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Injuries to the Lower Leg,

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Injuries to the Lower Leg, Ankle and Foot Bony Anatomy Bony Anatomy Medial Ligaments of Ankle Deltoid Ligament rarely injured in sports mechanism of injury typically ... – PowerPoint PPT presentation

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Title: Injuries to the Lower Leg,


1
  • Injuries to the Lower Leg,
  • Ankle and Foot

2
Bony Anatomy
Bony Anatomy includes Tibia, Fibula, Tarsals,
Metatarsals, Phalanges
3
Bony Anatomy
Medial view tarsals and metatarsals
4
Medial Ligaments of Ankle
  • Deltoid Ligament
  • rarely injured in sports
  • mechanism of injury typically eversion with
    dorsiflexion
  • longer time to heal than lateral ankle ligaments

5
Lateral Ligaments of Ankle
  • 3 primary ligaments
  • anterior talofibular
  • posterior talofibular
  • Calcaneofibular
  • NOT as large strong as the deltoid.
  • Mechanism of injury is inversion associated with
    plantar flexion.

6
Lower Leg Anatomy
  • 3 Compartments
  • Anterior, Lateral, Posterior

7
Fractures
  • Mechanism
  • most often caused by direct trauma to the tibia,
    fibular or bone(s) of the foot
  • repeated microtrauma can result in a stress
    fracture
  • growth plate injures can occur in the adolescent
    -- known as Salter-Harris fractures
  • Signs/symptoms
  • swelling/deformity, discoloration
  • broken bone end protruding
  • athlete reports a snap/pop
  • inability to bear weight
  • stress fractures often become more painful at
    night

8
Fractures
  • First Aid
  • treat for shock
  • apply sterile dressing to any open wounds
  • carefully immobilize using appropriate splinting
    technique
  • contact EMS and arrange for transport

9
Ankle Fracture
10
Ankle Fracture
11
Ankle Dislocation
12
Ankle Sprains
  • Details
  • one of the most common injuries to this region
  • Due to skeletal and ligamentous variables,
    lateral sprains are more common.
  • 80-85 of all ankle sprains are to the lateral
    ligaments --inversion sprains
  • Eversion sprains, while less frequent, are often
    severe.

Syndesmosis Sprain Sprain of the ligaments
connecting the tibia and fibula.
13
  • Signs/symptoms
  • 1st deg. -- pain, mild disability, pt.
    tenderness, little or no swelling
  • 2nd deg. -- pain, mild to moderate disability,
    pt. tenderness, loss of function, some laxity,
    swelling
  • 3rd deg. -- pain severe disability, pt.
    tenderness, loss of function, laxity, severe
    swelling

14
Ankle Sprains
  • First Aid
  • ice, compression and elevation
  • apply a horseshoe - or doughnut-shaped pad
  • use crutches, partial or full weight bearing
  • any questions regarding severity, refer to a
    physician for further evaluation and diagnosis

15
Ankle Sprain
  • Prevention
  • Research indicates that taping is only good for a
    short period of time. Braces may be as effective
    as tape and at a much lower cost
  • Best prevention is to strengthen the muscles of
    the lower leg as well as develop proprioception.

16
Two examples of rigid ankle braces
17
Tib/Fib Syndemosis Sprain
  • Signs and Symptoms
  • Often treated as lateral ankle sprain, which is
    inappropriate, hindering recovery.
  • The difference is the mechanism of injury.
    Tib-fib sprains involve dorsiflexion followed by
    axial loading with external rotation of the foot.
  • Symptoms positive sprain test, but athlete is
    in great pain.
  • Slower healing
  • Sometimes physicians will cast.

18
Achilles Tendon
  • Achilles tendon commonly injured -- more often in
    older (30) male athlete
  • can be either an acute or chronic, overuse injury
  • acute injuries often associated with blunt trauma
  • chronic injuries often associated with sudden
    increase in training intensity

19
Common Injuries
  • Signs/symptoms
  • swelling and deformity
  • pop or snap
  • pain in lower leg
  • loss of function, especially in plantar flexion
  • First Aid
  • immediate application of ice and compression
  • immobilize with appropriate splint
  • arrange for transport to a medical facility

20
Torn Tendon
21
Achilles Surgery
22
Compartment Syndrome
  • usually involves the anterior compartment of the
    lower leg
  • Chronic form is related to overuse of the muscles
    of the compartment
  • Trauma, such as being kicked in the leg, can
    result in swelling within the compartment as
    well.
  • In either case, swelling puts pressure on vessels
    and nerves.

23
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24
Compartment Syndrome
  • Signs/symptoms/First Aid
  • pain/swelling and loss of sensation and/or motor
    control in the lower
  • loss of pulse in the foot
  • inability to extend the big toe or dorsiflex the
    foot apply ice elevate -- do NOT apply
    compression
  • loss of pulse or sensation -- medical emergency -
    transport to medical facility

25
Shin Splints
  • Signs/symptoms
  • lower leg pain -- typically a chronic injury that
    progressively worsens
  • pain is often bilateral
  • Shin splints is generic pain in the lower legs,
    typically caused by change in surface or workout.
  • First Aid
  • apply ice and have the athlete rest
  • use of NSAIDs may be helpful
  • seek a professional to identify the cause

26
Foot Disorders
  • Plantar Fasciitis
  • plantar fascia spans from the metatarsal heads to
    the calcaneal tuberosity
  • Ball of foot to heel.
  • this tissue can become inflamed and painful
  • painful in the morning when first rising from bed
  • point tenderness in the region of the calcaneal
    tuberosity

27
Common Injuries
  • Heel Spurs
  • often related to chronic plantar fasciitis
  • involves ossification at the site of attachment
    to the calcaneus
  • Treatment of Plantar Fasciitis and Heel Spurs
  • rest and NSAIDs
  • stretching of the Achilles
  • doughnut pad beneath the heel spur

28
Common Injuries
  • Mortons Neuroma
  • growth (enlargement) of the interdigital nerve
    usually between the 3rd and 4th metatarsal heads
  • pain will radiate into the 3rd and 4th toes
  • tight fitting shoes have been identified as a
    major causative factor
  • going barefoot often relieves the symptoms
  • the neuroma may have to be treated surgically

29
Common Injuries
  • Care for Neuroma
  • Teardrop pad can be placed between met heads to
    increase space, decreasing pressure on neuroma
  • Shoes with wider toe box would be appropriate
  • the neuroma may have to be treated surgically

30
Common Injuries
  • Foot disorders
  • Arch problems
  • two groups of arch problems pes planus and pes
    cavus
  • Pes Planus flat arch
  • Pes Cavus high arch

31
Common Injuries
  • corrective taping may provide temporary support
    for the arch
  • In some cases, the athlete may benefit from a
    properly constructed orthosis.
  • Orthotics should be constructed by a trained
    professional.

32
Common Injuries
  • Blisters calluses
  • very common formations, result from friction
    between layers of skin
  • when a blister forms, fluid collects between skin
    layers, occasionally the fluid will contain blood
  • if the blister is large, it should be drained
  • When draining a blister, use sterile instruments,
    latex gloves and eye protection
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