Lower Leg and Ankle Injuries

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Lower Leg and Ankle Injuries
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Shin Splints

• Medial
• Anterior

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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.

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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.

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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.

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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

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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.

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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

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Causes of Stress Fractures

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

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Diagnosis (FYI)

• X-ray
• MRI
• CT scans

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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)

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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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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.

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Lateral Collateral Ligament
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Ankle Sprains
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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

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Ankle Sprains by Grade
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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.

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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.

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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.

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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.

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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

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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

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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.

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

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Ankle Exercises
Wobble Boards