Lab 6: Ankle and Lower Leg

Lab 6: Ankle and Lower Leg Complete the following activities during your lab class under the guidance of your instructor. Objectives of Lab: • Identify common injuries and overuse conditions that occur to the ankle and lower leg. • Demonstrate the application of tapes, wraps, braces, and pads to the ankle and lower leg for the purpose of preventing, treating, and rehabilitating injuries. Lab Activity 1: Lower Leg and Ankle Anatomy and Common Conditions 1. Look at the model and show your partner each of the bones of the foot/ankle/lower leg by name. Palpate these bones on your partner’s lower leg and ankle. a. Tibia d. Calcaneus g. Cuboid b. Fibula e. Navicular h. Metatarsals c. Talus f. Cuneiforms i. Phalanges 2. Identify and palpate the following muscles and describe their function in the space provided. a. Gastrocnemius/Achilles tendon: Plantarflexes the ankle and acts on the knee b. Tibialis posterior: Plantarflexion of the foot and inversion of the foot c. Tibialis anterior: Dorsiflexion of the ankle and helps invert the ankle d. Peroneus longus/brevis: Plantarflexion and eversion of the foot e. Peroneus tertius: Dorsiflexion and eversion of the foot 3. Look at the model and show your partner each of the following ligaments of the foot/ankle. Palpate these ligaments on your partner’s foot/ankle. List the function of each in the space provided. a. Anterior talofibular (ATF) ligament: Inversion and plantarflexion of the ankle b. Posterior talofibular (PTF) ligament: Inversion of the ankle c. Calcaneofibular (CF) ligament: Inversion of the ankle d. Deltoid ligaments: External rotation of the foot, eversion of the ankle e. Plantar calcaneonavicular: External rotation of the foot, eversion of the ankle f. Anterior and posterior tibiofibular: Makes up the back-wall area of the recipient socket for the talar trochlea of the ankle and holds the tibia and fibula together 4. Look at the model and show your partner each of the following ligaments of the foot. a. Longitudinal arch b. Transverse arch c. Metatarsal arch Lab Activity 2: Prevention of Common Conditions 1. Identify three effective prevention strategies and the associated common conditions related to the foot, ankle, and lower leg a. Proper footwear b. Strength training c. Neuromuscular control and balance training Lab Activity 3: Application of Taping, Wrapping, Bracing, and Padding Practice and demonstrate your ability to appropriately apply these techniques with a partner, as demonstrated and instructed in class. List one common condition that each of these techniques would be useful with during treatment and rehabilitation. 1. Taping a. Closed basketweave: Used to treat inversion and eversion sprains b. Achilles' tendon: Used to treat strains and tendonitis, to limit dorsiflexion and stretch of the tendon c. Kinesio tape: i. Lateral ankle sprain lymphatic correction: Helps reduce swelling of a sprain ii. Achilles tendon taping: Used to provide tendon correction and inhibit the gastrocnemius and soleus in the treatment of Achilles tendonitis 2. Bracing a. Walking boot: Used when an athlete has sustained a strain, sprain, stable acute stress fracture, or in postoperative patients b. Lace-up brace: Used to treat inversion and eversion ankle sprains c. Semirigid and air/gel bladder: Used to treat inversion, eversion, and syndesmosis sprains 2 3. Wrapping a. Compression wrap with horseshoe pad: Used when treating an acute ankle sprain to ensure that fluid doesn’t aggregate beneath the malleoli b. Compression wrap: Leg strains, ruptures, distal contusions 4. Padding a. Mandatory padding: Required protective equipment b. Off-the-shelf: Used when an athlete has suffered a contusion c. Custom-made: Used to treat lower leg muscle and bone contusions Lab Activity 4: Case Scenarios 1. A track athlete reports bilateral lower leg pain that has been progressively getting worse for the past 4 weeks, and it worsens with activity. He is tender to palpation along the posteromedial distal third of both tibias. Observation reveals bilaterally pes planus. a. From what condition is this athlete most likely suffering? He is flat footed b. What applications would likely be effective for lessening the symptoms associated with this condition? Arch taping 2. Natasha, a point guard for the Jr. Suns basketball team, accidently steps on another player’s foot, inverting her ankle, while driving to the basket. She immediately falls to the ground and holds her right ankle while she cries out in pain. The athletic trainer arrives on the court and discovers that Natasha reports lateral right ankle pain 6/10 and reports having felt a pop. She is tender to palpation over the distal fibula as well as the anterior talofibular ligament. Natasha is apprehensive to bear any weight on her ankle or walk. a. What would be the best option for getting Natasha to the sideline for further evaluation and why? The ambulatory aid method because she has assistance walking so she is able to take the weight off of her injured ankle b. After examination, the athletic trainer’s diagnosis of the injury is a first-degree lateral ankle sprain. What would be an appropriate treatment? POLICE Have them wear a semirigid and air/gel bladder brace while they are up walking Rehab Taping/Bracing once they are cleared to go back into practice 3 c. What would be most appropriate brace for initial treatment to provide moderate compression and support while limiting inversion and eversion at the ankle joint, yet allowing for plantarflexion and dorsiflexion and why? Semirigid and air/gel bladder brace because she will have support and compression while having limited eversion and inversion at the ankle joint but will still be able to plantar and dorsiflex d. After proper healing and rehabilitation have occurred, which taping technique would be most appropriate for providing moderate support to the subtalar and talocrural joints in order to assist Natasha with her return to play and why? The closed basketweave because it supports the subtalar and talocrural joints while preventing inversion and eversion and reduces range of motion while providing moderate support e. After the season is over, Natasha realizes she will not have an athletic trainer to rely on to receive prophylactic taping. What type of brace should her athletic trainer recommend for her while she participates in sport during the off-season and why? Lace up Brace because it limits inversion at the ankle joint 3. While batting in the fourth inning, the right fielder on the baseball team fouls a ball off his right lateral lower leg. After several days of treatment, the physician allows him to return to activity if protected with padding. What padding techniques are appropriate for this situation and why? Custom made padding because the athlete probably suffered a lower leg muscle or bone contusion and the custom-made pad will give him the protection, he needs 4. The available evidence provides minimal support for the use of kinesio taping, alone or in combination with rehabilitation, to lessen levels of pain associated with musculoskeletal injuries and conditions. Despite these findings, health care professionals continue to utilize multiple kinesio taping techniques in the treatment of various injuries and conditions. a. How can an evidence-based clinician substantiate the use of kinesio taping based on the available evidence? Provide rationale for your answer that includes the process of practicing evidence-based medicine. An evidence-based clinician can substantiate the use of KT based on the available evidence by stating that it helps with lymphatic drainage and can help the athlete psychologically. REFERENCES Prentice, W. E. (2017). Principles of athletic training: a guide to evidence-based clinical practice. New York, NY: McGraw-Hill Education. 4