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Toe raises or toe rise are used to strengthen the shin muscles the athlete raises the toes and forefoot up off the floor. Initially this should be seated, before performing in a standing position and then on an incline with the toes lower than the heels.
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I am now into physiotherapy again, awaiting another appointment with a different consultant from Orthopedics for a second opinion...
For physiotherapy regarding issues relating to my whole leg, eg. foot, knee and groin area, we determined that I should start at my foot. This seemed a good idea because that was where the initial problem started.
http://www.innerbody.com/image_skelfov/skel27_new.html#full-description
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At the fibula’s proximal end, just below the knee, is a slightly rounded enlargement known as the head of the fibula. The head of the fibula forms the proximal (superior) tibiofibular joint with the lateral edge of the tibia. From the proximal tibiofibular joint, the fibula extends slightly medially and anteriorly in a straight line toward the ankle. Upon reaching the ankle, the fibula swells into a bony knob known as the lateral malleolus, which can be seen and felt protruding from the outside of the ankle joint. At the medial malleolus, the fibula forms the distal (inferior) tibiofibular joint with the tibia and also the talocrural (ankle) joint with the tibia and talus of the foot.
While the fibula moves very little relative to the tibia, the joints that it forms contribute significantly to the function of the lower leg. The proximal and distal tibiofibular joints permit the fibula to adjust its position relative to the tibia, increasing the range of motion of the ankle. The lateral malleolus also forms the lateral wall of the talocrural joint and reinforces the ankle joint.
Many muscles of the thigh and lower leg attach to the fibula through tendons. One of the hamstrings, the biceps femoris muscle, has its insertion at the head of the fibula and pulls on the fibula to flex the leg at the knee. Eight other muscles – including the three fibularis (peroneus) muscles, the soleus, and several flexors and extensors of the toes – have their origins on the fibula as well.
http://www.wheelessonline.com/ortho/proximal_tibiofibular_joint_injuries
(Website)
- dislocations:
- patients c/o pain, swelling, and sometimes prominence of the fibular head
- many are unable to bear weight secondary to pain
- ankle motion exacerbates knee pain
- transient peroneal nerve palsy especially with posteromedial and superior dislocations
- anterolateral dislocation
- fall on a flexed knee with the foot inverted and plantarflexed
- flexion leads to LCL laxity, predisposing to lateral dislocation
- peroneal muscles, EHL and EDL pull the proximal fibula anteriorly
- most common pattern of proximal tibiofibular dislocation (>85%)
- lateral knee pain, swelling, and prominence of the fibular head
- ankle motion exacerbates knee pain
- may be unable to bear weight secondary to pain...
- chronic subluxation:
- best to examine c knee flexed at 90 degrees
- translation assessed in ant/post and med/lat planes
- radulescucent sign
- elicited in prone position
- one hand stabilizes the thigh and the leg is internally rotated in an attempt to produce anterior fibular subluxation
- physical examination
- Helfet Sign
- patient bears full weight through the affected limb
- if the patient has PTF instability they will hook the contralateral limb about the affected calf in an attempt to stabilize the PTF joint
- imaging
- plain radiographs in true AP and lateral planes (72% sensitive)
- comparison radiographs of the contralateral extremity (increases sensitivity to 82%)
- resnick’s line – follows the lateral tibial spine and should be found over the midpoint of the fibular head
- CT if dx is equivocal (86% sens compared c 82% on plain films)
http://postgraduateorthopaedics.com/clinical-examination/clinical-examination-of-the-spine/
(Website)
Gross screening of motor neurology
Ask the patient to walk on their heels (L4) and then tip toes (S1). Demonstrate these tests to the patient if necessary for ease of examination flow. These are very important sensitive tests for motor function which allow you to pick up subtle differences in motor power much easier than when examined supine on a couch “Can you stand on your toes and walk for me and now stand on your heels and walk”. “Can you walk a little bit on your toes (S1) and now on your heels (L4).” Ask the patient to squat- “Can you bend down and then get up again (L2 L3 L4)” • Squatting (L2, L3, L4) • Heel walking(Duck walking)tibialis anterior power L4 • Tiptoe gastrosoleus power S1 • Trendelenberg L5 Difficulty or inability to stand or walk on tip toe suggests a lesion of the S1 nerve root,difficulty or inability to stand or walk on the heel suggests a lesion of the L4 nerve root.A differential diagnosis must include a ruptured Achilles tendon which makes it very difficult to stand on tip toe.
(Website)
Pain along the outside or lateral knee can be caused by many things including tibiofibular joint instability. The tibiofibular joint is along the outside of the knee where the tibia (larger of the two lower leg bones) connects to the fibula (smaller of the two lower leg bones). Some patients with this problem also report tenderness when pressure is applied over the fibular head. Instability usually tells us the joint is loose or shifts either into subluxation (partial dislocation) or into a fully dislocated position. This can be caused by small but significant anatomic variations. Even slight changes that alter the natural angle of this joint can allow the fibula to slip out of the groove that holds it in place. Or a traumatic injury damaging ligaments and connecting soft tissue can damage the joint resulting in the same type of instability. Instability may keep some patients from putting weight on that leg. The examiner compares the unaffected knee to the painful one and looks for changes in how the joint moves. Any unnatural shifts in the fibula as it moves against the tibia (called joint translation) will be evaluated with more specific clinical tests. A tibiofibular joint that has been unstable for a long time can also cause knee popping, clicking, and catching. These symptoms are very similar to a lateral meniscal tear. The meniscus is a thick U-shaped piece of cartilage inside the knee joint. That's why every effort is made to make sure the diagnosis is correct and the right treatment is applied. The use of X-rays, MRIs, and clinical tests are used to make an accurate diagnosis. Joseph U. Barker, MD, et al. Extra-Articular Mimickers of Lateral Meniscal Tears. In Sports Health. January/February 2011. Vol. 3. No. 1. Pp. 82-88.
http://www.sportsinjuryclinic.net/anatomy/human-muscles/extensor-hallucis-longus
(Website)
The extensor hallucis longus is the only muscle responaible for extending (pulling back) the big toe.
Origin
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Middle 2/3 of the inner surface of the front of the fibula
Insertion
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Distal phalanx of the big toe
Actions
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Extension of the big toe
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Dorsiflexion
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Inversion
Innervation
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Peroneal (fibular) nerve
Daily uses
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Walking up the stairs it pulls the big toe up to clear the step
Example strengthening exercises
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Toe raises
Related injuries
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Inflammation of the extensor tendons of the toes
Related muscles
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Tibialis anterior
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Extensor digitorum longus
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http://www.bartleby.com/107/94.html
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Henry Gray (1821–1865). Anatomy of the Human Body. 1918.
7c. Articulations between the Tibia and Fibula
The articulations between the tibia and fibula are effected by ligaments which connect the extremities and bodies of the bones. The ligaments may consequently be subdivided into three sets: (1) those of the Tibiofibular articulation; (2) the interosseous membrane; (3) those of the Tibiofibular syndesmosis. 1
Tibiofibular Articulation (articulatio tibiofibularis; superior tibiofibular articulation).—This articulation is an arthrodial joint between the lateral condyle of the tibia and the head of the fibula. The contiguous surfaces of the bones present flat, oval facets covered with cartilage and connected together by an articular capsule and by anterior and posterior ligaments. 2
The Articular Capsule (capsula articularis; capsular ligament).—The articular capsule surrounds the articulation, being attached around the margins of the articular facets on the tibia and fibula; it is much thicker in front than behind. 3
The Anterior Ligament (anterior superior ligament).—The anterior ligament of the head of the fibula (Fig. 347) consists of two or three broad and flat bands, which pass obliquely upward from the front of the head of the fibula to the front of the lateral condyle of the tibia. 4
The Posterior Ligament (posterior superior ligament).—The posterior ligament of the head of the fibula (Fig. 348) is a single thick and broad band, which passes obliquely upward from the back of the head of the fibula to the back of the lateral condyle of the tibia. It is covered by the tendon of the Popliteus. 5
Synovial Membrane.—A synovial membrane lines the capsule; it is continuous with that of the knee-joint in occasional cases when the two joints communicate. 6
Interosseous Membrane (membrana interossea cruris; middle tibiofibular ligament).—An interosseous membrane extends between the interosseous crests of the tibia and fibula, and separates the muscles on the front from those on the back of the leg. It consists of a thin, aponeurotic lamina composed of oblique fibers, which for the most part run downward and lateralward; some few fibers, however, pass in the opposite direction. It is broader above than below. Its upper margin does not quite reach the tibiofibular joint, but presents a free concave border, above which is a large, oval aperture for the passage of the anterior tibial vessels to the front of the leg. In its lower part is an opening for the passage of the anterior peroneal vessels. It is continuous below with the interosseous ligament of the tibiofibular syndesmosis, and presents numerous perforations for the passage of small vessels. It is in relation, in front, with the Tibialis anterior, Extensor digitorum longus, Extensor hallucis proprius, Peronæus tertius, and the anterior tibial vessels and deep peroneal nerve; behind, with the Tibialis posterior and Flexor hallucis longus. 7
Tibiofibular Syndesmosis (syndesmosis tibiofibularis; inferior tibiofibular articulation).—This syndesmosis is formed by the rough, convex surface of the medial side of the lower end of the fibula, and a rough concave surface on the lateral side of the tibia. Below, to the extent of about 4 mm. these surfaces are smooth, and covered with cartilage, which is continuous with that of the ankle-joint. The ligaments are: anterior, posterior, inferior transverse, and interosseous. 8
The Anterior Ligament (ligamentum malleoli lateralis anterius; anterior inferior ligament).—The anterior ligament of the lateral malleolus (Fig. 355) is a flat, triangular band of fibers, broader below than above, which extends obliquely downward and lateralward between the adjacent margins of the tibia and fibula, on the front aspect of the syndesmosis. It is in relation, in front, with the Peronæus tertius, the aponeurosis of the leg, and the integument;behind, with the interosseous ligament; and lies in contact with the cartilage covering the talus. 9
The Posterior Ligament (ligamentum malleoli lateralis posterius; posterior inferior ligament).—The posterior ligament of the lateral malleolus (Fig. 355), smaller than the preceding, is disposed in a similar manner on the posterior surface of the syndesmosis. 10
The Inferior Transverse Ligament.—The inferior transverse ligament lies in front of the posterior ligament, and is a strong, thick band, of yellowish fibers which passes transversely across the back of the joint, from the lateral malleolus to the posterior border of the articular surface of the tibia, almost as far as its malleolar process. This ligament projects below the margin of the bones, and forms part of the articulating surface for the talus. 11
The Interosseous Ligament.—The interosseous ligament consists of numerous short, strong, fibrous bands, which pass between the contiguous rough surfaces of the tibia and fibula, and constitute the chief bond of union between the bones. It is continuous, above, with the interosseous membrane (Fig. 356). 12
Synovial Membrane.—The synovial membrane associated with the small arthrodial part of this joint is continuous with that of the ankle-joint.