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Injuries to the Lower Leg,


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,

  • Injuries to the Lower Leg,
  • Ankle and Foot

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

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.

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

  • Mechanism
  • most often caused by direct trauma to the tibia,
    fibular or bone(s) of the foot
  • repeated microtrauma can result in a stress
  • 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

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

Ankle Fracture
Ankle Fracture
Ankle Dislocation
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

Syndesmosis Sprain Sprain of the ligaments
connecting the tibia and fibula.
  • 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,
  • 3rd deg. -- pain severe disability, pt.
    tenderness, loss of function, laxity, severe

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

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.

Two examples of rigid ankle braces
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.

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

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

Torn Tendon
Achilles Surgery
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
  • In either case, swelling puts pressure on vessels
    and nerves.

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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
  • loss of pulse or sensation -- medical emergency -
    transport to medical facility

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

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

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

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

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

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

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

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