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Lower Leg and Ankle Injuries Shin Splints Medial Anterior

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Lower Leg and Ankle Injuries Shin Splints Medial Anterior Medial Tibial Stress Syndrome Tenderness is usually found between 3 and 12 centimeters above the tip of the ... – PowerPoint PPT presentation

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Title: Lower Leg and Ankle Injuries Shin Splints Medial Anterior


1
Lower Leg and Ankle Injuries
2
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3
Shin Splints
  • Medial
  • Anterior

4
Medial Tibial Stress Syndrome
  • Tenderness is usually found between 3 and 12
    centimeters above the tip of the medial malleolus
    at the posterio-medial aspect of the tibia.
  • Inflammation of the periostium (periostitis)
  • Most frequently involved is the Tibalis Posterior
    tendon and muscle, but the Flexor Digitorum
    Longus and Flexor Hallucis Longus may also be
    involved.
  • Stress fractures can also occur in this area.

5
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6
Anterior Compartment Syndrome
  • Soft tissue injuries at the muscular origin and
    bony or periosteal interface of the bone and
    muscle origin.
  • Due to micro tears of the Tibialis Anterior
    either at the origin or in the fibers themselves.
  • Or microtrauma to the bone structure itself.
  • Stress fractures can also occur in this area.

7
Exertional Compartment Syndrome
  • Caused by the muscles swelling within a closed
    compartment with a resultant increase in pressure
    in the compartment.
  • The blood supply can be compromised and muscle
    injury and pain may occur.
  • Abnormal compartment pressure
  • A resting pressure greater than 20 mm Hg or
  • An exertional pressure greater than 30 mm Hg or
  • A pressure of 25 mm Hg or higher 5 minutes after
    stopping exercise.
  • This may require surgical decompression of the
    compartment.

8
Key Causes
  • Tight posterior muscles
  • Imbalance between the posterior and anterior
    muscles
  • Running on concrete or other hard surfaces
  • Improper Shoes - inadequate shock protection
  • Overtraining

9
Treatment (FYI)
  • Rest. The sooner you rest the sooner it will
    heal.
  • Apply ice 10-15 minutes for 2-3x per day in the
    early stages when it is very painful.
  • Anti inflammatory drugs
  • Wear shock absorbing insoles in shoes.
  • Maintain fitness with other non weight bearing
    exercises.
  • Apply heat and use a heat retainer after the
    initial acute stage, particularly before
    training.

10
Stress Fractures
  • Bone remodeling
  • Repetitive stress weakens the bone
  • 10-20 of injuries to athletes
  • Most common locations tibia, fibula and
    metatarsals.
  • Tibial and fibular stress fractures can develop
    from shin splints

11
Causes of Stress Fractures
  • Training errors
  • Abnormal limb length
  • Low body weight (lt 75 of ideal)
  • Eating disorders
  • Previous inactivity
  • White race
  • Female

12
Diagnosis (FYI)
  • X-ray
  • MRI
  • CT scans

13
Metatarsal Stress Fracture
  • CAUSES
  • Decreased density of the bones (eg. osteoporosis)
  • Unusual stress on a metatarsal due to mal
    position or another forefoot deformity (eg.
    bunion)
  • Abnormal foot structure or mechanics (eg.
    flatfoot, over inversion)

14
Ankle Sprains
  • Most common athletic injury. 25 of all injuries.
  • The risk of ankle sprains varies with the sport
  • 21-53 basketball, 17-29 soccer, 25 volleyball.
  • Ankle sprains account for 10 to 15 of all lost
    playing time
  • The medial malleolus is shorter than the lateral
    mallelous so there is naturally more inversion
    than eversion.

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16
Ankle Sprains
  • Greater inversion increases the potential for
    over-stretching of the lateral ligaments.
  • Most sprains involve the lateral ligaments from
    excessive inversion.
  • Deltoid ligament is sprained less often (25 of
    ankle sprains)
  • Of the lateral ligments, the ATFL is sprained the
    most often followed by the CFL
  • Sprains ocur most often with the foot in plantar
    flexion and inversion.

17
Lateral Collateral Ligament
18
Ankle Sprains
19
Classification of Sprains
  • 1st Degree
  • Stretching of the ATFL
  • little or no edema
  • tenderness
  • maintain function.
  • 2nd Degree
  • Partial tear of the ATFL and/or CFL
  • moderate edema
  • some function loss
  • 3rd Degree
  • Complete tear ATFL, CFL, and/or PTFL
  • total loss of function
  • significant edema

20
Ankle Sprains by Grade
21
Treatment (FYI)
  • AAFP (see table 3)
  • R.I.C.E.
  • Ice for 20 minutes on and 20 minutes off for the
    first two hours.
  • After that, 20 min intervals over the next 48-72
    hours,
  • Compression wrap with donut or horse shoes to
    fill in gaps around malleolus from 24-36 hours
    after 48-72 hours contrasts baths with ROM
    exercises for 4 minutes in warm and 1 min in ice
    water.

22
Achilles Tendonitists
  • Causes
  • Rapidly increasing training effort
  • Adding hills or stair climbing to training
  • Starting too quickly after a layoff
  • Poor footwear
  • Excessive pronation
  • Tight posterior leg muscles
  • If left untreated, it may progress to a complete
    rupture.

23
Achilles Tendon Rupture
  • Most frequently ruptured tendon
  • Complete ruptures are due to eccentric loading
    during abrupt stopping, landing from a jump.
  • Usually a popping sound is heard with a complete
    tear.
  • There may or may not be an obvious gap 2 to 6 cm
    from the calcaneus attachment.
  • Treatment may or may not include surgery but both
    require immobilized for 3 months.

24
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25
Plantar Fasciitis
  • The plantar fascia runs from the calcaneus to the
    metatarsals.
  • This tight band acts like a bow string to
    maintain the arch of the foot.
  • Plantar fasciitis refers to an inflammation of
    the plantar fascia.

26
Plantar Fasciitis
  • Inflammation is usually due to repeated trauma to
    where the tissue attaches to the calcaneus.
  • The trauma results in microscpic tears at the
    calcaneus attachment site.
  • This may produce heal spurs

27
Plantar Fasciitis
  • Pain is worse in the morning or after a period of
    inactivity
  • Causes
  • High arch
  • Excessive pronation
  • Footwear (worn out, stiff)
  • Increase in intensity

28
Turf Toe
  • Turf toe is really a bruise or sprain that occurs
    at the base of the big toe at the joint called
    the metatarsal phalangeal joint.
  • It usually occurs when the toe is jammed forcibly
    into the ground or, more commonly, when the toe
    is bent backward too far (hyperextended)
  • It causes significant pain and swelling at the
    base of the big toe.
  • It can be a significant problem because players
    use the toe when they run and plant and push off.

29
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30
  • Ankle Exercises
  • Calf stretch
  • Soleus stretch
  • Resisted dorsal and plantar flexion
  • Heel raises
  • Step-up
  • Jump rope

31
Ankle Exercises
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