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Chapter 16

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

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Anatomy Review
Bones and Ligaments of the Ankle and Foot

Note the subtalar joint that is responsible
for inversion and eversion of the foot
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Anatomy Review (cont.)

• Foot Bones (medial view)

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Ligaments

• The deltoid ligament is the _________ _________of
  the medial side of the talocrural (ankle) joint.

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Ligaments (cont.)

• Ligaments of the Ankle (lateral view)
• The three primary ligaments are

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The Lateral Ankle

• These ligaments are NOT as large or strong as the
  deltoid.
• The talocrural joint is strongest in dorsiflexion
  and weakest in plantar flexion.

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Anatomy Review

• The innervation of the three compartments is
  supplied by the tibial, superficial, and deep
  peroneal nerves.
• The illustration shows the ______
  _______________ _____________________________.

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Common Sports Injuries

• Fractures
• Most often caused by direct trauma through
  contact. Contact causes most fractures to the
  lower leg and foot.
• Avulsion fracture of 5th metatarsal can occur
  with a lateral ankle sprain.

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Fractures

• Signs and symptoms include
• Swelling and/or deformity at the site of
  fracture.
• Possible broken bone end projecting through skin.
• Inability to bear weight on the affected leg.
• For a stress fracture or growth plate fracture
  that did not result from traumatic event, the
  athlete complains of extreme point tenderness and
  pain at the site of injury.

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Fractures (cont.)

• First Aid
• Watch and treat for shock, if necessary.
• Carefully immobilize the foot and leg using a
  splint.

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Soft Tissue Injuries

• Ankle Injuries
• Ankle sprains are one of the most common injuries
  to this region.
• Eversion sprains, while less frequent, are often
  severe.

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Ankle Injuries Sprains

• Signs and symptoms depend on degree of sprain.
• 1st degree Pain, mild disability, point
  tenderness, little laxity, little or no swelling
• 2nd degree
• 3rd degree Pain and severe disability, point
  tenderness, loss of function, laxity, moderate to
  severe swelling

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Ankle Injuries Sprains (cont.)

• First Aid

Courtesy of Brent Mangus
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Ankle Injuries Sprains (cont.)

• First Aid (cont.)
• If there is any question regarding the severity
  of the sprain, refer athlete to a medical
  facility for physicians evaluation.

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Ankle Injuries Sprains (cont.)

• Tibiofibular (tib-fib) Sprains
• These injuries are often treated inappropriately
  as lateral ankle sprains, hindering recovery.
• Symptoms include a positive sprain test, but
  athlete is also in great pain. Squeeze test
  elicits pain in syndesmosis area.

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Ankle Injuries Sprains (cont.)

• First Aid
• Immediately apply ice and compression, and
  elevate the leg.
• Have athlete rest and use crutches for first 72
  hours, followed by wearing a walking boot for 3
  to 7 days.

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Preventing Ankle Injuries

• Prophylactic adhesive taping supports the ankle
  only for a short time.
• Bracing combined with some high-top shoes may be
  helpful.

Courtesy of McDavid
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Tendon-Related Injuries

• Achilles tendon is commonly injured by
  long-distance runners, basketball players, and
  tennis players.
• Athletes who dramatically increase workout times
  or running distances, or who run on hard, uneven,
  or uphill surfaces are prone to Achilles
  tendonitis.
• The injury can be either acute or chronic. Acute
  injuries often associated with explosive jumping
  or blunt trauma.

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Achilles Tendon Injuries

• Signs and symptoms include
• Swelling and deformity at site of injury.
• Athlete reports a pop or snap associated with the
  injury.
• Loss of function, mainly in plantar flexion.
• First Aid
• Immediately apply ice and compression.
• Arrange for transport to nearest medical
  facility.

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Compartment Syndrome

• Compartment syndrome usually involves the
  anterior compartment of the lower leg.
• Chronic form is related to overuse of the
  compartments muscles that causes swelling of
  tissues.
• Acute 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.
• Properly sized shin guards can protect lower leg
  in soccer.

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Compartment Syndrome (cont.)

• Signs and symptoms include
• Pain and swelling in the lower leg.
• Athlete may complain of chronic or acute injury
  to the area.
• There can be loss of pulse in the foot.
• First Aid
• Apply ice and elevate. Do _____ apply
  compression.
• If there is numbness, loss of movement, or loss
  of pulse to the foot, seek medical advice
  immediately this is a true medical emergency.

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Shin Splints

• Shin splints is a very common disorder of lower
  leg. Term describes exercise-induced leg pain.
• The types of activities that produce this problem
  and the manifestations of the injury vary
  depending on the athlete.

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Shin Splints (cont.)

• Signs and symptoms include
• Lower leg pain either medially or
  posteromedially.
• Pain can be unilateral or bilateral.
• First Aid
• Apply ice and have the athlete rest.
• Athlete may need to have his or her gait analyzed
  for biomechanical deficiencies.
• If problem worsens, athlete should seek medical
  advice.

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Plantar Fasciitis

• The plantar fascia is a dense collection of
  tissues that traverses from the plantar aspect of
  the metatarsal heads to the calcaneal tuberosity.
• If this tissue becomes tight or inflamed by
  overuse or trauma, it can produce pain and
  disability.
• Athlete also has point tenderness in the region
  of the calcaneal tuberosity.

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Plantar Fasciitis (cont.)

• Treatment is typically conservative and includes
• Rest.
• Anti-inflammatories.
• Applying cold and heat alternatively to enhance
  healing.
• A heel pad and stretching the Achilles tendon
  complex can assist in recovery.
• Use of semirigid orthoses is also effective, but
  some athletes find it difficult to participate
  with such an orthotic in their shoes.
• Re-aggravating the injury increases the healing
  time.

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Heel Spurs

• Heel spurs can be related to chronic plantar
  fasciitis.
• Chronic inflammation can result in ossification
  at the site of attachment on the plantar aspect
  of the calcaneus.
• Treatment of Heel Spurs
• Athlete should consult a physician if spurs
  become incapacitating.
• Applying a doughnut-shaped pad beneath the heel
  spur may help but rarely do they ameliorate the
  problem.

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Mortons Foot

• Mortons foot
• The result shifts weight bearing to the 2nd
  metatarsal instead of along the 1st metatarsal.
• Results in pain throughout the foot during
  ambulation.

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Mortons Foot

• Mortons foot may result in Mortons neuroma.
• The problem is usually with the nerve between the
  3rd and 4th metatarsal heads.
• A neuroma is an abnormal growth on a nerve.
• Tight-fitting shoes may be the cause. Going
  barefoot may help.

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Arch Problems

• There are two groups of arch problems pes planus
  and pes cavus.
• Pes planus (_______) related to pronation.
• Excessive pronation can cause difficulties in the
  navicular bone and some of the joints around the
  ankle.
• Arch taping has limited effectiveness.
• Corrective arch orthoses may be beneficial.
• Pes cavas (_________) associated with plantar
  fasciitis and clawing of the toes.
• Athlete may benefit from orthotic device.

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Bunions

• Bunions are uncommon in high school and college
  athletes.
• Can be caused by improperly fitting shoes.
• Chronic bunion should be evaluated by physician.

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Blisters Calluses

• Blisters and calluses are very common formations,
  resulting from friction between layers of skin.
• When a blister forms, fluid collects between skin
  layers, occasionally the fluid will contain
  blood.
• When draining a blister, it is best to leave top
  layer of skin in place.
• Use sterile instruments and wear latex gloves or
  some other barrier to avoid contact with
  athletes body fluid.

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Blisters Calluses (cont.)

• NSC First Aid Procedures
• Wash area with soap and warm water sterilize
  area with rubbing alcohol.
• Use sterile needle to puncture the base of the
  blister and drain by applying light pressure.
  Process may need to be repeated during the first
  24 hours.
• Apply antibiotic ointment to the top and cover
  with sterile dressing.
• Check daily for signs of infection (redness or
  pus).
• After 37 days, remove the top of blister and
  apply antibiotic ointment and sterile dressing.

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Toe Injuries

• Common injuries are torn-off nails or hematoma
  formation under the nail.
• Use commercially available nail bore to drill
  small hole in nail to release blood.
• Ingrown toenails may result from improperly
  fitting shoes.
• Elevate toenail by placing a small cotton roll
  under it and leave in place as nail grows.
• Have athlete obtain shoes that fit more
  comfortably.

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Basic Taping
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Basic Taping (cont.)
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Basic Taping (cont.)
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Basic Taping (cont.)
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Basic Taping (concluded)
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