionTapingwillprovidesupportduringearlystagesofwalkingandrunningLongtermdisabilitywillincludechronicinstabilitywithinjuryrecurrencepotentiallyleadingtojointdegenerationMustcontinuetoengageinrehabtopreventagainstre-injury第40頁,共55頁，星期六，2024年，5月Grade3InversionAnkleSprainEtiologyRelativelyuncommonbutisextremelydisablingCausedbysignificantforce(inversion)resultinginspontaneoussubluxationandreductionCausesdamagetotheanterior/posteriortalofibularandcalcaneofibularligamentsaswellasthecapsuleSignsandSymptomsSeverepain,swelling,hemarthrosis,discolorationUnabletobearweightPositivetalartiltandanteriordrawer第41頁,共55頁，星期六，2024年，5月ManagementRICE,X-ray(physicianmayapplydorsiflexionsplintfor3-6weeks)CrutchesareprovidedaftercastremovalIsometricsincast;ROM,PREandbalanceexerciseonceoutSurgerymaybewarrantedtostabilizeankleduetoincreasedlaxityandinstability第42頁,共55頁，星期六，2024年，5月EversionAnkleSprains

-(Represent5-10%ofallanklesprains)EtiologyBonyprotectionandligamentstrengthdecreaseslikelihoodofinjuryEversionforceresultsindamagetodeltoidligamentandpossiblyfxofthefibulaDeltoidcanalsobeimpingedandcontusedwithinversionsprains第43頁,共55頁，星期六，2024年，5月第44頁,共55頁，星期六，2024年，5月第45頁,共55頁，星期六，2024年，5月第46頁,共55頁，星期六，2024年，5月InjuryPreventionStrengthtrainingallowsthesupportingmusculaturetostabilizewhereligamentsmaynolongerbecapableofholdingtheoriginaltensionbetweenbonesofthejoint.Thiswillalsohelppreventreinjury.第47頁,共55頁，星期六，2024年，5月ChronicAnkleInjury“theviciouscycle”Whyaresomepeoplepronetoanklere-injuryoverandover?Mostcommonlyduetolackofrehabilitation,butmoreimportantlylackofneuromusculartraining.Thismeansthepersonhasnotretrainedthebodytorecognizewheretheankleandfootareduringmotion.Thissetsupthebodyparttobere-injuredduetoimproperfeedbacktothebrainaboutbodyposition.第48頁,共55頁，星期六，2024年，5月InjuryPreventionNeuromuscularControlistheabilitytocompensateforunevensurfacesorsuddenchangeinsurfaces.ItisretrainedbyusingbalanceandagilityexercisessuchasaBAPSboardorstandingononelegwitheyesclosedaswellasusingasinglelegonaminitrampoline.第49頁,共55頁，星期六，2024年，5月NeuromuscularControlTrainingCanbeenhancedbytrainingincontrolledactivitiesUnevensurfaces,BAPSboards,rockerboards,orDynadiscscanal